New guidelines for ureteral stone management

The American Urological Association (AUA) is pleased to announce the release of a new Guideline for the Management of Ureteral Calculi prepared as a collaborative effort with the European Association of Urology (EAU).

This is the first international guideline on this topic, and the first time the two organizations have partnered to release information of mutual benefit to both urologists in the United States and in Europe.

The Guideline is an update to the 1997 AUA guideline on this topic, as well as an update of a section of the EAU's Guidelines on Urolithiasis (last updated in 2006). The joint EAU/AUA Nephrolithiasis Panel was convened in 2003 to incorporate the significant body of research that has become available over the past decade into the document, including the use of shockwave lithotripsy (SWL), ureteroscopy (URS) and other treatments, including medical expulsive therapies (MET) such as alpha blockers and nifedipine designed to aid in spontaneous stone passage.

One of the biggest changes in this document is the shift in indications for URS. The 1997 AUA Guideline recommended URS as the modality for surgical treatment of middle and distal ureteral stones while SWL was preferred for proximal ureteral stones. Data now support URS for stones in all locations and also is now considered appropriate for stones of any size in the proximal ureter. Additionally, ureteroscopic management of stones in the middle ureter, a location that has traditionally posed significant challenges for surgical stone treatments, is supported by the analyzed data.

“The Panel believes that the report will help both the clinician and the patient choose the most appropriate treatment modality for managing ureteral calculi and believes that future collaboration between the European Association of Urology and the American Urological Association will serve to establish a set of internationally approved guidelines, offering physician and patient guidance throughout the world,” said Glenn M. Preminger, M.D., Professor of Urologic Surgery at Duke University Medical Center and co-chairman of the joint Guidelines Panel.

“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,” said Hans- Göran Tiselius, M.D., Ph.D., co-chairman of the panel. “The statements in this 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."

In addition to making treatment recommendations, the Guideline Panel also addresses the direction of future research. The panel points out deficiencies in the number of randomized controlled trials (RCTs) available for extraction and identifies a need for RCTs comparing interventional techniques and pharmacological studies of stone-expulsion therapies as double-blinded RCTs. A complete list of recommendations for research is included in the full document.

The first chapter of the guideline document is being published in the December 2007 issue of The Journal of Urology® and European Urology. The documents are also posted on both the AUA and EAU web sites.