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The following is a summary of “Does having an asymptomatic renal stone increase morbidity after radical cystectomy?,” published in the May 2025 issue of World Journal of Urology by Savin et al. 

Asymptomatic renal stones detected before radical cystectomy (RC) and urinary diversion (UD) presented a potential treatment challenge.  

Researchers conducted a retrospective study to examine the outcomes and natural history of asymptomatic renal stones managed by observation following RC and UD.  

They reviewed individuals referred for RC and UD between 2015 and 2023 at a single center. Preoperative CT scans were analyzed to identify those with asymptomatic renal stones. Individuals with prior stone interventions, additional ureteric stones, or no postoperative imaging were excluded. The primary endpoints were 90-day postoperative complications, stone-related adverse events (AEs), and spontaneous stone passage (SSP) during follow-up. Kaplan-Meier survival analysis and regression models were used to assess outcomes.  

The results showed that among 606 patients with RC, 47 individuals with 52 renal units met the inclusion criteria. The mean stone burden was 4.5 mm (SD ± 2.75). Stones were mostly located in the lower pole (48%) and least in the renal pelvis (12%). Baseline characteristics and postoperative complication rates were similar between those with and without asymptomatic stones (overall complications: 60% vs 61%; major complications: 17% vs 18%). The 1-year cumulative incidence of stone-related AEs was 10%, while SSP occurred 47%. Higher BMI predicted SSP (P< 0.001) with an optimal cutoff of 28 kg/m². Larger stones correlated with stone-related AEs (P= 0.03).  

Investigators concluded that observation was an effective approach for managing preoperative asymptomatic renal stones in patients with RC and UD, with most stones passing spontaneously and minimal AEs post-surgery. 

Source: link.springer.com/article/10.1007/s00345-025-05720-3