More Kidney Stone Patients Could Have Non-invasive Treatment

Peter Russell

July 20, 2018

People with kidney stones (nephrolithiasis) should have greater access to non-invasive procedures, according to the National Institute for Health and Care Excellence (NICE).

The draft guidance for managing renal and ureteric stones in England said a priority was to improve the detection, clearance and prevention of stones to reduce pain and anxiety for the patient.

It recommended greater use of shockwave lithotripsy (SWL).

Breaking Down the Crystals

SWL directs beams of high-energy shock waves that break down kidney stones into small crystals so they can be passed out of the body in urine. The procedure is non-invasive and avoids the need to undergo traditional surgery.

The guidance recommended that people eligible for this treatment should be offered the procedure within 48-hours of a medical assessment.

Andrew Dickinson, a consultant urologist at Plymouth Hospitals NHS Trust and chair of the NICE committee that produced the guidance, said: "The use of shockwave lithotripsy is definitely a less traumatic experience for the patient.

"There are fewer problems afterwards and it reduces the amount of time patients have to wait to have the issue resolved."

More resources may be needed to extend the use of SWL, NICE acknowledged, including extra mobile lithotripters, more fixed-site machines or better organised referral systems. However, at a time when surgery for renal and ureteric stones has been increasing, one benefit would be that more patients could be seen as day cases, reducing theatre time and hospital stays.

"Waiting times for treatment are increasing and this means that patient satisfaction is likely to be lower," said Mr Dickinson. "This is why offering shockwave lithotripsy is important for both a patient's health and mental wellbeing."

CT Scans

A further recommendation was that patients should be offered a CT scan within 24 hours of an initial medical assessment if they were experiencing severe abdominal pain, thought to be caused by renal stones.

Current practise is to investigate renal colic using ultrasound or plain abdominal radiographs. However, NICE concluded that while a CT scan was more expensive, it lessened the likelihood of needing follow-up investigations.

The recommendation had been made because renal function can decline quickly when stones are present, NICE said.

Kidney stones can develop in one or both kidneys. They are caused by waste products in the blood forming crystals that collect inside the kidney. Small kidney stones may be passed out painlessly in urine. However, it is fairly common for a stone to block part of the urinary system such as the ureter and the urethra.

Kidney stones are quite common and most often affect people aged 30 to 60. Around 3 in 20 men and up to 1 in 10 women develop stones at some time in their life.

The National Institute for Health and Care Excellence (NICE). Guideline: Renal and ureteric stones: assessment and management. Draft for consultation, July 2018. Draft guideline.


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