Removal of small asymptomatic kidney stones cuts down their recurrence significantly: NEJM

A new study conducted by Mathew D. Sorensen and colleagues found that the frequency of recurrence was lower when tiny, asymptomatic kidney stones were removed during surgery to remove ureteral or contralateral kidney stones. The quantity of post-operative trips to the emergency room was comparable. The findings of this study were published in The New England Journal of Medicine.

It is uncertain if endoscopic kidney stone removal of tiny (≤6 mm), asymptomatic kidney stones is beneficial. According to current recommendations, the urologist and the patient make these choices. Observation is preferred in several retrospective investigations and prospective research using earlier, non-endoscopic technologies. However, published data shows that within 5 years of surgery, almost 50% of minor renal stones that were left behind when bigger stones were removed, produced subsequent clinical occurrences. Therefore, the purpose of this study was to determine if kidney stones would return following endoscopic removal.

In a randomized, multicenter, controlled trial, patients were divided into the treatment group (38 patients) and the control group (35 patients) during the endoscopic removal of ureteral or contralateral kidney stones (control group). The main result was relapse, which was determined by subsequent trips to the ER, operations, or the development of new stones.

The key findings of this study were as follows:

1. The therapy group took more time to revert than the control group did after a mean follow-up of 4.2 years.

2. The treatment group's limited mean (SE) time to relapse was 75% longer than the control group.

3. With 16% of patients in the treatment group experiencing a relapse as opposed to 63% of those in the control group, the probability of recurrence was 82% lower in the treatment group than in the control group.

4. A median of 25.6 minutes was added to the surgery's time by the treatment.

5. Within two weeks of surgery, five patients in the therapy group and four in the control group visited the emergency room.

6. Ten patients in the control group and eight patients in the treatment group both reported passing renal stones.

Reference: 

Sorensen, M. D., Harper, J. D., Borofsky, M. S., Hameed, T. A., Smoot, K. J., Burke, B. H., Levchak, B. J., Williams, J. C., Jr., Bailey, M. R., Liu, Z., & Lingeman, J. E. (2022). Removal of Small, Asymptomatic Kidney Stones and Incidence of Relapse. In New England Journal of Medicine (Vol. 387, Issue 6, pp. 506–513). Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2204253