GP & REFERRING CLINICIAN TOOL
Kidney Stone Referral Builder
Screen first for Queensland emergency / referral-safety features, then use stone location, size, obstruction, density and clinical context to generate an EAU-informed treatment discussion: observation / MET, SWL, ureteroscopy or pyeloscopy + laser, PCNL, urgent drainage, or selected chemolysis.
Queensland Health CPC directs acute/severe renal or ureteric colic, acute colic with obstruction and/or infection, and urinary sepsis/severe infection to the emergency department / local emergency pathway. This tool applies an additional hard safety rule: any ureteric stone with a suggestion of infection requires urgent clinical assessment. Infection plus an obstructed collecting system is a urological emergency.
Open Queensland Health Urinary Tract Calculi CPC →60-SECOND REFERRAL FRAMEWORK
A useful stone referral answers four questions
The builder below turns these into copy-ready wording. Missing non-essential information should not delay appropriate urgent or time-sensitive referral.
Is the patient safe for outpatient care?
Check infection, systemic illness, urine output, pain control, vomiting and renal deterioration first.
Where is the stone?
Ureteric versus renal location, size, obstruction and stone burden usually matter more than “renal calculus”.
What is the renal reserve?
Solitary kidney, transplant, bilateral obstruction, CKD and change from baseline can alter timing.
What are you asking urology to do?
Treatment, persistent obstruction, surveillance, recurrence prevention or review after previous treatment.
CLINICIAN TOOL
Build the kidney stone referral
Three steps generate a practical action plan: referral timing, next steps, a concise clinical summary, useful records, safety-net prompts and optional referral wording.
First: is routine outpatient referral appropriate?
Select the applicable features. This is a safety prompt, not an emergency-triage algorithm.
Capture only the information that changes the referral.
Unknown values are acceptable. The referral can still be generated.
Your clinical action plan
Use the summary below to decide the next workflow step, identify useful missing information, communicate safety-net advice and, if helpful, generate referral wording.
One or more selected features may be incompatible with routine elective referral. Apply clinical judgement and use appropriate local emergency / acute urology pathways.
Routine outpatient urology assessment
Queensland Health CPC cross-check
This does not replace Queensland Health triage. It flags whether the entered presentation may align with an emergency pathway or a public outpatient CPC category.
Treatment options depend on location and size
One-line clinical summary
Routine outpatient assessment
Kidney stones & endourology
Missing / useful information
These are workflow prompts, not mandatory prerequisites. Do not delay appropriate urgent referral to complete non-essential testing.
Attach these records
Useful clinical details
These prompts should be interpreted in the patient's clinical context and alongside local pathways.
Safety-net summary
A concise prompt that can be reviewed with the patient. It does not replace individual instructions or local emergency advice.
Optional: generate referral wording Open this only if you want copy-ready text for your referral letter.
Suggested referral text
REFERRAL TIMING
Think beyond stone diameter
The consequence of obstruction and the patient's clinical state often matter more to timing than size alone.
Do not wait for routine clinic
- Any ureteric stone with fever, UTI / positive culture or systemic infection features
- Suspected infected obstruction or urinary sepsis
- Anuria / marked oliguria
- Analgesia-refractory severe renal colic
- Significant acute deterioration or inability to maintain hydration
Higher-risk outpatient presentation
- Persistent obstruction or worsening symptoms
- Renal function deteriorating from baseline
- Solitary functioning kidney or renal transplant
- Bilateral obstruction / high-risk anatomy
- Large, complex or staghorn stone burden
Stable elective discussion
- Stable symptomatic renal stones
- Recurrent stone episodes
- Incidental stones requiring surveillance discussion
- Residual fragments after previous treatment
- Recurrent-stone prevention assessment
QUEENSLAND GP SAFETY LAYER
Cross-check the local pathway before slow-stream referral
Acute-care criteria take priority over elective procedure selection. For public referrals, use the official Queensland CPC and local HealthPathways / service requirements.
Urinary Tract Calculi
Queensland Health emergency criteria, outpatient priority criteria and minimum referral information for adult urinary tract calculi.
Open Queensland CPC → 02 · CLINICIAN PATHWAYBrisbane South HealthPathways
Point-of-care local assessment, management and referral pathways. Personal clinician account / login required.
