Robert M, Lanfrey P, Rey G, Guiter J, Navratil H
Department of Urology, Lapeyronie University Hospital, Montpellier, France.
J Endourol. 1999 Jul-Aug;13(6):391-5. doi: 10.1089/end.1999.13.391.
The development of newer-generation lithotripters has reduced the pain associated with SWL, but many patients still require some form of sedation. We prospectively compared the analgesic requirements for kidney and upper ureteral treatments. Predictive factors for pain during piezoelectric SWL were also studied.
A total of 102 consecutive patients without any previous experience of SWL were treated for renal (N = 70) or upper ureteral (N = 32) calculi using the EDAP LT02 lithotripter. The stones' largest diameter ranged from 4 to 30 mm (mean 9 mm). Patients were given an oral dose of 60 mg of dextropropoxyphene hydrochloride and 800 mg of paracetamol associated with 100 mg of ketoprofene per rectum 30 minutes before treatment. The SWL session was begun at low intensity and increased to the maximal range of energy as rapidly as could be tolerated by the patient. The amount of pain during treatment was recorded according to a visual analogue scale (VAS). Further analgesia using intravenous alfentanil was given as required by the severity of the pain. Visual analog pain scores, additional sedation requirements, and success rates after one session were analyzed.
The VAS scores and intravenous sedation requirements were significantly lower for patients with upper ureteral stones than for those with renal calculi (P < 0.01). The stone-free rates after one session were, respectively, 90% and 73% (P < 0.05). On the other hand, SWL tolerance was significantly lower for women presenting with renal stones (P < 0.05).
Piezoelectric SWL without intravenous sedation is suitable for the treatment of upper ureteral calculi. However, such an approach is less efficient in the management of kidney stones, especially for female patients.
新一代碎石机的发展减少了与体外冲击波碎石术（SWL）相关的疼痛，但许多患者仍需要某种形式的镇静。我们前瞻性地比较了肾脏和输尿管上段治疗的镇痛需求。还研究了压电式SWL过程中疼痛的预测因素。
共有102例既往无SWL经验的连续患者，使用EDAP LT02碎石机治疗肾（N = 70）或输尿管上段（N = 32）结石。结石最大直径为4至30毫米（平均9毫米）。治疗前30分钟，患者口服60毫克盐酸右丙氧芬和800毫克对乙酰氨基酚，并直肠给予100毫克酮洛芬。SWL治疗以低强度开始，并根据患者耐受程度尽快增加至最大能量范围。根据视觉模拟量表（VAS）记录治疗期间的疼痛程度。根据疼痛严重程度按需给予静脉注射阿芬太尼进一步镇痛。分析视觉模拟疼痛评分、额外镇静需求和单次治疗后的成功率。
输尿管上段结石患者的VAS评分和静脉镇静需求显著低于肾结石患者（P < 0.01）。单次治疗后的结石清除率分别为90%和73%（P < 0.05）。另一方面，患有肾结石妇女的SWL耐受性显著较低（P < 0.05）。
无需静脉镇静的压电式SWL适用于输尿管上段结石的治疗。然而，这种方法在肾结石治疗中效率较低，尤其是对女性患者。
