Article Name: Removal of Small, Asymptomatic Kidney Stones and Incidence of Relapse
Journal title: The New England Journal of Medicine
Publication Year: 2022
Authors: Sorensen, et al.
Description:
There are currently no guidelines pertaining to whether asymptomatic kidney stones should be removed. This article is a randomized control trial that attempts to look at the benefits of removing small asymptomatic kidney stones that are ureteral or located on the contralateral side during surgery. It defines small kidney stones as under 6mm. The trial included 73 total patients divided into two groups – the treatment group, which included 38 patients (where asymptomatic stones were removed) and the control group, which included 35 patients (where asymptomatic stones were not removed). Patients were then followed up for an average of 4.2 years and their relapse rates were observed.
Outcomes:
The primary outcome this study looked at was relapse, which they measured by looking at future emergency department visits, surgeries and secondary stone growth within the 2 week to 5 year follow up period. Stone growth was defined as an increase of more than 1 mm in stone size. The mean time to relapse was 1631.6 +/- 72.8 for the treatment group and 934.2 +/- 121.8 for the control group, revealing a 16% overall relapse rate in treatment group and 63% in the control group. Thus, the risk or relapse was found to be 82% lowers in the treatment group.
Conclusions:
This article concluded that removal of small asymptomatic kidney stones at the time of surgery for a symptomatic contralateral or ureteral stone led to a lower incidence of relapse rates.
Limitations:
This is a relatively small study with only 73 total patients. A vast majority of the patients were white, making it more difficult to generalize the results to the public. The study was not blinded, as surgeons knew which group the patients were assigned too.
This study can be used to guide clinical practice because it supports evidence found by other studies that emphasize the lower incidence rates of relapse with removal of small asymptomatic kidney stones. The procedure for removal of the additional small stones added an average of 25.6 minutes to surgery. Since there are no set clinical guidelines, this data can be used in shared decision making to determine which option is best for thee individual patient.
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