Guideline Based Algorithmic Approach for the Management of Renal and Ureteric Calculi

Abstract

Urolithiasis is a global pathology with increasing prevalence rate. The surgical management of kidney and ureteral stones is based on the stone location, size, the patient’s preference and the institutional availability of various modalities. To date, the available modalities in the management of urolithiasis includes external shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PNL), ureterorenoscopy (URS) including flexible and semirigid ureteroscopy. Tremendous technological advancement in the urological armamentarium has happened since its inception leading to multiple acceptable modalities for the treatment of a particular stone. In accordance with the available recommendations from various institutions and the newer evidence we recommend that the initial choice of modality for the treatment of a renal calculus depends on the stone size and whether the location is lower pole or not. For lower pole stones upto 20 mm PNL and RIRS is efficient irrespective of location while ESWL should only be considered for lower pole stones upto 10 mm. For stones larger than 20 mm mini PNL is effective for stones upto 40 mm while RIRS holds acceptable efficiency for stones not larger than 30 mm. For stones larger than 40 mm standard PNL only should be considered if single stage treatment is attempted.