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These guidelines have been developed by the British Association of Urological Surgeons to give a framework to clinicians, based primarily in the UK, for the management of patients presenting acutely with ureteric colic. They have been developed by consensus with reference to the American Urological Association/Endourological Society guidelines on the surgical management of stones and the European Association of Urology guidelines on urolithiasis, and adapted to the logistics of those practicing within the National Health Service. Grades of recommendation and levels of evidence are based upon the system adopted by the European Association of Urology. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Admissions for ureteric colic are relatively common, with up to 80% of stones passing spontaneously. In patients with refractory pain, drainage with stenting, percutaneous nephrostomy or stone removal can be performed. Due to the financial restrictions of the NHS, it is paramount to ensure patients are receiving optimal cost-effective care. We present a cost effectiveness analysis between primary ureteric stenting and emergency ureteroscopic stone removal in patients with refractory pain secondary to acute ureteric calculi. Methods: Fifty patients were analysed who underwent either primary ureteric stenting or emergency ureteroscopic stone removal in our institution. Each group contained 25 consecutive patients. The primary outcomes compared were: time to stone-free status, number of hospital re-admissions, and overall cost of treatment until stone free. Results: Both stenting (n=25) and ureteroscopic stone removal (n=25) groups were comparable with respect to age, sex, stone size and location. The hospital re-admission rate secondary to stone-specific issues was significantly lower in the ureteroscopy group, two versus 20. Patients became stone free significantly quicker in the ureteroscopy group (2.5 days vs. 61.9 days). The total overall cost until being declared stone free was significantly lower in the ureteroscopy group (£3104 vs. £4041, P⩽0.001). Conclusions: This study highlights that those patients undergoing ureteric stenting take significantly longer to become stone free, leading to increased hospital re-admissions, potentially increased morbidity and inevitably greater cost implications. We advocate that primary ureteroscopic stone removal should be consider instead of ureteric stenting in patients with ongoing, painful ureteric colic. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the diagnostic accuracy of ultra-low dose contrast-enhanced CT (ULDCECT) and its ability to measure differential renal function (DRF) in patients presenting clinically with acute ureteric colic by comparison to IVU (using an equivalent radiation exposure) and DMSA, respectively. Patients and methods: Fifty-three patients presenting clinically with acute ureteric colic underwent IVU, ULDCECT and DMSA on the same day of their hospital admission. Diagnostic accuracy of ULDCECT and IVU was compared to interventional findings and clinical outcome. Estimation of DRF by ULDCECT was derived through measurement of enhancing renal volumes and DMSA. Results: ULDCECT had superior sensitivity (97%) and specificity (100%) in the identification of renal tract stone disease compared to IVU (84 and 95% respectively), with comparable radiation exposure (1.7mSv versus 1.4mSv). Furthermore, ULDCECT revealed non-urological pathology in eight patients (15%), including perforated abdominal viscus and acute appendicitis. There was a very good correlation of ULDCECT and DMSA-derived DRF (regression of near unity, Pearson''s correlation coefficient of 0.72 (p <0.0001)). Conclusion: ULDCECT provides diagnostically accurate imaging in patients presenting with acute ureteric colic and significantly outperforms IVU for a comparable radiation burden. Use of ULDCECT instead of conventional CT-KUB may significantly reduce lifetime radiation exposure of ureteric colic patients without loss of diagnostic accuracy. [Copyright &y& Elsevier]

Abstract: Renal stone disease accounts for a significant proportion of attendances to the urological, surgical and A&E departments. Consequently, it is highly likely that most trainees embarking on foundation training will encounter patients with renal stone disease either in the acute emergency setting or the outpatient setting. Knowledge of presenting features and treatment strategies is important in order to correctly manage these patients. This article focuses on the clinical presentation of renal stone disease and the clinical management of these patients. It also aims to create a stepwise sequence of scenarios, similar to how a foundation trainee would encounter a patient with renal stones. [Copyright &y& Elsevier]