New Guidelines on the Management of Kidney Stones Released

The American Urological Association and the Endourological Society have released new guidance providing a clinical framework for the surgical management of patients with kidney and ureteral stones.1

To construct the new guideline, a panel of kidney stone experts performed a systematic review of literature published from January 1, 1985, to May 31, 2015.
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They identified 1911 peer-reviewed studies that pertained to the management of stones and rated the strength of the evidence as A for high quality, B for moderate quality, or C for low quality.

Strong, Moderate, or Conditional Recommendations were developed regardless of evidence strength and were based on benefits and risks/burdens to the patient.

The resulting guideline includes 56 statements, including the following:

  • Obtain non-contrast CT scans before performing percutaneous nephrolithotomy.
  • Patients with uncomplicated ureteral stones ≤10 mm should be offered observation.
  • Clinicians may perform nephrectomy when the involved kidney has negligible function in patients requiring treatment.
  • Staghorn stones should be removed if attendant comorbidities do not preclude treatment.
  • When residual fragments are present, clinicians should offer patients endoscopic procedures to render the patients stone free.
  • Open/laparoscopic surgery should not be offered as first-line therapy to most patients with stones.
  • Antimicrobial prophylaxis should be administered prior to stone intervention and is based primarily on prior urine culture results.

“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 panel of reviewers.2

“In the past, there was a portfolio of guidelines for physicians discussing prevention and treatment in various types of patients with kidney stones,” he concluded.

“Evidence has changed over time, prompting an update and the need for more comprehensive guidelines. The panel developed this set of guidelines based on evidence from past clinical trials and studies published in the peer reviewed literature, as well as expert consensus of the physician panelists.”

—Amanda Balbi

References:

1. Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: American Urological Association/Endourological Society guideline. https://www.auanet.org/education/guidelines/surgical-management-of-stones.cfm. Published August 10, 2016. Accessed August 11, 2016.

2. Rohan A. New guidelines published for physicians treating patients with kidney stones. University of Alabama at Birmingham. http://www.uab.edu/news/innovation/item/7508-new-guidelines-published-for-physicians-treating-patients-with-kidney-stones. Published August 10, 2016. Accessed August 11, 2016.