Unlike the symptomatic patient who is getting an imaging study because of their stone, the incidental stone patient is identified due to a disease process being worked up for something other than their stone. These patient have stones found due to abdominal US working up a patient with a presumed gallbladder stone; a patient who had a chest CT who is being worked up for a respiratory condition; a kidney stone found on lumbar sacral films when evaluating a patient’s spine; a bladder stone found on a pelvic US during a work up for a patient with BPH; a renal stone found on an abdominal CT scan during a work up abdominal pathology.

The command center for treating your stone should be from your urologist’s office, not from the ER. The ideal location to plan for your stone procedure is from the physician’s office as compared to the ER or the holding area of the operating room. Once you are in the ER, your treatment options are limited. If you have an obstructing stone, you may require an initial procedure with a stone placement. If your obstructing stone is associated with fever, it may require that you have nephrostomy tube placement.

From the office, you can speak with your urologist from a position of strength. This elective office visit allows you to prepare your questions in advance. Your sensorium is not clouded, as it might be with taking pain medication in the ER, and questions can be properly addressed and understood. Without pain, you make an objective decision for choosing the best surgical treatment options for you. Planning your procedure allows the patient to have greater options of stone procedures for incidental stone, a greater chance of less invasive stone procedures for an asymptomatic stone and greater chance of less number of stone procedures for asymptomatic stones.

Remember, planning your procedure from the office, allows the patient time on their side. Like a football game, this is first and 10 with all your time outs left to plan your stone procedure; not fourth and 1 with no time outs left where your treatment options are limited.

Your incidental stone was treated either conservatively or possibly, electively. While your stone was identified incidentally, the risk for a recurrent stone still remains. Nevertheless, it is imperative for you to pursue preventive care and minimize your risk for future stones. It is still important for you to collect your stone and obtain a 24 hour urine (See stone prevention, Chap. 24).

You have completed the marathon and you are on the last leg of your journey. Your stone is gone, the course and timing of stone prevention is in the same.

In summary, incidental stones can come in all shapes and sizes. These stones present as asymptomatic calcifications. Incidental stones present much differently than symptomatic stones (see Table 15.1). Once an incidental stone becomes identified, do not make this the forgotten stone. While these stones are treated the same way as symptomatic stones, time is not of the essence. Over time, stones can become larger, the change in size depends on the etiology of the stone. Sometimes these incidental stones behave like a ticking time bomb, and if left forgotten, they can set off unexpectedly. Making a plan with your urologist to treat this stone before it becomes symptomatic, is the best medicine of all. Having the time and ability to plan the appropriate treatment option for your stone will give you the luxury to sit down with your urologist and allow you to make the best decision. The planning and timing of your treatment options are the ingredients for success. Remember, incidental stones may still need to be treated, but time is on your side!