Urgency classification | Indications | Important considerations | ||
---|---|---|---|---|
Emergency or Tier 0 | Organ-threatening or life-threatening | < 24 h | Obstructed infected kidney [11,12,13,14,15,16,17,18, 20] Obstructing stone in solitary kidney [12,13,14,15, 20] Obstructing stone associated with acute renal impairment [12,13,14,15, 20] | Offer temporarily drainage if infection and fever present Consider definitive treatment, except if staged treatment is expected |
High priority or Tier 1–3 | It is likely to cause clinical harm | < 2–8 weeks | Obstructing ureteric stone if failed MET (> 4 weeks), large to pass (> 8 mm) [13] or (> 10 mm) [20] Symptomatic stone on mediation [11, 13, 14, 16, 20] Extreme stent-related symptoms [13, 15, 20] Obstructing ureteral stone [11, 12, 14, 20] Obstructed staghorn stone [20] Recurrent UTI on non-obstructing renal stone [13] Stent exchange [11] | Weigh patient’s risk and surgery benefit before treatment Procedures with lower auxiliary retreatments are preferred, e.g., URS over SWL Stentless or stents with strings are encouraged If possible, insert stents and NPT under local anesthesia to spare a ventilator If possible, perform procedures as an outpatient or day surgery To reduce anesthesia time and complications, seniors should do surgery |
Low priority or Tier 1–3 | It may cause clinical harm, but it is unlikely | <12 weeks | Stone with well-tolerated stent or NPT [11,12,13,14, 16] Bladder stone with recurrent UTI or obstruction [14] Ureteral stent removal [17] | |
Postpone or Tier 4 | It is unlikely to cause clinical harm | >12 weeks | Asymptomatic renal stone [11,12,13,14,15] Non-obstructing renal stone [11,12,13,14,15] Non-urgent PCNL procedures [13] Normal renal function [12] No solitary kidney [12] Asymptomatic bladder stone [14] Ureteral stents and NPT exchange [14, 18] Ureteral stent removal [16] |