[Guidelines for the urological management of renal and ureteric stones in adults]

Abstract

Progress in the treatment of urinary stones over the last 20 years requires a clearer definition of the indications for each treatment modality for the urological management of renal and ureteric stones in adults. The Stones Committee of the Association Française d'Urologie reviewed the European and American guidelines, the literature published over the last five years, and the experience of its members to establish a set of practical guidelines for the treatment of urinary stones. The site (kidney or ureter) and size (dimensions) of the stone are the initial descriptive criteria for the choice of treatment. Indications are classified as "standard" for first-line treatments, or "optional" for alternative modalities. The success of treatment is defined by the absence of residual fragments. ESWL is the reference treatment for renal stones less than 20 mm in diameter. PCNL is the most effective treatment for stones larger than 20 mm. Flexible ureteroscopy is still under evaluation. Open surgery and laparoscopy have limited indications in less than 1% of cases. ESWL is the first-line treatment for proximal ureteric stones. ESWL and ureteroscopy are both treatments of choice for stones of the pelvic ureter less than 10 mm in diameter, while ureteroscopy is recommended for stones larger than 10 mm. Stone morphology and composition analysis and an aetiological survey must be performed after surgical treatment and the patient must be given dietary advice to prevent recurrence.