Christian Türk1, Aleš Petřík2, Kemal Sarica3, Christian Seitz4, Andreas Skolarikos5, Michael Straub6, Thomas Knoll7. 1. Department of Urology, Rudolfstiftung Hospital, Vienna, Austria. 2. Department of Urology, Region Hospital, České Budějovice, Czech Republic; Department of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic. 3. Department of Urology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul, Turkey. 4. Department of Urology, Medical University Vienna, Vienna, Austria. 5. Second Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece. 6. Department of Urology, Technical University Munich, Munich, Germany. 7. Department of Urology, Sindelfingen-Böblingen Medical Centre, University of Tübingen, Sindelfingen, Germany. Electronic address: t.knoll@klinikverbund-suedwest.de.
Abstract
CONTEXT: Low-dose computed tomography (CT) has become the first choice for detection of ureteral calculi. Conservative observational management of renal stones is possible, although the availability of minimally invasive treatment often leads to active treatment. Acute renal colic due to ureteral stone obstruction is an emergency that requires immediate pain management. Medical expulsive therapy (MET) for ureteral stones can support spontaneous passage in the absence of complicating factors. These guidelines summarise current recommendations for imaging, pain management, conservative treatment, and MET for renal and ureteral stones. Oral chemolysis is an option for uric acid stones. OBJECTIVE: To evaluate the optimal measures for diagnosis and conservative and medical treatment of urolithiasis. EVIDENCE ACQUISITION: Several databases were searched for studies on imaging, pain management, observation, and MET for urolithiasis, with particular attention to the level of evidence. EVIDENCE SYNTHESIS: Most patients with urolithiasis present with typical colic symptoms, but stones in the renal calices remain asymptomatic. Routine evaluation includes ultrasound imaging as the first-line modality. In acute disease, low-dose CT is the method of choice. Ureteral stones <6mm can pass spontaneously in well-controlled patients. Sufficient pain management is mandatory in acute renal colic. MET, usually with α-receptor antagonists, facilitates stone passage and reduces the need for analgesia. Contrast imaging is advised for accurate determination of the renal anatomy. Asymptomatic calyceal stones may be observed via active surveillance. CONCLUSIONS: Diagnosis, observational management, and medical treatment of urinary calculi are routine measures. Diagnosis is rapid using low-dose CT. However, radiation exposure is a limitation. Active treatment might not be necessary, especially for stones in the lower pole. MET is recommended to support spontaneous stone expulsion. PATIENT SUMMARY: For stones in the lower pole of the kidney, treatment may be postponed if there are no complaints. Pharmacological treatment may promote spontaneous stone passage.
CONTEXT: Low-dose computed tomography (CT) has become the first choice for detection of ureteral calculi. Conservative observational management of renal stones is possible, although the availability of minimally invasive treatment often leads to active treatment. Acute renal colic due to ureteral stone obstruction is an emergency that requires immediate pain management. Medical expulsive therapy (MET) for ureteral stones can support spontaneous passage in the absence of complicating factors. These guidelines summarise current recommendations for imaging, pain management, conservative treatment, and MET for renal and ureteral stones. Oral chemolysis is an option for uric acid stones. OBJECTIVE: To evaluate the optimal measures for diagnosis and conservative and medical treatment of urolithiasis. EVIDENCE ACQUISITION: Several databases were searched for studies on imaging, pain management, observation, and MET for urolithiasis, with particular attention to the level of evidence. EVIDENCE SYNTHESIS: Most patients with urolithiasis present with typical colic symptoms, but stones in the renal calices remain asymptomatic. Routine evaluation includes ultrasound imaging as the first-line modality. In acute disease, low-dose CT is the method of choice. Ureteral stones <6mm can pass spontaneously in well-controlled patients. Sufficient pain management is mandatory in acute renal colic. MET, usually with α-receptor antagonists, facilitates stone passage and reduces the need for analgesia. Contrast imaging is advised for accurate determination of the renal anatomy. Asymptomatic calyceal stones may be observed via active surveillance. CONCLUSIONS: Diagnosis, observational management, and medical treatment of urinary calculi are routine measures. Diagnosis is rapid using low-dose CT. However, radiation exposure is a limitation. Active treatment might not be necessary, especially for stones in the lower pole. MET is recommended to support spontaneous stone expulsion. PATIENT SUMMARY: For stones in the lower pole of the kidney, treatment may be postponed if there are no complaints. Pharmacological treatment may promote spontaneous stone passage.
Authors: Martin Schoenthaler; Simon Hein; Christian Seitz; Christian Türk; Hansjörg Danuser; Werner Vach; Arkadiusz Miernik Journal: World J Urol Date: 2017-12-07 Impact factor: 4.226
Authors: Peter Alexander Massaro; Avinash Kanji; Paul Atkinson; Ryan Pawsey; Tom Whelan Journal: Can Urol Assoc J Date: 2017 Mar-Apr Impact factor: 1.862
Authors: Tim Nestler; Kai Nestler; Andreas Neisius; Hendrik Isbarn; Christopher Netsch; Stephan Waldeck; Hans U Schmelz; Christian Ruf Journal: World J Urol Date: 2018-08-03 Impact factor: 4.226
Authors: Helena C Chang; David T Tzou; Manint Usawachintachit; Brian D Duty; Ryan S Hsi; Jonathan D Harper; Mathew D Sorensen; Marshall L Stoller; Roger L Sur; Thomas Chi Journal: J Endourol Date: 2016-11-01 Impact factor: 2.942
Authors: Tae Jin Kim; In Jae Lee; Jung Keun Lee; Hak Min Lee; Chang Wook Jeong; Sung Kyu Hong; Seok-Soo Byun; Jong Jin Oh Journal: World J Urol Date: 2018-10-03 Impact factor: 4.226