The Natural History of Asymptomatic Urolithiasis

Abstract

An inception cohort of 107 patients was reviewed to establish the natural history of asymptomatic urolithiasis. With an over-all mean followup of 31.6 months, 73 patients (68.2%) remained asymptomatic and were censored at the time of the last clinical visit. A symptomatic event developed in 34 patients (31.8%). Spontaneous passage occurred in 16 patients (15.0%), endoureteral removal was done in 6 (5.6%), percutaneous nephrostolithotomy was done in 3 (2.8%) and 9 (8.4%) were referred for therapeutic lithotripsy. Cumulative 5-year probability of a symptomatic event developing was 48.5%. A linear association was identified between the development of a symptomatic event and the number of previous stones as well as the number of asymptomatic stones at identification. A significant burden of illness is associated with an expectant strategy as an approach to asymptomatic urolithiasis. Of the patients who had a symptomatic event 47% had spontaneous stone passage, while 26.5% required urological intervention and 26.5% were referred for therapeutic lithotripsy. Prophylactic extracorporeal shock wave lithotripsy, although often advocated, has associated risks and is not always a benign procedure. A randomized controlled trial is required to evaluate properly the role of prophylactic lithotripsy versus an expectant strategy.

Silent Ureteral Stones: Impact on Kidney Function—Can Treatment of Silent Ureteral Stones Preserve Kidney Function?

“…In 17 patients (63%), postoperative DMSA revealed impaired renal function (comparative DMSA difference Ͼ10%). When analyzing the effect of stone size on renal function, we found that 11 of the 27 patients had stone size Յ10 mm (mean 8.1 Ϯ 1.99, range [5][6][7][8][9][10]. In that population, the mean pre-and postoperative DMSA finding was 20% Ϯ 13.5% (range 0%-30%) and 33% Ϯ 19.2% (range 0%-60%), respectively.…”

“…1 Management algorithms have been established for both symptomatic and silent kidney stones based on research of the natural history of nephrolithiasis. 6,7 In contrast, quiet ureteral calculi disease and its potential burden have been poorly studied. Our report is the first to study the influence of stone removal on the recovery of renal function using pre-and postoperative DMSA analysis in this population.…”

“…Studies of the natural history of stones have revealed that only 20% of patients yearly actually become symptomatic from a new stone, and one half of those require surgical intervention at some point. [5][6][7] The guidelines are well established for the treatment of symptomatic urolithiasis, and many investigators have extensively studied the management of silent kidney stones. However, the same is not true for silent ureterolithiasis.…”

Influência do cálculo ureteral silencioso sobre a função renal antes e após o tratamento

“…Previamente, haviam sido realizadas apenas menções a casos de cálculo ureteral silencioso diagnosticados no seguimento pós ureterolitotripsia e litotripsia extracorpórea por ondas de choque (LECO) [26][27][28] .…”

“…A história natural da litíase renal mostra que 20% dos pacientes tornamse sintomáticos a cada ano, e que metade deles necessita de algum tipo de intervenção cirúrgica em algum momento [26][27][28] . O manejo de pacientes com cálculos ureterais sintomáticos possui algoritmo validado [29] .…”