Streeper Necole M
Division of Urology, Penn State Milton S. Hershey Medical Center, Mail Code H055, 500 University Drive, PO Box 850, Hershey, PA, 17033-0850, USA.
Curr Urol Rep. 2018 Mar 17;19(5):29. doi: 10.1007/s11934-018-0782-3.
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.
目前尚无关于无症状肾结石最佳管理的指南。本综述总结了当前文献，重点关注近期为增加该主题证据而开展的研究。
近期研究发现，结石大小是未来需要手术干预的重要预测因素，儿童患者结石直径>7mm，经皮肾镜取石术（PNL）和输尿管镜检查（URS）后残留碎片直径>4mm。一项近期的随机对照试验得出结论，对于直径<1cm的无症状下极结石，URS和体外冲击波碎石术（SWL）的疗效相当，从而更好地明确了URS的作用。无症状肾结石的治疗决策应考虑多种相关的患者和结石因素；然而，最终应采用共同决策的方法。对于得到适当咨询的患者，主动监测或预防性手术干预可能是合适的。
