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1.Clinicians should obtain a non-contrast CT scan on patients prior to performing PCNL. Strong Recommendation; Evidence Level Grade C 1. 临床医师应在PCNL前对患者进行非增强CT扫描。（强烈推荐，证据水平C级） 2. Clinicians may obtain a non-contrast CT scan to help select the best candidate for SWL versus URS. Conditional Recommendation; Evidence Level Grade C 2. 临床医生可以进行非增强CT扫描，以帮助选择URS、SWL的最佳候选者。（有条件推荐，证据水平C级） 3. Clinicians may obtain a functional imaging study (DTPA or MAG‐3) if clinically significant loss of renal function in the involved kidney or kidneys is suspected. Conditional Recommendation; Evidence Level Grade C 3. 如果怀疑分肾或双肾有明显的功能丧失，临床医师可进行肾功能显像。（DTPA或MAG-3）（有条件推荐，证据水平C级） 4. Clinicians are required to obtain a urinalysis prior to intervention. In patients with clinical or laboratory signs of infection, urine culture should be obtained. Strong Recommendation; Evidence Level Grade B 4. 临床干预之前需要查尿常规。对于有临床或实验室感染迹象的患者，应该做尿培养。（强烈推荐，证据水平B级） 5. Clinicians should obtain a CBC and platelet count on patients undergoing procedures where there is a significant risk of hemorrhage or for patients with symptoms suggesting anemia, thrombocytopenia, or infection; serum electrolytes and creatinine should be obtained if there is suspicion of reduced renal function. Expert Opinion 5. 临床医师应对有显著出血风险或贫血症状的患者检查血细胞及血小板计数。如果怀疑肾功能减退，应进行血清电解质和肌酐检测。（专家意见） 6. In patients with complex stones or anatomy, clinicians may obtain additional contrast imaging if further definition of the collecting system and the ureteral anatomy is needed. Conditional Recommendation; Evidence Level Grade C 6. 对于结石或者解剖结构较复杂的患者，如果需要更清晰地显示集合系统和输尿管，可额外进行对比成像。（有条件推荐，证据水平C级） Treatment of adult patients with ureteral stones: 成年输尿管结石患者的治疗 7. Patients with uncomplicated ureteral stones <10 mm should be offered observation, and those with distal stones of similar size should be offered MET with α-blockers. (Index Patient 3) Strong Recommendation; Evidence Level Grade B 7. 单纯输尿管结石≤10mm应该给予观察治疗，而同样大小的输尿管末端结石应该给予α-受体阻滞剂药物排石治疗。（索引患者3）（强烈推荐，证据水平B级） 8. Clinicians should offer reimaging to patients prior to surgery if passage of stones is suspected or if stone movement will change management. Reimaging should focus on the region of interest and limit radiation exposure to uninvolved regions. Clinical Principle 8. 如果对结石的路径有疑惑或者结石的移动会改变治疗方案，需要重新做影像学检查。重新成像应侧重感兴趣的区域，减少未涉及区域的辐射照射。（临床原则） 9. In most patients, if observation with or without MET is not successful after four to six weeks and/or the patient/clinician decide to intervene sooner based on a shared decision making approach, clinicians should offer definitive stone treatment. (Index Patients 1-3) Moderate Recommendation; Evidence Level Grade C 9. 对于大多数患者，不管是否行药物排石治疗，观察4-6周后结石未排出，或者医生跟患者一致决定尽快采取干预措施，医生需提供明确的结石治疗。（索引患者1-3）（中度推荐，证据水平C级） 10. Clinicians should inform patients that SWL is the procedure with the least morbidity and lowest complication rate, but URS has a greater stone-free rate in a single procedure. (Index Patients 1-6) Strong Recommendation; Evidence Level Grade B 10. 