[What's new in the diagnosis and management of urinary lithiasis?].
OBJECTIVE
To update some aspects of the diagnosis and management of urinary lithiasis.


METHODS
A review of the main articles published in PubMed indexed journals was performed.


RESULTS
The occurrence of urinary stones is higher among patients with body mass index above 30. Urinary stones are correctly diagnosed by non-contrast CT in 98% of the cases. SWL is the best method for treatment of renal stones smaller than 2 cm with tomographic density under 1000 HU except for stones located at the lower renal pole where the limit is 1 cm. PCNL reaches a stone-free rate between 60% and 100% for renal stones larger than 2 cm. Semirigid ureteroscopy renders patients with distal ureteral stones free in up to 94% of the cases compared to 74% of SWL. Regarding upper ureteral stones, ureteroscopy promotes stone-free rates between 77% and 91%and SWL between 41% and 82%.


CONCLUSIONS
The link between urinary stones, obesity and diabetes mellitus is well established. Non-contrast CT is the gold standard for diagnosis of urinary stones. SWL is the mainstay in the treatment of renal stones with less than 2 cm and density under 1000 Hounsfield Units, except for lower pole calculi where the limit is 1 cm. PCNL is the preferred method for treatment of renal stones larger than 2 cm. Semirigid ureteroscopy is the method of election for lower ureteral stones; flexible ureteroscopy is reserved for upper ureteral or renal stones with less than 1.5 cm non responsive to SWL or for those patients with contraindications to PCNL.
Mazzucchi
Eduardo
E
Setor de endourologia e litíase, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP.
Srougi
Miguel
M
D006801:Humans; D014057:Tomography, X-Ray Computed; D018666:Ureteroscopy; D052878:Urolithiasis / Q000175:diagnosis* / Q000601:surgery