The European Association of Urology guideline panel on urolithiasis has proposed evidence-based follow-up of patients who receive surgical or medical kidney stone treatment.
No standardized algorithm exists for follow-up of these patients. So the panel conducted a systematic review and meta-analysis of 50 mostly observational studies conducted from 1970 to August 2020 to guide surveillance and further intervention.
Based on a pooled analysis of data from 5467 patients who were stone-free after intervention, those with radiopaque stones should receive up to 2 years of follow-up with radiography and those with radiolucent stones up to 3 years of follow-up with radiography or ultrasound before considering discharge, Andreas Skolarikos, MD, PhD, of National and Kapodistrian University of Athens in Greece and colleagues stated in European Urology Focus. Using a safety margin of 90%, patients can be discharged after 5 years if they have no kidney stone recurrence.
Follow-up of patients with residual disease should be based on the size of kidney stone fragments, according to the panel. Patients with fragments sized 4 mm or less could be offered surveillance for up to 4 years. For this group, reintervention rates have ranged from 17% to 29%, disease progression from 9% to 34%, and spontaneous passage from 21% to 34% at 49 months.
Patients with residual fragments greater than 4 mm should be offered further definitive intervention since reintervention rates ranged from 24% to 100% across studies, according to the panel.
For high-risk patients diagnosed with metabolic abnormalities (eg, hypercalciuria, hyperuricosuria, and hypocitraturia) or with staghorn, struvite, or recurrent stones, the data are less clear. Patients who adhere to medical treatment, however, seem to experience less stone growth or regrowth of residual fragments, according to the panel, and may be discharged after 36-48 months of nonprogressive disease on imaging. High-risk patients not on medical treatment should receive follow-up for 10 years and perhaps longer.
“The need to homogenize follow-up practices is imperative, since it will aid in identifying recurrences earlier and avoid devastating complications such as urosepsis or chronic kidney disease,” Dr Skolarikos and colleagues wrote. “More importantly, ionizing radiation exposure can be minimized.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Tzelves L, Geraghty R, Lombardo R, et al. Duration of follow-up and timing of discharge from imaging follow-up, in adult patients with urolithiasis after surgical or medical intervention: a systematic review and meta-analysis from the European Association of Urology Guideline panel on urolithiasis. Eur Urol Focus. Published online July 15, 2022. doi:10.1016/j.euf.2022.06.016