医生应告知患者SWL是发病率最低且并发症发生率更低的手术，但是URS单次术后无石率更高。（索引患者1-6）（强烈推荐，证据水平B级） 11. In patients with mid or distal ureteral stones who require intervention (who were not candidates for or who failed MET), clinicians should recommend URS as first-line therapy. For patients who decline URS, clinicians should offer SWL. (Index Patients 2,3,5,6) Strong Recommendation; Evidence Level Grade B 11. 输尿管中、末段结石需要介入治疗的患者（不适合药物排石或者药物排石治疗失败者），医生应该推荐URS作为一线治疗方式。对于拒绝做URS的患者，临床医师应提供SWL。（索引患者2、3、5、6）（强烈推荐，证据水平B级） 12. URS is recommended for patients with suspected cystine or uric acid ureteral stones who fail MET or desire intervention. Expert Opinion 12. 对于疑似胱氨酸或尿酸输尿管结石，行药物排石治疗失败或者需要干预治疗的患者应推荐URS。（专家意见） 13. Routine stenting should not be performed in patients undergoing SWL. (Index Patients 1-6) Strong Recommendation; Evidence Level Grade B 13. 行SWL治疗的患者不应进行常规支架植入术。（索引患者1-6）（强烈推荐，证据水平B级） 14. Following URS, clinicians may omit ureteral stenting in patients meeting all of the following criteria: those without suspected ureteric injury during URS, those without evidence of ureteral stricture or other anatomical impediments to stone fragment clearance, those with a normal contralateral kidney, those without renal functional impairment, and those in whom a secondary URS procedure is not planned. (Index Patients 1-6) Strong Recommendation; Evidence Level Grade A 14. 行URS的患者如果有以下几种情况可省略常规支架植入术：URS期间没有可疑的输尿管损伤；没有输尿管狭窄或者影响结石碎片排出的解剖因素；对侧肾正常；无肾功能损伤；没有二次URS计划的患者。（索引患者1-6）（强烈推荐，证据水平A级） 15. Placement of a ureteral stent prior to URS should not be performed routinely. (Index Patient 1-6) Strong Recommendation; Evidence Level Grade B 15. 行URS之前不应常规放置双J管。（索引患者1-6）（强烈推荐，证据水平B级） 16. Clinicians may offer α-blockers and antimuscarinic therapy to reduce stent discomfort. (Index patients 1-6) Moderate Recommendation; Evidence Level Grade B 16. 医生可以给予α受体阻滞剂或者抗胆碱能药物来缓解双J管引起的不适感。（索引患者1-6）（中度推荐，证据水平B级） 17. In patients who fail or are unlikely to have successful results with SWL and/or URS, clinicians may offer PCNL, laparoscopic, open, or robotic assisted stone removal. (Index patient 1-6) Moderate Recommendation; Evidence Level Grade C 17. 对于行SWL或URS治疗失败或者不太可能取得成功的患者，医生可推荐行PCNL、腹腔镜、开放式或机器人辅助取石术。（索引患者1-6）（中度推荐，证据水平C级） 18. Clinicians performing URS for proximal ureteral stones should have a flexible ureteroscope available. (Index Patients 1, 4) Clinical Principle 18. 对于近端输尿管结石行URS，临床医师应准备输尿管软镜。（索引患者1、4）（临床原则） 19. Clinicians should not utilize EHL as the first-line modality for intra-ureteral lithotripsy. (Index patients 1-6,13,15) Expert Opinion 19. 临床医师不应将液电碎石作为输尿管内碎石术的一线方式。（索引患者1-6、13、15）（专家意见） 20. In patients with obstructing stones and suspected infection, clinicians must urgently drain the collecting system with a stent or nephrostomy tube and delay stone treatment. Strong Recommendation; Evidence Level Grade C 20. 对于梗阻性结石或者疑似感染的患者，医生必须用支架或肾造瘘管紧急引流收集系统，并延迟治疗。（强烈推荐，证据水平C级） Treatment of adult patients with renal stones 成年人肾结石治疗 21. In symptomatic patients with a total non-lower pole renal stone burden ≤ 20 mm, clinicians may offer SWL or URS. (Index Patient 7) Strong Recommendation; Evidence Level Grade B 21. 