Removal of small asymptomatic renal stones to reduce relapse

The Journal of Urology(2023)

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You have accessJournal of UrologyCME1 Apr 2023MP23-11 REMOVAL OF SMALL ASYMPTOMATIC RENAL STONES TO REDUCE RELAPSE Mathew D. Sorensen, Jonathan D. Harper, Michael S. Borofsky, Tariq A. Hameed, Kimberly J. Smoot, Barbara H. Burke, Branda J. Levchak, James C. Williams, Ziyue Liu, Michael R. Bailey, and James E. Lingeman Mathew D. SorensenMathew D. Sorensen More articles by this author , Jonathan D. HarperJonathan D. Harper More articles by this author , Michael S. BorofskyMichael S. Borofsky More articles by this author , Tariq A. HameedTariq A. Hameed More articles by this author , Kimberly J. SmootKimberly J. Smoot More articles by this author , Barbara H. BurkeBarbara H. Burke More articles by this author , Branda J. LevchakBranda J. Levchak More articles by this author , James C. WilliamsJames C. Williams More articles by this author , Ziyue LiuZiyue Liu More articles by this author , Michael R. BaileyMichael R. Bailey More articles by this author , and James E. LingemanJames E. Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The benefit of endoscopically removing small (≤6 mm) asymptomatic renal stones is unknown. AUA guidelines leave the decision to the urologist and patient. A prospective study with shock wave lithotripsy and some retrospective studies favor observation. However, several studies quoted in AUA guidelines show about half of small renal stones cause a stone event within 5 years. We performed a randomized, controlled trial (ClinicalTrials.gov number, NCT02210650) of removing small asymptomatic renal stones at the time of ureteral or contralateral stone surgery and hope to discuss the results with the AUA community. METHODS: In a multi-center, randomized, controlled trial, 38 patients had their small asymptomatic renal stones removed, and 35 patients (Control group) did not, during endoscopic removal of ureteral or contralateral renal stones. The primary outcome was relapse measured by future emergency department (ED) visits, surgeries, and stone growth. RESULTS: After a mean follow up duration of 4.2 years, the Treatment group had longer relapse time than the Control group (p<0.0001, logrank test). The restricted mean time-to-relapse was 75% longer in the Treatment group (1631.6 (standard error 72.8) days vs. 934.2 (121.8)). Relapse risk was 82% lower in the Treatment group (hazard ratio 0.18, 95% confidence interval 0.07-0.44) with 16% vs. 63% of subjects relapsing. Treatment added a median of 25.6 (interquartile range 18.5-35.2) minutes to surgery. ED visits within 2 weeks of surgery were 5 in the Treatment group and 4 in the Control group. Eight Treatment and 10 Control subjects reported passing stones. CONCLUSIONS: Removal of small, asymptomatic renal stones during surgery for ureteral or contralateral renal stones reduced relapse. Treatment increased surgery duration but did not increase surgical returns to the ED or passing stones. As surgical tools and techniques continue to improve, the balance may further tilt toward early intervention. Source of Funding: Supported by NIH NIDDK grant P01 DK043881 and from resources through the Veterans Affairs Puget Sound Health Care System © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e310 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mathew D. Sorensen More articles by this author Jonathan D. Harper More articles by this author Michael S. Borofsky More articles by this author Tariq A. Hameed More articles by this author Kimberly J. Smoot More articles by this author Barbara H. Burke More articles by this author Branda J. Levchak More articles by this author James C. Williams More articles by this author Ziyue Liu More articles by this author Michael R. Bailey More articles by this author James E. Lingeman More articles by this author Expand All Advertisement PDF downloadLoading ...
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small asymptomatic renal stones,reduce relapse,removal
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