Management of Asymptomatic Renal Stones (MARS)

May 2024 Council

Lead Division/Office


Point(s) of Contact

Ziya Kirkali, M.D.; Chris Mullins, Ph.D.

Executive Summary

An asymptomatic renal stone in the kidney is like a time bomb! Patients are anxious not knowing what will happen to them and when, as symptomatic stone events are unpredictable and can vary in intensity. Philosophically, all symptomatic stones were once asymptomatic; and clinically, a planned intervention is always better than an unplanned one. Since there are no definitive trials, management of asymptomatic stones is controversial.

A patient-centered approach will be taken to identify what matters most to the person who harbors an incidental or a residual asymptomatic stone after surgery. First, a workshop is planned to get patient input, bring in the urologic community and flesh out the idea. Then a Notice of Funding Opportunity will be developed to support a Clinical Research Consortium. The study will ask to consent all patients with an asymptomatic renal stone who do not want to be randomized (patient choice) and collect data. Patients with incidental or residual asymptomatic stones smaller than 15 mm in largest diameter consenting to the study to be randomized to either active surveillance or intervention (ureteroscopy/Shock Wave Lithotripsy) (patient/surgeon choice). The primary outcome will be stone-related surgery or Emergency Department visit, with multiple secondary outcomes. Machine Learning will be used to; a) identify best management options for individuals with different characteristics, and b) identify optimal follow-up strategies for active surveillance.