对于有症状的非下极肾结石患者，结石负荷≤20mm，医生可提供SWL或者URS。（索引患者7）（强烈推荐，证据水平B级） 22. In symptomatic patients with a total renal stone burden >20 mm, clinicians should offer PCNL as first -line therapy. (Index Patient 8) Strong Recommendation; Evidence Level Grade C 22. 对于有症状患者，结石总负荷＞20mm，医生应该将PCNL作为一线治疗方案。（索引患者8）（强烈推荐，证据水平C级） 25. In patients with total renal stone burden >20 mm, clinicians should not offer SWL as first-line therapy. (Index Patient 8) Moderate Recommendation; Evidence Level Grade C 25. 对于肾结石总负荷＞20mm的患者，医生不应该将SWL作为一线治疗方案。（索引患者8）（中度推荐，证据水平C级） 27. Clinicians may perform nephrectomy when the involved kidney has negligible function in patients requiring treatment. (Index Patients 1-14) Conditional Recommendation; Evidence Level Grade C 27. 当需要治疗的患者肾功能忽略不计时，临床医师可施行肾切除术。（索引患者1-14）（有条件推荐，证据水平C级） 28. For patients with symptomatic (flank pain), non-obstructing, caliceal stones without another obvious etiology for pain, clinicians may offer stone treatment. (Index Patient 12) Moderate Recommendation; Evidence Level Grade C 28. 对于有症状（腰痛）、非梗阻性钙盐结石患者，无其他明显的疼痛病因，医生可提供排石治疗。（索引患者12）（有条件推荐，证据水平C级） 29. For patients with asymptomatic, non-obstructing caliceal stones, clinicians may offer active surveillance. Conditional Recommendation; Evidence Level Grade C 29. 对于无症状、非梗阻性钙盐结石患者，医生可提供主动监测。（有条件推荐，证据水平C级） 30. Clinicians should offer SWL or URS to patients with symptomatic ≤ 10 mm lower pole renal stones. (Index Patient 9) Strong Recommendation; Evidence Level Grade B 30. 临床医师应对有症状且直径≤10mm的肾下极结石患者提供SWL或者URS。（索引患者9）（强烈推荐，证据水平B级） 31. Clinicians should not offer SWL as first-line therapy to patients with >10mm lower pole stones. (Index Patient 10) Strong Recommendation; Evidence Level Grade B 31. 对于直径＞10mm的肾下极结石患者，医生不应将SWL作为一线治疗方式。（索引患者10）（强烈推荐，证据水平B级） 32. Clinicians should inform patients with lower pole stones >10 mm in size that PCNL has a higher stone -free rate but greater morbidity. (Index patient 10). Strong Recommendation; Evidence Level Grade B 32. 对于直径＞10mm的肾下极结石患者，医生应该告知PCNL具有较高的无石率但并发症发生率更高。（索引患者10）（强烈推荐，证据水平B级） 33. In patients undergoing uncomplicated PCNL who are presumed stone-free, placement of a nephrostomy tube is optional. Conditional Recommendation; Evidence Level Grade C 33. 对于行非复杂PCNL且预期结石清除干净的患者，可选择留置肾造瘘管。（有条件推荐，证据水平C级） 34. Flexible nephroscopy should be a routine part of standard PCNL. Strong Recommendation; Evidence Level Grade B 34. 软性肾镜检查应该作为标准PCNL的常规部分。（强烈推荐，证据水平B级） 35. Clinicians must use normal saline irrigation for PCNL and URS. Strong Recommendation; Evidence Level Grade B 35. PCNL和URS中，临床医师必须用普通生理盐水灌注。（强烈推荐，证据水平B级） 39. In patients not considered candidates for PCNL, clinicians may offer staged URS. Moderate Recommendation; Evidence Level Grade C 39. 对于不适合做PCNL的患者，临床医师可给予分期URS。（中度推荐，证据水平C级） 40. Clinicians may prescribe α-blockers to facilitate passage of stone fragments following SWL. Moderate Recommendation; Evidence Level Grade B 40. 医生可以给SWL术后的患者开α受体阻滞剂以促进结石碎片顺畅排出。