Daly Killian F, Horan Michelle T, Lincoln Marc C, MacCraith Eoin, Quinlan Mark R, Walsh Michael T, Skolarikos Andreas, Davis Niall F
Department of Urology, Connolly Hospital, Blanchardstown, Dublin, Ireland.
St. James's Hospital, Dublin, Ireland.
J Endourol. 2022 Apr;36(4):444-447. doi: 10.1089/end.2021.0736. Epub 2022 Jan 5.
There is a lack of data on the natural history of asymptomatic intrarenal calculi. In this study, we investigate stone-related events (SREs) in patients with untreated intrarenal calculi. We also investigate predictive factors for SREs. All patients found with an asymptomatic intrarenal calculus on CT kidney, ureter, bladder managed conservatively with interval imaging for ≥6 months were included. Patients were evaluated for any SRE. The rate of event according to calculus size, location, and number of calculi was also analyzed. Multivariate logistic regression analysis was performed to determine significant predictors for SREs. In total, 266 renal units from 177 patients met inclusion criteria. The mean stone size was 4.44 mm (range 1-25 mm). Duration of follow-up was 43.78 ± 26.86 months (range 6-106 months). The overall rate of SREs, including intervention ( = 80) and spontaneous stone passage after ureteral colic ( = 40), was 45.1% ( = 120/266). Stones >5 mm were more likely to lead to an event compared with stones ≤5 mm (odds ratio [OR]: 2.94; = 0.01). Interpolar stones and stones located in multiple calices were more likely to cause a SRE than lower pole stones (OR: 2.05; = 0.05 and OR: 2.29; = 0.03, respectively). In this large series of patients with asymptomatic intrarenal calculi, the incidence of a spontaneous SRE was 45.1% after 41 months. Stone size and stone location were significant predictors for a SRE. Information from this study will enable urologists to accurately risk stratify patients with asymptomatic renal stones.
目前缺乏关于无症状肾内结石自然病程的数据。在本研究中，我们调查了未经治疗的肾内结石患者的结石相关事件（SREs）。我们还研究了SREs的预测因素。纳入所有在CT肾、输尿管、膀胱检查中发现无症状肾内结石且接受保守治疗并进行间隔成像≥6个月的患者。对患者进行任何SREs评估。还分析了根据结石大小、位置和结石数量的事件发生率。进行多变量逻辑回归分析以确定SREs的显著预测因素。共有来自177例患者的266个肾单位符合纳入标准。平均结石大小为4.44毫米（范围1 - 25毫米）。随访时间为43.78±26.86个月（范围6 - 106个月）。SREs的总体发生率，包括干预（n = 80）和输尿管绞痛后结石自发排出（n = 40），为45.1%（n = 120/266）。与≤5毫米的结石相比，>5毫米的结石更有可能导致事件发生（优势比[OR]：2.94；P = 0.01）。肾柱间结石和位于多个肾盏的结石比下极结石更有可能引起SRE（OR分别为：2.05；P = 0.05和OR：2.29；P = 0.03）。在这一大组无症状肾内结石患者中，41个月后自发SREs的发生率为45.1%。结石大小和结石位置是SREs的显著预测因素。本研究的信息将使泌尿外科医生能够准确地对无症状肾结石患者进行风险分层。
