Abstract
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 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.
