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At least one in 5 referrals to Urology is for suspected renal stones.
Referrals for suspected stones are increasing.
With the correct imaging, many of these patients do not have stones and are discharged back to primary care.
The majority of renal stones of 4mm or less do not need further treatment, but should be referred via pre-choice triage for an opinion and may not require a face-to-face appointment.
Most patients with a stone have at least a trace of blood in their urine but up to 10% of patients with a stone may not.
If an USS suggests stones a low dose non contrast CT KUB (also known as non contrast CT Abdo and pelvis -CABPE) will then be required (unless pregnant).
(If an outside provider has reported the USS please attach report to the low dose non contrast CT KUB request).
A negative USS does not exclude stones.
NB: Please attach radiology results as part of the referral as it cannot be guaranteed that the triaging consultant will be able to access the results.
Acute presentation with significant pain can be referred to emergency department or surgical assessment ward for timely confirmation of diagnosis (with low dose non contrast CT KUB), pain control and appropriate management.
Cases presenting less acutely with adequate analgesia in the community should be imaged and managed as per this guidance.
In order to ensure optimal secondary care treatment referrals sent without the following information may be returned
Painless visible haematuria – see 2ww guidance
GP should work through a recommended scheme of assessment for suspected kidney stones.
This may include one or all of the following:
Acute presentation with significant pain can be referred to emergency department or surgical assessment ward
Pain relief with NSAIDs; where safe to use, and consider timely follow up with urgent imaging.
If pain not well managed consider acute referral.
The majority of renal stones of 4mm or less do not need further treatment, but should be referred via pre-choice triage for an opinion and may not require a face-to-face appointment.
The majority of ureteric stones less than 4mm will pass spontaneously though this may take up to 6 weeks. If symptoms persist they should be referred.
Ureteric stones greater than 7mm will almost always need intervention.
It is also worth noting that stones within the renal calyces do not cause pain so alternative diagnoses may need to be considered.
Pre-choice triage will assess the clinical information including the site and size of the stone which will then determine whether the patient needs to be seen for a face-to-face appointment.
NB Please attach radiology results as part of the referral as it cannot be guaranteed that the triaging consultant will be able to access the results.
Referrals sent without the following information may be returned
This guideline has been signed off on behalf of NHS Devon.
Publication date: March 2018