📃 Paper Title: The Role for Active Monitoring in Urinary Stones: A Systematic Review
🧍 Author: A Skolarikos
🕒 Year: 2010
📚 Journal: Journal of Endourology
🌎 Country: Greece
ㅤContext to the study:
Can you give me an overall summary of the evidence on active monitoring in the treatment of urinary stones?
ㅤ✅ Take-home message of study:
2/3rd of all symptomatic ureteric calculi pass spontaneously within 4 weeks of onset of symptoms
Symptoms or need for intervention for asymptomatic renal calculi: approximately 10% per year
21% of CIRFs (<=4mm) after SWL needed intervention at 5 years (Osman 2005)
43% of residual fragments after PCNL are associated with stone related event within 41 months (Raman 2009)
ㅤ Systematic review
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Study participants:
Total studies included: 37
Inclusion criteria:
Studies which assessed active monitoring for:
Small symptomatic ureteric stones (n=13)
Newly diagnosed asymptomatic renal stones (n=7)
Residual stone fragments after definitive treatment (n=17)
No restriction by study type for inclusion
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Key study outcomes:
Small symptomatic ureteric stones (n=13):
38 to 71% of symptomatic ureteric calculi <4mm pass spontaneously
4.8% of symptomatic ureteric calculi <2mm need intervention during surveillance compared to 50% for those 4 to 6mm
2/3rd symptomatic ureteric calculi pass within 4 weeks of onset of symptoms
Rate of complications relates to duration of symptoms: 7% (symptoms <4weeks) vs 20% (symptoms >4 weeks)
Newly diagnosed asymptomatic renal stones (n=7):
Risk of symptomatic episode or intervention approximately 10% per year
Cumulative risk of symptomatic episode or intervention: 49 to 83% at 5 years
When compared to surveillance, SWL did not offer significant benefit in terms of stone free rate, need for additional treatment or GP visits (see Keeley 2001)
Isolated stones which were small (<4mm) and of non-uric acid composition were less likely to fail active monitoring
Residual stone fragments after definitive treatment (n=17):
After SWL:
Of the studies with longest period of follow-up (5 years); 79% of CIRFs <=4mm cleared within a few weeks and did not recur; 21% needed re-treatment (Osman 2005, European Urology)
After PCNL:
Of the studies with longest period of follow-up (41 months); 26% of patients with residual fragments needed further surgical intervention or SWL; 43% of patients had a stone related event (stone growth; emergency room attendance; medical or surgical intervention) (Raman 2009; J Urology)
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Study Limitations:
Poorly defined study inclusion criteria and primary outcome(s)
Significant heterogeneity of included studies meant meta-analysis not possible
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