A new guideline for the surgical management of patients with kidney and/or ureteral stones has been released by the American Urologic Association.

Chairman of the panel, Dr. Dean Assimos of UAB worked with a team of experts to develop one of the largest  documents ever produced, highlighting more than 50 best practices.

“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, chairman of the UAB Department of Urology.

Kidney stones affect about 9 percent of people in the United States, with direct and indirect treatment costs estimated to be several billion dollars per year.

The expert recommendations include treatment of renal stones, which are small hard mineral deposits formed inside the kidneys, and ureteral stones, which have moved from the kidney to the ureter.

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

The guidelines include imaging and preoperative testing, as well as treatments for adult, pediatric and pregnant patients with renal or ureteral stones.

The guidelines provide instruction on the evaluation of patients and highlight the lab and imaging studies that should be used prior to intervention.

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:

• no ureteral injury during ureteroscopy
• no anatomic obstruction, hindrance or obstacle to stone fragment clearance
• normal function in the opposite kidney and normal renal function
• no plans for secondary ureteroscopic procedure.

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