TOPLINE

A meta-analysis found that patients who received proactive treatment for asymptomatic kidney stones had lower odds for later recurrence of stones and a lower need for surgeries than those who underwent watchful observation.

METHODOLOGY

• Researchers conducted a systematic review and meta-analysis of six randomized controlled trials involving 592 patients to compare proactive treatment with observation for asymptomatic kidney stones.
• Active interventions included shock wave lithotripsy, ultrasonic propulsion, and ureteroscopy.
• Researchers compared the recurrence rate using a composite stone-related outcome that included subsequent surgery, unscheduled stone-related visits, or stone growth.
• Statistical heterogeneity, the risk for bias, and the quality of evidence of the studies were assessed.

TAKEAWAY

• Follow‑up durations ranged from about 6 months to 4.2 years. The studies had a low-to-moderate risk for bias, and the quality of evidence was rated moderate to low.
• Intervention was associated with 65% lower odds of the composite recurrence outcome than observation (five studies; P = .003), with moderate heterogeneity (I², 56.3%).
• The odds of requiring subsequent surgery were 55% lower in patients who received active intervention (five studies; P = .006), with no statistical heterogeneity (I², 0%).
• Active intervention was associated with lower odds for stone growth (two studies). The odds of adverse events did not differ between groups.

IN PRACTICE

“A thorough discussion of the potential benefits and risks of intervention vs observation should be undertaken, taking into account individual patient factors such as age, stone characteristics and location, comorbidities, occupational considerations, and patient preferences. This individualized approach ensures that clinical decisions are aligned with both the medical context and the patient’s values and circumstances,” the researchers wrote.

SOURCE

The study was led by Xingyuan Tuo of Sichuan University in Chengdu, People’s Republic of China. It was published online on June 14 in the World Journal of Urology.

LIMITATIONS

Outcome definitions varied across studies and were not standardized. Researchers could not perform reliable subgroup analyses by stone size, location, or clinical context.

DISCLOSURES

The study received funding from the Sichuan Science and Technology Program. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.