What are the guidelines for the surgical treatment of nephrolithiasis?

Updated: Jun 21, 2018
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Guidelines are now available to assist the urologist in selecting surgical treatments. The 2005 AUA staghorn calculus guidelines recommend percutaneous nephrostolithotomy as the cornerstone of management; this is consistent with the 2016 AUA/Endourological society and the 2018 EAU guidelines. [70, 1] In the same guidelines, ureteroscopy (URS) is considered the first-line therapy for mid-distal ureteral stones that require intervention, although patients should be offered ESWL if URS is declined. [41]

With regard to renal stones, the guidelines recommend ESWL or URS to symptomatic patients with non–lower pole stones with a total stone burden ≤20 mm or lower pole renal stones ≤10 mm. PCNL is recommended for symptomatic patients with a total renal stone burden >20 mm or lower pole stones >10 mm. [41]

In pediatric patients, URS or ESWL can be offered for ureteral stones that are unlikely to pass or when MET has failed. ESWL or PCNL can be offered to pediatric patients with a total renal stone burden >20 mm. [41]


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