"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 Assimos, chair of the University of Alabama at Birmingham Department of Urology.
Kidney stones affect more than 8.8 percent of the population in the United States, with direct and indirect treatment costs estimated to be several billion dollars per year, making it a common and costly disease.
The guidelines further outline expert recommendations in relation to treatment of renal stones, small hard mineral deposits formed inside the kidneys, and ureteral stones, stones that have moved from the kidney to the ureter.
The guidelines provide instruction on the evaluation of patients with renal and/or ureteral stones and highlight the lab and imaging studies that should be used prior to intervention for such patients.
The technical aspects of ureteroscopic removal of stones are addressed more extensively in the guidelines. The previous guidelines discussed medical expulsive therapy via the utilization of alpha blockers to facilitate the passage of stones in all segments of the ureter. However, the recent guidelines recommend this therapy only for stones in the distal ureter, which is located in the lower part of the kidney. Ureteroscopic removal of ureteral stones may potentially render a patient stone-free in one procedure. In this process, a ureteroscope is used to either extract an intact stone or break it up using a laser with subsequent removal of the generated fragments.
The guidelines further discuss the use of stents in the ureter after a ureteroscopic procedure. Clinicians may omit ureteral stenting in patients meeting all of the following criteria: