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01-12-2024 | Urolithiasis | Invited Review

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

Authors: Riccardo Lombardo, Lazaros Tzelves, Robert Geraghty, Niall F. Davis, Andreas Neisius, Ales Petřík, Giovanni Gambaro, Christian Türk, Bhaskar Somani, Kay Thomas, Andreas Skolarikos

Published in: World Journal of Urology | Issue 1/2024

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 < 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.

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Title: Follow-up of urolithiasis patients after treatment: an algorithm from the EAU Urolithiasis Panel
Authors: Riccardo Lombardo
Lazaros Tzelves
Robert Geraghty
Niall F. Davis
Andreas Neisius
Ales Petřík
Giovanni Gambaro
Christian Türk
Bhaskar Somani
Kay Thomas
Andreas Skolarikos
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keyword: Urolithiasis
Published in: World Journal of Urology / Issue 1/2024
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-024-04872-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Objective

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusions

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