Options in the management of renal and ureteral stones in adults
- Glenn M Preminger, MD
Glenn M Preminger, MD
- Section Editor — Renal Ureteral Stones
- Professor of Urologic Surgery
- Duke University Medical Center
- Director of Education
- Endourological Society
- Section Editors
- Stanley Goldfarb, MD
Stanley Goldfarb, MD
- Editor-in-Chief — Nephrology
- Section Editor — Mineral and Bone Metabolism; Renal Ureteral Stones
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Michael P O'Leary, MD, MPH
Michael P O'Leary, MD, MPH
- Section Editor — Urology
- Professor of Surgery, Harvard Medical School
- Senior Urologic Surgeon, Brigham and Women's Hospital
Considerable progress has been made in the medical and surgical management of nephrolithiasis over the past 20 years. Approximately 10 to 20 percent of all kidney stones require surgical removal, which is determined based upon the presence of symptoms and the size and location of the stones. Larger stones and proximal ureteral stones are less likely to pass spontaneously. (See 'Facilitation of stone passage' below and "Diagnosis and acute management of suspected nephrolithiasis in adults", section on 'Stone passage'.)
Stone removal is also indicated for pain or obstruction or for an infected struvite stone. On the other hand, no specific surgical therapy is required for asymptomatic stones, particularly those that are less than 5 mm in diameter.
Three minimally invasive surgical techniques that significantly reduce the morbidity of stone removal are available:
●Percutaneous nephrolithotomy (PNL)
●Rigid and flexible ureteroscopy (URS)
- Preminger GM, Clayman RV, Hardeman SW, et al. Percutaneous nephrostolithotomy vs open surgery for renal calculi. A comparative study. JAMA 1985; 254:1054.
- Jewett MA, Bombardier C, Menchions CW. Comparative costs of the various strategies of urinary stone disease management. Urology 1995; 46:15.
- Grasso M, Beaghler M, Loisides P. The case for primary endoscopic management of upper urinary tract calculi: II. Cost and outcome assessment of 112 primary ureteral calculi. Urology 1995; 45:372.
- Meretyk S, Gofrit ON, Gafni O, et al. Complete staghorn calculi: random prospective comparison between extracorporeal shock wave lithotripsy monotherapy and combined with percutaneous nephrostolithotomy. J Urol 1997; 157:780.
- Al-Otaibi K, Hosking DH. Percutaneous stone removal in horseshoe kidneys. J Urol 1999; 162:674.
- Pietrow PK, Auge BK, Zhong P, Preminger GM. Clinical efficacy of a combination pneumatic and ultrasonic lithotrite. J Urol 2003; 169:1247.
- Auge BK, Sekula JJ, Springhart WP, et al. In vitro comparison of fragmentation efficiency of flexible pneumatic lithotripsy using 2 flexible ureteroscopes. J Urol 2004; 172:967.
- Akman T, Binbay M, Yuruk E, et al. Tubeless procedure is most important factor in reducing length of hospitalization after percutaneous nephrolithotomy: results of univariable and multivariable models. Urology 2011; 77:299.
- Limb J, Bellman GC. Tubeless percutaneous renal surgery: review of first 112 patients. Urology 2002; 59:527.
- Desai MR, Kukreja RA, Desai MM, et al. A prospective randomized comparison of type of nephrostomy drainage following percutaneous nephrostolithotomy: large bore versus small bore versus tubeless. J Urol 2004; 172:565.
- Shah HN, Kausik VB, Hegde SS, et al. Tubeless percutaneous nephrolithotomy: a prospective feasibility study and review of previous reports. BJU Int 2005; 96:879.
- Rana AM, Mithani S. Tubeless percutaneous nephrolithotomy: call of the day. J Endourol 2007; 21:169.
- Zilberman DE, Lipkin ME, de la Rosette JJ, et al. Tubeless percutaneous nephrolithotomy--the new standard of care? J Urol 2010; 184:1261.
- Mouracade P, Spie R, Lang H, et al. Tubeless percutaneous nephrolithotomy: what about replacing the Double-J stent with a ureteral catheter? J Endourol 2008; 22:273.
- Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH. Totally tubeless percutaneous nephrolithotomy. J Endourol 2008; 22:267.
- Xue W, Pacik D, Boellaard W, et al. Management of single large nonstaghorn renal stones in the CROES PCNL global study. J Urol 2012; 187:1293.
- Li K, Liu C, Zhang X, et al. Risk factors for septic shock after mini-percutaneous nephrolithotripsy with holmium laser. Urology 2013; 81:1173.
