Asymptomatic Renal Stones-to Treat or Not to Treat

There are no current guidelines on the optimal management of asymptomatic renal stones. This review summarizes the current literature, focusing on more recent studies that have been done to grow the body of evidence on this topic.

Recent studies have found that stone size is a significant predictor of need for future surgical intervention, with > 7 mm for pediatric population and > 4 mm for residual fragments after both PNL and ureteroscopy (URS). The role of URS has been better defined with a recent RCT concluding that URS and SWL had comparable outcomes for an asymptomatic lower pole stone < 1 cm. The treatment decision for asymptomatic renal stones should take into consideration a variety of relevant patient and stone factors; however, ultimately, a shared decision-making approach should be used. In the properly counseled patient, active surveillance or prophylactic surgical intervention may be appropriate.