Journal Club: Small renal stones can be managed conservatively

An evaluation of the outcomes of conservative management of small renal stones in prepubertal children found that this approach was associated with low rates of complications and interventions. In addition, according to the study, larger stone size is the only independent predictor of the need for intervention.

Investigators conducted a chart review of 52 children no older than 12 (median age 46.1 months) with renal stones from 3 to 10mm who underwent conservative management, including renal ultrasonography every 6 months and good hydration. They also compared conservative management outcomes for patients who presented during infancy with outcomes in those who presented when they were older.

At a median follow-up of 39 months, 15 patients were stone free. Of the 10 patients who had symptomatic stone events, all had stones that measured at least 4 mm. Of these patients, 6 underwent surgical interventions, and 4 had complications. Analysis showed, with 100% sensitivity and 29% specificity, that a stone size of 4mm or more was associated with stone events. Further, stone size was the only significant factor associated with subsequent surgical intervention. In addition, stones were far more likely to resolve spontaneously without complications in infants than in those who were older, suggesting that conservative management is especially effective in the youngest patients.

THOUGHTS FROM DR. FARBER

Most of these stones were discovered incidentally during an ultrasound for other reasons.  It would appear that stones do not require intervention. With larger stones, around 25% of patients developed complications, so even in this population, a conservative approach is warranted for asymptomatic children.

Reference

Hodhod A, Moneir WM, Alhams A, Burki T, Jamalalail Y, Almodhen F, Alsufyani A, Alaqeel A, Alshammari. Outcome of conservative management of small renal stones in prepubertal children. J Pediatr Urol. 2025; Jul 30:S1477-5131(25)00414-0.doi:10.1016/j.jpurol.2025.07.029.