Extraction prevented subsequent symptomatic stone occurrences.
background
The benefits of endoscopic removal of small asymptomatic kidney stones (≤6 mm) are unknown. Current guidelines leave such decisions up to the urologist and the patient. A prospective study involving older non-endoscopic techniques and some retrospective studies favor observation.
However, published data indicate that about half of the small kidney stones remaining at the time the large stones are removed cause other symptomatic events within 5 years of surgery.
methods
We conducted a multicentre, randomized, controlled trial in which, during endoscopic removal of ureteral or opposite lateral kidney stones, they were fired The remaining small asymptomatic stones in 38 patients (treatment group) and they were not fired in 35 patients (control group). The primary outcome was relapse as measured by future emergency department visits, surgery, or secondary stone development.
Result
after average follow-up 4.2 yearsThe treatment group had a longer time than the control group (p < 0.001 by log-rank test). The mean time to restriction (± SE) was 75% longer in the treatment group than in the control group (1631.6 ± 72.8 days vs 934.2 ± 121.8 days).
was in danger of reoccurring 82% less In the treatment group compared with the control group (hazard ratio, 0.18; 95% confidence interval, 0.07 to 0.44), 16% of the patients in the treatment group had a relapse compared to 63% of those in the control group. Treatment added a median of 25.6 min (interquartile range, 18.5 to 35.2) in time to surgery.
Five patients in the treatment group and four in the control group visited the emergency department within 2 weeks of surgery. Eight patients in the treatment group and 10 patients in the control group reported passing kidney stones.
conclusion
a result of removal of small, asymptomatic kidney stones during surgery to remove ureteral or opposite kidney stones low incidence of recurrence compared to no evacuation and the same number of visits to the emergency department related to surgery.
