title: EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis.
abstract: BACKGROUND
  Low-dose computed tomography (CT) has become the first choice for detection of ureteral calculi. Conservative observational management of renal stones is possible, although the availability of minimally invasive treatment often leads to active treatment. Acute renal colic due to ureteral stone obstruction is an emergency that requires immediate pain management. Medical expulsive therapy (MET) for ureteral stones can support spontaneous passage in the absence of complicating factors. These guidelines summarise current recommendations for imaging, pain management, conservative treatment, and MET for renal and ureteral stones. Oral chemolysis is an option for uric acid stones.
  
  
  OBJECTIVE
  To evaluate the optimal measures for diagnosis and conservative and medical treatment of urolithiasis.
  
  
  METHODS
  Several databases were searched for studies on imaging, pain management, observation, and MET for urolithiasis, with particular attention to the level of evidence.
  
  
  RESULTS
  Most patients with urolithiasis present with typical colic symptoms, but stones in the renal calices remain asymptomatic. Routine evaluation includes ultrasound imaging as the first-line modality. In acute disease, low-dose CT is the method of choice. Ureteral stones <6mm can pass spontaneously in well-controlled patients. Sufficient pain management is mandatory in acute renal colic. MET, usually with α-receptor antagonists, facilitates stone passage and reduces the need for analgesia. Contrast imaging is advised for accurate determination of the renal anatomy. Asymptomatic calyceal stones may be observed via active surveillance.
  
  
  CONCLUSIONS
  Diagnosis, observational management, and medical treatment of urinary calculi are routine measures. Diagnosis is rapid using low-dose CT. However, radiation exposure is a limitation. Active treatment might not be necessary, especially for stones in the lower pole. MET is recommended to support spontaneous stone expulsion.
  
  
  RESULTS
  For stones in the lower pole of the kidney, treatment may be postponed if there are no complaints. Pharmacological treatment may promote spontaneous stone passage.
authors: Department of Urology, Rudolfstiftung Hospital, Vienna, Austria.
authors: Christian
authors: C
authors: Türk
authors: Department of Urology, Region Hospital, České Budějovice, Czech Republic; Department of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors: Aleš
authors: A
authors: Petřík
authors: Department of Urology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul, Turkey.
authors: Kemal
authors: K
authors: Sarica
authors: Department of Urology, Medical University Vienna, Vienna, Austria.
authors: Christian
authors: C
authors: Seitz
authors: Second Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece.
authors: Andreas
authors: A
authors: Skolarikos
authors: Department of Urology, Technical University Munich, Munich, Germany.
authors: Michael
authors: M
authors: Straub
authors: Department of Urology, Sindelfingen-Böblingen Medical Centre, University of Tübingen, Sindelfingen, Germany. Electronic address: t.knoll@klinikverbund-suedwest.de.
authors: Thomas
authors: T
authors: Knoll
mesh_terms: D058070:Asymptomatic Diseases; D003952:Diagnostic Imaging / Q000592:standards*; D003950:Diagnostic Techniques, Urological / Q000592:standards*; D006801:Humans; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D052878:Urolithiasis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D014572:Urology / Q000592:standards*
keywords: Chemolitholysis; Computed tomography; EAU guidelines; Medical expulsive therapy; Percutaneous nephrolithotomy; Shock wave lithotripsy; Stone surgery; Ureteroscopy; Urinary calculi