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1. |
Automatic, Easily Excreted Stones
If newly diagnosed stones measure less
than 0.4 cm, 90% of the cases will be
excreted automatically. The recommended
treatment option is conservative,
involving supportive monitoring. If the
symptoms persist (include: renal colic,
fever, infection, Hydronephrosis, and
functional damage to the kidney), then
more aggressive treatments will be
implemented, include: Extracorporeal
Shock Wave Lithotripsy (ESWL),
ureteroscopy, placement of double-J
catheters or Percutaneous
Nephrolithotomy (PCN) drainage therapy.
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2. |
Non-Automatic, Hard to be Excreted
Stones
For stones that are not easily excreted
automatically, before utilizing any
treatment options, you must inform the
patients of the relative advantages and
disadvantages of each treatment and
possible complications. |
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3. |
After being treated with SWL on any of
the body parts for urolithiasis, if
X-ray demonstrates that the stones are
not significantly disintegrated, then
SWL is not recommended to be used again.
Other treatment options should be
attempted.
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Treatment
Guidelines for Ureteral Stones |
|
1. |
Stones Less than once centimeter and
located at proximal ureter
Surgery should not be the first-line
treatment option. SWL should be the
first Choice in terms of treatment. |
|
2. |
Stones Larger than one centimeter and
located at proximal ureter
Surgery should not be the first-line
treatment option. SWL, ureteroscopy, and
PCN are acceptable treatment options. |
|
3. |
Stones Less than one centimeter and
located at distal ureter
Sugery should not be the first-line
treatment option. SWL and ureteroscopy
are
Acceptable treatment options. |
|
4. |
Stones Larger than one centimeter and
locate at distal ureter
Surgery should not be the first-line
treatment option. SWL and ureteroscopy
are
Acceptable treatment options. |
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Ureteral Stones Larger than one
centimeter and complicated with severe
Hydronephrosis
This type of ureteral stones, due to
long-term obstruction, responds poorly
to SWL tretments. For this stype of
urolithiasis, it is recommended to
utilize ureteroscopy, PCN, endoscopic
surgery or open surgery for treatment,
depending on the location of the stones.
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Treatment
Guidelines for Renal Lithiasis |
|
1. |
For Renal stones less than one
centimeter, regardless of the
ingredients and location, SWL is the
first choice of treatment. |
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2. |
Stones of the renal calyx that range
form one to two centimeters in diameter
can choose SWL or PCNL for treatment.
For one to two centimeter renal stones
in the other parts of the kidney, SWL is
the first choice in terms of treatment. |
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3. |
Renal stones larger than two centimeters
in diameter can be respond better to
PCNL treatment. If the stones are made
from softer ingredients (eg. Uric
acid,magnesium ammonium phosphate,
calcium oxalate), then SWL will serve as
the first-line treatment option. |
|
4. |
General staghorn-shaped renal stones
should be treated with PCNL first. If
there are residual stones after the
procedure, then either ESWL or PCNL can
be utilized as an adjunctive therapy,
depending on the size of the residual
stones. |
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5. |
If the patient is prone to bleeding,
then the combination of ureteroscopy and
laser lithotripsy of the renal stones
should be considered as an acceptable
treatment choice. |
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6. |
Treatment Guidelines for Infectious
Staghorn Lithiasis |
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|
I. General
Principles
| (1) |
Even if there
are no significant symptoms from
the patients with infectious
staghorn stones, the patients
need to be cared for
aggressively, unless the
patients are not eligible to
receive an operation. According
to the opinions of the American
Urological Association, an
observatory supportive therapy
is not the best choice of
treatment for the staghorn
stones. |
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(2) |
When selecting the treatment option,
the physician must inform the patients,
orally or in writing, the benefits and
risks of each aggressive treatment
option. |
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II. Specific principles
|
(1) |
For most patients with infectious staghorn lithiasis, ESWL treatment alone
and open surgery should not be used as
the first-line treatment option. |
|
(2) |
Most patients with infectious staghorn lithiasis should first be
treated with PCNL. If there are residual
stones after the procedure, either ESWL
or PCNL should be used as an adjunctive
therapy, depending on the size of the
residual stones. |
| (3) |
Staghorn lithiasis with a small
volume (<500 mm2, length ´width (mm)),
and with a normal or slightly enlarged
urine collection system can be treated
with ESWL alone (it is better to place
the double-J catheters beforehand to
prevent obstruction of the ureters). |
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(4) |
For Infectious Staghorn stones that
have a complicated structure or are
large in volume, if it is expected that
the stones cannot be eliminated
completely even with multiple PCNLs and
ESWLs, then open surgery should be an
appropriate choice of treatment. |
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(5) |
If the patient with staghorn
lithiasis has poor kidney function on
the side of the lithiasis, or has
recurrent renal abscess, then excision
of the kidney is an appropriate choice
of treatment. |
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