The European Association of Urology (EAU) has updated its guidelines on clinical best practice in urolithiasis for 2021. We therefore aimed to present a summary of best clinical practice in surgical intervention for patients with upper tract urolithiasis.
The panel performed a comprehensive literature review of novel data up to May 2021. The guidelines were updated and a strength rating was given for each recommendation, graded using the modified Grading of Recommendations, Assessment, Development, and Evaluations methodology.
The choice of surgical intervention depends on stone characteristics, patient anatomy, comorbidities, and choice. For shockwave lithotripsy (SWL), the optimal shock frequency is 1.0-1.5 Hz. For ureteroscopy (URS), a postoperative stent is not needed in uncomplicated cases. Flexible URS is an alternative if percutaneous nephrolithotomy (PCNL) or SWL is contraindicated, even for stones >2 cm. For PCNL, prone and supine approaches are equally safe. For uncomplicated PCNL cases, a nephrostomy tube after PCNL is not necessary. Radiation exposure for endourological procedures should follow the as low as reasonably achievable principles.
This is a summary of the EAU urolithiasis guidelines on best clinical practice in interventional management of urolithiasis. The full guideline is available at https://uroweb.org/guidelines/urolithiasis.
The European Association of Urology has produced guidelines on the best management of kidney stones, which are summarised in this paper. Kidney stone disease is a common condition; computed tomography (CT) is increasingly used to diagnose it. The guidelines aim to decrease radiation exposure to patients by minimising the use of x-rays and CT scans. We detail specific advice around the common operations for kidney stones.
European urology focus. 2022 Aug 01 [Epub ahead of print]
Robert M Geraghty, Niall F Davis, Lazaros Tzelves, Riccardo Lombardo, Cathy Yuan, Kay Thomas, Ales Petrik, Andreas Neisius, Christian Türk, Giovanni Gambaro, Andreas Skolarikos, Bhaskar K Somani
Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK; Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK., Department of Urology, Beaumont Hospital, Dublin 9, Co Dublin, Ireland; Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland., Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece., Sant 'Andrea Hospital, Sapienza University, Rome, Italy., Division of Gastroenterology & Cochrane UGPD Group, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, Canada., Department of Urology, Guy's and St Thomas' Hospital, London, UK., Department of Urology, Region Hospital, Ceske Budejovice, Czech Republic; Department of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic., Department of Urology, Bruederkrankenhaus Trier, Johannes Gutenberg University Mainz, Trier, Germany., Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria., Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Verona, Italy., Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: ., Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.