European Association of Urology Guidelines on the Diagnosis and Treatment of Urolithiasis

Abstract

Background and objective

The European Association of Urology urolithiasis guidelines provide evidence-based recommendations for the diagnosis and treatment of urinary stone disease. Given the complexity and variability of stone formation, individualised patient management is emphasised.

Methods

The guidelines incorporate evidence from the latest research and focus on risk assessment, imaging techniques, pharmacological management, and surgical interventions. A research librarian conducted literature searches for urolithiasis in the Cochrane Library, Medline, and Embase databases via Dialog-Datastar. The strength of recommendations is also rated.

Key findings and limitations

Diagnosis relies on a combination of clinical history, biochemical evaluation, and imaging, with ultrasound as the first-line modality and low-dose computed tomography as the gold standard for precise stone assessment. Stone composition and burden influence treatment decisions with algorithms primarily based on stone size, location, and composition. Nonsteroidal anti-inflammatory drugs are recommended for first-line pain management, with opioids reserved as a secondary option. Medical expulsive therapy with α-blockers may be considered for selected patients with ureteral stones. Extracorporeal shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy remain the primary intervention modalities, with selection based on stone characteristics and patient factors. Advances in multiplanar imaging have improved assessment of the stone burden, although further research is needed to refine predictive models. Genetic testing is recommended for high-risk patients to guide personalised treatment.

Conclusions and clinical implications

The guidelines provide a framework for clinical decision-making while acknowledging the need for continued advances in urolithiasis.