A guideline regarding the surgical management of patients with kidney or ureteral stones has been published by the American Urological Association (AUA) and Endourological Society.

Investigators used 1,911 peer-reviewed studies relevant to the surgical management of kidney stones to create the guideline, which was expanded to incorporate the management of patients with staghorn renal stones.

A summary of the recommendations is as follows:

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Preoperative Testing

  • Patients should undergo a non-contrast CT scan prior to percutaneous nephrolithotomy, and to help clinicians decide the best candidates for shock wave lithotripsy compared to ureteroscopy.
  • A functional imaging study should be performed if clinicians suspect significant loss of renal function in the kidney.
  • A urinalysis should be obtained prior to intervention, and a urine culture should be obtained from patients with signs of infection. A complete blood count and platelet count should also be obtained for patients undergoing procedures with significant risk of hemorrhage or for patients with suspected anemia, thrombocytopenia, or infection.
  • Additional contrast imaging may be required in patients with complex stones “if further definition of the collecting system and the ureteral anatomy is needed.”

Treatment for Patients With Ureteral or Renal Stones

  • Patients could consider endoscopic procedures when residual fragments are present to render the stone free. A safety guide wire should be used for endoscopic procedures.
  • Open, laparoscopic, or robotic surgery should not be a first-line therapy, except in rare cases of anatomic abnormalities, large or complex stones, or in those requiring concomitant reconstruction.
  • If purulent urine is encountered during endoscopic intervention, clinicians should stop the stone removal procedure, establish appropriate drainage, continue antibiotic therapy, and obtain a urine culture.
  • Endoscopic therapy should be used as the next treatment option if the initial shock wave lithotripsy fails. In patients requiring continuous anticoagulation or antiplatelet therapy, ureteroscopy should be the first-line therapy.