Surgery vs Observation for Kidney Stones

(OASIS Trial)

This trial explores two approaches for individuals with asymptomatic kidney stones, meaning the stones do not cause pain or other symptoms. It compares observation (monitoring the stones) and surgery to determine which approach leads to less disruption in daily life. The goal is to identify the most effective strategy for different individuals and understand their preferences. Individuals diagnosed with kidney stones that do not cause symptoms might be suitable candidates for this study. As an unphased trial, this study provides a unique opportunity to contribute to understanding the best management strategies for asymptomatic kidney stones.

Research has shown that surgeries for kidney stones are generally safe and well-tolerated. Studies have found that procedures like ureteroscopy (using a small scope to remove stones) and percutaneous nephrolithotomy (PCNL, removing stones through a small cut in the back) are very successful. Ureteroscopy achieves about an 88% success rate, while PCNL reaches a 95% success rate after just one surgery.

However, like any surgery, risks exist. Some patients might experience complications such as infections or bleeding. PCNL, for example, may lead to more complications and longer hospital stays compared to other methods. Still, these procedures are considered safe for most people, especially when stones cause problems like pain or blocked urine flow.

Most treatments for kidney stones involve medications to manage pain and assist stone passage or surgeries like ureteroscopy and lithotripsy to physically remove or break up stones. However, researchers are exploring whether surgery is necessary for all cases by comparing it against simple observation. The excitement here lies in potentially identifying cases where surgery might be safely avoided, sparing patients from invasive procedures, recovery time, and associated risks. This approach could lead to more personalized treatment plans, where only those who truly need surgery undergo it, thereby improving patient care and resource management in healthcare.

This trial will compare surgery with observation for kidney stones. Research has shown that surgery effectively removes kidney stones. For stones measuring 1-3 cm, the success rate ranges from 88% to 91%. For stones larger than 3 cm, the success rate is about 75%. Specifically, percutaneous nephrolithotomy achieves a 95% success rate for larger stones, while ureteroscopy has an 88% success rate. These figures suggest that surgery is a reliable option for removing kidney stones, particularly larger ones.¹⁴⁶⁷⁸