Guidelines

Urolithiasis

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1. INTRODUCTION

1.1. Aims and scope

The European Association of Urology (EAU) Urolithiasis Guidelines Panel has prepared these guidelines to help urologists assess evidence-based management of stones/calculi in the urinary tract and incorporate recommendations into clinical practice. This document covers most aspects of the disease, which is still a cause of significant morbidity despite technological and scientific advances. The Panel is aware of the geographical variations in healthcare provision. In addition, information on the management of bladder stones is also included in these Guidelines.

It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients but rather help to focus decisions – also taking personal values and preferences/individual circumstances of patients into account. Guidelines are not mandates and do not purport to be a legal standard of care.

1.2. Panel composition

The EAU Urolithiasis Guidelines Panel consists of an international group of clinicians with expertise in this area. All experts involved in the production of this document have submitted potential conflicts of interest, which can be viewed on the EAU website Uroweb: http://uroweb.org/guideline/urolithiasis/.

1.3. Available publications

A quick reference document (Pocket Guidelines) is available in print. This is an abridged version which may require consultation together with the full text version. Several scientific publications are available [1-3], as are a number of translations of all versions of the EAU Urolithiasis Guidelines. All documents are accessible through the EAU website Uroweb: http://www.uroweb.org/guideline/urolithiasis/.

An EAU Guidelines App for iOS and Android devices is also available, containing the Pocket Guidelines, interactive algorithms and calculators, clinical decision support tools, guidelines cheat sheets, and links to extended guidelines.

1.4. Publication history and summary of changes

1.4.1. Publication history

The EAU Guidelines on Urolithiasis were first published in 2000. Standard procedure for EAU Guidelines includes an annual assessment of newly published literature in the field to guide future updates. These 2026 Urolithiasis Guidelines present a full update of the 2025 publication and have gone through a peer review process prior to publication. The Urolithiasis Guidelines will be updated in full for 2028. 

1.4.2. Summary of changes

For the 2026 Urolithiasis Guidelines, new and relevant evidence was identified, collated and appraised through a structured assessment of the literature for all sections of the Guidelines. This resulted in the inclusion of 126 updated studies across the Guidelines. Key changes include:

  • Revision of the summary of evidence and recommendations for the management of renal colic
  • Revision of Section 3.4.3, on Medical expulsive therapy
  • Revision of the information on antibiotic prophylaxis in Section 3.4.5, Extracorporeal shock wave lithotripsy
  • Revision of the summary of evidence and recommendations for shockwave lithotripsy
  • Revision of Section 3.4.6, Ureteroscopy (retrograde and antegrade)
  • Revision of Section 3.4.7, Percutaneous nephrolithotomy
  • Revision of the Section 3.4.8.b, Antithrombotic therapy and stone treatment
  • Revision of Section 3.4.15.e, Endourological procedures – Rigid/semi-rigid ureteroscopy
  • Revision of Section 3.5, Radiation exposure and protection during endourology
  • Revision of Section 4.6, Disorders and diseases related to calcium stones
  • Updates to Table 3.2, Stone composition
  • Updates to Table 3.11, Suggested strategy for antithrombotic therapy in stone removal
  • Updates to Table 4.2, Laboratory values for urinary parameters in adults
  • Updates to Table 4.3, Normal values for spot urine samples: creatinine ratios (solute/creatinine) in children
  • Updates to Table 4.6, Pharmacological substances used for stone prevention – characteristics, specifics and dosage
  • Revised and updated references throughout the text