Urolithiasis

Full Text Guidelines Summary of Changes Scientific Publications & Appendices Pocket Guidelines Archive Panel

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C. Türk (Chair), A. Neisius, A. Petrik, C. Seitz, A. Skolarikos, A. Tepeler, K. Thomas
Guidelines Associates: S. Dabestani, T. Drake, N. Grivas, Y. Ruhayel

1.INTRODUCTION

1.1.Aims and scope

The European Association of Urology (EAU) Urolithiasis Guidelines Panel has prepared these guidelines to help urologists assess evidence-based management of stones/calculi in the urinary tract and incorporate recommendations into clinical practice. Management of bladder stones is not addressed in these guidelines. This document covers most aspects of the disease, which is still a cause of significant morbidity despite technological and scientific advances. The Panel is aware of the geographical variations in healthcare provision.

It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and preferences/individual circumstances of patients into account.

Guidelines are not mandates and do not purport to be a legal standard of care.

1.2.Panel composition

The EAU Urolithiasis Guidelines Panel consists of an international group of clinicians with particular expertise in this area. All experts involved in the production of this document have submitted potential conflict of interest statements which can be viewed on the EAU website Uroweb: http://uroweb.org/guideline/urolithiasis/.

1.3.Available publications

A quick reference document (Pocket guidelines) is available, both in print and in a number of versions for mobile devices. These are abridged versions which may require consultation together with the full text versions. Also a number of scientific publications are available [1-3]. All documents can be accessed through the EAU website: http://uroweb.org/guideline/urolithiasis/.

1.4.Publication history and summary of changes

1.4.1.Publication history

The EAU Urolithiasis Guidelines were first published in 2000. This 2017 document presents a limited update of the 2016 publication of the EAU Urolithiasis Guidelines.

1.4.2.Summary of changes

The literature for the entire document has been assessed and updated, whenever relevant (see Methods section below).

Key changes for the 2017 publication:

3.4.1.1 Renal colic

Summary of evidence

LE

Administration of daily α-blockers seems to reduce colic episodes, although controversy remains in the published literature.

1b

.3.4.2.1.3.2 Best clinical practice

Summary of evidence - Number of shock waves, energy setting and repeat treatment sessions

LE

Stepwise power ramping prevents renal injury.

1b

Clinical experience has shown that repeat sessions are feasible (within one day for ureteral stones).

4

Optimal shock wave frequency is 1.0 to 1.5Hz.

1a

3.4.2.2 Indication for active stone removal of renal stones

Recommendation

GR

Offer active treatment for renal stones in case of stone growth, de novo obstruction, associated infection, and acute and/or chronic pain.

C

3.4.3.1.2 Pharmacological treatment, Medical expulsive therapy (MET)

Summary of evidence

LE

Medical expulsion therapy (MET) seems to be efficacious treating patients with ureteric stones who are amenable to conservative management. The greatest benefit might be among those with larger (distal) stones.

1a

Recommendations

LE

GR

Select patients for an attempt at spontaneous passage or MET, based on well-controlled pain, no clinical evidence of sepsis, and adequate renal functional reserve.

4

C

Offer α-blockers as MET as one of the treatment options, in particular for (distal) ureteral stones > 5 mm.

1a

A

Counsel patients regarding the controversies in the literature, attendant risks of MET, including associated drug side effects. Inform the patient that α-blockers as MET are administered off-label**.

1b

A*

† It is not known if tamsulosin harms the human foetus or if it is found in breast milk.

*Upgraded based on panel consensus.

**MET in children cannot be recommended due to the limited data in this specific population.

.3.4.3.1.4.1.2 Best clinical practice in ureterenoscopy

Summary of evidence

LE

In ureterorenoscopy (URS) (in particular for renal stones), pre-stenting has been shown to improve outcome.

1b

3.4.3.3 Selection of procedure for active removal of ureteral stones

Recommendation

GR

In obese patients ureterorenoscopy is a safe and efficient option to remove renal stones.

2b

Ureterorenoscopy in morbidly obese patients have significantly higher complication rates as compared to normal weight patients.

1a

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