surgical
Last edited 01/2019
This is dependent on the site and size of the stone.
Lithotripsy, endoscopy and percutaneous techniques have largely replaced open surgery.
NICE have summarised the indications for surgery based on size and site of renal stone/ureteric stone (1):
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watchful waiting should be considered for asymptomatic renal stones in adults, children and young people if:
- the stone is less than 5mm or
- the stone is larger than 5 mm and the person (or their family or carers,
as appropriate) agrees to watchful waiting after an informed discussion
of the possible risks and benefits
Surgical treatment (including SWL) of renal stones in adults, children and young people
Stone type and size Treatment for adults (16 years and over) Treatment for children and young people (under 16 years) Renal stone less than 10mm Offer SWL
Consider URS:
- if there are contraindications for SWL or
- if a previous course of SWL has failed or
- because of anatomical reasons, SWL is not indicated
Consider PCNL if SWL and URS have failed to treat the current stone or they are not an option
Consider URS or SWL Consider PCNL if:
URS or SWL have failed or
for anatomical reasons, PCNL is the more favourable option
Renal stone 10 to 20mm Consider URS or SWL
Consider PCNL if URS or SWL have failed
Consider URS, SWL or PCNL1 Renal stone larger than 20 mm, including staghorn stones Offer PCNL2
Consider URS if PCNL is not an option
Consider URS, SWL or PCNL1 Abbreviations: PCNL, percutaneous nephrolithotomy; SWL, shockwave lithotripsy; URS, ureteroscopy.
1 Use clinical judgement when considering mini or standard PCNL.
2 Use clinical judgement when considering tubeless, mini or standard PCNL, and supine or prone positions.
Ureteric stones
Surgical treatment (including SWL) of ureteric stones in adults, children and young people
Stone type and size Treatment for adults (16 years and over) Treatment for children and young people (under 16 years) Ureteric stone less than 10mm Offer SWL
Consider URS if:
- stone clearance is not possible within 4 weeks with SWL or
- there are contraindications for SWL or
- the stone is not targetable with SWL or
- a previous course of SWL has failed
Consider URS or SWL Ureteric stone 10 to 20mm Offer URS
Consider SWL if local facilities allow stone clearance within 4 weeks
Consider PCNL for impacted proximal stones when URS has failed
Consider URS or SWL Abbreviations: PCNL, percutaneous nephrolithotomy; SWL, shockwave lithotripsy; URS, ureteroscopy.
Timing of surgical treatment (including SWL) for adults with ureteric stones and renal colic
surgical treatment (including SWL) should be offered to adults with ureteric stones and renal colic within 48 hours of diagnosis or readmission, if:
- pain is ongoing and not tolerated or
- the stone is unlikely to pass
Notes:
- number of upper urinary tract stone hospital episodes increased by 63% to
83,050 in the 10-year period 2000/2001 to 2009/2010
- use of shock wave lithotripsy (SWL) for treating all upper tract stones
increased from 14,491 cases in 2000-2001 to 22,402 cases in 2010 (a 55% increase)
with a 69% increase in lithotripsy for renal stones
- was a 127% increase in the number of ureteroscopic stone treatments from
6,283 to 14,242 cases over the 10-year period with a 49% increase from 2007/2008
to 2009/2010
- was a decline in open surgery for upper tract stones from 278 cases in 2000/2001
to 47 cases in 2009/2010 (an 83% reduction)
- treatment for stone disease has increased substantially in comparison with
other urological activity
- in 2009/2010, SWL was performed almost as frequently as transurethral resection of the prostate or transurethral resection of bladder tumour, ureteroscopy for stones was performed more frequently than nephrectomy, radical prostatectomy and cystectomy combined, and percutaneous nephrolithotomy was performed more frequently than cystectomy
Reference: