Renal and ureteric stones: assessment and management – NICE guideline

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This National Institute for Health and Care Excellence (NICE) guideline covers the assessment and management of renal and ureteric stones. It aims to identify techniques for diagnosis, pain management and surgical interventions, and ways in which recurrence can be prevented.

Renal and ureteric stones usually present as an acute episode with severe pain, although some stones are picked up incidentally during imaging or may present as a history of infection. The initial diagnosis is made by taking a clinical history and examination and carrying out imaging; initial management is with painkillers and treatment of any infection.

Ongoing treatment of renal and ureteric stones depends on the site of the stone and size of the stone. Options for treatment range from observation with pain relief to surgical intervention. As well as the site and size of the stone, treatment also depends on local facilities and expertise.

Recommendations

Recommendations in the new NICE guideline cover the following areas:

  • diagnostic imaging
  • pain management
  • medical expulsive therapy
  • stenting before shockwave lithotripsy
  • surgical treatments (including shockwave lithotripsy):
    • renal stones
    • ureteric stones
    • timing of surgical treatment for adults with ureteric stones and renal colic
    • medical expulsive therapy as adjunct to shockwave lithotripsy for adults with ureteric stones.
  • stenting after ureteroscopy for adults with ureteric stones less than 20 mm
  • metabolic testing
  • preventing recurrence:
    • dietary and lifestyle advice
    • potassium citrate
    • thiazides.

You can read the guideline on NICE's website.