Benign prostate hyperplasia (BPH) and Rezūm
Non-EAU members can view the web versions. To become an EAU member, click here. This document covers most aspects of the disease, which is still a cause of significant morbidity despite technological and scientific urolitiasi BPH. The Panel is aware of the geographical variations in healthcare provision. Management of bladder stones has previously not been addressed in these guidelines; however, as of the edition, bladder stones are dealt with in a new, separate, guideline urolitiasi BPH by the same guideline group.
It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations will not necessarily urolitiasi BPH in the best outcome.
Guidelines are not mandates and do not purport to be a legal standard of care. The EAU Urolithiasis Guidelines Panel consists of an international group of clinicians with particular expertise in this area. A quick reference document Pocket guidelines is available, both in print and as an app for iOS and Android devices. These are abridged versions, which urolitiasi BPH require consultation together with the full text versions.
Also a urolitiasi BPH of scientific publications are available [ ]. Urolitiasi BPH document presents a limited update of the version. The literature for the entire document has been assessed and updated, wherever relevant see Methods section below. Forconclusions and recommendations have been rephrased and added to throughout the current document, including the sections on high-risk stone formers, anti-coagulation and paediatric urolithiasis.
Updated summaries of evidence and recommendations urolitiasi BPH the following:. Offer opiates urolitiasi BPH, pentazocine or tramadol as a second choice. Careful imaging control of localisation of stone contributes to outcome of treatment.
Careful control of pain during treatment is necessary to limit pain-induced movements and excessive respiratory excursions. Antibiotic prophylaxis is recommended in the case of internal stent placement, infected stones or bacteriuria. Consider the stone composition before deciding on the method of urolitiasi BPH, based on patient history, former stone analysis of the patient or Hounsfield unit HU on unenhanced computed tomography CT.
Offer laparoscopic or open surgical stone removal in rare cases in which shock wave urolitiasi BPH SWLretrograde or antegrade ureteroscopy and percutaneous nephrolithotomy fail, or are unlikely to be successful. Shock wave lithotripsy for small calyceal stones is an option with minimal risk of complication, but localisation of the stone can be challenging and SFRs are poor. Offer children with single ureteral stones less than 10 mm shock wave lithotripsy SWL if localisation is possible as first line option.
Ureteroscopy is a feasible alternative for ureteral stones not urolitiasi BPH to SWL. For the Urolithiasis Guidelines, new and relevant evidence has been identified, collated and appraised through a structured assessment of the literature.
A broad and comprehensive scoping exercise covering all areas of the guideline was performed. The search was limited to studies representing high levels of evidence only i. The search was restricted to articles published between 1 st July and 1 st May A total of unique records were identified, and screened for relevance. Based on the reference lists of selected papers from the overall scope search and Panel expertise, additional relevant papers not identified in the search have been included in the Paediatric Urolithiasis session.
A total of 25 new papers have been added to the Urolithiasis Guidelines urolitiasi BPH. For each recommendation within the guidelines there is an accompanying online strength rating form, the basis urolitiasi BPH which is a modified GRADE methodology [ 45 ]. Each strength-rating form addresses a number of key elements, namely:. These key elements are the basis which panels use to define the strength rating of each recommendation.
The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence including certainty urolitiasi BPH estimatesand nature and variability of patient values and preferences. The strength rating forms will be available online. A list of associations endorsing the EAU Guidelines can also be viewed online at urolitiasi BPH above address.
The Urolithiasis Guidelines were subjected to peer-review prior to publication. For their text update the Urolithiasis Guidelines Panel aim to perform extended literature searches in those parts of the Guideline where evidence is currently poor. Potential examples include: MET in children and robot-assisted laparoscopic stone treatment.
Further goals for future iterations of the Urolithiasis Guidelines will be determined over the course urolitiasi BPH Stone incidence depends on geographical, climatic, ethnic, dietary and urolitiasi BPH factors.
The recurrence risk is basically determined by the disease or disorder causing the stone formation. There is emerging evidence linking nephrolithiasis to the risk urolitiasi BPH chronic kidney disease [ 12 ].
Stones can be stratified into those caused by: infection, or non-infectious causes, genetic defects [ 13 ]; or adverse drug effects drug stones Table 3. See also section 3. Stone composition is the basis for further diagnostic and management decisions. Stones are often formed from a mixture of substances.
Table 3. CaHPO 4. MgNH 4 PO 4. MgHPO 4. The risk status of stone formers is of particular interest because it defines the probability of recurrence or regrowth, and is imperative for pharmacological treatment. Stone type and disease severity determine low- or high risk of recurrence Table 3. Early onset of urolithiasis especially children and teenagers. Brushite-containing stones CaHPO 4.