（中度推荐，证据水平B级） 43. SWL should not be used in the patient with anatomic or functional obstruction of the collecting system or ureter distal to the stone. Strong Recommendation; Evidence Level Grade C 43. 对于集合系统或者输尿管远端有解剖性或功能性梗阻的患者，不应使用SWL。（强烈推荐，证据水平C级） 44. In patients with symptomatic caliceal diverticular stones, endoscopic therapy (URS, PCNL, laparoscopic, robotic) should be preferentially utilized. Strong Recommendation; Evidence Level Grade C 44. 对有症状的憩室内钙盐结石患者，应优先使用内镜治疗（URS、PCNL、腹腔镜、机器人）。（强烈推荐，证据水平C级） 45. Staghorn stones should be removed if attendant comorbidities do not preclude treatment. Clinical Principle 45. 如果伴随并发症不影响治疗，应该清除鹿角形结石。（临床原则） Treatment for pediatric patients with ureteral or renal stones 儿童输尿管或肾结石的治疗 46. In pediatric patients with uncomplicated ureteral stones ≤10 mm, clinicians should offer observation with or without MET using α-blockers. (Index Patient 13) Moderate Recommendation; Evidence Level Grade B 46. 对于直径≤10mm非复杂性输尿管结石的患儿，医生应该给予观察，用或不用α受体阻滞剂行药物排石治疗。（索引患者13）（中度推荐，证据水平B级） 47. Clinicians should offer URS or SWL for pediatric patients with ureteral stones who are unlikely to pass the stones or who failed observation and/or MET, based on patient-specific anatomy and body habitus. (Index Patient 13) Strong Recommendation; Evidence Level Grade B 47.因患者解剖异常或者体质问题导致结石不能排出或者观察及药物排石治疗失败，医生应给予URS或者SWL。（索引患者13）（强烈推荐，证据水平B级） 48. Clinicians should obtain a low-dose CT scan on pediatric patients prior to performing PCNL. (Index Patient 13) Strong Recommendation; Evidence Level Grade C 48. 儿童患者行PCNL之前应行低辐射量CT扫描。（索引患者13）（强烈推荐，证据水平C级） 49. In pediatric patients with ureteral stones, clinicians should not routinely place a stent prior to URS. (Index Patient 13) Expert Opinion 49. 儿童输尿管结石患者，不应在行URS前常规放置双J管。（索引患者13）（专家意见） 50. In pediatric patients with a total renal stone burden ≤20mm, clinicians may offer SWL or URS as first -line therapy. (Index Patient 14) Moderate Recommendation; Evidence Level Grade C 50. 对于儿童患者肾结石负荷≤20mm，医生应将URS或SWL作为一线治疗方式。（索引患者14）（中度推荐，证据水平C级） 51. In pediatric patients with a total renal stone burden >20mm, both PCNL and SWL are acceptable treatment options. If SWL is utilized, clinicians should place an internalized ureteral stent or nephrostomy tube. (Index Patient 14) Expert Opinion 51. 对于儿童患者肾结石负荷＞20mm，PCNL和SWL都是可行的治疗方式。如果行SWL，医生需要给患者放置输尿管内支架或者肾盂造瘘管。（索引患者14）（专家意见） 52. In pediatric patients, except in cases of coexisting anatomic abnormalities, clinicians should not routinely perform open/laparoscopic/robotic surgery for upper tract stones. (Index Patients 13, 14) Expert Opinion 52. 对于儿童上尿路结石患者，除非有共存的解剖异常，否则医生不可常规使用开放、腹腔镜、机器人手术取石。（索引患者13、14）（专家意见） 53. In pediatric patients with asymptomatic and non-obstructing renal stones, clinicians may utilize active surveillance with periodic ultrasonography. (Index Patient 14) Expert Opinion 53. 对于没有症状以及非梗阻性结石的儿童患者，医生可以积极观察，定期行超声检查。（专家意见） Treatment for pregnant patients with ureteral or renal stones 妊娠期输尿管结石或肾结石患者的治疗 54. In pregnant patients, clinicians should coordinate pharmacological and surgical intervention with the obstetrician. (Index Patient 15) Clinical Principal 54. 