RCT Results: Should Small Asymptomatic Kidney Stones be Surgically Removed or Observed?
BACKGROUND AND PURPOSE:
Small (≤6 mm), asymptomatic kidney stones may be removed surgically or managed conservatively
Sorensen et al. (NEJM, 2022) sought to determine whether small kidney stone removal vs observation result in in fewer relapses
Multicenter, randomized, controlled trial
Scheduled for endoscopic surgical treatment of a primary stone
Removal of small, asymptomatic secondary stones
No removal (control)
Relapse: Future emergency department visits, surgeries, or growth of secondary stones
Removal group: 38 patients | Control group: 35 patients
Mean follow-up: 4.2 years
The treatment group had a longer time to relapse than the control group
The restricted mean time to relapse was 75% longer in the treatment group than in the control group
Removal group: 1631.6 days
Control group: 934.2 days
The risk of relapse was 82% lower in the treatment group than the control group
Removal group: 16% relapsed
Control group: 63% relapsed
Hazard ratio (HR) 0.18 (95% CI, 0.07 to 0.44)
Additional surgery time in the removal group
25.6 (IQR, 18.5 to 35.2) minutes
Emergency department visits within 2 weeks of surgery
Removal group: 5 patients
Control group: 4 patients
Patient reported passing kidney stones
Removal group: 8 patients
Control group: 10 patients
For patients undergoing endoscopic removal of primary kidney stones, removing small, secondary, asymptomatic stones at the time of surgery reduced the risk of relapse, and lengthened the time to relapse
Additional surgery time for the treatment group was minimal
The authors state
Results of our prospective, randomized trial support removal of small, asymptomatic renal stones at the time of surgery to remove a symptomatic stone
The additional 25 minutes needed to remove small, asymptomatic renal stones at the time of surgery for a primary stone (extending the procedure by 38%) should be weighed against the potential need for repeat surgery in the 63% of patients who had a relapse
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