For the 2019 Urolithiasis Guidelines, new and relevant evidence has been identified, collated and appraised through a structured assessment of the literature with a total of 25 new papers having been added to the Urolithiasis 2019 Guidelines publication.

For 2019, conclusions and recommendations have been rephrased and amended throughout the current document, including the sections on high-risk stone formers, anti-coagulation. The section on paediatric urolithiasis has been completely revised.

Updated summaries of evidence and recommendations include the following: Summary of evidence and guidelines for the management of renal colic

RecommendationStrength rating
Offer opiates (hydromorphine, pentazocine or tramadol) as a second choice.Weak Summary of evidence and guidelines for shock wave lithotripsy

Summary of evidenceLE
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 Stone composition

RecommendationStrength 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 Summary of evidence and guidelines for laparoscopy and open surgery

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

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

Summary of evidenceLE
In children, the indications for SWL, URS and PNL are similar to those in adults.1b


RecommendationsStrength 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


Table 3.3: High-risk stone formers has been updated to include:

Diseases associated with stone formation
Increased levels of vitamin D
Environmental factors
High ambient temperatures
Chronic lead and cadmium exposure