Leave no stone unturned

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Abstract
Established guidelines provide recommendations on the management of kidney stones to prevent recurrence. However, clear and clinically useful terminology for recurrence of kidney stones is needed. This review describes the various manifestations of kidney stone recurrence and the reported rates of kidney stone recurrence in various clinical settings. Kidney stone recurrence has a wide range of symptomatic and radiographic presentations. Symptomatic recurrence may include characteristic symptoms of stone passage via the ureter (renal colic and gross hematuria). This may be self-managed or result in clinical care, with or without confirmation of an obstructing stone on imaging. Radiographic recurrence has been variably defined as new stone formation, stone growth, or stone disappearance (from passage with or without symptoms). Studies have used inconsistent definitions of recurrence, and recurrence rates vary substantially. Stone free rates and residual stone fragment size after surgical interventions are useful predictors of symptomatic recurrence. The recurrence rate of kidney stones has been assessed in stone formers from sub-specialty clinics, the general community, and clinical trials. The definition of recurrence is quite heterogenous between studies, but the rate of recurrence generally increases as more manifestations are included in the definition.

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