Urinary lithiasis: the perfect balance

Urinary lithiasis is one of the conditions that have undergone revolutionary changes in treatment over the past decades. The technological advances in diagnosis (with ultrasound and computed tomography) and interventional treatment of urinary calculi observed in the 1980s and 1990s were very striking. In this century, we have seen the improvement of techniques and the refinement of indications. Currently, the treatment of urinary calculi is almost exclusively by minimally invasive procedures, with extremely low rates of severe complications. However, having minimally invasive procedures available does not mean they should be used indiscriminately. Many physicians sworn the Hippocratic Oath stating " they will not cut through the bladder " , but this is part of a distant past, and has been efficiently replaced by less invasive procedures. The principle of primum non nocere [first do not harm] remains a maxim of the medical profession. Therefore, the most appropriate interventions will be those precisely indicated for each situation. In this context, some situations are extremely commonplace, such as the following. Renal colic is a common cause of patient visits to the emergency room, and ureterolithiasis is the most common diagnosis in these cases. One of the main precautions in these situations is, on one hand, to avoid the excessive indication of surgical procedures for calculi likely to be spontaneously eliminated without further damage. In this sense, professionals involved in treating these patients should maintain an ethical position, educating and reassuring patients, without letting themselves be led by financial interests, and focusing on ensuring the best therapeutic outcomes for patients. On the other hand, another important step is being careful not to take the disease for granted, which could result in undertreatment of patients' pain, missed diagnosis of infections associated with the urinary tract obstruction (which could aggravate and impair renal function), or not appropriately following up patients care. The role of the physician at this time includes avoiding complications and loss of renal function, and guiding follow-up care for prevention of new episodes. The constant training and updating of urgency care professionals is essential in this context. Decision-making cannot be