Removal of small kidney stones without symptoms and the occurrence of relapse

background

The benefits of laparoscopic removal of small asymptomatic kidney stones (6 mm) are unknown. Current guidelines leave such decisions to the urologist and the patient. A prospective study including an older non-laparoscopic technique and some retrospective studies favor observational.

However, published data indicate that approximately half of small kidney stones remaining at the time large stones were removed caused further accidental events within 5 years of surgery.

Methods

We conducted a multicenter, randomized controlled trial, during laparoscopic removal of kidney or ureter stones, They have been extracted Small stones remained asymptomatic in 38 patients (treatment group) and They are not extracted In 35 patients (control group). The primary outcome was relapse as measured by future emergency department visits, surgeries, or secondary stone growth.

consequences

After follow mean 4.2 years, the treatment group had a longer time to relapse than the control group (P < 0.001 by logarithmic classification test). The mean (± SE) time to relapse was 75% longer in the treatment group than in the control group (1631.6 ± 72.8 days versus 934.2 ± 121.8 days).

Was the risk of relapse 82% less In the treatment group compared to the control group (hazard ratio, 0.18; 95% confidence interval, 0.07 to 0.44), 16% of patients in the treatment group had a relapse compared to 63% of those in the control group. Treatment added a mean of 25.6 minutes (interquartile range, 18.5 to 35.2) to the time of surgery.

Five patients in the treatment group and four in the control group visited the emergency department within two weeks of surgery. Eight patients in the treatment group and 10 in the control group reported having discharged kidney stones.

Conclusions

Removal of small, asymptomatic kidney stones during surgery to remove the corresponding kidney or ureter stones resulted in a Low relapse rate of no extraction and in a similar number of visits to the emergency department related to surgery.