MONTEREY, Calif.-For most small ureteral stones, it should be laissez passer.
So say the American Urological Association’s new guidelines for ureteral-stone management. Its expert panel recommends that unless the patient is in excruciating pain, observation and pain management are all that’s usually needed. Stones measuring less than 5 mm-about 85% of the total-generally pass spontaneously, it says.The guidelines, issued at an AUA regional meeting here, sanction more aggressive treatment for larger stones or severe symptoms. Okayed were shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy.
But the panel, headed by Dr. Joseph Segura of the Mayo Clinic, strongly advised against open surgery as the initial treatment option, as well as blind basketing and routine stenting. Dr. Segura and colleagues based their recommendations on outcomes reported in nearly 400 published studies, and said they hoped the guidelines would help sort out recent technological advances in kidney-stone treatment.
Beyond size and symptom severity as treatment variables, the panel also cited as important factors location, degree of obstruction, status of infection, and level of renal function.
Members clearly preferred lithotripsy for stones of less than 1 cm lodged in the upper ureter, though they deemed percutaneous nephrolithotomy and ureteroscopy as acceptable alternatives. For distal stones that size, it was a toss-up between shock wave and ureteroscopy, with lithotripsy getting the nod for being noninvasive but ureteroscopy scoring higher for efficacy.
MONTEREY, Calif.-For most small ureteral stones, it should be laissez passer.
