Management of stone disease

Abstract Urolithiasis is common, with a lifetime prevalence risk of around 10% in the adult population. It is estimated to affect men more commonly with a male/female ratio of 3:1. Multiple factors influence stone formation and these may be intrinsic to the patient, as a result of environmental factors or be a consequence of other pathological processes. Renal colic accounts for up to 1% of all hospital admissions and should be considered in any patient presenting to the surgical team with loin/groin pain. The relevant investigations with regards to blood, urine and imaging tests to diagnose stone disease are discussed. In addition, the absolute indications for urgent intervention are reviewed. Treatment for ureteric stones and renal calculi includes a wide armamentarium of endourological techniques including extracorporeal shock wave lithotripsy (ESWL), ureteroscopy and percutaneous nephrolithotomy (PCNL), if conservative therapy fails. Therapy is guided by anatomical factors, stone factors, previous treatment failures as well as the patient's wishes. Indications, contraindications and complications of the common procedures are discussed.