Renal and ureteric stones: assessment and 1.7.1 Consider stone analysis for adults with ureteric or...

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  • Renal and ureteric stones: assessmentRenal and ureteric stones: assessment and managementand management

    NICE guideline

    Published: 8 January 2019 nice.org.uk/guidance/ng118

    © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).

    http://nice.org.uk/guidance/ng118

  • YYour responsibilityour responsibility

    The recommendations in this guideline represent the view of NICE, arrived at after careful

    consideration of the evidence available. When exercising their judgement, professionals and

    practitioners are expected to take this guideline fully into account, alongside the individual needs,

    preferences and values of their patients or the people using their service. It is not mandatory to

    apply the recommendations, and the guideline does not override the responsibility to make

    decisions appropriate to the circumstances of the individual, in consultation with them and their

    families and carers or guardian.

    Local commissioners and providers of healthcare have a responsibility to enable the guideline to be

    applied when individual professionals and people using services wish to use it. They should do so in

    the context of local and national priorities for funding and developing services, and in light of their

    duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of

    opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a

    way that would be inconsistent with complying with those duties.

    Commissioners and providers have a responsibility to promote an environmentally sustainable

    health and care system and should assess and reduce the environmental impact of implementing

    NICE recommendations wherever possible.

    Renal and ureteric stones: assessment and management (NG118)

    © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights).

    Page 2 of 33

    https://www.nice.org.uk/about/who-we-are/sustainability https://www.nice.org.uk/about/who-we-are/sustainability

  • ContentsContents

    Overview .............................................................................................................................................................................. 5

    Who is it for? ..................................................................................................................................................................................... 5

    Recommendations ............................................................................................................................................................ 6

    1.1 Diagnostic imaging.................................................................................................................................................................. 6

    1.2 Pain management .................................................................................................................................................................... 6

    1.3 Medical expulsive therapy ................................................................................................................................................... 7

    1.4 Stenting before shockwave lithotripsy ........................................................................................................................... 7

    1.5 Surgical treatments (including shockwave lithotripsy) ............................................................................................ 7

    1.6 Stenting after ureteroscopy for adults with ureteric stones less than 20 mm ............................................... 10

    1.7 Metabolic testing..................................................................................................................................................................... 10

    1.8 Preventing recurrence........................................................................................................................................................... 11

    Terms used in this guideline ........................................................................................................................................................ 12

    Recommendations for research .................................................................................................................................. 13

    Key recommendations for research ....................................................................................................................................... 13

    Rationale and impact ....................................................................................................................................................... 15

    Diagnostic imaging ........................................................................................................................................................................ 15

    Pain management ........................................................................................................................................................................... 16

    Medical expulsive therapy........................................................................................................................................................... 18

    Stenting before shockwave lithotripsy .................................................................................................................................. 19

    Surgical treatments (including shockwave lithotripsy).................................................................................................... 20

    Timing of surgical treatment for ureteric stones ............................................................................................................... 25

    Medical expulsive therapy as adjunctive to shockwave lithotripsy............................................................................ 26

    Stenting after ureteroscopy ....................................................................................................................................................... 27

    Metabolic testing ............................................................................................................................................................................ 28

    Frequency of follow-up imaging ............................................................................................................................................... 29

    Preventing recurrence .................................................................................................................................................................. 29

    Context.................................................................................................................................................................................. 32

    Renal and ureteric stones: assessment and management (NG118)

    © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights).

    Page 3 of 33

  • Finding more information and resources ................................................................................................................ 33

    Renal and ureteric stones: assessment and management (NG118)

    © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights).

    Page 4 of 33

  • OvOverviewerview

    This guideline covers assessing and managing renal and ureteric stones. It aims to improve the

    detection, clearance and prevention of stones, so reducing pain and anxiety, and improving quality

    of life.

    Who is it for?

    Healthcare professionals

    Commissioners and providers

    People with renal and ureteric stones, their families and carers

    Renal and ureteric stones: assessment and management (NG118)

    © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights).

    Page 5 of 33

  • RecommendationsRecommendations

    People have the right to be involved in discussions and make informed decisions about their

    care, as described in your care.

    Making decisions using NICE guidelines explains how we use words to show the strength (or

    certainty) of our recommendations, and has information about prescribing medicines

    (including off-label use), professional guidelines, standards and laws (including on consent and

    mental capacity), and safeguarding.

    1.1 Diagnostic imaging

    1.1.1 Offer urgent (within 24 hours of presentation) low-dose non-contrast CT to

    adults with suspected renal colic. If a woman is pregnant, offer ultrasound

    instead of CT.

    1.1.2 Offer urgent (within 24 hours of presentation) ultrasound as first-line imaging

    for children and young people with suspected renal colic.

    1.1.3 If there is still uncertainty about the diagnosis of renal colic after ultrasound for

    children and young people, consider low-dose non-contrast CT.

    To find out why the committee made the recommendations on diagnostic imaging and

    how they might affect practice, see rationale and impact.

    1.2 Pain management

    1.2.1 Offer a non-steroidal anti-inflammatory drug (NSAID) by any route a