Skolarikos A. et al., 2025: . European Association of Urology Guidelines on the Diagnosis and Treatment of Urolithiasis.

Andreas Skolarikos 1, Robert Geraghty 2, Bhaskar Somani 3, Thomas Tailly 4, Helene Jung 5, Andreas Neisius 6, Ales Petřík 7, Guido M Kamphuis 8, Niall Davis 9, Carla Bezuidenhout 10, Michael Lardas 11, Giovanni Gambaro 12, John A Sayer 13, Riccardo Lombardo 14, Lazaros Tzelves 11
12nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece.
2Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK.
3Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
4Servicio de Urología, Hospital Universitario de Gante, Gante, Belgium.
5Urinvejskirurgisk Afdeling, Sygehus Lillebælt, Vejle, Denmark.
6Department of Urology, Hospital of the Brothers of Mercy Trier, Medical Campus University Mainz, Trier, Germany.
7Department of Urology, Region Hospital, Ceske Budejovice, Czechia.
8Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
9Department of Urology, Connolly Hospital, Dublin, Ireland.
10European Association of Urology, Arnhem, The Netherlands.
112nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleio Hospital, Athens, Greece.
12Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Verona, Italy.
13Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
14Sant'Andrea Hospital, Sapienza University, Rome, Italy.

Abstract

Background and objective: The European Association of Urology urolithiasis guidelines provide evidence-based recommendations for the diagnosis and treatment of urinary stone disease. Given the complexity and variability of stone formation, individualised patient management is emphasised.

Methods: The guidelines incorporate evidence from the latest research and focus on risk assessment, imaging techniques, pharmacological management, and surgical interventions. A research librarian conducted literature searches for urolithiasis in the Cochrane Library, Medline, and Embase databases via Dialog-Datastar. The strength of recommendations is also rated.

Key findings and limitations: Diagnosis relies on a combination of clinical history, biochemical evaluation, and imaging, with ultrasound as the first-line modality and low-dose computed tomography as the gold standard for precise stone assessment. Stone composition and burden influence treatment decisions with algorithms primarily based on stone size, location, and composition. Nonsteroidal anti-inflammatory drugs are recommended for first-line pain management, with opioids reserved as a secondary option. Medical expulsive therapy with α-blockers may be considered for selected patients with ureteral stones. Extracorporeal shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy remain the primary intervention modalities, with selection based on stone characteristics and patient factors. Advances in multiplanar imaging have improved assessment of the stone burden, although further research is needed to refine predictive models. Genetic testing is recommended for high-risk patients to guide personalised treatment.

Conclusions and clinical implications: The guidelines provide a framework for clinical decision-making while acknowledging the need for continued advances in urolithiasis.

Eur Urol. 2025 Jul;88(1):64-75. doi: 10.1016/j.eururo.2025.03.011. Epub 2025 Apr 22.
PMID: 40268592.