Urolithiasis

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

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C. Türk (Chair), A. Skolarikos (Vice-chair), A. Neisius, A. Petřík, C. Seitz, K. Thomas
Guidelines Associates: J.F. Donaldson, 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. 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 has previously not been addressed in these guidelines; however, as of the 2019 edition, bladder stones are dealt with in a new, 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 2019 document presents a limited update of the 2018 version.

1.4.2.Summary of changes

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

For 2019, conclusions and recommendations have been rephrased and added to throughout the current document, including the sections on high-risk stone formers, anti-coagulation and paediatric urolithiasis. Updated summaries of evidence and recommendations include the following:

3.4.1.1 Summary of evidence and guidelines for the management of renal colic

Recommendation

Strength rating

Offer opiates (hydromorphine, pentazocine or tramadol) as a second choice.

Weak

3.4.5.1 Summary of evidence and guidelines for SWL

Summary of evidence

LE

Proper acoustic coupling between the cushion of the treatment head and the patient’s skin is important.

2

Careful imaging control of localisation of stone contributes to outcome of treatment.

2a

Careful control of pain during treatment is necessary to limit pain-induced movements and excessive respiratory excursions.

1a

Antibiotic prophylaxis is recommended in the case of internal stent placement, infected stones or bacteriuria.

1a

3.4.8.4 Stone composition

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).

Strong

3.4.11.1 Summary of evidence and guidelines for laparoscopy and open surgery

Recommendations

Strength rating

Offer laparoscopic or open surgical stone removal in rare cases in which shock wave lithotripsy (SWL), retrograde or antegrade ureteroscopy and percutaneous nephrolithotomy fail, or are unlikely to be successful.

Strong

.3.4.14.4.1 Summary of evidence and guidelines for the management of stones in patients with transplanted kidneys

Summary of evidence

LE

Shock wave lithotripsy for small calyceal stones is an option with minimal risk of complication, but localisation of the stone can be challenging and SFRs are poor.

4

3.4.15.8 Summary of evidence and guidelines for the management of stones in children

Summary of evidence

LE

In children, the indications for SWL, URS and PNL are similar to those in adults.

1b

Recommendations

Strength rating

Offer children with single ureteral stones less than 10 mm shock wave lithotripsy (SWL) if localisation is possible as first line option.

Strong

Ureteroscopy is a feasible alternative for ureteral stones not amenable to SWL.

Strong

Offer children with renal stones with a diameter of up to 20 mm (~300 mm2) shock wave lithotripsy.

Strong

Offer children with renal pelvic or calyceal stones with a diameter > 20 mm (~300 mm2) percutaneous nephrolithotomy.

Strong

Retrograde renal surgery is a feasible alternative for renal stones smaller than 20 mm in all locations.

Weak