- Segura JW, Preminger GM, Assimos DG, et al. Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. The American Urological Association. J Urol 1997; 158:1915.
- Kourambas J, Munver R, Preminger GM. Ureteroscopic management of recurrent renal cystine calculi. J Endourol 2000; 14:489.
- Kourambas J, Delvecchio FC, Munver R, Preminger GM. Nitinol stone retrieval-assisted ureteroscopic management of lower pole renal calculi. Urology 2000; 56:935.
- Auge BK, Dahm P, Wu NZ, Preminger GM. Ureteroscopic management of lower-pole renal calculi: technique of calculus displacement. J Endourol 2001; 15:835.
- Pengfei S, Yutao L, Jie Y, et al. The results of ureteral stenting after ureteroscopic lithotripsy for ureteral calculi: a systematic review and meta-analysis. J Urol 2011; 186:1904.
- Nabi G, Cook J, N'Dow J, McClinton S. Outcomes of stenting after uncomplicated ureteroscopy: systematic review and meta-analysis. BMJ 2007; 334:572.
- Pais VM Jr, Smith RE, Stedina EA, Rissman CM. Does Omission of Ureteral Stents Increase Risk of Unplanned Return Visit? A Systematic Review and Meta-Analysis. J Urol 2016; 196:1458.
- Lingeman JE, Preminger GM, Berger Y, et al. Use of a temporary ureteral drainage stent after uncomplicated ureteroscopy: results from a phase II clinical trial. J Urol 2003; 169:1682.
- Deliveliotis C, Chrisofos M, Gougousis E, et al. Is there a role for alpha1-blockers in treating double-J stent-related symptoms? Urology 2006; 67:35.
- Damiano R, Autorino R, De Sio M, et al. Does the size of ureteral stent impact urinary symptoms and quality of life? A prospective randomized study. Eur Urol 2005; 48:673.
- Streem SB. Contemporary clinical practice of shock wave lithotripsy: a reevaluation of contraindications. J Urol 1997; 157:1197.
- Streem SB, Yost A, Dolmatch B. Combination "sandwich" therapy for extensive renal calculi in 100 consecutive patients: immediate, long-term and stratified results from a 10-year experience. J Urol 1997; 158:342.
- Matlaga BR, Assimos DG. Changing indications of open stone surgery. Urology 2002; 59:490.
- Wiesenthal JD, Ghiculete D, D'A Honey RJ, Pace KT. A comparison of treatment modalities for renal calculi between 100 and 300 mm2: are shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy equivalent? J Endourol 2011; 25:481.
- Gupta M, Bolton DM, Irby P 3rd, et al. The effect of newer generation lithotripsy upon renal function assessed by nuclear scintigraphy. J Urol 1995; 154:947.
- Krambeck AE, Gettman MT, Rohlinger AL, et al. Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of followup. J Urol 2006; 175:1742.
- Gulum M, Yeni E, Kocyigit A, et al. Sperm DNA damage and seminal oxidative status after shock-wave lithotripsy for distal ureteral stones. Fertil Steril 2011; 96:1087.
- Zhou Y, Cocks FH, Preminger GM, Zhong P. Innovations in shock wave lithotripsy technology: updates in experimental studies. J Urol 2004; 172:1892.
- Weizer AZ, Zhong P, Preminger GM. Twenty-five years of shockwave lithotripsy: back to the future? J Endourol 2005; 19:929.
- Maloney ME, Marguet CG, Zhou Y, et al. Progressive increase of lithotripter output produces better in-vivo stone comminution. J Endourol 2006; 20:603.
- Preminger GM, Peterson R, Peters PC, Pak CY. The current role of medical treatment of nephrolithiasis: the impact of improved techniques of stone removal. J Urol 1985; 134:6.
- Preminger GM. Renal calculi: pathogenesis, diagnosis, and medical therapy. Semin Nephrol 1992; 12:200.
- Fine JK, Pak CY, Preminger GM. Effect of medical management and residual fragments on recurrent stone formation following shock wave lithotripsy. J Urol 1995; 153:27.
- PERCUTANEOUS NEPHROLITHOTOMY
- - Procedural complications
- Rigid ureteroscopy
- Flexible ureteroscopy
- Indications for stent placement
- SHOCK WAVE LITHOTRIPSY
- OPEN STONE SURGERY
- MEDICAL THERAPY
- Prevention of new stone formation
- Facilitation of stone passage
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS