Treatment selection for urolithiasis: percutaneous nephrolithomy, ureteroscopy, shock wave lithotripsy, and active monitoring

Mahesh Desai, Yinghao Sun, Noor Buchholz, Andrew Fuller, Tadashi Matsuda, Brian Matlaga, Nicole Miller, Damien Bolton, Mohammad Alomar, Arvind Ganpule

Research output: Contribution to journalArticle

Abstract

Urolithiasis is a significant worldwide source of morbidity, constituting a common urological disease that affects between 10 and 15% of the world population. Recent technological and surgical advances have replaced the need for open surgery with less invasive procedures. The factors which determine the indications for percutaneous nephrolithotomy include stone factors (stone size, stone composition, and stone location), patient factors (habitus and renal anomalies), and failure of other treatment modalities (ESWL and flexible ureteroscopy). The accepted indications for PCNL are stones larger than 20 mm2, staghorn and partial staghorn calculi, and stones in patients with chronic kidney disease. The contraindications for PCNL include pregnancy, bleeding disorders, and uncontrolled urinary tract infections. Flexible ureteroscopy can be one of the options for lower pole stones between 1.5 and 2 cm in size. This option should be exercised in cases of difficult lower polar anatomy and ESWL-resistant stones. Flexible ureteroscopy can also be an option for stones located in the diverticular neck or a diverticulum. ESWL is the treatment to be discussed as a option in all patient with renal stones (excluding lower polar stones) between size 10 and 20 mm. In addition, in lower polar stones of size between 10 and 20 mm if the anatomy is favourable, ESWL is the option. In proximal ureteral stones, ESWL should be considered as a option with flexible ureteroscopy Active monitoring has a limited role and can be employed in post-intervention (PCNL or ESWL) residual stones, in addition, asymptomatic patients with no evidence of infection and fragments less than 4 mm can be monitored actively.

Original languageEnglish (US)
Pages (from-to)1-5
Number of pages5
JournalWorld Journal of Urology
DOIs
StateAccepted/In press - Mar 16 2017

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Ureteroscopy
Urolithiasis
Lithotripsy
Anatomy
Urologic Diseases
Percutaneous Nephrostomy
Diverticulum
Therapeutics
Chronic Renal Insufficiency
Urinary Tract Infections
Renal Insufficiency
Neck
Hemorrhage
Morbidity
Kidney
Pregnancy
Infection
Population

Keywords

  • Lithotripsy
  • Percutaneous nephrlithotomy
  • Ureteroscopy

ASJC Scopus subject areas

  • Urology

Cite this

Treatment selection for urolithiasis : percutaneous nephrolithomy, ureteroscopy, shock wave lithotripsy, and active monitoring. / Desai, Mahesh; Sun, Yinghao; Buchholz, Noor; Fuller, Andrew; Matsuda, Tadashi; Matlaga, Brian; Miller, Nicole; Bolton, Damien; Alomar, Mohammad; Ganpule, Arvind.

In: World Journal of Urology, 16.03.2017, p. 1-5.

Research output: Contribution to journalArticle

Desai, Mahesh ; Sun, Yinghao ; Buchholz, Noor ; Fuller, Andrew ; Matsuda, Tadashi ; Matlaga, Brian ; Miller, Nicole ; Bolton, Damien ; Alomar, Mohammad ; Ganpule, Arvind. / Treatment selection for urolithiasis : percutaneous nephrolithomy, ureteroscopy, shock wave lithotripsy, and active monitoring. In: World Journal of Urology. 2017 ; pp. 1-5.
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