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 (Vice-chair), K. Thomas
Guidelines Associates: N.F. Davis, J.F. Donaldson, R. Lombardo, 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. 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. Management of bladder stones are dealt with in a separate guideline authored by the same guideline group.

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 as an app for iOS and Android 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 2020 document presents a limited update of the 2019 version.

1.4.2.Summary of changes

The literature for the entire document has been checked and, wherever relevant, updated (see Methods section 2.1).

For 2020, conclusions and recommendations have been rephrased and strength ratings reassessed across a number of sections. Updated recommendations include the following:

3.3.2.3 Guidelines for laboratory examinations and stone analysis

Recommendations

Strength rating

Urine

Dipstick test of spot urine sample:

• red cells;

• white cells;

• nitrites;

• approximate urine pH;

• urine microscopy and/or culture.

Weak

Blood

Serum blood sample:

• creatinine;

• uric acid;

• (ionised) calcium;

• sodium;

• potassium;

• blood cell count;

• C-reactive protein.

Weak

3.4.10.5 Summary of evidence and guidelines for the management of renal stones

Recommendations

Strength rating

Consider the stone composition before deciding on the method of removal, based on patient history, former stone analysis of the patient or Hounsfield unit (HU) on unenhanced computed tomography (CT). Stones with density > 1,000 HU (and with high homogeneity) on non-contrast-enhanced CT are less likely to be disintegrated by shock wave lithotripsy.

Strong

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