Author(s): Glowacki LS, Beecroft ML, Cook RJ, Pahl D, Churchill DN
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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.
This article was published in J Urol
and referenced in Medical & Surgical Urology