Department of Urology, Rudolfstiftung Hospital, Vienna, Austria.
Department of Urology, Region Hospital, České Budějovice, Czech Republic; Department of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
Eur Urol. 2016 Mar;69(3):468-74. doi: 10.1016/j.eururo.2015.07.040. Epub 2015 Aug 28.
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.
To evaluate the optimal measures for diagnosis and conservative and medical treatment of urolithiasis.
Several databases were searched for studies on imaging, pain management, observation, and MET for urolithiasis, with particular attention to the level of evidence.
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.
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.
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.
低剂量计算机断层扫描（CT）已成为检测输尿管结石的首选方法。尽管微创治疗方法的可用性常常导致积极治疗，但肾脏结石的保守观察管理是可能的。输尿管结石梗阻引起的急性肾绞痛是一种紧急情况，需要立即进行止痛治疗。对于没有合并症的输尿管结石，药物排石治疗（MET）可以支持结石自行排出。这些指南总结了肾脏和输尿管结石的影像学检查、疼痛管理、保守治疗和 MET 的当前推荐。尿酸结石可以选择口服化学溶石治疗。
评估诊断和保守及药物治疗尿石症的最佳方法。
对尿石症的影像学、疼痛管理、观察和 MET 的研究进行了多项数据库检索，并特别关注证据水平。
大多数患有尿石症的患者表现出典型的绞痛症状，但肾盏中的结石仍无症状。常规评估包括超声成像作为一线检查方法。在急性疾病中，低剂量 CT 是首选方法。在病情得到良好控制的患者中，<6mm 的输尿管结石可以自行排出。急性肾绞痛时必须进行充分的疼痛管理。MET，通常使用α受体拮抗剂，可促进结石排出，减少对镇痛剂的需求。建议进行对比成像以准确确定肾脏解剖结构。无症状的肾盏结石可以通过主动监测观察。
诊断、观察性管理和药物治疗尿石症是常规措施。使用低剂量 CT 可以快速诊断。然而，辐射暴露是一个限制。可能不需要积极治疗，尤其是对于下极的结石。建议进行 MET 以支持结石自行排出。
如果肾脏下极的结石没有症状，可能会推迟治疗。药物治疗可能会促进结石自行排出。
