Extracts from the 1-8-19 NICE Guideline
"Renal and ureteric stones: assessment and management (NG 118)
The" treatment "recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian."     
Recommendations
"Diagnostic Imaging
Offer urgent (within 24 hours of presentation) low-dose non-contrast CT to adults with suspect renal colic. If a woman is pregnant, offer ultrasound instead of CT.
Offer urgent (within 24 hours of presentation) ultrasound as first-line imaging for children and young people with suspected renal colic.
If there is still uncertainty about the diagnosis of renal colic after ultrasound for children and young people, consider low-dose non-contrast CT."   
"Pain management
Offer a non-steroidal anti-inflammatory drug (NSAID) by any route as first line treatment for adults, children and young people with suspected renal colic.
Offer intravenous paracetamol to adults, children and young people with suspected renal colic if  NSAIDs are contraindicated or are not giving sufficient pain relief.
Consider opiods for adults, children and young people with suspected renal colic if both NSAIDs and intravenous paracetamol are contraindicated or are not giving sufficient pain relief.
Do not offer antispasmodics to adults, children and young people with suspected renal colic." 
"Medical expulsive therapy
Consider alpha blockers for adults, children and young people with distal ureteric stones less than 10 mm"
"Stenting before shockwave lithotripsy
Do not offer pre-treatment stenting to adults having shockwave lithotripsy (SWL)for ureteric or renal stones.
Consider pre-treatment stenting for children and young people having SWL for renal staghorn stones."
 “Surgical treatments (including shockwave lithotripsy)”
This recommendation is found on page 7 through to and on page 9 on the NICE web site https://www.nice.org.uk/guidance/ng118

“Timing of surgical treatment (including SWL) for adults with ureteric stones and renal colic
Offer surgical treatment (including SWL) to adults with ureteric stones and renal colic within 48 hours of diagnosis or readmission, if: 
pain is ongoing and not tolerated or the stone is unlikely to pass”
“Medical expulsive therapy as an adjunct to SWL for adults with ureteric stones less than 10 mm
Consider alpha blockers[1] as adjunctive therapy for adults having SWL for ureteric stones less than 10 mm.”
“[1] At the time of publication (January 2019), alpha blockers did not have a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information.”
“Stenting after ureteroscopy for adults with ureteric stones less than 20 mm
Do not routinely offer post-treatment stenting to adults who have had ureteroscopy for ureteric stones less than 20 mm.”
Metabolic testing
Consider stone analysis for adults with ureteric or renal stones.
Measure serum calcium for adults with ureteric or renal stones.
Consider referring children and young people with ureteric or renal stones to a paediatric nephrologist or paediatric urologist with expertise in this area for assessment and metabolic investigations
“Preventing recurrence
Dietary and lifestyle advice
Discuss diet and fluid intake with the person (and their family or carers, as appropriate), and advise:
adults to drink 2.5 to 3 litres of water per day, and children and young people (depending on their age) 1 to 2 litres
adding fresh lemon juice to drinking water avoiding carbonated drinks
adults to have a daily salt intake of no more than 6 g, and children and young people (depending on their age) 2 to 6 g
not restricting daily calcium intake, but maintaining a normal calcium intake of 700 to 1,200 mg for adults, and 350 to 1,000 mg per day for children and young people (depending on their age).
Follow the recommendations on maintaining a healthy lifestyle in the NICE guideline on preventing excess weight gain.”

“Potassium citrate
The following recommendations apply alongside the recommendations on dietary and lifestyle advice.
 Consider potassium citrate[2] for adults with a recurrence of stones that are predominantly (more than 50%) calcium oxalate.
Consider potassium citrate for children and young people with a recurrence of stones that are predominantly (more than 50%) calcium oxalate, and with hypercalciuria or hypocitraturia.”
“[2] At the time of publication (January 2019), potassium citrate did not have a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information.”

“Thiazides
The following recommendation applies alongside the recommendations on dietary and lifestyle advice.
Consider thiazides[3] for adults with a recurrence of stones that are predominantly (more than 50%) calcium oxalate and hypercalciuria, after restricting their sodium intake to no more than 6 g a day.
[3] At the time of publication (January 2019), thiazides did not have a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information.”

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