2022 Recommendations of the AFU Lithiasis Committee: Endoscopic description of renal papillae and stones
Prog Urol. 2023 Nov;33(14):766-781. doi: 10.1016/j.purol.2023.08.012.ABSTRACTEndoscopic observation is performed during treatments by flexible ureteroscopy to differentiate in situ between renal papillary abnormalities and stones based on their concordance with Daudon's morphological/composition descriptions adapted to endoscopy. These intraoperative visual analyses are now an integral part of the urinary stone disease diagnostic approach in addition to the morphological/structural and spectrophotometric analysis that remains the reference exam, but that loses information on the stone component representativeness due to th...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: C Almeras V Estrade P Meria lithiasis committee of the French Association of Urology (CLAFU) Source Type: research
2022 Recommendations of the AFU Lithiasis Committee: Diagnosis
Prog Urol. 2023 Nov;33(14):782-790. doi: 10.1016/j.purol.2023.08.014.ABSTRACTThe choice of imaging modality is guided by the clinical presentation and the context (acute or not). Although ultrasound is safe (no radiation) and easily available, non-contrast-enhanced CT has become the gold standard in the diagnostic strategy for patients with acute flank pain because of its sensitivity (93.1%) and specificity (96.6%). It also allows determining the stone size, volume and density, visualizing their internal structure, and assessing their distance from the skin and the adjacent anatomy. All these parameters can influence the s...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: P Leyendecker F-R Roustan P Meria C Almeras lithiasis committee of the French Association of Urology (CLAFU) Source Type: research
2022 Recommendations of the AFU Lithiasis Committee: Management of symptomatic urinary stones
Prog Urol. 2023 Nov;33(14):791-811. doi: 10.1016/j.purol.2023.08.018.ABSTRACTThe acute situation, caused by an obstructive stone, is defined by a renal colic that may be uncomplicated, complicated, or at risk in specific conditions. Its management may be medical or require interventional treatment by extracorporeal shockwave lithotripsy, endoscopic removal, or ureteroscopy. METHODOLOGY: These recommendations were developed using two methods, the Clinical Practice Recommendations (CPR) and the ADAPTE method, in function of whether the question was considered in the European Association of Urology (EAU) recommendations (http...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: P Meria G Raynal E Denis C Plassais P Cornet C Gil-Jardin é C Almeras Lithiasis Committee of the French Association of Urology (CLAFU) Source Type: research
2022 Recommendations of the AFU Lithiasis Committee: Extracorporeal shock wave lithotripsy (ESWL)
Prog Urol. 2023 Nov;33(14):812-824. doi: 10.1016/j.purol.2023.08.011.ABSTRACTExtracorporeal shock wave lithotripsy (ESWL) is a minimally invasive technique for the fragmentation of urinary tract stones using shock waves under fluoroscopic and/or ultrasound guidance. ESWL results depend on the indication (stone size/composition, clinical context) and also on how it is performed. The stone structure, nature and density (Hounsfield units; evaluated by CT without contrast agent) influence the fragmentation achieved by ESWL. The upper size limit of kidney stones has been lowered to 15mm (1.68cm3) due to the increased risk of st...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: C Almeras N Abid P Meria lithiasis committee of the French Association of Urology (CLAFU) Source Type: research
2022 Recommendations of the AFU Lithiasis Committee: Laser - utilization and settings
Prog Urol. 2023 Nov;33(14):825-842. doi: 10.1016/j.purol.2023.08.008.ABSTRACTEndocorporeal lithotripsy has progressed thanks to the development of lasers. Two laser sources are currently available: Holmium:YAG (Ho:YAG) and more recently Thulium Fiber Laser (TFL). The settings generally used are dusting, fragmentation, and "pop-corning". These are the first recommendations on laser use for stone management and their settings. Settings must be modulated and can be changed during the treatment according to the expected and obtained effects, the location and stone type that is treated. METHODOLOGY: These recommendations have b...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: F Panthier N Abid A Hoznek O Traxer P Meria C Almeras lithiasis committee of the French Association of Urology (CLAFU) Source Type: research
