The American Urologic Association has issued a new guideline for the surgical management of patients with kidney and/or ureteral stones, containing over 50 statements on best practices. In addition, the guidelines outline recommendations related to treatment of renal stones and ureteral stones. These include:

  • Imaging and pre-operative testing
  • Treatment of adult patients with ureteral stones
  • Treatment of adult patients with renal stones
  • Treatment for pediatric patients with ureteral or renal stones
  • Treatment for pregnant patients with ureteral or renal stones
  • Treatment for all patients with ureteral or renal stones

The guidelines also include information on how to evaluate patients with renal and/or ureteral stones and the appropriate lab and imaging studies for use prior to intervention in these patients. Regarding ureteroscopic removal of stones, medical expulsive therapy via alpha-blocker use is recommended only for stones in the distal ureter instead of for all segments of the ureter as discussed in previous guidelines. Ureteroscopic removal may allow a patient to be stone-free in a single procedure. 

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The use of ureter stents following a ureteroscopic procedure is also discussed in the new guidelines. Clinicians can forego ureteral stenting in patients that have no ureteral injury during ureteroscopy; no anatomic obstruction, hindrance or obstacle to stone fragment clearance; normal function in the opposite kidney and normal renal function; and no plans for secondary ureteroscopic procedure.

The guidelines were developed by an expert panel based on data from past clinical studies, trials published in peer-reviewed literature, and from expert consensus of the physician panelists.

“The most pertinent change is that decision-making for treatment and therapy for patients with kidney and ureteral stones should be shared between physician and patient,” said Dean Assimos, MD, chair of the University of Alabama at Birmingham Department of Urology. 

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