Tzelves Lazaros, Mourmouris Panagiotis, Skolarikos Andreas
Second Department of Urology. National and Kapodistrian University of Athens. Sismanogleio General Hospital. Athens. Greece.
Arch Esp Urol. 2021 Jan;74(1):171-182.
The objective of this study isto present the content of existing Guidelines on medical management of urinary stone disease.
A search for current Guidelines from national and international urological Associations was performed in Societe International d'Urologie and American Urological Association websites, along with a search in Pubmed/MEDLINE until 30/06/2020. Two authors performed an independent search and data extraction regarding medical management of acute renal colic, medical expulsive treatment, dietary modifications and pharmaceutical interventions for prevention of stone disease recurrence. Quality of Guidelines was assessed by the two reviewers using the AGREE II instrument.
Literature search revealed 82 Associations, while eight of them provide recommendations/Guidelines on medical management of stone disease. Non-steroidalanti-inflammatory drugs or paracetamol are the most common 1st line treatment proposed for acute pain management, with opiates following next. Use of a-blockers is also indicated by most Guidelines for facilitating expulsion of distal ureteral stones 5-10 mm, after shockwave or laser lithotripsy or for alleviating stent-related symptoms. Adequate fluid in take, normal dietary calcium consumption and sodium restriction with varying daily limits, are universal dietary modifications from urological Associations on prevention of stone disease. Thiazidesand alkaline citrates are proposed usually for calciumoxalate stone formers with differences in grading of the recommendations, while urinary alkalization with allopurinol or febuxostat as a second line treatment is acommon treatment algorithm for urate stones, but with differences in target urine pH. European and American Urological Association Guidelines, along with National Institute for Health and Care Excellence recommendations were the most highly rated based on AGREE II.
Despite methodological heterogeneity and subjective rating of recommendations, an acceptable degree of consensus was noted on Guidelines regarding medical management of stone disease.
本研究的目的是介绍现有尿石症医学管理指南的内容。
在国际泌尿外科学会和美国泌尿外科学会网站上搜索国家和国际泌尿外科学会的现行指南，并在Pubmed/MEDLINE上进行搜索，直至2020年6月30日。两位作者就急性肾绞痛的医学管理、药物排石治疗、饮食调整和预防结石病复发的药物干预进行了独立搜索和数据提取。两位审稿人使用AGREE II工具对指南的质量进行了评估。
文献检索发现82个协会，其中8个协会提供了关于结石病医学管理的建议/指南。非甾体抗炎药或对乙酰氨基酚是急性疼痛管理中最常用的一线治疗药物，其次是阿片类药物。大多数指南也指出，在冲击波或激光碎石术后，使用α受体阻滞剂有助于排出5-10毫米的远端输尿管结石，或缓解与支架相关的症状。充足的液体摄入、正常的饮食钙摄入量和不同每日限量的钠限制，是泌尿外科学会预防结石病的普遍饮食调整措施。噻嗪类药物和碱性柠檬酸盐通常用于草酸钙结石形成者，建议分级有所不同，而使用别嘌醇或非布司他进行尿液碱化作为二线治疗是尿酸结石的常见治疗方案，但目标尿液pH值有所不同。根据AGREE II，欧洲和美国泌尿外科学会指南以及英国国家卫生与临床优化研究所的建议评分最高。
尽管指南在方法上存在异质性且建议的主观评分存在差异，但在结石病医学管理指南方面仍达成了可接受程度的共识。