Open HealthPathways → 03 · PUBLIC REFERRALGP Smart Referrals
Queensland Health digital referrals with CPC-aligned templates, essential-information prompts and referral tracking.
Open Smart Referrals →EAU 2026 · TREATMENT QUICK REFERENCE
Location and size change the treatment discussion
This summary applies only after acute safety concerns have been addressed. Infection with obstruction, sepsis, anuria or another acute complication bypasses slow-stream elective treatment selection.
Observation ± MET
Stable newly diagnosed small ureteric stones may be observed where active removal is not indicated. EAU recommends an α-blocker as one treatment option for suitable distal ureteric stones 5–10 mm; this use is off-label.
URS / laser or SWL
Both are established options. URS generally gives earlier stone-free status and fewer retreatments; SWL is less invasive and has lower morbidity. Stone density, body habitus, obstruction and anatomy influence SWL success.
SWL or RIRS / pyeloscopy
SWL can achieve good outcomes up to 20 mm outside the lower pole, although retreatment may be needed. Flexible ureteroscopy / RIRS offers an endoscopic alternative. Stones over ~1,000 HU are less favourable for SWL fragmentation.
PCNL first-line
EAU recommends PCNL as first-line treatment for renal stones over 2 cm. Flexible ureteroscopy or SWL are alternatives mainly when PCNL is not an option, with a greater likelihood of staged or additional treatment.
RIRS / pyeloscopy or PCNL
Lower-pole fragment clearance after SWL is less reliable. EAU recommends PCNL or RIRS for lower-pole stones over 1 cm, depending on anatomy and other factors.
Oral chemolysis may be possible
Selected uric-acid stones can be dissolved with urinary alkalinisation and monitoring. An obstructed system may require drainage; infection or acute deterioration overrides a slow elective dissolution pathway.
KIDNEY STONE CLINICAL RESOURCES
Go directly to the relevant pathway
These pages can support the GP discussion or be shared with the patient once the clinical pathway is established.
Kidney Stones
General assessment, symptoms and treatment overview.
Explore → 02 · CONDITIONUreteric Stones
Stone passage, obstruction and ureteric stone management.
Explore → 03 · DECISIONWhen Does a Stone Need Surgery?
Factors that commonly influence intervention versus observation.
Explore → 04 · CONSERVATIVEMedical Expulsive Therapy
Conservative management of selected ureteric stones.
Explore → 05 · PROCEDUREUreteroscopy & Laser
Endoscopic laser treatment of ureteric and renal calculi.
Explore → 06 · PROCEDUREShock Wave Lithotripsy
Non-invasive fragmentation for selected stones.
Explore → 07 · COMPLEX STONESPCNL
Percutaneous treatment of larger or complex renal stone burden.
Explore → 08 · PREVENTIONRecurrent Stone Prevention
Metabolic review and prevention strategies for recurrent stone formers.
Explore →REFERRING CLINICIANS
A concise clinical question is enough to start specialist assessment.
Include the presentation, relevant imaging, renal function, acute-risk features and what you would like urology to assess. The builder above can generate the wording.
Clinician information only. This referral builder provides general referral-support prompts for qualified healthcare professionals. It does not replace clinical judgement, local emergency pathways, HealthPathways, Queensland Health referral criteria or formal specialist triage. It does not diagnose stone disease, determine suitability for outpatient care or prescribe treatment. The treatment summary is an EAU-informed educational decision-support layer based on the information entered; it does not replace review of the CT images, anatomy, stone composition, local capability or specialist judgement. Queensland CPC labels generated by this page are cross-check prompts only and are not formal Queensland Health triage decisions. Always confirm the current Queensland Health Clinical Prioritisation Criteria, local HealthPathways and the receiving service's requirements. A ureteric stone with any suggestion of infection must not be routed to slow-stream routine outpatient review and requires urgent clinical assessment. If urinary obstruction is also present, an infected obstructed collecting system is a urological emergency. Fever/rigors with suspected stone disease requires acute assessment, particularly where obstruction has not yet been excluded. Urinary sepsis, anuria, significant renal deterioration, analgesia-refractory colic or another acutely unwell presentation also requires appropriate urgent assessment. Pregnancy, children, transplanted kidneys and other special clinical situations require individual assessment.