Passing a kidney stone without symptoms accounts for a third of stone events in recurrent formers of calcium-containing stones, investigators reported at the American Urological Association Annual Meeting in Chicago, Illinois.
In the NOSTONE trial, 224 of 411 stone formers (55%) experienced 476 stone events. Of these, 52% were symptomatic spontaneous passages, 15% were surgical stone removals, and 33% were asymptomatic spontaneous passages.
Patients with a higher number of stones on computed tomography (CT) had significantly greater frequency of passing a kidney stone without symptoms, Kevin Stritt, MD, of the University of Lausanne in Switzerland reported on behalf of his team. Those with a lower total volume of stones also had significantly greater asymptomatic spontaneous stone passages.
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“Although stone recurrence is high in formers of calcium-containing kidney stones, a relevant number of these stones will pass spontaneously and without symptoms,” Dr Stritt said in an interview. “Our data should encourage urologists to counsel patients about the possibility of a conservative approach to stone management. This includes drinking more than 2 liters of fluid daily, consuming enough dietary calcium, and limiting foods high in salt, animal protein, oxalate, and uric acid.”
NOSTONE investigators recently reported in the New England Journal of Medicine that hydrochlorothiazide, a thiazide diuretic, does not prevent kidney stone recurrence, regardless of dosage.
According to Dr Stritt, intervention is required in the presence of infection/urinary sepsis, acute renal failure, or uncontrolled pain. In an emergency setting, the patient receives a double J stent or a nephrostomy to drain the kidney. Depending on the size and location of the stone, shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, or open surgery may be performed.
Reference
Stritt K, Bonny O, Fuster D, Christe A, and Roth B. Asymptomatic spontaneos stone passage is frequent in recurrent kidney stone formers: results of the prospective, randomized NOSTONE trial. Presented at: AUA 2023, Chicago, Illinois, April 28-May 1. Poster MP16-20.
