Observation vs. SurgeryObservational Approach Versus Surgical Intervention for Stones

Inclusion Criteria:

1. Individuals age 6 or older
2. Diagnosis of kidney stone disease (nephrolithiasis)
3. Asymptomatic, non-obstructive kidney stones measuring 4 to 10 mm (inclusive)

• Asymptomatic is defined as the absence of abdominal pain, flank pain, gross hematuria, and nausea and/or vomiting in the last 3 months that in the judgement of the site PI could be attributable to kidney stones.
• Non-obstructive is defined as a stone in a renal calyx or stones in multiple renal calyces on CT, ultrasound, and/or x-ray obtained within 6 months of screening.

4. Informed consent and if appropriate, child assent.
5. Willingness to be randomized to surgery or observation Note: subjects otherwise eligible who decline randomization may be enrolled in a parallel observational cohort.
6. Fluent in English or Spanish
7. Willingness to be audio- and/or video- recorded during interviews

Exclusion Criteria:

1. Untreated hydronephrosis or caliectasis
2. Pain (e.g., renal colic, abdominal pain) or gross hematuria attributed to kidney stones.
3. Recurrent symptomatic urinary tract infections (≥3 in 12 months or ≥2 in 6 months). A symptomatic urinary tract infection is defined as having at least one bladder or voiding symptom (e.g., frequency, urgency, dysuria) with bacteriuria (≥105 colony forming units/mL of no more than 2 urinary tract pathogens).
4. Stone in the renal pelvis, ureter, bladder or urethra
5. Pregnant females
6. Solitary kidney, transplant kidney, urinary diversion, medullary sponge kidney
7. Anatomic abnormality of the kidney (e.g., horseshoe kidney)
8. Parents/guardians or subjects who, in the opinion of the Investigator, may be non-compliant with study schedules or procedures