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Treat patients with kidney stones in severe pain ‘sooner’, says NICE draft guidance

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Patients with some forms of kidney stones should have greater access to non-invasive procedures to remove them, according to new draft clinical guidance for England.

The draft guidance, which has been published for consultation by the National Institute for Health and Care Excellence, has recommended the greater use of shockwave lithotripsy (SWL).

“The use of shockwave lithotripsy is definitely a less traumatic experience for the patient”

Andrew Dickinson

The procedure directs beams of soundwaves into the kidneys from outside the body without the need for traditional surgery, noted NICE in its draft guidance.

The soundwaves destroy the stones so they can be passed more easily. The patient can often be seen as a day case, reducing theatre time and hospital stays.

Eligible people should be offered the procedure within 48-hours of medical assessment, said the draft guideline – titled Renal and ureteric stones: assessment and management.

More equipment may be needed for SWL, such as more responsive networks of mobile lithotripters, more fixed-site machines or better organised referral systems.

While this is likely to have an impact on NHS resources, there will be savings made by avoiding invasive operations, stated NICE.

The institute also recommended avoiding use of stents before SWL treatment, because it said it does not significantly improve outcomes and they should move directly to SWL if possible.

“These NICE guidelines will help both patients and clinicians make more informed decisions2

Mark Baker

Around three in 20 men and up to two in 20 women experience the condition at some stage in their lives, most often affecting people aged between 30 and 60, noted NICE.

Among its other recommendations was to offer a CT scan within 24 hours of initial medical assessment to people with severe abdominal pain, thought to be caused by renal stones.

It said this recommendation had been made because renal function could decline quickly when stones were present.

The draft guidance highlighted that severe pain in the kidneys – known as renal colic – was usually investigated with ultrasound or plain abdominal radiograph.

But NICE concluded that, while a CT scan was more expensive than either of these options, it was less likely patients will need additional investigations.

Andrew Dickinson, consultant urologist at Plymouth Hospitals NHS Trust and chair of the NICE committee that drew up the draft guidance, said: “The use of shockwave lithotripsy is definitely a less traumatic experience for the patient.

“There are fewer problems afterwards and it reduces the amount of time patients have to wait to have the issue resolved,” he said.

“There has been an increase in surgery for renal and ureteric stones,” he said. “Waiting times for treatment are increasing and this means that patient satisfaction is likely to be lower.

Mark Baker

Mark Baker

Mark Baker

“This is why offering shockwave lithotripsy is important for both a patient’s health and mental wellbeing,” he added.

Professor Mark Baker, director for the centre for guidelines at NICE, said: “The incidence of renal and ureteric stones and the rate of intervention are increasing.

“These NICE guidelines will help both patients and clinicians make more informed decisions about treatment options,” he said.

It is estimated that up to half of all people who have had kidney stones will experience them again within the following five years.

The consultation on the draft guideline is open until 29 August, with the final version due to be published on 12 December.

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