Comparison of symptomatic versus asymptomatic urolithiasis: surgical outcomes and medium-term follow-up

Background: Injury extent and optimal management of asymptomatic urinary stones remain unclear, though they can be removed by almost any version of surgical management that is applicable to symptomatic stones. Objective: To compare the general characteristics, surgical outcomes, safety and postoperative renal functional changes between symptomatic and asymptomatic urolithiasis treated with surgical procedures. Design, setting and participants: We retrospectively reviewed 87 symptomatic cases and 79 asymptomatic cases of upper urinary tract calculi treated with surgical procedures between the years of 2006-2011 and followed for no less than one year. Outcome Measurements and Statistical Analysis: We compared general characteristics, surgical outcomes, safety and postoperative renal functional changes between the two groups. A multiple logistic regression was performed to identify the factors independently associated with postoperative renal functional decline. Results and Limitations: The asymptomatic cases had a smaller mean stone size (1.8 vs. 1.5 cm), shorter operative time (110.5 vs. 95.1 min) and postoperative hospital stay (7.6 vs. 5.7 d). There was no statistical difference between the two groups in perioperative complications, stone free rate (SFR) and estimated glomerular filtration rate (eGFR) at hospital discharge (P>0.05). The incidence of renal functional decline was higher in the asymptomatic group (31.0% vs. 58.2%). Age, hydronephrosis and diabetes mellitus were the independent risk factors associated with renal functional decline in asymptomatic urolithiasis. Limited by duration of follow-up, only medium-term outcomes were analyzed. Conclusions: Regular monitoring should be considered for asymptomatic urolithiasis after hospital discharge, especially for those elderly, diabetic or preoperatively hydronephrosis-complicated patients. Patient summary: In this report we compared symptomatic and asymptomatic urolithiasis. We found that asymptomatic urolithiasis can cause more renal functional decline.