Türk C et al, 2015: EAU Guidelines on Interventional Treatment for Urolithiasis.
Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T.
Department of Urology, Rudolfstiftung Hospital, Vienna, Austria.
Department of Urology, Region Hospital, České Budějovice, Czech Republic.
Department of Urology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul, Turkey.
Department of Urology, Medical University Vienna, Austria.
Second Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece.
Department of Urology, Technical University Munich, Munich, Germany.
Department of Urology, Sindelfingen-Böblingen Medical Centre, University of Tübingen, Sindelfingen, Germany.
CONTEXT: Management of urinary stones is a major issue for most urologists. Treatment modalities are minimally invasive and include extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL). Technological advances and changing treatment patterns have had an impact on current treatment recommendations, which have clearly shifted towards endourologic procedures. These guidelines describe recent recommendations on treatment indications and the choice of modality for ureteral and renal calculi.
OBJECTIVE: To evaluate the optimal measures for treatment of urinary stone disease.
EVIDENCE ACQUISITION: Several databases were searched to identify studies on interventional treatment of urolithiasis, with special attention to the level of evidence.
EVIDENCE SYNTHESIS: Treatment decisions are made individually according to stone size, location, and (if known) composition, as well as patient preference and local expertise. Treatment recommendations have shifted to endourologic procedures such as URS and PNL, and SWL has lost its place as the first-line modality for many indications despite its proven efficacy. Open and laparoscopic techniques are restricted to limited indications. Best clinical practice standards have been established for all treatments, making all options minimally invasive with low complication rates.
CONCLUSION: Active treatment of urolithiasis is currently a minimally invasive intervention, with preference for endourologic techniques.
PATIENT SUMMARY: For active removal of stones from the kidney or ureter, technological advances have made it possible to use less invasive surgical techniques. These interventions are safe and are generally associated with shorter recovery times and less discomfort for the patient.
Eur Urol. 2015 Sep 3. pii: S0302-2838(15)00700-9. doi: 10.1016/j.eururo.2015.07.041. [Epub ahead of print]
This is a summary of EAU Guidelines with recommendations on how to diagnose and treat stones conservatively. There are a number of recommendations presented in Tables that might be useful for the clinical routine work. One of the most important messages is to reduce the radiation dosage in the diagnostic and follow-up imaging. KUB plain films thereby expose the patients to the lowest radiation dose and this method has been my routine in the follow-up of patients with radio-dense stones, treated or un-treated.
Another aspect worthwhile to mention is that, for decompression of the renal collecting system, stents and percutaneous nephrostomy catheters are equally efficient.
Regarding the chemolytic treatment of uric acid stones it is recommended that the pH should be regularly checked at least three times daily. I personally do not think that this is necessary and such a routine will definitely reduce patient compliance. In my hands this routine was abandoned many years ago. It is my own experience that there have been no complications of the alkali treatment that have motivated re-starting daily pH-measurements. Standard doses of KCit or Na-bicarbonate twice or three times a day without pH-measurements have been the routine. The only reason for occasionally measuring pH is during long-term treatment, when an estimate of APuric acid is desirable or required for further therapeutic decisions.