ㅤTake-home message from Mathew D Sorensen 2022, published in The New England Journal of Medicine):
The removal of small, asymptomatic kidney stones during surgery to remove ureteral
or contralateral kidney stones resulted in an 82% lower incidence of relapse than
non-removal.
ㅤTake-home message from Blandy and Singh 1976, published in The journal of urology:
Conservatively managed stones carry a mortality risk.
Follow-up in conservative and operative group were not matched.
The mortality rates are not applicable to modern mortality rates
The conservatively managed group is not representative of the modern cohort of incidentally detected staghorn stones (20% had solitary kidneys, all has pain and infection)
ㅤTake-home message from Teichman 1995, published in Journal of Urology:
Patients with staghorn stones are at risk of renal deterioration, and this study stresses the importance of preserving renal function in these patients.
Strategies include maximizing stone-free rates, metabolic work-up, treatment of voiding dysfunction, control of hypertension.
ㅤTake-home message from Abram Burgher 2004, published in Journal of Endourology):
In men presenting with asymptomatic renal stones:
26% will need surgical treatment within 3 years
77% will have an increase in stone size, develop pain or need surgical treatment within 3 years
ㅤTake-home message from Deutsch 2016, published in BJUI:
The conservative approach to treating staghorn calculi, especially in patients who are medically unfit for surgery or choose not to undergo intervention, can be a viable and successful option when patients are carefully selected.
This approach necessitates consistent monitoring of infection and renal function, along with the use of appropriate antimicrobial prophylaxis and conservative surgical interventions as necessary.
ㅤTake-home message from BM Dropkin 2015, published in USA):
Of included asymptomatic renal stones:
17% needed surgical intervention within 3 years
28% became symptomatic within 3 years
ㅤTake-home message from LS Glowacki 1992, published in The Journal of Urology):
Approximately half (49%) of patients with asymptomatic renal stones will develop symptoms by 5 years
At approximately 3 years (32 months): approximately 1/3rd (32%) will have symptoms; 17% will need surgical intervention (SWL or URS or PCNL)
ㅤTake-home message from Keeley 2001, published in British Journal of Urology International (BJUI)):
Prophylactic shock wave lithotripsy (ESWL) for small asymptomatic stones offers little advantage compared to observation in terms of stone-free rates or need for further treatment.
ㅤTake-home message from Pearle 2005, published in Journal of Urology ):
The 'Lower Pole II' study did not find strong evidence to favour either shockwave lithotripsy (SWL) or ureteroscopy (URS) for the management of lower pole caliceal stones measuring ≤10mm at three months of follow-up. SWL was, however, noted to have the benefits of better patient satisfaction, lesser analgesic requirement, and shorter time to recovery.
ㅤTake-home message from Idir Ouzaid 2012, published in BJU International):
Measuring stone density on non-contrast CT imaging is an important factor in predicting the success of extracorporeal shockwave lithotripsy (ESWL).
Stones <970 HU had a stone-free rate of 96% compared to 38% in stones >970 HU.
ㅤTake-home message from Elbahnasy 1998, published in The Journal of Urology):
This paper investigates the impact of lower pole radiographic anatomy on the clearance of lower caliceal stones after either extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy (URS).
Three factors were found to decrease stone free clearance after ESWL for lower pole stones: An acute infundibulo-pelvic angle,
A short infundibular length, A narrow infundibular width. Spatial anatomy of the lower pole does not significantly influence stone free-rate after ureteroscopy.
ㅤTake-home message from Alsawi 2020, published in Ann R Coll Surg Eng:
Conservative management of staghorn calculi can be performed safely
Patient selection is key - minimal infection, asymptomatic stones
ㅤTake-home message from Attasit Srisubat 2014, published in Cochrane Database of Systematic Reviews ):
ESWL, PCNL, and RIRS are all effective treatments for kidney stones, but the treatment choice should be tailored to the individual patient's needs based on factors such as stone size, location, and preference.
PCNL had a significantly higher success rate regarding stone-free kidneys than ESWL. As for RIRS, it did not differ significantly from ESWL.
PCNL and RIRS are more effective in removing stones for larger stones (> 2 cm) but have higher complication rates than ESWL, while ESWL is associated with fewer complications and a shorter hospital stay but has a lower stone clearance rate for larger stones.
PCNL is not dependent on the stone burden or composition and is indicated for large-volume stones, as RIRS or ESWL could be an alternative in patients with low-volume stones.
ㅤTake-home message from D M Albala 2001, published in The Journal of Urology):
For management of lower pole kidney stones ≤30mm:
Overall, stone free clearance rate was higher with percutaneous nephrolithotomy (PCNL) than with shock wave lithotripsy (SWL) (95% vs 37%).
However, SWL had an acceptable stone free rate (63%) for stones ≤10mm, and is therefore recommended for stones in this size bracket due to an anticipated lower morbidity.
The authors conclude that stones greater than 10mm should preferably be managed with PCNL, given the much higher stone free clearance rate.
ㅤTake-home message from Andreas Skolarikos 2015, published in The Journal of Urology ):
In patients undergoing flexible ureterorenoscopy (fURS) for a single renal stone:
Stone-free rate is worse for stones >20mm (31%) than for stones <10mm (91%) and 10-20mm (80%).
Overall complication rate is acceptable (6%), and there is no difference in overall complication rate by stone size, adjusting for body mass index (BMI).
ㅤTake-home message from Christian Seitz 2012, published in European Urology):
Percutaneous nephrolitholapaxy (PNL) is a common and safe surgical procedure with low-rate complications.
Careful patient selection, preoperative urine culture with appropriate antibiotic therapy and prophylaxis can prevent complication rates. Stone burden, number and size of access tracts, procedure duration, preoperative hemoglobin institutional experience also affect complication rates.
A modified Clavien classification is recommended to be used to monitor outcomes following PNL in different centers.
ㅤTake-home message from Shuba De 2014, published in European Urology):
Percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for kidney stones are associated with different efficacy and complication profiles. The type of treatment should be tailored based on the patient's and the stone's features.
ㅤTake-home message from F X Keely Jr 1999, published in European Urology):
To assess the effect of anatomic factors, including angle of lower pole infundibulum, for clearance using SWL of lower calyceal stones measuring 11-20mm.
The stone free rate was 52%
The only significant anatomical factor determining stone-free rate in this study was the infundibulopelvic angle.
The size of the stone did not predict eventual stone free status (p=0.911)
Patients treated with SWL for an 11-20mm stone who have an infundibulopelvic angle of >100 degrees are twice as likely to obtain stone free status.
Other factors to consider (although not significant in this study) are the infundibular diameter and calyceal distortion.
ㅤTake-home message from J E Lingeman 1994, published in The Journal of Urology):
Percutaneous nephrostolithotomy (PCNL) provides better stone-free rates (SFR) for the treatment of lower pole nephrolithiasis than Extracorporeal shock wave lithotripsy (ESWL); 90% vs 60%.
ㅤTake-home message from Kenneth T. Pace 2001, published in The Journal of Urology):
Mechanical percussion and inversion, in combination with diuresis, are safe and effective treatment options for residual lower pole fragments following shock wave lithotripsy. This approach significantly improves the stone-free rate and reduces the stone burden, making it a promising alternative to observation alone. However, larger studies with longer follow-up are needed to confirm these findings and determine the optimal treatment duration.