From the Guidelines
For the treatment of urinary stones, a multimodal approach considering size, location, and composition is crucial, with conservative management recommended for small stones less than 10mm, and urological intervention for larger stones or those causing severe symptoms. The management strategy should prioritize minimizing morbidity, mortality, and improving quality of life.
Key Considerations
- For uncomplicated ureteral stones, conservative management is possible, with a cutoff size for observation being 10mm and 6mm in AUA and EAU guidelines, respectively 1.
- Medical expulsive therapy with alpha-blockers is an option for distal ureteral stones greater than 5mm, according to EAU guidelines, and for distal ureteral stones only, as per AUA recommendations 1.
- Ureteroscopy (URS) is recommended as the first-line treatment for distal ureteral stones greater than 10mm, and for proximal ureteral stones regardless of size, with some guidelines suggesting extracorporeal shock wave lithotripsy (SWL) as an equivalent option for smaller stones 1.
Treatment Approaches
- Conservative management includes increased fluid intake and medical expulsive therapy.
- Urological interventions such as URS, SWL, and percutaneous nephrolithotomy are considered based on stone size and location.
- Prevention strategies involve dietary modifications and medications to prevent recurrence, such as potassium citrate and thiazide diuretics.
Monitoring and Follow-Up
- Regular follow-up with urinalysis and imaging is essential to monitor treatment effectiveness and prevent complications.
- The choice between observation and intervention should be guided by the most recent and highest quality evidence, prioritizing patient outcomes in terms of morbidity, mortality, and quality of life 1.
From the Research
Treatment Options for Urinary Stones
- The treatment of urinary stones depends on the size and location of the stone, with options including lithotripsy, litholapaxy, and alpha-blocker medication 2
- Lithotripsy is used to break down stones in the ureter or kidney, while litholapaxy is used for stones in the bladder that are too large to be passed urethrally 2
- Alpha-blocker medication, such as tamsulosin, can facilitate the spontaneous passing of a stone 2, 3
Medical Expulsive Therapy
- Alpha-blockers have been shown to be beneficial in promoting the passage of stone fragments after shock wave lithotripsy (SWL) 3, 4
- A review of 40 studies found that alpha-blockers may improve clearance of stone fragments after SWL, reduce the need for auxiliary treatments, and reduce major adverse events 4
- The most widely used alpha-blocker is tamsulosin, but other alpha-blockers such as silodosin, doxazosin, terazosin, and alfuzosin have also been used 4
Preventing Stone Formation
- Strategies for preventing stone formation include increasing urine output by drinking 2-3 liters of fluid per day and dietary modification, particularly reduction in animal protein and salt content 2
- A review of treatment options for urinary stones highlights the importance of understanding the clinical indications and efficacy of each treatment modality 5
Diagnostic Techniques
- Diagnostic techniques for urinary stones include plain X-ray, X-ray with contrast media, ultrasound imaging, and computed tomographic (CT) scanning 2, 6
- Newer diagnostic techniques and technologies are improving the ability to determine the size, location, and composition of stones, and thus inform treatment approaches 6