DOI: https://doi.org/10.36347/sasjs.2026.v12i04.010

Pages: 300-303

The increasing use of abdominal imaging has led to a growing detection of asymptomatic renal stones, creating an important management dilemma between prophylactic intervention and conservative follow-up. Active surveillance has progressively emerged as a valid strategy for selected patients with asymptomatic, non-obstructing renal calculi, particularly when stone burden is limited and the risk of progression appears low. Current French, European, and American urological guidelines all recognize active surveillance as an acceptable option in carefully selected cases. Observational studies suggest that many asymptomatic renal stones remain silent over time, yet a substantial proportion may enlarge, become symptomatic, migrate, or ultimately require intervention. More recent comparative studies indicate that prophylactic treatment may reduce future stone-related events in some clinical contexts, especially when small asymptomatic stones are encountered during surgery already being performed for another indication. The available evidence therefore supports a risk-adapted and patient-centered approach rather than systematic treatment or indiscriminate observation. Active surveillance should not be regarded as therapeutic inaction, but as a structured management strategy requiring appropriate patient selection, periodic imaging, and shared decision-making. This narrative review examines the current evidence supporting active surveillance in asymptomatic non-obstructing renal stones, discusses its clinical rationale and limitations, and highlights the situations in which conservative management appears most appropriate.