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<div><div>What's new in primary care</div> <span></span><div><div><dl><dt><span> </span>Authors:</dt><dd><a>Jane Givens, MD, MSCE</a></dd><dd><a>Zehra Hussain, MD, FACP</a></dd><dd><a>Karen Law, MD, FACP</a></dd><dd><a>Han Li, MD</a></dd><dd><a>Sara Swenson, MD</a></dd></dl><p><a>Contributor Disclosures</a></p></div><div><div><span>All topics are updated as new evidence becomes available and our <a>peer review process</a> is complete.</span></div><div><div><bdi><span>Literature review current through:</span>&nbsp;Jun 2025.</bdi></div><div><bdi><span>This topic last updated:</span>&nbsp;Jul 24, 2025.</bdi></div></div></div></div><div><div></div></div><p>Please read the <a>Disclaimer </a>at the end of this page.</p><div><p>The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.</p><p><span>SCREENING</span></p><p><span>Screening and surveillance of ind

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<div><div>Kidney stones in adults: Uric acid nephrolithiasis</div> <span></span><div><div><dl><dt><span> </span>Author:</dt><dd><a>Gary C Curhan, MD, ScD</a></dd><dt><span> </span>Section Editor:</dt><dd><a>Glenn M Preminger, MD</a></dd><dt><span> </span>Deputy Editor:</dt><dd><a>Albert Q Lam, MD</a></dd></dl><p><a>Contributor Disclosures</a></p></div><div><div><span>All topics are updated as new evidence becomes available and our <a>peer review process</a> is complete.</span></div><div><div><bdi><span>Literature review current through:</span>&nbsp;Jun 2025.</bdi></div><div><bdi><span>This topic last updated:</span>&nbsp;Oct 19, 2023.</bdi></div></div></div></div><div><div></div></div><div><p><span>INTRODUCTION</span><span>&nbsp;—&nbsp;</span></p><p>Uric acid stones account for 5 to 10 percent of urinary tract stones in the United States and Europe. By contrast, they comprise 40 percent or more of stones in areas with hot, arid climates in which the tendency to a low urine volume and acid urine pH promote uri

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<div><div>Kidney stones in adults: Evaluation of the patient with established stone disease</div> <span></span><div><div><dl><dt><span> </span>Authors:</dt><dd><a>Glenn M Preminger, MD</a></dd><dd><a>Gary C Curhan, MD, ScD</a></dd><dt><span> </span>Section Editor:</dt><dd><a>Michael P O'Leary, MD, MPH</a></dd><dt><span> </span>Deputy Editor:</dt><dd><a>Albert Q Lam, MD</a></dd></dl><p><a>Contributor Disclosures</a></p></div><div><div><span>All topics are updated as new evidence becomes available and our <a>peer review process</a> is complete.</span></div><div><div><bdi><span>Literature review current through:</span>&nbsp;Jun 2025.</bdi></div><div><bdi><span>This topic last updated:</span>&nbsp;Jul 22, 2025.</bdi></div></div></div></div><div><div></div></div><div><p><span>INTRODUCTION</span><span>&nbsp;—&nbsp;</span></p><p>Kidney stone disease (nephrolithiasis) is a common problem in primary care practice. Patients may present with the classic symptoms of renal colic and hematuria. Some patients may be asympto

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<div><div>Kidney stones in adults: Kidney stones during pregnancy</div> <span></span><div><div><dl><dt><span> </span>Authors:</dt><dd><a>Glenn M Preminger, MD</a></dd><dd><a>Gary C Curhan, MD, ScD</a></dd><dt><span> </span>Section Editors:</dt><dd><a>Charles J Lockwood, MD, MHCM</a></dd><dd><a>Deborah A Baumgarten, MD, MPH</a></dd><dt><span> </span>Deputy Editor:</dt><dd><a>Albert Q Lam, MD</a></dd></dl><p><a>Contributor Disclosures</a></p></div><div><div><span>All topics are updated as new evidence becomes available and our <a>peer review process</a> is complete.</span></div><div><div><bdi><span>Literature review current through:</span>&nbsp;Jun 2025.</bdi></div><div><bdi><span>This topic last updated:</span>&nbsp;Apr 30, 2025.</bdi></div></div></div></div><div><div></div></div><div><p><span>INTRODUCTION</span><span>&nbsp;—&nbsp;</span></p><p>Kidney stone disease (nephrolithiasis) is a common problem in primary care practice. Patients may present with the classic symptoms of renal colic and hematuria. Others

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<div><div>Kidney stones in adults: Diagnosis and acute management of suspected nephrolithiasis</div> <span></span><div><div><dl><dt><span> </span>Authors:</dt><dd><a>Gary C Curhan, MD, ScD</a></dd><dd><a>Mark D Aronson, MD</a></dd><dd><a>Glenn M Preminger, MD</a></dd><dt><span> </span>Section Editors:</dt><dd><a>Michael P O'Leary, MD, MPH</a></dd><dd><a>Deborah A Baumgarten, MD, MPH</a></dd><dt><span> </span>Deputy Editor:</dt><dd><a>Albert Q Lam, MD</a></dd></dl><p><a>Contributor Disclosures</a></p></div><div><div><span>All topics are updated as new evidence becomes available and our <a>peer review process</a> is complete.</span></div><div><div><bdi><span>Literature review current through:</span>&nbsp;Jun 2025.</bdi></div><div><bdi><span>This topic last updated:</span>&nbsp;May 16, 2025.</bdi></div></div></div></div><div><div><div><div><p></p><ul></ul>What's New<p></p> <div><div><p><span>Nonsteroidal antiinflammatory drugs for pain control in patients with acute renal colic (May 2025)</span></p><div><p>Kidne

