Introduction: Urinary lithiasis involves a major source of morbidity and economic costs. The aim of this study was to evaluate the adherence to the European Association of Urology Guidelines on Urolithiasis with regard to treatment among Spanish urologists. Methods: A total of 723 patients were included in a prospective study between May 1, 2014, and July 31, 2014. The study involved 8 hospitals responsible of urolithiasis in a geographical area of Spain (Comunidad Valenciana) with approximately 4,500,000 inhabitants. Data were collected about the demographic characteristics of the patients, the characteristics of the stones, and the indicated treatment, in order to analyze the adherence to the clinical guidelines. A 90% threshold was used in concordance with the indications in the guidelines. Results: Adherence to guidelines was poor in chemolysis, distal and ureteral calculi, and >2 cm renal calculi. Adherence was high in <2 cm renal calculi. Conclusions: In our study, the overall adherence to the clinical guidelines regarding the therapeutic indication for urinary lithiasis has been low. In the case of both renal and ureteral stones, the adherence in small lithiasis has been greater, compared with larger ones. In our survey, a trend has been observed in favor of endoscopic procedures even in large lithiasis.

1.
Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010 Spring;12(2-3):e86–96.
2.
Pearle MS, Calhoun EA, Curhan GC; Urologic Diseases of America Project. Urologic diseases in America project: urolithiasis. J Urol. 2005 Mar;173(3):848–57.
3.
Trinchieri A. Epidemiological trends in urolithiasis: impact on our health care systems. Urol Res. 2006 Apr;34(2):151–6.
4.
Tenny S, Varacallo M. Evidence based medicine. EBM; 2018.
5.
Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993 Nov;342(8883):1317–22.
6.
Cacciamani G, Artibani W, Briganti A, N’Dow J. Adherence to the European Association of Urology Guidelines: a national survey among Italian Urologists. Urol Int. 2018;100(2):139–45.
7.
Rahnama’i MS, Vrijens D, Marcelissen T. The discrepancy between European Association of Urology (EAU) guidelines and daily practice in the evaluation of nocturia: results of a Dutch survey. Eur Urol Suppl. 2018;17(2):e344–5.
8.
Nestler T, Baunacke M, Dräger D, von Landenberg N, Groeben C, Huber J. Testicular cancer guideline adherence and patterns of care in Germany: a nationwide survey. Eur J Cancer Care (Engl). 2019 Jan;28(1):e12917.
9.
Hendricksen K, Aziz A, Bes P, Chun FK, Dobruch J, Kluth LA, et al.; Young Academic Urologists Urothelial Carcinoma Group of the European Association of Urology. Discrepancy between European Association of Urology Guidelines and daily practice in the management of non-muscle-invasive bladder cancer: results of a European Survey. Eur Urol Focus. 2017 Oct; pii:S2405-4569(17)30206-7.
10.
Türk C, Skolarikos A, Neisius A, Petřík A, Seitz C, Thomas K, et al. EAU Guidelines on Urolithiasis. Arnhem, The Netherlands: EAU Guidelines Office; 2018.
11.
García FG, Budia AA, Palmero JL, Morera J, Galán JA, Gil GJ, et al. E40 Estimated incidence of stone disease candidate for active treatment in Valencian Region: characteristics and epidemiology of the population, urolithiasis, and treatment indicated. Eur Urol Suppl. 2015;14(4):45.
12.
Jones P, Elmussareh M, Aboumarzouk OM, Mucksavage P, Somani BK. Role of minimally invasive (micro and ultra-mini) PCNL for adult urinary stone disease in the modern era: evidence from a systematic review. Curr Urol Rep. 2018 Mar;19(4):27.
13.
Gupta NP, Singh DV, Hemal AK, Mandal S. Infundibulopelvic anatomy and clearance of inferior caliceal calculi with shock wave lithotripsy. J Urol. 2000 Jan;163(1):24–7.
14.
Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol. 2016 Mar;69(3):475–82.
15.
Zheng C, Xiong B, Wang H, Luo J, Zhang C, Wei W, et al. Retrograde intrarenal surgery versus percutaneous nephrolithotomy for treatment of renal stones [{GT}]2 cm: a meta-analysis. Urol Int. 2014;93(4):417–24.
16.
Wolf JS Jr. Treatment selection and outcomes: ureteral calculi. Urol Clin North Am. 2007 Aug;34(3):421–30.
17.
Manikandan R, Mittal JK, Dorairajan LN, Mishra AK, Sreerag KS, Verma A. endoscopic combined intrarenal surgery for simultaneous renal and ureteral stones: a retrospective study. J Endourol. 2016 Oct;30(10):1056–61.
18.
Pickard R, Starr K, MacLennan G, Lam T, Thomas R, Burr J, et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet. 2015 Jul;386(9991):341–9.
19.
Seitz C, Liatsikos E, Porpiglia F, Tiselius HG, Zwergel U. Medical therapy to facilitate the passage of stones: what is the evidence? Eur Urol. 2009 Sep;56(3):455–71.
20.
Campschroer T, Zhu Y, Duijvesz D, Grobbee DE, Lock MT. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev. 2014 Apr;(4):CD008509.
21.
Campschroer T, Zhu X, Vernooij RW, Lock MT. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev. 2018 Apr;4:CD008509.
22.
Peschel R, Janetschek G, Bartsch G. Extracorporeal shock wave lithotripsy versus ureteroscopy for distal ureteral calculi: a prospective randomized study. J Urol. 1999 Dec;162(6):1909–12.
23.
Pearle MS, Nadler R, Bercowsky E, Chen C, Dunn M, Figenshau RS, et al. Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi. J Urol. 2001 Oct;166(4):1255–60.
24.
Ma Q, Fang L, Su R, Ma L, Xie G, Cheng Y. Uric acid stones, clinical manifestations and therapeutic considerations. Postgrad Med J. 2018 Aug;94(1114):458–62.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.