OBJECTIVE: To develop a follow-up algorithm for urinary stone patients after definitive treatment. MATERIALS AND METHODS: The panel performed a systematic review on follow-up of urinary stone patients after treatment (PROSPERO: CRD42020205739). Given the lack of comparative studies we critically evaluated the literature and reached a consensus on the follow-up scheme. RESULTS: A total of 76 studies were included in the analysis, including 17 RCTs. In the stone-free general population group, 71-100% of patients are stone-free at 12 months while 29-94% remain stone-free at 36 months. We propose counselling these patients on imaging versus discharge after the first year. The stone-free rate in high-risk patients not receiving targeted medical therapy is < 40% at 36 months, a fact that supports imaging, metabolic, and treatment monitoring follow-up once a year. Patients with residual fragments ≤ 4 mm have a spontaneous expulsion rate of 18-47% and a growth rate of 10-41% at 12 months, supporting annual imaging follow-up. Patients with residual fragments > 4 mm should be considered for surgical re-intervention based on the low spontaneous expulsion rate (13% at 1 year) and high risk of recurrence. Plain film KUB and/or kidney ultrasonography based on clinicians' preference and stone characteristics is the preferred imaging follow-up. Computed tomography should be considered if patient is symptomatic or intervention is planned. CONCLUSIONS: Based on evidence from the systematic review we propose, for the first time, a follow-up algorithm for patients after surgical stone treatment balancing the risks of stone recurrence against the burden of radiation from imaging studies.

Department of Urology 1st Faculty of Medicine Charles University Prague Prague Czech Republic

Department of Urology Connolly Hospital Blanchardstown Dublin 15 Ireland

Department of Urology Freeman Hospital 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

Department of Urology Region Hospital Ceske Budejovice Czech Republic

Department of Urology University Hospital Southampton NHS Foundation Trust Southampton UK

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

Institute of Genetic Medicine Newcastle University Newcastle Upon Tyne UK

National and Kapodistrian University of Athens Chairman of the EAU Urolithiasis Guidelines Department of Urology Sismanogleio Hospital Athens Greece

Sant'Andrea Hospital Sapienza University Rome Italy

Urologische Praxis Vienna Austria

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