PMID- 29675983
OWN - NLM
STAT- MEDLINE
DCOM- 20190318
LR  - 20190617
IS  - 1464-410X (Electronic)
IS  - 1464-4096 (Linking)
VI  - 122
IP  - 2
DP  - 2018 Aug
TI  - The natural history of asymptomatic calyceal stones.
PG  - 263-269
LID - 10.1111/bju.14354 [doi]
AB  - OBJECTIVES: To evaluate the outcomes of patients with incidentally detected 
      asymptomatic calyceal stones on active surveillance, and to identify risk factors 
      for stone-related adverse events (AEs). PATIENTS AND METHODS: In this 
      retrospective case series, we identified all renal units with non-contrast 
      computed tomography diagnosed asymptomatic calyceal stones in a single reference 
      centre between August 2005 and August 2016. Primary endpoints were spontaneous 
      stone passage and need for stone-related surgical intervention. The secondary 
      endpoints were stone-related symptoms and AEs. Cox proportional hazards models 
      were used. RESULTS: We identified 301 renal units from 238 adult patients. The 
      median average age of the study group was 56 years, with two-thirds consisting of 
      males. The mean average cumulative stone size was 10.8 mm. At the end of the 
      study, 58.8% of renal units with stones remained on surveillance with a median 
      follow-up of 63 months. Overall, 26.6% of patients proceeded to surgical 
      intervention with the majority secondary to pain with no stone relocation (30%) 
      or stone relocation to the ureter with or without pain (25%). Over the 5-year 
      period, 14.6% of stones passed spontaneously. On analysis of the secondary 
      endpoints, 39.5% had a stone-related AE (either symptoms and/or need for surgical 
      intervention). Younger patients (aged <50 years), and those with stone growth >1 
      mm annually were significantly more likely to have an AE (P = 0.012 and P = 
      0.006, respectively). The risk of an AE during surveillance at 1, 3, and 5 years 
      was 3.4%, 18.9%, and 30.7% respectively. CONCLUSIONS: Long-term conservative 
      approaches for asymptomatic renal stones are an effective management option with 
      ~60% of renal units remaining on active surveillance in >5 years of follow-up. 
      Appropriate counselling with careful patient selection is advocated, as younger 
      patients and those with evidence of stone growth were found to be at greatest 
      risk of an adverse outcome.
CI  - (c) 2018 The Authors BJU International (c) 2018 BJU International Published by John 
      Wiley & Sons Ltd.
FAU - Darrad, Maitrey P
AU  - Darrad MP
AUID- ORCID: 0000-0001-7034-2071
AD  - Urology Department, University Hospital Birmingham, Birmingham, UK.
FAU - Yallappa, Sachin
AU  - Yallappa S
AD  - Urology Department, University Hospital Birmingham, Birmingham, UK.
FAU - Metcalfe, John
AU  - Metcalfe J
AD  - Urology Department, University Hospital Birmingham, Birmingham, UK.
FAU - Subramonian, Kesavapillai
AU  - Subramonian K
AD  - Urology Department, University Hospital Birmingham, Birmingham, UK.
LA  - eng
PT  - Journal Article
DEP - 20180514
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Humans
MH  - Incidental Findings
MH  - Kidney Calculi/diagnostic imaging/*pathology/therapy
MH  - Lithotripsy/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Nephrolithotomy, Percutaneous/statistics & numerical data
MH  - Remission, Spontaneous
MH  - Retrospective Studies
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
MH  - Ureteral Calculi/diagnostic imaging/*pathology/therapy
MH  - Ureteroscopy/statistics & numerical data
MH  - Watchful Waiting/statistics & numerical data
MH  - Young Adult
OTO - NOTNLM
OT  - #KidneyStones
OT  - asymptomatic calyceal stones
OT  - natural history
OT  - renal stones
OT  - urolithiasis
EDAT- 2018/04/21 06:00
MHDA- 2019/03/19 06:00
CRDT- 2018/04/21 06:00
PHST- 2018/04/21 06:00 [pubmed]
PHST- 2019/03/19 06:00 [medline]
PHST- 2018/04/21 06:00 [entrez]
AID - 10.1111/bju.14354 [doi]
PST - ppublish
SO  - BJU Int. 2018 Aug;122(2):263-269. doi: 10.1111/bju.14354. Epub 2018 May 14.