Seitz C. et al., 2020: [Stone therapy-use and limitations of the guidelines]

Based on a case report of a patient with Crohn’s disease and intestinal resection the authors discuss problems associated with this pathological condition. This patient had a 5 mm mid ureteral stone on the left side. This stone caused acute stone colic. Moreover, there were two stones in the right kidney: one 4 mm stone in an upper calyx and a 15x14x12 mm stone in a lower calyx. Different treatment modalities for stone removal were discussed according to the German and EAU guidelines. My personal advice would have been to treat the left ureteral stone with SWL early (within one or two days). During the current pandemic it would also be possible to plan for SWL of the right-sided stones. The large volume of the lower calyx stone might require more than one session and some procedure for fragment elimination after disintegration. Although other treatment options can be considered for the latter stones the advantage of SWL would be to avoid the need of anaesthetic service. It needs to be emphasized that during and after the current pandemic the service of anaesthetists should be reserved and used for patients who in the widest sense cannot be treated with analgesics and sedatives only. Finally, the medical recurrence prevention is discussed. For patients with Crohn’s disease such efforts are as important at as surgery. Hans-Göran Tiselius