Charalampos Mavridis et al., 2024: Recurrent Urinary Stone Formers: Imaging Assessment and Endoscopic Treatment Strategies: A Systematic Search and Review
Charalampos Mavridis 1 , Athanasios Bouchalakis 1 , Vasiliki Tsagkaraki 2 , Bhaskar Kumar Somani 3 , Charalampos Mamoulakis 1 , Theodoros Tokas 1
1Department of Urology, School of Medicine, University General Hospital of Heraklion, 71110 Heraklion, Greece.
2Campus of Voutes, University of Crete Library, 70013 Heraklion, Greece.
3Department of Urology, University Hospitals Southampton, NHS Trust, Southampton SO16 6YD, UK.
4Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria.
Abstract
Background/Objectives: Nephrolithiasis is a heterogeneous disease with a high prevalence and recurrence rate. Although there has been much progress regarding the surgical treatment of stones, a standardized follow-up, especially in recurrent stone formers (SFs), has yet to be decided. This fact leads to the overuse of computed tomography (CT) scans and many reoperations in patients, thus increasing their morbidity and the financial burden on the health systems. This review systematically searched the literature for original articles regarding imaging strategies and endoscopic treatment for patients with recurrent urolithiasis, aiming to identify optimal strategies to deal with these patients. Methods: We systematically searched the Medline database (accessed on 1 April 2024) for articles regarding imaging modalities and endoscopic treatment for patients with recurrent urinary tract lithiasis. Results: No specific follow-up or endoscopic treatment strategy exists for patients with recurrent urolithiasis. CT scan was the imaging modality most used in the studies, followed by X-ray, ultrasonography, and digital tomosynthesis. A transparent algorithm could not be identified. Percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and ureteroscopy (URS) were used in the studies for endoscopic treatment. PCNL showed the best stone-free (SFr) rate and lowest hazard ratio (HR) for reoperation. RIRS showed superiority over extracorporeal shockwave lithotripsy for recurrent SFs, but fragments over 4 mm increased the recurrent rate. URS has an increased HR for reoperation for bilateral stones. Conclusions: The heterogeneity of urolithiasis leaves urologists without a standardized plan for recurrent SFs. Thus, each patient's follow-up should be planned individually and holistically. Pre-stenting is not to be avoided, especially in high-risk patients, and SFr status needs to be the aim. Finally, CT scans should not be generally overused but should be part of a patient's treatment plan. Prospective studies are required to define SFr status, the size of significant residual fragments, and the modalities of intervention and follow-up.
Endoscopic Treatment Strategies: A Systematic Search and Review J Clin Med. 2024 Jun 13;13(12):3461. doi: 10.3390/jcm13123461. PMID: 38929988 FREE ARTICLE
Comments 1
This report has no direct reference to SWL because SWL is mentioned in only 8 of the publications listed in Table 2. And in these reports SWL is mentioned only as a low-rated treatment alternative. The focus of this systematic review rather is on RIRS, URS and PCNL.
It is interesting, however, to note that patients with active stone disease had nearly ten times as many CTs as controls during a period of 3 years!
The need of an individual follow-up and imaging approach is emphasized and so is the need to increase ultrasound examinations, an imaging method that should be preferred.
It is mentioned that also small ( 10 mm, and particularly so in high-risk patients. For the latter group the reviewer supports the recommendation.
The bottom-line is the need of individualized imaging strategies in the follow-up process and to avoid over-use of CT!
Hans-Göran Tiselius