[Conditional recommendation with moderate evidence] Clinicians may offer MET with alpha-adrenergic blockers for approximately 30 days, but benefits are less clear compared to distal stones.
[CONDITIONAL recommendation, MODERATE evidence] [Conditional recommendation] Clinicians may offer standard or mini-PCNL for adult patients undergoing PCNL for kidney stones up to 3 cm in size. [Moderate evidence] Based on Grade B evidence.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Clinicians should obtain a complete blood count, basic metabolic panel, urinalysis, and urine culture for adult and pediatric patients with obstructing stones and suspected infection. [Expert opinion] Based on expert consensus.
[STRONG recommendation, LOW evidence] [Strong recommendation] Clinicians should initiate urgent renal drainage for adult patients with obstructing kidney and/or ureteral stones and suspected infection. [Low evidence] Based on Grade C evidence.
[CONDITIONAL recommendation, HIGH evidence] [Conditional recommendation] Clinicians may drain the collecting system with either a nephrostomy tube or ureteral stent for adult patients with obstructing kidney and/or ureteral stones and suspected infection. [High evidence] Based on Grade A evidence.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Clinicians should obtain a urine sample from the collecting system for culture, when possible, during urgent drainage for adult and pediatric patients with obstructing stones and suspected infection. [Expert opinion] Based on expert consensus.
[MODERATE recommendation, MODERATE evidence] [Moderate recommendation] Clinicians should offer concurrent URS removal of secondary, asymptomatic non-obstructing kidney stones <6 mm during the same surgical session for adult patients undergoing URS or PCNL for a primary stone. [Moderate evidence] Based on Grade B evidence.
[CONDITIONAL recommendation, MODERATE evidence] [Conditional recommendation] Clinicians may offer bilateral same-session stone treatment for adult patients with bilateral kidney and/or ureteral stones. [Moderate evidence] Based on Grade B evidence.
[MODERATE recommendation, LOW evidence] [Moderate recommendation] Clinicians should offer secondary endoscopic removal of residual fragments and engage in shared decision-making for adult and pediatric patients with residual stones after surgical intervention, considering benefits and risks. [Low evidence] Based on Grade C evidence.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Clinicians should utilize US as first-line imaging for pregnant patients with suspected symptomatic kidney and/or ureteral stones; if needed, non-contrast MRI or CT are appropriate alternatives. [Expert opinion] Based on expert consensus.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Clinicians should coordinate pharmacologic and/or surgical intervention with the obstetrician for pregnant patients with symptomatic kidney and/or ureteral stones. [Expert opinion] Based on clinical principle.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Clinicians should offer observation with a trial of stone passage for pregnant patients with kidney and/or ureteral stones and well controlled symptoms. [Expert opinion] Based on clinical principle.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] Clinicians may offer URS for pregnant patients with ureteral stones when trial of passage is unsuccessful or not feasible; alternatively, placement of a ureteral stent or nephrostomy tube with frequent changes may be offered. [Low evidence] Based on Grade C evidence.
[WEAK recommendation, HIGH evidence] [Weak recommendation] Medical expulsive therapy may be considered to reduce the rate of surgical intervention in patients with ureteral stones, but its overall benefit-risk balance is uncertain. [High evidence] This is supported by a meta-analysis of multiple randomized controlled trials.
[MODERATE recommendation, HIGH evidence] [Moderate recommendation based on high evidence] Tamsulosin is probably effective for facilitating the expulsion of distal ureteral stones, supported by multiple randomized controlled trials.
[WEAK recommendation, MODERATE evidence] [Weak recommendation based on moderate evidence] Either ureteroscopic lithotripsy or extracorporeal shock wave lithotripsy may be considered for proximal ureteral stones, as evidence from randomized trials shows comparable efficacy, but optimal choice depends on individual patient and stone characteristics.
[Strong recommendation] Offer α-blockers as medical expulsive therapy for distal ureteral stones > 5 mm, noting it is an off-label use. [Low evidence] Based on contradictory evidence from studies.
[Strong recommendation] Perform percutaneous nephrolithotomy as first-line treatment for renal stones larger than 2 cm. [Expert Opinion] Based on EAU guideline consensus.
[Weak recommendation] Offer active surveillance to patients at high risk of thrombotic complications with asymptomatic calyceal stones. [Expert Opinion] Based on EAU guideline consensus.
[Strong recommendation based on expert opinion] Clinicians should obtain a medical history, perform a physical examination, and obtain laboratory studies appropriate to procedural risk and patient comorbidities.
[Strong recommendation based on expert opinion] Yes, clinicians should obtain a urinalysis and/or urine culture prior to surgical intervention.
