Demirkesen O, Yaycioglu O, Onal B, Kalkan M, Tansu N, Yalcin V, Kural A R, Solok V
Department of Urology, Istanbul University, Cerrahpasa Faculty of Medicine, Turkey.
J Endourol. 2001 Sep;15(7):681-5. doi: 10.1089/08927790152596235.
We reviewed our experience with SWL for stones in abnormal urinary tracts and compared the results with those in normal urinary tracts.
The study group was composed of 2566 renal units (RU) treated on the Siemens Lithostar lithotripter at our SWL unit whose treatment and follow-up at 10 to 12 weeks were completed. Sixty-eight RUs (2.7%) belonged to 52 patients who had congenital upper urinary tract abnormalities. Logistic regression analysis was performed to analyze the impact of age, stone size, location, and the type of abnormality on the outcome of the SWL in the abnormal RU. The student t-, chi-square, and Fisher's exact tests were used for the comparison of stone load, number of treatment sessions, catheter placement, and success rates of the patients with normal and abnormal RU. Results of long-term follow-up for available patients (38 RU; 56%) were also evaluated.
Age, stone load, stone location, and the type of abnormality did not have a statistically significant impact on the outcome of SWL for abnormal RU. The average stone load was 2.1 +/- 2.8 cm2 in the abnormal and 1.4 +/- 1.3 cm2 in the normal RU. Thus, the stone load was significantly higher in the abnormal RU (P < 0.05). In the abnormal group, 56% of the RU became stone free, 37% had nonobstructive and noninfectious clinically insignificant residual fragments < or = 4 mm (CIRF), and SWL failed in 7%. In the normal group, 78% of the RU became stone-free, 18.5% had CIRF, and SWL failed in 4%. There was no significant difference in the success rates in the groups if success was defined as stone free and CIRF together (P > 0.05). However, there was significant a difference when stone-free, CIRF, and failure rates were evaluated separately (P < 0.05). Recurrence, regrowth, and retreatment rates in abnormal RU were 50%, 37%, and 34%, respectively.
Although the fragmentation rates were similar, clearance of the fragments was hampered in abnormal urinary tracts. Thus, especially for large stones, other endourologic treatment options should be considered. High recurrence and regrowth rates warrant careful monitoring and consideration for medical treatment during follow-up.
我们回顾了体外冲击波碎石术（SWL）治疗异常尿路结石的经验，并将结果与正常尿路结石的治疗结果进行比较。
研究组由在我们的SWL治疗单元接受西门子Lithostar碎石机治疗的2566个肾单位（RU）组成，这些患者的治疗及10至12周的随访已完成。68个RU（2.7%）属于52例患有先天性上尿路异常的患者。进行逻辑回归分析，以分析年龄、结石大小、位置及异常类型对异常RU中SWL治疗结果的影响。采用学生t检验、卡方检验和Fisher精确检验来比较正常RU和异常RU患者的结石负荷、治疗次数、导管置入情况及成功率。还对可获得长期随访结果的患者（38个RU；56%）进行了评估。
年龄、结石负荷、结石位置及异常类型对异常RU的SWL治疗结果无统计学显著影响。异常RU的平均结石负荷为2.1±2.8 cm²，正常RU为1.4±1.3 cm²。因此，异常RU的结石负荷显著更高（P<0.05）。在异常组中，56%的RU结石清除，37%有非梗阻性、非感染性且临床意义不大的残留碎片≤4 mm（CIRF），7%的SWL治疗失败。在正常组中，78%的RU结石清除，18.5%有CIRF，4%的SWL治疗失败。如果将成功定义为结石清除和CIRF两者，则两组成功率无显著差异（P>0.05）。然而，分别评估结石清除率、CIRF率和失败率时存在显著差异（P<0.05）。异常RU的复发率、再生长率和再次治疗率分别为50%、37%和34%。
虽然碎石率相似，但异常尿路中碎片的清除受到阻碍。因此，尤其是对于大结石，应考虑其他腔内泌尿外科治疗选择。高复发率和再生长率需要在随访期间进行仔细监测并考虑药物治疗。