2022 Recommendations of the AFU Lithiasis Committee: Ureteroscopy and ureterorenoscopy
Prog Urol. 2023 Nov;33(14):843-853. doi: 10.1016/j.purol.2023.08.016.ABSTRACTTechnical advances, including miniaturization, have improved the deflection and optical performance of the ureteroscopes, and the availability of dedicated disposable devices have led to their increasing use for kidney and ureteral stone management. Ureterorenoscopy brings diagnostic evidence through the endoscopic description of stones and renal papillary abnormalities. Currently, intracorporeal lithotripsy during ureterorenoscopy is based on laser sources. Routine ureteral stenting is not necessary before ureterorenoscopy, especially because pre...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: G Raynal B Malval F Panthier F-R Roustan O Traxer P Meria C Almeras lithiasis committee of the French Association of Urology (CLAFU) Source Type: research
2022 Recommendations of the AFU Lithiasis Committee: Percutaneous nephrolithotomy
Prog Urol. 2023 Nov;33(14):854-863. doi: 10.1016/j.purol.2023.08.010.ABSTRACTPercutaneous nephrolithotomy (Labate et al.) is the standard procedure for the treatment of large (≥2cm) kidney stones. The patient can be in prone or modified supine position. The puncture is performed under fluoroscopy and/or ultrasound guidance. The stone-free rate seems to be comparable between miniaturized and standard PCNL. Procedures performed with smaller diameter instruments tend to be associated with significant lower blood loss, but longer procedure times. The limitation of the number of percutaneous tracts results in better preservat...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: N Abid P Conort Q Franquet F-R Roustan P Meria C Almeras Lithiasis Committee of the French Association of Urology (CLAFU) Source Type: research
2022 Recommendations of The AFU Lithiasis Committee: Open surgery and laparoscopy
Prog Urol. 2023 Nov;33(14):864-870. doi: 10.1016/j.purol.2023.08.007.ABSTRACTOnly few hundred interventions are performed in France each year to remove upper urinary tract stones using a laparoscopic/robotic transperitoneal or retroperitoneal approach. These interventions are proposed to patients with large (>20mm) and complex stones, sometimes after failure of endoscopic techniques or in the presence of malformations that can be treated at the same time. The major interest of these interventions is the possibility to remove the whole stone without prior fragmentation. Some anatomical situations can increase the technic...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: P Meria C Almeras Lithiasis Committee of the French Association of Urology (CLAFU) Source Type: research
2022 Recommendations of the AFU Lithiasis Committee: Combined approach for the management of kidney and ureteral stones (Endoscopic Combined IntraRenal Surgery, ECIRS)
Prog Urol. 2023 Nov;33(14):871-874. doi: 10.1016/j.purol.2023.08.009.ABSTRACTThe primary objective of the combined approach is to limit the number of percutaneous access tracts for the treatment of staghorn, or complex kidney stones by simultaneous percutaneous antegrade and retrograde ureteroscopy. The other indication is the simultaneous presence of several kidney and ureteral stones or of an impacted pelvic stone. The combination of the two techniques may increase the stone-free rate and decrease the retreatment rate of complex stones compared with percutaneous nephrolithotomy alone. The patient is usually in the modifi...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: V Estrade P Meria C Almeras Lithiasis Committee of the French Association of Urology (CLAFU) Source Type: research
2022 Recommendations of the AFU Lithiasis Committee: Specific cases - chronic kidney disease, bilateral stones, and solitary kidney
Prog Urol. 2023 Nov;33(14):875-882. doi: 10.1016/j.purol.2023.08.006.ABSTRACTChronic kidney disease, diabetes and hypertension are risk factors of kidney function impairment. The relative risk of kidney failure is 1.52 in patients with urinary stone disease. The various techniques used to remove upper urinary tract stones generally do not alter kidney function in patients with normal kidney function and may sometimes improve kidney function or slow its deterioration in patients with kidney disease. Compared to the asynchronous treatment of bilateral renal and ureteral stones, concomitant treatment is associated with higher...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: P Meria C Almeras Lithiasis Committee of the French Association of Urology (CLAFU) Source Type: research