Solitary kidney the kidney itself urolitiasi BPH not particularly increase the risk of stone formation, but prevention of stone recurrence is of more importance. Diseases associated urolitiasi BPH stone formation. Gastrointestinal diseases i. Genetically determined stone formation. Drug-induced stone urolitiasi BPH see Table 4. Anatomical abnormalities associated with stone formation. Medullary sponge kidney tubular ectasia.
Urinary stones can be classified according to size, location, X-ray characteristics, aetiology of formation, composition, and risk of recurrence [ 10]. Stones can be classified according to anatomical position: upper, middle or lower calyx; renal pelvis; upper, middle or distal ureter; and urinary bladder.
Treatment of bladder stones is not discussed in these guidelines. Stones can be classified according to plain X-ray appearance [kidney-ureter-bladder KUB radiography] Table 3. Non-contrast-enhanced computed tomography NCCT can be used to classify stones according to density, inner structure and composition, which can affect treatment decisions Section 3. Stratification of stones according to aetiology, composition and risk of recurrence is addressed in Section 3. The most appropriate imaging urolitiasi BPH will be determined by the clinical situation, which will differ depending on if a ureteral or a renal stone is suspected.
Standard evaluation includes a detailed medical history and physical examination. Patients with ureteral stones usually present with loin pain, vomiting, and sometimes fever, but may also be asymptomatic [ 35 ]. Immediate evaluation is indicated in patients with solitary kidney, fever or when there is doubt regarding a diagnosis of renal colic. Ultrasound US should be used as the primary diagnostic imaging tool, although pain relief, or any other emergency measures, should not be delayed by imaging assessments.
Ultrasound is safe no risk of radiationreproducible and inexpensive. It can identify stones located in the urolitiasi BPH, pelvis, and pyeloureteric and vesico-ureteral junctions US with filled bladderas well as in patients with upper urinary tract UUT dilatation.
Kidney-ureter-bladder radiography should not be performed urolitiasi BPH NCCT is considered [ 39 ]. However, KUB is helpful in differentiating between radiolucent and radiopaque stones and should be used for comparison during follow-up. Non-contrast-enhanced computed tomography CT has urolitiasi BPH the standard for diagnosing urolitiasi BPH flank pain, and has replaced intravenous urography IVU.
Non-contrast-enhanced CT can determine stone diameter and density. When stones are absent, urolitiasi BPH cause of abdominal pain should be identified. Non-contrast-enhanced CT can detect uric acid and xanthine stones, which urolitiasi BPH radiolucent on plain films, but not indinavir stones [ 41 ].
Non-contrast-enhanced CT can determine stone density, inner structure of the stone, skin-to-stone distance and surrounding anatomy; all of which affect selection of treatment modality [ 34]. The advantage of non-contrast imaging must be balanced against loss of information on renal function and urinary collecting system anatomy, as well as higher radiation dose [ ].
Radiation risk urolitiasi BPH be reduced by low-dose CT, which may, however, be difficult to introduce in standard clinical practice [ ]. A MA of prospective studies [ 51 ] urolitiasi BPH shown that low-dose CT diagnosed urolithiasis with a pooled sensitivity of Dual-energy CT can differentiate uric acid containing stones from calcium-containing stones [ 53 ].
Intravenous urography can provide information about renal function, the anatomy of the collecting system and the level of an obstruction, urolitiasi BPH CT allows for rapid 3D data acquisition including information on stone size and density, skin-to-stone urolitiasi BPH and surrounding anatomy, but at the cost of increased radiation exposure.
Low-dose and ultra-low-dose protocols seem to yield comparable results as standard-dose protocols with the exception of detection of very small stones or stones in obese patients [ 515254 ]. A urolitiasi BPH randomised study showed that in supine percutaneous antegrade ureteroscopy PNLpre-operative planning using CT, compared to IVU, resulted in easier access and shorter operating times [ 55 ].
In case stone removal is planned and the renal collecting system needs to be assessed, a contrast urolitiasi BPH should be performed [ 56 ]. Non-contrast-enhanced CT is used to confirm stone diagnosis in patients with acute flank pain, as it is superior to IVU. Enhanced CT enables 3D reconstruction of the collecting system, as well as measurement of stone density and skin-to-stone distance. With fever or solitary kidney, and when diagnosis is doubtful, immediate imaging is indicated. Following initial ultrasound assessment, use non-contrast-enhanced computed tomography to confirm stone diagnosis in patients with acute flank pain.
Perform a contrast study if stone removal is planned and the anatomy of the renal collecting system needs to be assessed. Each emergency patient with urolithiasis needs a succinct biochemical work-up of urolitiasi BPH and blood besides imaging. At this point, no distinction is made between high- and low-risk patients for stone formation.
Biochemical work-up is similar for all stone patients.