Although stone-related symptoms usually occur due to obstruction, non-obstructing kidney stones can also cause symptoms in patients. We aimed to analyze the characteristics of non-obstructing kidney stones that cause preoperative symptoms and whether the presence or absence of symptoms affects postoperative outcomes, including patients’ quality of life.

We retrospectively analyzed the medical records of patients with non-obstructing kidney stones who underwent retrograde intrarenal surgery (RIRS) and completed the preoperative and postoperative Wisconsin Stone Quality of Life Questionnaire (WISQoL) from January 2021 to September 2023. Patients were divided into preoperative asymptomatic and symptomatic group according to the preoperative stone-related symptoms, such as flank pain, hematuria and fever. Patients’ baseline characteristics, surgical outcomes and WISQoL scores were compared between the two groups.

A total of 62 patients with non-obstructing kidney stones were included. The mean D1 (Energy and Fatigue) and D5 (Physical Symptoms) scores were significantly lower in the preoperative symptomatic group compared to the asymptomatic group. However, there were no significant differences between the two groups in other domain scores and patients' baseline characteristics. Additionally, there were no significant differences in postoperative improvement of WisQoL scores, length of hospital stay, operation time, complication rate, and residual stones between both groups. Interestingly, postoperative D1, D4 (Nutrition and pharmacological therapies), and D5 scores significantly decreased compared to preoperative scores in asymptomatic group, while D2 (Sleep) and D4 scores significantly decreased compared to preoperative scores in symptomatic group.

Patients with symptomatic non-obstructing kidney stones showed relatively lower D1 and D5 scores. This study demonstrated that patients with non-obstructing kidney stones may experience worse quality of life after surgery regardless of preoperative symptoms. Therefore, discussing about this possibility with patients is deemed necessary.