URETERAL STONES CLINICAL GUIDELINES PANEL SUMMARY REPORT ON THE MANAGEMENT OF URETERAL CALCULI

Purpose: The American Urological Association convened the Ureteral Sto nes Clinical Guidelines Panel to analyze the literature regarding avai lable methods for treating ureteral calculi and to make practice polic y recommendations based on the treatment outcomes data. Materials and Methods: The panel searched the MEDLINE data base for all articles rel ated to ureteral calculi published from 1966 to January 1996, Outcomes data were extracted from articles accepted after panel review. The da ta were then meta-analyzed to produce outcome estimates for alternativ e treatments of ureteral calculi. Results: The data indicate that up t o 98% of stones less than 0.5 cm, in diameter, especially in the dista l ureter, will pass spontaneously. Shock wave lithotripsy is recommend ed as first line treatment for most patients with stones 1 cm. or less in the proximal ureter. Shock wave lithotripsy and ureteroscopy are a cceptable treatment choices for stones 1 cm, or less in the distal ure ter.Conclusions: Most ureteral stones will pass spontaneously. Those t hat do not can be removed by either shock wave lithotripsy or ureteros copy. Traditional blind basket extraction, without fluoroscopic contro l and guide wires, is not recommended. Open surgery is appropriate as a salvage procedure or in certain unusual circumstances.