Management of kidney stones

doi:10.1136/bmj.39113.480185.80

BMJ 2007;334:468-472 (3 March), doi:10.1136/bmj.39113.480185.80

Clinical Review

Management of kidney stones

Nicole L Miller, fellow in endourology and minimally invasive surgery, James E Lingeman, physician and surgeon

Methodist Hospital Institute for Kidney Stone Disease, Indiana University School of Medicine, and International Kidney Stone Institute, Indianapolis, IN 46202, USA

Correspondence to: J E Lingeman jlingeman@clarian.org

The first 150 words of the full text of this article appear below.

Urolithiasis affects 5-15% of the population worldwide.¹ ^w1Recurrence rates are close to 50%,² ^w2 and the cost of urolithiasisto individuals and society is high. Acute renal colic is a commonpresentation in general practice, so a basic understanding ofits evaluation and treatment would be useful. Most of the literatureis retrospective, but we will try to provide an evidence basedreview of the management of urolithiasis and will cite prospectiverandomised controlled trials when available.

Summary points

Unenhanced helical computed tomography is thebest radiographic technique for diagnosing urolithiasis
Shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomyhave replaced open surgery for treating urolithiasis
Most simplerenal calculi (80-85%) can be treated with shock wave lithotripsy
Percutaneousnephrolithotomy is the treatment of choice for complex renalcalculi
Staghorn calculi should be treated, and percutaneousnephrolithotomy is the preferred treatment in most patients
Ureteroscopyis the preferred treatment in pregnant, morbidly obese, or . . . [Full text of this article]

Sources and selection criteria

What is the clinical presentation and initial evaluation?

Box 1 Important factors to identify in the patient's history
Presenceof systemic illness
Anatomical features
Previous kidneydisease
Drugsthat affect stone disease
Box 2 Indications for urgent intervention