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Treat patients in pain sooner, says NICE on kidney stones

People suffering some forms of kidney stones should have greater access to non-invasive procedures to remove them, NICE has said in new draft guidance.

The procedure, shockwave lithotripsy (SWL), directs beams of soundwaves into the kidneys from outside the body without the need for traditional surgery. 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, the guideline says. 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.

“Offering shockwave lithotripsy is important for both a patient’s health and mental wellbeing”

Kidney stones are caused by waste products in the blood that form crystals that collect inside the organ. Over time, the crystals may build up to form a hard stone-like lump.
They can be caused by a lack of fluids, some types of medication, or if a medical condition raises the levels of certain substances in your urine.
It’s estimated that up to half of all people who have had kidney stones will experience them again within the following five years.

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

Another recommendation is 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.The recommendation has been made as renal function can decline quickly when stones are present.

Severe pain in the kidneys is usually investigated with ultrasound or plain abdominal radiograph but the committee concluded that while a CT scan is more expensive than either of these options, it is less likely patients will need additional investigations.

Andrew Dickinson, consultant urologist at Plymouth Hospitals NHS Trust and chair of the NICE committee, 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. There has been an increase in surgery for renal and ureteric stones. Waiting times for treatment are increasing and this means that patient satisfaction is likely to be lower. This is why offering shockwave lithotripsy is important for both a patient’s health and mental wellbeing.”

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.”


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Hannah Alderton
Hannah is an Account Executive at E4H.


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