Asymptomatic Renal Stones—to Treat or Not to Treat

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•• Sener NC, Bas O, Sener E, Zengin K, Ozturk U, Altunkol A, et al. Asymptomatic lower pole small renal stones: shock wave lithotripsy, flexible ureteroscopy or observation? A prospective randomized trail. Urology. 2015;85:33–7. RCT randomizing patients with asymptomatic single lower pole stones <1cm to ureteroscopy, shockwave lithotripsy, and observation. The stone free rate for URS was 92% and 90% for SWL after an average of 1.48±0.65 sessions. Observation group had a 12% rate of stone progression over 2 year follow-up

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• Chew BH, Brotherhood HL, Sur RL, Wang AQ, Knudsen BE, Yong C, et al. Natural history, complications, and re-intervention rates of asymptomatic residual stone fragments after ureteroscopy: a report from the EDGE Research Consortium. J Urol. 2016;195:982–6. A multicenter retrospective review of the natural history of asymptomatic residual fragments following ureteroscopy, including 232 patients. They reported that 56% of patients remained asymptomatic with a mean follow up of 16.8 months. 29% of patients required a secondary procedure. In addition, they concluded that residual fragment size > 4mm after ureteroscopy was associated with significantly higher rate of stone growth and need for re-intervention

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