title: Treatment selection for urolithiasis: percutaneous nephrolithomy, ureteroscopy, shock wave lithotripsy, and active monitoring.
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.
authors.affiliation: Muljibhai Patel Urological Hospital, Dr Virendra Desai Road, Nadiad, Gujarat, India. mrdesai@mpuh.org.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Desai
authors.affiliation: Department of Urology, Changhai Hospital the First Affiliated Hospital of the Second Military Medical University (SMMU), Shanghai, China.
authors.forename: Yinghao
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Sobeh Medical Center, Dubai Health Care City, Dubai, United Arab Emirates.
authors.forename: Noor
authors.initials: N
authors.lastname: Buchholz
authors.affiliation: South Terrace Urology, 326 South Terrace, Adelaide, 5000, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fuller
authors.affiliation: Department of Urology and Andrology, Kansai Medical University Hospital, Kansai Medical University, Shin-machi 2-5-1, Hirakata, Osaka, 573-1010, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
authors.affiliation: The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Matlaga
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232-2765, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Miller
authors.affiliation: University of Melbourne, Melbourne, Australia.
authors.forename: Damien
authors.initials: D
authors.lastname: Bolton
authors.affiliation: King Saud University, Riyadh, Saudi Arabia.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Alomar
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Ganpule
mesh_terms: D019468:Disease Management; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy; D008096:Lithotripsy; D000074642:Nephrolithotomy, Percutaneous; D018579:Patient Selection; D000069856:Staghorn Calculi / Q000628:therapy; D014514:Ureteral Calculi / Q000628:therapy; D018666:Ureteroscopy; D052878:Urolithiasis / Q000628:therapy*; D057832:Watchful Waiting
keywords: Lithotripsy; Percutaneous nephrlithotomy; Ureteroscopy