2019年亚洲泌尿协会尿路结石诊治指南2019年4月，亚洲泌尿协会（UAA）发布了泌尿系结石指南，指南的主要目的是针对泌尿系结石的诊断和治疗达成一致的专家共识，主要内容涉及泌尿系结石的病因学、诊断、代谢评估、药物治疗、手术治疗以及预防复发等。
为帮助大家临床工作，现将指南重要部分翻译整理如下。
因中英文语言环境不同，翻译难免有所疏忽，附上英文原文，以供参考！该指南意见根据牛津循证医学证据等级分级，其中GR表示推荐级别（A-D，推荐强度由高至低），LE表示证据水平（1-5，证据强度由高至低）。
尿路结石的诊断Urine routine and microscopic investigations (red blood and white blood cellcounts, nitrites, urinary pH and culture, and sensitivity tests (LE:3, GR:B).Blood samples for total and differential counts, serum urea, creatinine, Na andK are investigated in first-time stone-former patients (LE:3, GR:B). If thepatient is a recurrent stone former, then stone analysis, serum (ionized)calcium, phosphorus, uric acid, magnesium, as well asurinary calcium,phosphate, uric acid, magnesium, citrates and cystine levels are investigatedat least once (LE:3, GR:B).实验室诊断方法尿常规和显微镜检查（红细胞和白细胞计数、亚硝酸盐、尿液pH值和尿培养以及敏感性试验）。
对首发结石患者进行血液样本总体和差异计数、血清尿素、肌酐、钠和钾检查。
如果患者是复发性结石，则对结石成分、血清（离子）钙、磷、尿酸、镁以及尿钙、磷酸盐、尿酸、镁、柠檬酸和胱氨酸水平至少进行一次分析（LE：3，GR：B）。
Plainradiography is not sensitive and specific enough for the diagnosis of stone(LE:4, GR:B). US is the recommended choice of diagnosis for most renal stonesand ureteric stones, particularly in children (LE:4, GR:B). NCCThas the best sensitivity and specificity for the detection of renal stones, andwould be superior to US, in particular for ureteric stones. However, risks ofradiation exposure should be considered (LE:4, GR:B). If possible, a low-doseNCCT protocol should be used for patients with BMI <30 kg/m2, to minimizeradiation risk to patients (LE:4, GR:B).影像学诊断方法平片对结石的诊断不够灵敏和特异。
超声检查是大多数肾结石和输尿管结石诊断的推荐选择，尤其在儿童中。
计算机断层扫描（CT）检测肾结石敏感性和特异性最强，并且优于超声，尤其在输尿管结石人群中。
但是，应考虑辐射暴露的风险。
BMI指数<30 kg/m2的患者应尽可能采用低剂量CT方案，以尽量减少辐射风险（LE：4，GR：B）。
In pregnant women, use US as a first-line imagingmodality and MRI as a second-line approach (LE:2, GR:B). In pregnant women,reserve low-dose CT as a last-line option (LE:2, GR:B). In children, US is afirst-line imaging modality, and lowdose CT is an alternative option if UScannot exclude urinary calculi (LE:2, GR:B).儿童和孕妇在孕妇中，超声可作为一线成像方式，MRI可作为二线成像方式，低剂量CT应保留作为最后一种选择。
在儿童中，超声是一线成像方式，如果超声不能排除尿路结石，可选择低剂量CT（LE：2，GR：B）。
泌尿系结石治疗方法What is an algorithm for treatment of adult patients with ureteral stones? Expectantmanagement or MET might be considered for non-obstructing ureteral stoneswithout complications (LE:1,GR:B). Once the surgery is indicated, URS or SWLare acceptable (LE:2, GR:B).成人输尿管结石的治疗对于没有并发症的非阻塞性输尿管结石，可考虑采用期待治疗或药物治疗（LE：1，GR：B）。
一旦有手术指征，可采用输尿管镜下碎石或冲击波碎石（LE：2，GR：B）。
In pregnant patients with uncomplicated urinary stones, offerconservative management as a first-line therapy (LE:4, GR:B). URS has emergedas a preferred treatment for pregnant patients who failed conservativemanagement (LE:2, GR:B). Placement of a ureteral stent or a percutaneousnephrostomy tube is an alternative option, with frequent stent or tube changesusually being necessary (LE:2, GR:C).儿童和孕妇对于非复杂性泌尿结石的孕妇，保守治疗可作为一线治疗（LE：4，GR：B）。
输尿管镜下碎石可作为经保守治疗失败孕妇的首选治疗方法（LE：2，GR：B）。
放置输尿管支架或经皮肾造瘘管是另一选择，通常需要频繁更换支架或管道（LE：2，GR：C）。
The first step in considering surgical intervention for renal stones is to con firmany anatomical abnormalities. (1) Horseshoe kidneys with calyceal diverticulausually have narrow and long infundibula, making SWL ineffecive; therefore,either RIRS or PCNL should be considered, depending on the stone burden. Inaddition, miniaturized PCNL and ECIRS could be an option, depending onanatomical features. (2) A concomitant ureteral stone is more appropriatelymanaged with a retrograde approach, using RIRS or ECIRS. Antegrade lithotripsywith mini or standard-PCNL is also appropriate for a stone >20 mm. (3) Largelower pole stones measuring <20 mm should be treated with RIRS or miniaturized PCNL, and lower pole stones >20 mm should be treated with standard PCNLor ECIRS. SWL is less effective due to potential postprocedure complica tionsand limited evidence for efficacy. (4) Small, simple renal stones are treatablewith SWL, RIRS or miniaturized PCNL. Stones >20 mm should be treated usingstandard PCNL or ECIRS. *There are somelimitations/exceptions regarding theanatomical difficulties in approaching the stone with a flexible uretero scope.**Cases predominantly having lower caliceal stones >10 mm.图1 症状肾结石患者的治疗流程图症状性肾结石患者治疗流程考虑手术治疗肾结石的第一步是确认是否存在解剖异常。
（1）伴有肾盏憩室的马蹄肾通常漏斗部狭窄、较长，使得SWL（冲击波碎石）无效；因此，应根据结石质量考虑行RIRS（输尿管软镜取石术）或PCNL（经皮肾取石术）。
此外，根据解剖特征，微型PCNL和ECIRS（内镜联合肾内手术）也是一种选择。
（2）采用RIRS或ECIRS，通过逆行方法可以更好地管理伴随的输尿管结石。