MP62 All-cause mortality from kidney stone disease (ureteroscopy, percutaneous nephrolithotomy, extracorporeal shock wave lithotripsy, and conservative management): A systematic review of literature

Published Date: 27th November 2025

Publication Authors: Harrison. NL

Introduction and Objectives
Kidney stone disease (KSD) is increasing in prevalence and represents a growing global health burden. It may be managed through a range of interventions, such as ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), and extracorporeal shock wave lithotripsy (ESWL), or conservative treatment. While these are widely considered safe, mortality is a rare but serious outcome. This review aims to assess mortality associated with each management modality, causes of death, and clinical implications.

Material(s) and Method(s)
A literature search was conducted across Medline, Embase, CINAHL, and Cochrane Library in accordance with PRISMA guidelines (PROSPERO: CRD42024606297). The PICO framework defined the population as patients with KSD, with interventions including URS, PCNL, ESWL, or conservative management. There was no comparator, and the primary outcome was mortality. Inclusion criteria were English articles involving adult or paediatric patients that reported mortality from any modality. Extracted data included demographics, comorbidities, stone characteristics, procedural details, rational for conservative management, complications, causes of death, and learning points.

Result(s)
A total of 107 studies were included after screening, encompassing 2,029,516 patients, with 3,915 reported deaths across all management modalities. URS was associated with 1,009 deaths, PCNL with 2,774 deaths, ESWL with 13 deaths and conservative management accounted for 119 deaths. Among the 276 cases with reported causes of death, distinct trends were identified across treatment modalities (Table 1). URS-related mortality was most often attributed to sepsis (55.1%) and infection (29.4%). For PCNL, the leading causes were sepsis (35.6%) and myocardial infarction (23.3%). ESWL-related deaths were mainly due to haemorrhage (38.5%) and cardiac events (23.1%). In the conservatively managed group, the most frequent causes were renal failure alone (50%) and renal failure with sepsis or infection (34.2%).

Conclusions
Although rare, mortality from KSD management is not negligible. Sepsis, infection, cardiac events, and renal failure were the leading causes of death. These findings highlight the importance of proactive risk assessment and tailored patient counselling.

Dassanayake, S; Harrison, N; et al. (2025). MP62 All-cause mortality from kidney stone disease (ureteroscopy, percutaneous nephrolithotomy, extracorporeal shock wave lithotripsy, and conservative management): A systematic review of literature. European Urology Open Science. 81(Suppl 2), p. S81-S82 [Online]. Available at: https://doi.org/10.1016/S2666-1683(25)02018-X [Accessed 8 January 2026]