Asymptomatic renal stones are identified in 8–10% of screened populations. With the increasing utilization of CT, the number of patients seeking urologic care for incidentally diagnosed renal calculi is likely to increase. Such patients present an important management dilemma: differentiating those to treat surgically from those who can be safely observed. Observational studies have revealed that approximately 50% of asymptomatic stones will progress, but most will not require surgery. Stones >15 mm in diamater and located in the renal pelvis are at highest risk of progression. Although no guidelines exist for the optimal monitoring regimen for asymptomatic stones, follow-up studies may include serum creatinine, plain radiography, ultrasonography, and CT. Shock wave lithotripsy (SWL) does not seem to offer significant benefit over observation for asymptomatic calyceal stones. Percutaneous nephrolithotomy does improve stone-free rates compared to SWL or observation. Additional research is needed to characterize the role of ureteroscopic management of asymptomatic renal stones.
The prevalence of asymptomatic stones identified in screened populations is 8–10%, and is likely to grow with increased CT utilization
Outcomes of asymptomatic stones <10 mm in diamater include a symptomatic stone event (13–32%), spontaneous passage (13–20%), size increase (30–46%) and intervention (7–26%)
Asymptomatic stones located in the renal pelvis and >15 mm are at high risk of progression, defined as increase in size, symptomatic stone event, or need for intervention
Shockwave lithotripsy does not improve stone-free rates or quality of life compared to observation for asymptomatic calyceal stones <15 mm
Percutaneous nephrolithotomy improves stone-free rates compared to shockwave lithotriposy and observation for asymptomatic lower pole stones
Randomized trials are needed to define the role of ureteroscopy in the management of asymptomatic renal stones
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M. E. Lipkin declares he has been a consultant for Boston Scientific. Z. G. Goldsmith declares no competing interests.
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Goldsmith, Z., Lipkin, M. When (and how) to surgically treat asymptomatic renal stones. Nat Rev Urol 9, 315–320 (2012). https://doi.org/10.1038/nrurol.2012.43
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