2022 Recommendations of the AFU Lithiasis Committee: Radiation protection in the operating theater
Prog Urol. 2023 Nov;33(14):883-887. doi: 10.1016/j.purol.2023.08.002.ABSTRACTIt has been shown that the relative risk of cancer is higher in patients with urinary stone disease, probably due to the repeated radiological exams and procedures under fluoroscopic guidance. Reducing the radiation doses delivered to the patient also decreases the doses delivered to the operators and their assistants. The doses delivered during endoscopic procedures decrease with the urologist's experience. Training in radiation protection and the use of protocols can decrease the use of ionizing radiation in the operating room. METHODOLOGY: Thes...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: P Meria C Almeras lithiasis committee of the French Association of Urology (CLAFU) Source Type: research
2022 Recommendations of the AFU Lithiasis Committee: Postural therapy
Prog Urol. 2023 Nov;33(14):888-892. doi: 10.1016/j.purol.2023.08.003.ABSTRACTPostural therapy is a postural procedure to fight against the gravity phenomenon responsible for the non-elimination of lower calyceal stones. It allows improving or accelerating their expulsion and it increases the stone-free rate. This procedure associates forced diuresis, postural inversion, and lumbar percussion. It allows a 50% improvement and an acceleration of fragment elimination. Despite its positive impact, postural therapy remains under-used. These are the first practical recommendations on postural therapy. METHODOLOGY: These recommend...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: C Almeras P Meria lithiasis committee of the French Association of Urology (CLAFU) Source Type: research
2022 recommendations of the AFU Lithiasis Committee: Objectives, results, residual stones and fragments
Prog Urol. 2023 Nov;33(14):893-900. doi: 10.1016/j.purol.2023.08.005.ABSTRACTThe main objectives of interventional stone treatment are stone removal, symptom elimination, and kidney function preservation. After treatment of kidney stones (extracorporeal shock wave lithotripsy [ESWL], or endoscopy), fragments may remain in the kidney, either deliberately left in place or due to treatment failure (i.e. residual stone [RS], resistant to ESWL, left or inaccessible by endoscopy), or due to failure to eliminate the obtained fragments (i.e. residual fragments [RF]). Their management may differ. The most commonly used definition o...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: C Almeras G Raynal P Meria lithiasis committee of the French Association of Urology (CLAFU) Source Type: research
2022 Recommendations of the AFU Lithiasis Committee: Summary of indications
The objectives of stone surveillance are to detect the occurrence of a complication (e.g., fever, clinical tolerance) and to verify the potential stone migration/elimination. The use of urological procedures and the choice of technique are based on many different factors. Kidney stone surveillance is proposed mainly to people with low risk of progression or complications (size<4mm and/or lower calyx location and non-infection stone). Surveillance may be extended to patients with larger stones, in function of the clinical context and comorbidities. Conversely, a urological procedure may also be proposed to patients with ...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: C Almeras P Meria lithiasis committee of the French Association of Urology (CLAFU) Source Type: research
2022 Recommendations of the AFU Lithiasis Committee: Medical management - from diagnosis to treatment
Prog Urol. 2023 Nov;33(14):911-953. doi: 10.1016/j.purol.2023.08.004.ABSTRACTThe morphological-compositional analysis of urinary stones allows distinguishing schematically several situations: dietary, digestive, metabolic/hormonal, infectious and genetic problems. Blood and urine testing are recommended in the first instance to identify risk factors of urinary stone disease in order to avoid recurrence or progression. The other objective is to detect a potential underlying pathology associated with high risk of urinary stone disease (e.g. primary hyperparathyroidism, primary or enteric hyperoxaluria, cystinuria, distal ren...
Source: Progres en Urologie - November 2, 2023 Category: Urology & Nephrology Authors: S Lemoine P Dahan J P Haymann P Meria C Almeras Lithiasis Committee of the French Association of Urology (CLAFU) Source Type: research
