Position statement from BAUS and GIRFT

Provision of ureteroscopy and shock wave lithotripsy for ureteric stones

30 April 2025 (Last updated: 30 Apr 2025 15:03)

   

The recent inclusion of the AoRMC EBI guidance onto Model Hospital has led to some confusion and misinterpretation of the data. Some trusts have been informed by their local ICB that they should no longer carry out ureteroscopy for stone disease and instead that patients should be treated with shock wave lithotripsy (SWL). Units have been advised to seek ‘prior approval’ before ureteroscopy (URS), which may lead to delays (and potential harm) in patients having appropriate treatment.

Both the AoRMC EBI guidance and the relevant NICE guidance (NG118) set out clearly where shockwave treatment (SWL) is the preferred option for renal and ureteric stones (and equally where other surgical modalities are the preferred option). For stones 5-10mm in size, SWL should be offered as first line treatment if it can be offered in a timely fashion (unless contraindicated or the stone is not targetable due to its position or other patient factors). For ureteric stones 10-20mm, timely ureteroscopy (URS) should be offered, but SWL may be considered if local facilities allow stone clearance within 4 weeks.

Provider units should

(a) ensure appropriate access to SWL – either locally or through a network arrangement and

(b) appropriate protocols for ensuring NICE guidance is adhered to, including stone MDT provision to ratify treatment choices.

The uptake and outcome of SWL should be subject to regular local audit. Within these parameters, the GIRFT position is that continued utilisation of surgical options (URS) where indicated is in line with guidance and should not be subject to additional prior approval. ICBs are encouraged to ensure that timely SWL is available and commissioned through their local Urology Area Network.

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