Slide 1: Q: Asymptomatic kidney stones in which patients should be treated for the purposes of employment?

Slide 2: A: Military pilots!

Slide 3: Most asymptomatic kidney stones do not eventually lead to symptoms and only a minority eventually require surgical intervention. The American Urologic ASsociation (AUA) deems it appropriate to take a watch-and-wait approach to asymptomatic kidney stones, even in children.

Slide 4: However, some jobs are considered high risk if a stone were to become symptomatic. This mainly applies to pilots in whom symptomatic nephrolithiasis may jeopardize a flight. For the US Air Force and US Army aircrew, nephrolithiasis, whether symptomatic or not, is a disqualification. The Federal Aviation Administration (FAA) is more lenient and grants waivers for asymptomatic stones depending on their size, location, and rate of growth. In fact, there are currently over 17,000 pilots with the diagnosis of nephrolithiasis in the FAA registry.


  • Dropkin BM, Moses RA, Sharma D, Pais VM Jr. The natural history of nonobstructing asymptomatic renal stones managed with active surveillance. J Urol. 2015 Apr;193(4):1265-9. Epub 2014 Nov 15. PMID 25463995.
  • Assimos D, Krambeck A, Miller NL, et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I. J Urol. 2016 Oct;196(4):1153-60. Epub 2016 May 27. PMID 27238616.
  • Gammill A, Canby-Hagino E, Van Syoc D. Clinical Practice Guideline for Renal and Ureteral Stones (Nephrolithasis). Aerospace Medical Association Updated May 21, 2012. Accessed July 9, 2019.

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