Pace K T, Weir M J, Tariq N, Honey R J
Division of Urology, Saint Michael's Hospital, Toronto, Ontario, Canada.
J Urol. 2000 Dec;164(6):1905-7.
We determined the number of shock wave lithotripsy treatments that should be given for a single ureteral stone before alternate modalities are used.
We compared the stone-free rate of initial shock wave lithotripsy for ureteral calculi with that of subsequent treatments. We evaluated 1,593 ureteral stones treated with the Dornier MFL 5000 lithotriptor* from January 1, 1994 to September 1, 1999 using various parameters associated with treatment outcome.
The stone-free rate after initial treatment was 68% (1,086 of 1,593 stones), which decreased to 46% (126 of 273) after re-treatment 1. We observed a further decrease in the stone-free rate after re-treatment 2 to 31% (19 of 61 stones, p = 0.001). The cumulative stone-free rate increased to 76% (1,212 of 1,593 stones) after 2 treatments and to 77% (1,231 of 1593) after 3. The stone-free rate for stones 10 mm. or less was significantly better than that of stones 11 to 20 mm. initially (64% versus 43%) and after re-treatment (49% versus 37%). A ureteral stent decreased the stone-free rate of initial treatment and re-treatment 1 by 12% and 14%, respectively (p = 0.001). After initial treatment the stone-free rate of the upper and mid ureter was significantly higher than that of the lower ureter. Patient weight had no significant impact on success in either group.
The stone-free rate of re-treating ureteral calculi with shock wave lithotripsy decreases significantly after the initial treatment. These findings imply that ureteroscopic management of ureteral stones may be better than shock wave lithotripsy after initial shock wave lithotripsy fails.
我们确定了在采用其他治疗方式之前，单次输尿管结石应接受的冲击波碎石治疗次数。
我们比较了输尿管结石初次冲击波碎石与后续治疗的结石清除率。我们评估了1994年1月1日至1999年9月1日期间使用多尼尔MFL 5000碎石机*治疗的1593例输尿管结石，采用了与治疗结果相关的各种参数。
初次治疗后的结石清除率为68%（1593例结石中的1086例），再次治疗1次后降至46%（273例中的126例）。我们观察到再次治疗2次后结石清除率进一步降至31%（61例中的19例，p = 0.001）。2次治疗后累积结石清除率增至76%（1593例结石中的1212例），3次治疗后增至77%（1593例中的1231例）。10毫米及以下结石的结石清除率在初始时（64%对43%）和再次治疗后（49%对37%）明显优于11至20毫米的结石。输尿管支架使初次治疗和再次治疗1次的结石清除率分别降低了12%和14%（p = 0.001）。初次治疗后，输尿管上段和中段的结石清除率明显高于下段。患者体重对两组的成功率均无显著影响。
输尿管结石初次冲击波碎石治疗后，再次用冲击波碎石的结石清除率显著降低。这些发现表明，在初次冲击波碎石失败后，输尿管镜治疗输尿管结石可能优于冲击波碎石。