对于妊娠期患者，泌尿外科医生需要同产科医生协商药物和手术治疗。（临床原则） 55. In pregnant patients with ureteral stones and well controlled symptoms, clinicians should offer observation as first-line therapy. (Index Patient 15) Strong recommendation; Evidence Level Grade B 55. 妊娠期输尿管结石患者，如果症状得到良好的控制，医生应首选观察等待。（索引患者15）（强烈推荐，证据水平B级） 56. In pregnant patients with ureteral stones, clinicians may offer URS to patients who fail observation. Ureteral stent and nephrostomy tube are alternative options with frequent stent or tube changes usually being necessary. (Index Patient 15) Strong Recommendation; Evidence Level Grade C 56.对于妊娠期输尿管结石患者，如果观察等待治疗失败，医生可给予URS。输尿管支架和肾盂造瘘管也是备选的治疗方案，且需经常更换管道。（索引患者15）（强烈推荐，证据水平C级） Treatment for all patients with ureteral or renal stones 所有肾结石或输尿管结石患者的治疗 23. When residual fragments are present, clinicians should offer patients endoscopic procedures to render the patients stone free, especially if infection stones are suspected. (Index Patient 11) Moderate Recommendation; Evidence Level Grade C 23. 当有结石碎片存在时，医生需要给予内镜治疗使碎片排出，尤其是怀疑感染性结石。（索引患者11）（中度推荐，证据水平C级） 24. Stone material should be sent for analysis. Clinical Principle 24. 结石标本需要送检做结石分析。（临床原则） 26. Open/ laparoscopic /robotic surgery should not be offered as first-line therapy to most patients with stones. Exceptions include rare cases of anatomic abnormalities, with large or complex stones, or those requiring concomitant reconstruction. (Index Patients 1-15) Strong Recommendation; Evidence Level Grade C 26. 对于大部分结石患者不应将开放、腹腔镜、机器人手术作为一线治疗方式。除非是有解剖异常、巨大或者复杂结石以及需要尿路重建的患者。（索引患者1-15）（强烈推荐，证据水平C级） 36. A safety guide wire should be used for most endoscopic procedures. (Index Patients 1-15) Expert Opinion 36. 在大多数的内镜操作中，一个安全的导丝是必须的。（索引患者1-15）（专家意见） 37. Antimicrobial prophylaxis should be administered prior to stone intervention and is based primarily on prior urine culture results, the local antibiogram, and in consultation with the current Best Practice Policy Statement on Antibiotic Prophylaxis. Clinical Principle 37. 结石治疗之前需要预防性使用抗生素，基于之前的尿培养结果、当地抗菌谱并参照当前抗生素预防使用的最佳实践政策声明。（临床原则） 38. Clinicians should abort stone removal procedures, establish appropriate drainage, continue antibiotic therapy, and obtain a urine culture if purulent urine is encountered during endoscopic intervention. (Index Patients1-15) Strong Recommendation; Evidence Level Grade C 38. 如果内镜操作中发现脓尿，医生需立即停止碎石操作，通畅引流，继续抗生素治疗以及行尿培养。（索引患者1-15）（强烈推荐，证据水平C级） 41. If initial SWL fails, clinicians should offer endoscopic therapy as the next treatment option. (Index Patient 1-14) Moderate Recommendation; Evidence Level Grade C 41. 如果初次SWL失败，医生应该将内镜治疗作为下一步治疗方案的选择。（索引患者1-14）（中度推荐，证据水平C级） 42. Clinicians should use URS as first-line therapy in most patients who require stone intervention in the setting of uncorrected bleeding diatheses or who require continuous anticoagulation/antiplatelet therapy. (Index Patients1-15) Strong Recommendation; Evidence Level Grade C 42. 对于大部分患有未纠正的出血性疾病或者需要长期抗凝/抗血小板治疗的结石患者，如果其需要手术治疗，应将URS作为一线治疗方案。（索引患者1-15）（强烈推荐，证据水平C级） |
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