Lovegrove Catherine E, Geraghty Robert M, Yang Bingyuan, Brain Eleanor, Howles Sarah, Turney Ben, Somani Bhaskar
Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK.
Department of Surgical Sciences, University of Oxford Nuffield, Oxford, UK.
BJU Int. 2022 Apr;129(4):442-456. doi: 10.1111/bju.15522. Epub 2021 Sep 6.
To systematically review the natural history of small asymptomatic kidney and residual stones, as the incidental identification of small, asymptomatic renal calculi has risen with increasing use of high-resolution imaging.
We reviewed the natural history of small asymptomatic kidney and residual stones using the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We searched MEDLINE, Scopus, EMBASE, EBSCO, Cochrane library and Clinicaltrials.gov using themes of 'asymptomatic', 'nephrolithiasis', 'observation', 'symptoms', 'admission', 'intervention' and similar allied terms for all English language articles from 1996 to 2020 (25 years). Inclusion criteria were studies with ≥50 patients, stones ≤10 mm, and a mean follow-up of ≥24 months. Primary outcomes were occurrence of symptoms, emergency admission, and interventions.
Our literature search returned 2247 results of which 10 papers were included in the final review. Risk of symptomatic episodes ranged from 0% to 59.4%. Meta-analysis did not identify any significant difference in the likelihood of developing symptoms when comparing stones <5 mm to those >5 mm, nor those <10 mm to those >10 mm. Risk of admission varied from 14% to 19% and the risk of intervention from 12% to 35%. Meta-analysis showed a significantly decreased likelihood of intervention for stones <5 vs >5 mm and <10 vs >10 mm. Studies had variable risk of bias due to heterogeneous reporting of outcome measures with significant likelihood that observed differences in results were compatible with chance alone (Symptoms: I =0%, Cochran's Q = 3.09, P = 0.69; Intervention: I =0%, Cochran's Q = 1.76, P = 0.88).
The present systematic review indicates that stone size is not a reliable predictor of symptoms; however, risk of intervention is greater for stones >5mm vs <5 mm and >10 vs <10 mm. This review will inform urologists as they discuss management strategies with patients who have asymptomatic renal stones and offer insight to committees during the development of evidence-based guidelines.
随着高分辨率成像技术的使用日益增多，偶然发现的无症状小肾结石及残留结石也越来越多，本研究旨在系统回顾无症状小肾结石及残留结石的自然病史。
我们采用Cochrane协作网及系统评价与Meta分析的首选报告项目（PRISMA）方法，回顾无症状小肾结石及残留结石的自然病史。我们在MEDLINE、Scopus、EMBASE、EBSCO、Cochrane图书馆及Clinicaltrials.gov数据库中进行检索，使用“无症状”“肾结石”“观察”“症状”“入院”“干预”等主题词及类似相关术语，检索1996年至2020年（共25年）的所有英文文章。纳入标准为研究对象≥50例、结石≤10 mm且平均随访时间≥24个月。主要结局指标为症状的发生、急诊入院及干预措施。
我们的文献检索共返回2247条结果，最终纳入10篇论文进行综述。有症状发作的风险范围为0%至59.4%。Meta分析未发现比较<5 mm结石与>5 mm结石、<10 mm结石与>10 mm结石时出现症状可能性的显著差异。入院风险为14%至19%，干预风险为12%至35%。Meta分析显示，与>5 mm结石相比，<5 mm结石以及与>10 mm结石相比，<10 mm结石进行干预的可能性显著降低。由于结局指标报告存在异质性，研究存在不同程度的偏倚风险，观察到的结果差异很可能仅与机遇相符（症状：I² = 0%，Cochran's Q = 3.09，P = 0.69；干预：I² = 0%，Cochran's Q = 1.76，P = 0.88）。
本系统综述表明，结石大小并非症状的可靠预测指标；然而，与<5 mm结石相比，>5 mm结石以及与<10 mm结石相比，>10 mm结石的干预风险更高。本综述将为泌尿外科医生在与无症状肾结石患者讨论治疗策略时提供参考，并在制定循证指南过程中为委员会提供见解。
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