WASHINGTON: When kidney stones are surgically removed from patients, small stones that do not cause problems are often left behind. Leaving these asymptomatic stones behind, however, dramatically increases the likelihood a patient will experience Downfall In the coming five years according to recent randomized controlled research.
The findings of the research were published in the ‘Journal’.New England Journal of Medicine,
Generally, stones less than 6 mm in diameter are not removed, which is not the primary goal of a procedure, but they are monitored because “secondary” stones have a higher rate of successful passage if they enter the ureter. go away, said lead author Dr. Mathew sorensena urologist in University of Washington School of Medicine,
“Prior to this study, clinical views were very mixed on whether some of these stones should be treated,” he said. “Most physicians will decide based on the size of the stone whether it has hit the bar to treat, and if it doesn’t, you will often ignore smaller stones.”
The investigators studied 75 patients who were treated at multiple institutions in the period from 2015 to 2021. About half of the patients were treated for only their large primary stone, while in others the primary and secondary stones were removed. Relapse was defined as going to the emergency room or undergoing an additional procedure due to recurrence or if a follow-up CT scan revealed increased secondary stones.
The researchers found that the removal of secondary stones reduced relapse rates by 82 percent, leading the authors to recommend that smaller stones should not be left behind.
“Our trial results support the removal of small asymptomatic kidney stones at the time of surgery with a larger stone,” their paper concluded. The authors note that while the removal of small stones may increase the duration and cost of the procedure, those costs are likely to be less than the costs associated with a repeat procedure for the patient or a visit to the emergency room.
Some of the patients in the study visited the emergency department multiple times and then required surgery, the report said.
Sorensen said he would share the results of the study with colleagues with the hope of changing his sensitivity to small stones. Further study is needed to determine whether treatment of small stones alone is appropriate, as technology improves and the costs and risks of interventions decrease, he said.
“I think we’ve proved through this rigorous study that there is a benefit to removing small asymptomatic stones when possible and in patients who are candidates to treat all of their stones in one procedure,” he said. Told. “Leaving stones behind is a problem of future exposure.”
The findings of the research were published in the ‘Journal’.New England Journal of Medicine,
Generally, stones less than 6 mm in diameter are not removed, which is not the primary goal of a procedure, but they are monitored because “secondary” stones have a higher rate of successful passage if they enter the ureter. go away, said lead author Dr. Mathew sorensena urologist in University of Washington School of Medicine,
“Prior to this study, clinical views were very mixed on whether some of these stones should be treated,” he said. “Most physicians will decide based on the size of the stone whether it has hit the bar to treat, and if it doesn’t, you will often ignore smaller stones.”
The investigators studied 75 patients who were treated at multiple institutions in the period from 2015 to 2021. About half of the patients were treated for only their large primary stone, while in others the primary and secondary stones were removed. Relapse was defined as going to the emergency room or undergoing an additional procedure due to recurrence or if a follow-up CT scan revealed increased secondary stones.
The researchers found that the removal of secondary stones reduced relapse rates by 82 percent, leading the authors to recommend that smaller stones should not be left behind.
“Our trial results support the removal of small asymptomatic kidney stones at the time of surgery with a larger stone,” their paper concluded. The authors note that while the removal of small stones may increase the duration and cost of the procedure, those costs are likely to be less than the costs associated with a repeat procedure for the patient or a visit to the emergency room.
Some of the patients in the study visited the emergency department multiple times and then required surgery, the report said.
Sorensen said he would share the results of the study with colleagues with the hope of changing his sensitivity to small stones. Further study is needed to determine whether treatment of small stones alone is appropriate, as technology improves and the costs and risks of interventions decrease, he said.
“I think we’ve proved through this rigorous study that there is a benefit to removing small asymptomatic stones when possible and in patients who are candidates to treat all of their stones in one procedure,” he said. Told. “Leaving stones behind is a problem of future exposure.”