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<div><div>Kidney stones in adults: Surgical management of kidney and ureteral stones</div> <span></span><div><div><dl><dt><span> </span>Author:</dt><dd><a>Glenn M Preminger, MD</a></dd><dt><span> </span>Section Editor:</dt><dd><a>Michael P O'Leary, MD, MPH</a></dd><dt><span> </span>Deputy Editor:</dt><dd><a>Albert Q Lam, MD</a></dd></dl><p><a>Contributor Disclosures</a></p></div><div><div><span>All topics are updated as new evidence becomes available and our <a>peer review process</a> is complete.</span></div><div><div><bdi><span>Literature review current through:</span>&nbsp;Jun 2025.</bdi></div><div><bdi><span>This topic last updated:</span>&nbsp;Aug 12, 2024.</bdi></div></div></div></div><div><div></div></div><div><p><span>INTRODUCTION</span><span>&nbsp;—&nbsp;</span></p><p>Kidney stone disease (nephrolithiasis) is a common problem in primary care practice. Approximately 10 to 20 percent of all kidney stones require surgical removal, which is determined based upon the presence of symptoms and the size and 

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<div><div>Clinical use of saw palmetto</div> <span></span><div><div><dl><dt><span> </span>Author:</dt><dd><a>Robert B Saper, MD, MPH</a></dd><dt><span> </span>Section Editors:</dt><dd><a>Joann G Elmore, MD, MPH</a></dd><dd><a>David Seres, MD</a></dd><dt><span> </span>Deputy Editor:</dt><dd><a>Zehra Hussain, MD, FACP</a></dd></dl><p><a>Contributor Disclosures</a></p></div><div><div><span>All topics are updated as new evidence becomes available and our <a>peer review process</a> is complete.</span></div><div><div><bdi><span>Literature review current through:</span>&nbsp;Jun 2025.</bdi></div><div><bdi><span>This topic last updated:</span>&nbsp;Oct 04, 2023.</bdi></div></div></div></div><div><div></div></div><div><p><span>INTRODUCTION</span><span>&nbsp;—&nbsp;</span></p><p>Extracts of the fruit from saw palmetto (<em>Serenoa repens</em>), the American dwarf palm tree  (<a>picture 1</a>), are commonly ingested to treat prostate related conditions; however, we do not recommend their use. The first evidence of saw p

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<div><div>Surgical treatment of benign prostatic hyperplasia (BPH)</div> <span></span><div><div><dl><dt><span> </span>Author:</dt><dd><a>Kevin T McVary, MD, FACS</a></dd><dt><span> </span>Section Editor:</dt><dd><a>Michael P O'Leary, MD, MPH</a></dd><dt><span> </span>Deputy Editor:</dt><dd><a>Wenliang Chen, MD, PhD</a></dd></dl><p><a>Contributor Disclosures</a></p></div><div><div><span>All topics are updated as new evidence becomes available and our <a>peer review process</a> is complete.</span></div><div><div><bdi><span>Literature review current through:</span>&nbsp;Jun 2025.</bdi></div><div><bdi><span>This topic last updated:</span>&nbsp;Jun 26, 2024.</bdi></div></div></div></div><div><div></div></div><div><p><span>INTRODUCTION AND TERMINOLOGY</span><span>&nbsp;—&nbsp;</span></p><p>Benign prostatic hyperplasia (BPH) is defined as an increase in the total number of prostatic stromal cells and prostatic glandular epithelial cells within the transition zone of the prostate [<a>1</a>]. As a result of this hyper

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<div><div>Medical treatment of benign prostatic hyperplasia</div> <span></span><div><div><dl><dt><span> </span>Author:</dt><dd><a>Kevin T McVary, MD, FACS</a></dd><dt><span> </span>Section Editor:</dt><dd><a>Michael P O'Leary, MD, MPH</a></dd><dt><span> </span>Deputy Editor:</dt><dd><a>Karen Law, MD, FACP</a></dd></dl><p><a>Contributor Disclosures</a></p></div><div><div><span>All topics are updated as new evidence becomes available and our <a>peer review process</a> is complete.</span></div><div><div><bdi><span>Literature review current through:</span>&nbsp;Jun 2025.</bdi></div><div><bdi><span>This topic last updated:</span>&nbsp;Jun 03, 2025.</bdi></div></div></div></div><div><div></div></div><div><p><span>INTRODUCTION</span><span>&nbsp;—&nbsp;</span></p><p>Lower urinary tract symptoms related to benign prostatic hyperplasia (LUTS/BPH) increase in prevalence with age. Urinary symptoms include increased frequency of urination, nocturia, hesitancy, urgency, and weak urinary stream. Treatment includes medical a

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<div><div>Society guideline links: Hemorrhoids</div> <span></span><p></p><div><div></div></div><div><p><span>Introduction</span><span>&nbsp;—&nbsp;</span></p><p>This topic includes links to society and government-sponsored guidelines from selected countries and regions around the world. We will update these links periodically; newer versions of some guidelines may be available on each society's website. Some societies may require users to log in to access their guidelines.</p><p>The recommendations in the following guidelines may vary from those that appear in UpToDate topic reviews. Readers who are looking for UpToDate topic reviews should use the UpToDate search box to find the relevant content.</p><p>Links to related guidelines are provided separately. (See  <a>"Society guideline links: Gastrointestinal bleeding in adults"</a>.)</p><p><span>International</span></p><p></p><ul></ul><a>World Society of Emergency Surgery (WSES)-American Association for the Surgery of Trauma (AAST): Guidelines on anorectal emer