The Natural History of Minimally Symptomatic Nonobstructing Calyceal Stones

July 18, 2022 updated by: Omar Anwar Sayed, Assiut University
  • The primary aim is to study the natural history of single-calyx asymptomatic nonobstructing stone disease.
  • The Secondary aim is to determine the predictors of the need for intervention and of cure in such population.

Study Overview

Status

Enrolling by invitation

Conditions

Intervention / Treatment

Detailed Description

The prevalence and incidence of urolithiasis have been increasing worldwide. The prevalence of urinary stone disease in the U.S. had increased from 5.5% at 1994 to 8.8% at 2010. In most of the European and Asian countries, the prevalence is high. The risk of developing urolithiasis in adults appears to be higher in the western hemisphere than in the eastern hemisphere, although the highest risks have been reported in some Asian countries such as Saudi Arabia (20.1%).

Although many lines of treatment have been developed for this disease, none of these lines is completely satisfactory and many cases are still not easy to manage. The lines of treatment for renal stones include:

  1. Open surgery: It includes nephrolithotomy and pyelolithotomy. Advances in endoscopic management of calculous disease promoted a rapid decrease in the use of this approach. The stone free rate (SFR) of open surgery is over 90%. Intraoperative complications, including bleeding requiring blood transfusion and pleural, vascular or ureteral injuries, represented about 37.8 %. Postoperative complications, including massive hematuria requiring blood transfusion, septicemia, urinary leakage and wound infection, were observed in 31.1%.
  2. Percutaneous nephrolithotripsy (PCNL): It offers direct removal of stone fragments through the nephrostomy tract. The SFR is up to 95%. Complications such as extravasation (7.2%), blood transfusion (11.2-17.5%) or post-operative fever (21-32.1%) are common. However, severe complications are rare, e.g., urosepsis (0.3-4.7%), perforation of the colon (0.2-0.8%) or pleura (0.0-3.1%).
  3. Retrograde intra-renal surgery (RIRS): With the advance in flexible ureteroscopic instrumentation and laser, the ability to access and treat intra-renal calculi has been improved [9]. SFR ranges between 90.9 and 93.3%. Intraoperative complications include mucosal injuries (1.5%), ureteral perforation (1.7%), significant bleeding (0.1%) and ureteral avulsion (0.1%). Post-operative complications include fever or urosepsis (1.1%), persistent hematuria (2%), renal colic (2.2%), transient vesico-ureteral reflux (4.6%), persistent vesico-ureteral reflux (0.1%) and ureteric stricture (0.1%).
  4. Extracorporeal shockwave lithotripsy (ESWL): Unlike more invasive urological modalities, ESWL does not remove stones as a whole; it disintegrates them into fragments of various sizes, and these fragments must pass out of the urinary tract spontaneously [11]. The SFR depends on stone location, size and composition [10]. It ranges from 45-98%. Complications include steinstrasse (4-7%), re-growth of residual stones (21-59%), renal colic (2-4%), sepsis (1-2.7%), symptomatic hematoma (<1%), asymptomatic hematoma (4%) and arrhythmia (11-59%).
  5. Pharmacological treatement.
  6. Active surveillance.

The financial burden on the U.S. health care system for urolithiasis alone costs more than $2 billion yearly. Naturally, the economic burden has a greater impact on developing countries.

The prevalence of urolithiasis in asymptomatic adults was 7.8% using low-dose non-contrast computed tomography according to a study in Wisconsin, U.S. The investigators could not find a study reporting the prevalence of asymptomatic nonobstructing calyceal stones although they encounter these cases frequently in the practice.

Single calyceal stones may present as a de novo finding, or they may be residual after PCNL, RIRS, ESWL or open surgery. Accordingly, many cases have scarring from previous surgery and/or have previous failed attempts at ESWL, so options of management are usually limited in these cases.

Research hypothesis: Substantial proportions of patients with asymptomatic nonobstructing calyceal stone(s) will not be complicated and does not require active treatment.

Study Type

Observational

Enrollment (Anticipated)

100

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Egypt
      • Assiut, Egypt
        • Assiut University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 100 years (Adult, Older Adult)

Accepts Healthy Volunteers

N/A

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Patients attending the outpatient clinic of urolithiasis in Assiut Urology and Nephrology Hospital.

Description

Inclusion Criteria:

  • Cases older than 18 years with renal stone disease affecting no more than one major calyx and causing neither obstruction nor bothersome pain.
  • We define calyceal obstruction as calyceal dilatation with stone impaction at the calyceal neck.
  • If the stones are not impacted or are casting the calyx, they are not considered obstructing.

Exclusion Criteria:

  1. Gross or microscopic hematuria.
  2. Patients who have difficulty to reach our tertiary center for follow-up.
  3. Other pathology in the target uretero-renal unit that requires intervention, e.g., ureteropelvic junction obstruction, malignancies, ureteric stones, …etc.
  4. History of recurrent urinary tract infection.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
study the natural history of single-calyx asymptomatic nonobstructing stone disease
Time Frame: Baseline
Time to events indicating the need for intervention or cure
Baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Assiut University

Investigators

  • Study Chair: Ahmed S. Elazab, Professor, Assiut University
  • Study Chair: Mohamed E. Othman, Professor, Assiut University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

September 1, 2019

Primary Completion (Anticipated)

September 1, 2023

Study Completion (Anticipated)

October 1, 2023

Study Registration Dates

First Submitted

August 25, 2019

First Submitted That Met QC Criteria

August 27, 2019

First Posted (Actual)

August 28, 2019

Study Record Updates

Last Update Posted (Actual)

July 20, 2022

Last Update Submitted That Met QC Criteria

July 18, 2022

Last Verified

July 1, 2022

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Calyceal stones

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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