Quality standard

Quality statement 3: Timing of surgical treatment

Quality statement 3: Timing of surgical treatment

Quality statement

Adults with ureteric stones and renal colic have surgical treatment within 48 hours of diagnosis or readmission, if pain is ongoing and not tolerated, or the stone is unlikely to pass.

Rationale

Early intervention for ureteric stones can make treatment easier and more effective, and reduce the need for temporary measures, like stenting, and further treatment after surgery. It can also prevent prolonged pain, and potential damage to the kidney caused by the ureter being blocked.

Quality measures

Structure

a) Evidence of local referral pathways to ensure that adults with ureteric stones and renal colic have surgical treatment within 48 hours of diagnosis or readmission.

Data source: Local data collection, for example, local commissioning agreements and service specifications.

b) Evidence of the availability of lithotripters, emergency operating theatres and staff needed to perform surgical treatment for adults with ureteric stones and renal colic within 48 hours of diagnosis or readmission.

Data source: Local data collection, for example, service specifications and staff rotas.

Process

a) Proportion of adults with a new diagnosis of ureteric stones and renal colic, with ongoing pain that is not tolerated, or a stone that is unlikely to pass, who have surgical treatment within 48 hours of diagnosis.

Numerator – the number in the denominator who have surgical treatment within 48 hours of diagnosis.

Denominator – the number of adults with a new diagnosis of ureteric stones and renal colic, with ongoing pain that is not tolerated, or a stone that is unlikely to pass.

Data source: Local data collection, for example, local audit of patient records.

b) Proportion of adults readmitted with ureteric stones and renal colic, with ongoing pain that is not tolerated, or a stone that is unlikely to pass, who have surgical treatment within 48 hours of readmission.

Numerator – the number in the denominator who have surgical treatment within 48 hours of readmission.

Denominator – the number of adults readmitted with ureteric stones and renal colic, with ongoing pain that is not tolerated, or a stone that is unlikely to pass.

Data source: Local data collection, for example, local audit of patient records.

Outcomes

a) Proportion of adults who have had ureteric stones who had a primary stenting procedure.

Numerator – the number in the denominator who had a primary stenting procedure.

Denominator – the number of adults who have had ureteric stones.

Data source: Local data collection, for example, local audit of patient records. The Getting It Right First Time (GIRFT) urology report includes findings on the use of ureteric stenting in trusts across England.

b) Health-related quality of life in adults with ureteric stones.

Data source: Local data collection, for example, patient surveys.

What the quality statement means for different audiences

Service providers (such as secondary care services) ensure that referral pathways are in place so that adults with ureteric stones and renal colic with ongoing pain that persists with the maximum dose and type of analgesia, or a stone that is unlikely to pass, have surgical treatment within 48 hours of diagnosis or readmission. They also ensure that lithotripters, emergency operating theatres and staff are available to perform the surgical treatment within this timeframe.

Healthcare professionals (such as urologists) assess adults with ureteric stones and renal colic to see if they still have pain after receiving the maximum dose and type of analgesia, or whether the stone is unlikely to pass. If so, they refer them for surgical treatment to be performed within 48 hours of diagnosis or readmission.

Commissioners (such as clinical commissioning groups) ensure that services have referral pathways for adults with ureteric stones and renal colic with pain that persists with the maximum dose and type of analgesia, or a stone that is unlikely to pass, to have surgical treatment within 48 hours of diagnosis or readmission. They also ensure that services have access to lithotripters and emergency operating theatres, and capacity to perform the surgical treatment within this timeframe.

Adults with a stone in their ureter and severe pain caused by the stone are checked to see if they still have pain with the highest dose and type of pain medication, or the stone is unlikely to pass on its own. If so, they have surgical treatment within 48 hours of diagnosis or readmission.

Definitions of terms used in this quality statement

Surgical treatment

Surgical treatment for ureteric stones includes shockwave lithotripsy, ureteroscopy and percutaneous nephrolithotomy. Treatment will depend on the size of the stone. [NICE's guideline on renal and ureteric stones, recommendation 1.5.3]

Equality and diversity considerations

No evidence was found to make a recommendation on timing of surgical treatment for children and young people, and so this statement only applies to adults. Children and young people may spontaneously pass larger stones and therefore it is reasonable to have a period of observation or conservative treatment before intervention. See evidence review G in NICE's guideline on renal and ureteric stones.