CONTEXT: No algorithm exists for structured follow-up of urolithiasis patients. OBJECTIVE: To provide a discharge time point during follow-up of urolithiasis patients after treatment. EVIDENCE ACQUISITION: We performed a systematic review of PubMed/Medline, EMBASE, Cochrane Library, clinicaltrials.gov, and reference lists according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Fifty studies were eligible. EVIDENCE SYNTHESIS: From a pooled analysis of 5467 stone-free patients, we estimated that for a safety margin of 80% for remaining stone free, patients should be followed up using imaging, for at least 2 yr (radiopaque stones) or 3 yr (radiolucent stones) before being discharged. Patients should be discharged after 5 yr of no recurrence with a safety margin of 90%. Regarding residual disease, patients with fragments ≤4 mm could be offered surveillance up to 4 yr since intervention rates range between 17% and 29%, disease progression between 9% and 34%, and spontaneous passage between 21% and 34% at 49 mo. Patients with larger residual fragments should be offered further definitive intervention since intervention rates are high (24-100%). Insufficient data exist for high-risk patients, but the current literature dictates that patients who are adherent to targeted medical treatment seem to experience less stone growth or regrowth of residual fragments, and may be discharged after 36-48 mo of nonprogressive disease on imaging. CONCLUSIONS: This systematic review and meta-analysis indicates that stone-free patients with radiopaque or radiolucent stones should be followed up to 2 or 3 yr, respectively. In patients with residual fragments ≤4 mm, surveillance or intervention can be advised according to patient preferences and characteristics, while for those with larger residual fragments, reintervention should be scheduled. PATIENT SUMMARY: Here, we review the literature regarding follow-up of urolithiasis patients. Patients who have no stones after treatment should be seen up to 2-3 yr, those with large fragments should be reoperated, and those with small fragments could be offered surveillance with imaging.

Department of Urology Connolly Hospital Blanchardstown Dublin Ireland

Department of Urology Freeman Hospital Newcastle upon Tyne UK; Institute of Genetic Medicine Newcastle University Newcastle upon Tyne UK

Department of Urology Guy's and St Thomas' Hospital London UK

Department of Urology Hospital of the Brothers of Mercy Trier Medical Campus University Mainz Trier Germany

Department of Urology Hospital of the Sisters of Charity Vienna Austria; Urologische Praxis Vienna Austria

Department of Urology Region Hospital Ceske Budejovice Czech Republic; Department of Urology 1st Faculty of Medicine Charles University Prague Prague Czech Republic

Department of Urology Sismanogleio Hospital National and Kapodistrian University of Athens Athens Greece

Department of Urology University Hospital Southampton NHS Foundation Trust Southampton UK

Division of Nephrology and Dialysis Department of Medicine University of Verona Verona Italy

Sant 'Andrea Hospital Sapienza University Rome Italy

Eur Urol Focus. 2023 Mar;9(2):383. doi: 10.1016/j.euf.2022.08.018. PubMed

Eur Urol Focus. 2023 Mar;9(2):381-382. doi: 10.1016/j.euf.2022.09.008. PubMed

References provided by Crossref.org

Follow-up of urolithiasis patients after treatment: an algorithm from the EAU Urolithiasis Panel