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Upper urinary tract stones

Last edited Jan 22, 2019

Stones less than 0.5 cm in diameter are often treated conservatively. They often pass through the urinary tract spontaneously, and the likelihood of complications such as hydronephrosis from urinary obstruction is low.

NICE have summarised the indications for surgery based on size and site of renal stone/ureteric stone (1):

Stone type and size	Treatment for adults (16 years and over)	Treatment for children and young people (under 16 years)
Ureteric stone less than 10mm	Offer SWL Consider URS if: stone clearance is not possible within 4 weeks with SWL or there are contraindications for SWL or the stone is not targetable with SWL or a previous course of SWL has failed	Consider URS or SWL
Ureteric stone 10 to 20mm	Offer URS Consider SWL if local facilities allow stone clearance within 4 weeks Consider PCNL for impacted proximal stones when URS has failed	Consider URS or SWL

Notes:

number of upper urinary tract stone hospital episodes increased by 63% to 83,050 in the 10-year period 2000/2001 to 2009/2010
use of shock wave lithotripsy (SWL) for treating all upper tract stones increased from 14,491 cases in 2000-2001 to 22,402 cases in 2010 (a 55% increase) with a 69% increase in lithotripsy for renal stones
was a 127% increase in the number of ureteroscopic stone treatments from 6,283 to 14,242 cases over the 10-year period with a 49% increase from 2007/2008 to 2009/2010
was a decline in open surgery for upper tract stones from 278 cases in 2000/2001 to 47 cases in 2009/2010 (an 83% reduction)
treatment for stone disease has increased substantially in comparison with other urological activity
- in 2009/2010, SWL was performed almost as frequently as transurethral resection of the prostate or transurethral resection of bladder tumour, ureteroscopy for stones was performed more frequently than nephrectomy, radical prostatectomy and cystectomy combined, and percutaneous nephrolithotomy was performed more frequently than cystectomy

Reference:

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