Follow-up of urolithiasis patients after treatment: an algorithm from the EAU Urolithiasis Panel

• Published in: World journal of urology Vol. 42; no. 1; p. 202
• Main Authors: Lombardo, Riccardo, Tzelves, Lazaros, Geraghty, Robert, Davis, Niall F., Neisius, Andreas, Petřík, Ales, Gambaro, Giovanni, Türk, Christian, Somani, Bhaskar, Thomas, Kay, Skolarikos, Andreas
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 28.03.2024; Springer Nature B.V
• Subjects: Algorithms; Computed tomography; Invited Review; Lithiasis; Medicine; Medicine & Public Health; Nephrology; Oncology; Patients; Risk groups; Systematic review; Urinary tract diseases; Urology; Metabolic; Algorithm; Urinary stone treatment; Imaging; Follow-up
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-024-04872-y

Objective To develop a follow-up algorithm for urinary stone patients after definitive treatment. Materials and methods The panel performed a systematic review on follow-up of urinary stone patients after treatment (PROSPERO: CRD42020205739). Given the lack of comparative studies we critically evaluated the literature and reached a consensus on the follow-up scheme. Results A total of 76 studies were included in the analysis, including 17 RCTs. In the stone-free general population group, 71–100% of patients are stone-free at 12 months while 29–94% remain stone-free at 36 months. We propose counselling these patients on imaging versus discharge after the first year. The stone-free rate in high-risk patients not receiving targeted medical therapy is < 40% at 36 months, a fact that supports imaging, metabolic, and treatment monitoring follow-up once a year. Patients with residual fragments ≤ 4 mm have a spontaneous expulsion rate of 18–47% and a growth rate of 10–41% at 12 months, supporting annual imaging follow-up. Patients with residual fragments > 4 mm should be considered for surgical re-intervention based on the low spontaneous expulsion rate (13% at 1 year) and high risk of recurrence. Plain film KUB and/or kidney ultrasonography based on clinicians’ preference and stone characteristics is the preferred imaging follow-up. Computed tomography should be considered if patient is symptomatic or intervention is planned. Conclusions Based on evidence from the systematic review we propose, for the first time, a follow-up algorithm for patients after surgical stone treatment balancing the risks of stone recurrence against the burden of radiation from imaging studies.