SWL and ureteroscopy acceptable as first-line treatments for patients requiring ureteral stone removal.


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Ureteroscopy (URS) is appropriate for the surgical treatment of ureteral stones regardless of their location in the ureter, according to a new guideline document developed by a panel convened by the American Urological Association (AUA) and the European Association of Urology (EAU).


In addition, the guideline states that ureteroscopy is appropriate for proximal ureteral stones of any size.


The new guideline, which update those released in 1997 by the AUA and 2006 by the EUA, is the first international guideline for managing ureteral stones.

The 1997 AUA guideline recommended ureteroscopy as the modality for surgical treatment of middle and distal ureteral stones, whereas shock wave lithotripsy (SWL) was preferred for proximal ureteral stones.


Based on a meta-analysis of data on stone-free rates and complications associated with each modality, the panel concluded that SWL and URS are acceptable first-line treatments for patients requiring stone removal and that both should be discussed as initial treatment options for the majority of cases.


“Regardless of the availability of this equipment and physician experience,” the guideline states, “this discussion should include stone-free rates, anesthesia requirements, need for additional procedures, and associated complications. Patients should be informed that URS is associated with a better chance of becoming stone free with a single procedure, but has higher complication rates.”


In a press release, guideline panel co-chair Hans-Göran Tiselius, MD, PhD,of Karolinska University Hospital in Stockholm, Sweden, observed: “At a time when knowledge and technology develop rapidly, it is absolutely necessary to keep up with therapeutic achievements and take advantage of recent observations. The statements in the EAU/AUA document, resulting from extensive analyses of recent literature data by a highly qualified panel, should be a most useful guide to urologists in their daily practical work.”


The first chapter of the guideline document is being published in the December 2007 issue The Journal of Urology and European Urology. The guideline is posted on the AUA and EAU websites (www.auanet.organdwww.uroweb.org