[Conditional recommendation with low evidence] Clinicians may obtain cross-sectional imaging to guide surgical treatment selection, depending on patient circumstances.
[Moderate recommendation with low evidence] Yes, clinicians should obtain a CT prior to PCNL for surgical planning.
[Strong recommendation with high evidence] Yes, clinicians should offer MET with alpha-adrenergic blockers for approximately 30 days to facilitate stone passage.
[Conditional recommendation with moderate evidence] Clinicians may offer URS or SWL, depending on patient factors and shared decision-making.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] Clinicians may utilize a suction sheath during mini-PCNL in adult patients to improve stone-free rates and reduce secondary procedures, when available. [Low evidence] Based on Grade C evidence.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] Clinicians may perform laparoscopic/robotic pyelolithotomy or ureterolithotomy in adult patients when endoscopic or percutaneous treatments are unavailable, unsuccessful, or limited by patient factors. [Low evidence] Based on Grade C evidence.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Surgery is recommended for patients with BPH who have complications such as renal insufficiency, refractory urinary retention, recurrent UTIs, bladder stones, gross hematuria, or LUTS refractory to other therapies. [Expert opinion] Based on clinical principles.
[STRONG recommendation, MODERATE evidence] [Strong recommendation] Clinicians should inform adult and pediatric patients that URS is associated with a higher stone-free rate than SWL for kidney and ureteral stones. [Moderate evidence] Based on Grade B evidence.
[CONDITIONAL recommendation, MODERATE evidence] [Conditional recommendation] Clinicians may omit pre-operative prophylactic antibiotics for adult patients undergoing SWL for kidney or ureteral stones. [Moderate evidence] Based on Grade B evidence.
[MODERATE recommendation, MODERATE evidence] [Moderate recommendation] Clinicians should administer pre-operative prophylactic antibiotics for adult patients undergoing URS and PCNL for kidney or ureteral stones. [Moderate evidence] Based on Grade B evidence.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Clinicians should not place a ureteral stent with the intention of improving stone-free rate for adult patients undergoing SWL for kidney and/or ureteral stones. [Expert opinion] Based on clinical principle.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] Clinicians may perform URS for adult patients with kidney and/or ureteral stones who have uncorrected bleeding diatheses or require continued AC/AP therapy. [Low evidence] Based on Grade C evidence.
[CONDITIONAL recommendation, EXPERT OPINION evidence] [Conditional recommendation] Clinicians may offer primary URS without prior stent placement for adult patients with kidney and/or ureteral stones. [Expert opinion] Based on expert consensus.
[CONDITIONAL recommendation, MODERATE evidence] [Conditional recommendation] Clinicians may use a UAS for adult patients undergoing URS for kidney and/or ureteral stones. [Moderate evidence] Based on Grade B evidence.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] Clinicians may choose a flexible and navigable suction UAS for adult patients undergoing URS with a UAS for kidney and/or ureteral stones. [Low evidence] Based on Grade C evidence.
[CONDITIONAL recommendation, HIGH evidence] [Conditional recommendation] Clinicians may use either a single-use or reusable flexible ureteroscope for adult patients undergoing URS for kidney and/or ureteral stones. [High evidence] Based on Grade A evidence.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] Clinicians may utilize either a holmium:YAG or thulium fiber laser for lithotripsy during URS in adult patients for kidney and/or ureteral stones. [Low evidence] Based on Grade C evidence.
[CONDITIONAL recommendation, MODERATE evidence] [Conditional recommendation] Clinicians may utilize a strategy of fragmenting and basketing or dusting for laser lithotripsy during URS in adult and pediatric patients for kidney and/or ureteral stones. [Moderate evidence] Based on Grade B evidence.
[CONDITIONAL recommendation, LOW evidence] [Conditional recommendation] Clinicians may omit post-operative ureteral stent placement following uncomplicated URS for adult patients with kidney and/or ureteral stones. [Low evidence] Based on Grade C evidence.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Clinicians should obtain stone for analysis when possible for adult and pediatric patients undergoing surgical intervention for kidney and/or ureteral stones. [Expert opinion] Based on clinical principle.
[MODERATE recommendation, LOW evidence] [Moderate recommendation] Clinicians should utilize a multi-modal, non-opioid analgesic regimen and minimize use of opioids for post-operative pain management in adult patients undergoing surgical intervention for kidney and/or ureteral stones. [Low evidence] Based on Grade C evidence.
[STRONG recommendation, EXPERT OPINION evidence] [Strong recommendation] Clinicians should order follow-up imaging to assess residual stone burden and identify hydronephrosis or other complications for adult and pediatric patients undergoing surgical intervention for kidney and/or ureteral stones. [Expert opinion] Based on expert consensus.