STORZ MEDICAL – Literature Databases
STORZ MEDICAL – Literature Databases
Literature Databases
Literature Databases

Kamal W. et al., 2024: The Saudi urological association guidelines on urolithiasis.

Kamal W, Azhar RA, Hamri SB, Alathal AH, Alamri A, Alzahrani T, Abeery H, Noureldin YA, Alomar M, Al Own A, Alnazari MM, Alharthi M, Awad MA, Halawani A, Althubiany HH, Alruwaily A, Violette P.
Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia.
Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Specialized Medical Center, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Surgery Department, College of Medicine, King Khalid University, Abha, Saudi Arabia.
Dr. Sulaiman Al Habib Hospital (Swaidi), Riyadh, Saudi Arabia.
Security Forces Hospital, Riyadh, Saudi Arabia.
Department of Urology, Faculty of Medicine, Benha University, Egypt.
Department of Clinical Sciences, Northern Ontario School of Medicine, ON, Canada.
Department of Urology, King Fahad Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia.
Department of Urology, College of Medicine, Taibah university, Madinah, Saudi Arabia.
Seoul National University Hospital, Seoul, South Korea.
Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia.
Department of Urology, University of Texas Southwestern Medical Southwestern Medical Centre, Dallas, TX, USA.
Department of Urology, Imam Abdulrahman Bin Faisal University, Dammam King Fahd Hospital of the University, Dammam, Saudi Arabia.
Prince Sultan Medical Military City, Riyadh, Saudi Arabia.
Woodstock General Hospital, London Ontario, Canada.
McMaster University, London Ontario, Canada.

Abstract

Aims: The Saudi Urolithiasis Guidelines are a set of recommendations for diagnosing, evaluating, and treating urolithiasis in the Saudi population. These guidelines are based on the latest evidence and expert consensus to improve patient outcomes and optimize care delivery. They cover the various aspects of urolithiasis, including risk factors, diagnosis, medical and surgical treatments, and prevention strategies. By following these guidelines, health-care professionals can improve care quality for individuals with urolithiasis in Saudi Arabia.

Panel: The Saudi Urolithiasis Guidelines Panel consists of urologists specialized in endourology with expertise in urolithiasis and consultation with a guideline methodologist. All panelists involved in this document have submitted statements disclosing any potential conflicts of interest.

Methods: The Saudi Guidelines on Urolithiasis were developed by relying primarily on established international guidelines to adopt or adapt the most appropriate guidance for the Saudi context. When necessary, the panel modified the phrasing of recommendations from different sources to ensure consistency within the document. To address areas less well covered in existing guidelines, the panel conducted a directed literature search for high quality evidence published in English, including meta analyses, randomized controlled trials, and prospective nonrandomized comparative studies. The panel also searched for locally relevant studies containing information unique to the Saudi Arabian population. The recommendations are formulated with a direction and strength of recommendation based on GRADE terminology and interpretation while relying on existing summaries of evidence from the existing guidelines.

Urol Ann. 2024 Jan-Mar;16(1):1-27. doi: 10.4103/ua.ua_120_23. Epub 2024 Jan 25.
PMID: 38415236 FREE PMC ARTICLE

0
 

Comments 1

Hans-Göran Tiselius on Wednesday, 29 May 2024 11:00

The Saudi guidelines for treatment of patients with urolithiasis were developed by applying data from several published international guidelines.
It is of note that the prevalence of stone disease in Saudi Arabia is 9% and that the risk of stone formation is about 2.5 times higher than in other places. 85% of the stones are composed of CaOx. That back-ground information is of interest when reading the recommendations.
The diagnosis is established by NCCT as first line method. Conservative treatment with MET by administration of alpha-blockers are used for stones measuring 5-10 mm. First line treatment for renal colic is accomplished with NSAIDs. A period of 4-6 weeks is allowed for spontaneous passage. In case of delayed passage, stenting should be considered.
Surgical intervention of any kind is undertaken in patients with obstruction, stone growth, stones with infection, symptomatic stones and when the stone diameter is >15mm.
Uric acid stones should be treated with chemolysis.
First line treatment I commonly SWL For SWL, there is no need of antibiotics in case of negative cultures. Neither is there any need of stenting. For hard stones HU > 1000 alternative method should be considered. During SWL pain control is important and shock waves should be administered by ramping.
Factors that should be considered instead of SWL are:
Stones > 20 mm
Obesity
Stones composed of CaOx monohydrate, brushite and cystine
Lower pole stones
Factors that also speak against SWL are skin-to-stone distance > 10 cm, unfavorable geometry with steep infundibulo-pelvic angle 25 mm or narrow calyx strasse, both URS and SWL are good treatment alternatives.
Important to note is that recurrence prevention should be considered after stone removal.
Above I only emphasized some points that might be subject to discussion. For additional details the reader is referred to the text.

Hans-Göran Tiselius

The Saudi guidelines for treatment of patients with urolithiasis were developed by applying data from several published international guidelines. It is of note that the prevalence of stone disease in Saudi Arabia is 9% and that the risk of stone formation is about 2.5 times higher than in other places. 85% of the stones are composed of CaOx. That back-ground information is of interest when reading the recommendations. The diagnosis is established by NCCT as first line method. Conservative treatment with MET by administration of alpha-blockers are used for stones measuring 5-10 mm. First line treatment for renal colic is accomplished with NSAIDs. A period of 4-6 weeks is allowed for spontaneous passage. In case of delayed passage, stenting should be considered. Surgical intervention of any kind is undertaken in patients with obstruction, stone growth, stones with infection, symptomatic stones and when the stone diameter is >15mm. Uric acid stones should be treated with chemolysis. First line treatment I commonly SWL For SWL, there is no need of antibiotics in case of negative cultures. Neither is there any need of stenting. For hard stones HU > 1000 alternative method should be considered. During SWL pain control is important and shock waves should be administered by ramping. Factors that should be considered instead of SWL are: Stones > 20 mm Obesity Stones composed of CaOx monohydrate, brushite and cystine Lower pole stones Factors that also speak against SWL are skin-to-stone distance > 10 cm, unfavorable geometry with steep infundibulo-pelvic angle 25 mm or narrow calyx strasse, both URS and SWL are good treatment alternatives. Important to note is that recurrence prevention should be considered after stone removal. Above I only emphasized some points that might be subject to discussion. For additional details the reader is referred to the text. Hans-Göran Tiselius
Saturday, 13 July 2024