[New guidelines for urinary stone treatment. Controversy or development?].

Area of Science:

• Urology
• Evidence-based medicine
• Medical guidelines

Context:

• New European (EAU), American (AUA), German, and Austrian urology guidelines have been released.
• These guidelines are based on comprehensive literature analysis and meta-analyses, particularly for ureteral stones (Level 1A evidence).
• Methodologies for guideline development are diverse, with a trend towards international cooperation and clearer evidence evaluation.

Purpose:

• To present the latest evidence-based recommendations for managing urinary stones.
• To highlight new aspects and shifts in treatment paradigms, including medication-based therapies and surgical interventions.
• To integrate advancements in electronic data processing and medical instrumentation into clinical practice.

Summary:

• The updated guidelines feature enhanced clarity in statement evaluation and evidence levels.
• Key updates include medication use for spontaneous stone passage, revised roles for extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopy, and the integration of retrograde intrarenal surgery and laparoscopy.
• Metaphylaxis in diagnosis and therapy is given increased importance.

Impact:

• These guidelines reflect the rapid evolution of medical technology and data processing in urology.
• They provide clinicians with updated, evidence-based approaches to urinary stone management.
• The guidelines aim to optimize treatment strategies, considering both established and emerging procedures like ESWL and advanced endoscopic techniques.