Time-sensitive elements in elective treatment of urinary lithiasis: a narrative review.

Abstract

Background and objective: Managing surgical queues for urinary lithiasis is a persistent challenge in healthcare systems. Despite substantial research in this area, clear criteria for prioritizing patients and determining those who can safely wait longer without complications remain elusive. This review aims to develop a rational framework for optimizing surgical queue management in urinary stone treatment by analyzing primary literature.

Methods: We conducted a review of relevant guidelines, held departmental discussions to identify additional factors, and performed an extensive PubMed search using key terms related to queue management and expectant care in lithiasis.

Key contents and findings: Significant factors identified include stone volume and location, presence of hydronephrosis, patient frailty and comorbidities, recurrent urinary infections, nephrostomy or double-J stent, urinary diversion, high occupational risk, limited healthcare access, and refractory pain impacting quality of life. A detailed analysis of these factors is presented in the article.

Conclusions: Effective management of surgical waitlists for urinary lithiasis requires a comprehensive assessment of factors such as stone characteristics, hydronephrosis, patient frailty, comorbidities, infections, drainage devices, accessibility, and quality of life, as prioritization based solely on waiting time is insufficient and potentially harmful.