Asymptomatic lower pole stone < 1 cm: to treat or not to treat?

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Vol. 42 (2): 185-187, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2016.02.04


DIFFERENCE OF OPINION


Asymptomatic lower pole stone < 1 cm: to treat or not to treat?
Opinion: Do not treat

Wesley W. Ludwig 1, Justin B. Ziemba 2, Brian R. Matlaga 1
1 James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA;
2 Division of Urology, Department of Surgery, Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, PA, USA


Keywords: Urinary Calculi; Kidney Calculi; Hydronephrosis


The increasing use of cross-sectional imaging has made the incidental detection of asymptomatic stones a common occurrence with an estimated 8% of the population affected (1). Despite its frequency the average asymptomatic stone size is only 3 mm and is frequently located in the lower pole (1, 2). Nevertheless, urologists are often faced with the decision to treat or not to treat these asymptomatic stones. Favoring treatment is the theoretical benefit of preventing a future symptomatic stone event. Against treatment is the potential for morbidity related to our treatment modalities in the setting of a stone which may never become symptomatic. Therefore, we argue that avoidance of treatment in an asymptomatic lower pole renal stone < 1 cm, especially initially, in favor of surveillance is the best management choice.

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