Aynehchi Shahrad, Samadi Albert A, Gallo Stephen J, Konno Sensuke, Tazaki Hiroshi, Eshghi Majid
Department of Urology, New York Medical College, Valhalla, USA.
J Endourol. 2002 Aug;16(6):355-8. doi: 10.1089/089277902760261374.
When intervention is necessary, controversy remains as to the best treatment modality for stones of the distal ureter. In general, ureteroscopy is favored over extracorporeal shockwave lithotripsy (SWL) as the treatment of choice for distal ureteral stones. Although uncommon, ureteroscopy failures have traditionally necessitated repeat ureteroscopy to retrieve retained stone fragments. We evaluated the efficacy of salvage SWL for failed primary distal ureteroscopy in the community setting.
From December 1989 to December 2000, 6099 patients underwent SWL with the Dornier HM4 lithotripter at our institution. We retrospectively identified 31 patients who had undergone the SWL after a failed distal ureteroscopy.
The average stone size in these patients was 9.4 mm, the average time interval from ureteroscopy to SWL was 17.2 days, and the average number of shockwaves delivered was 2386. All patients had had stents placed after ureteroscopy. Twenty-seven patients (87%) had resolution of their stone burden after one SWL session. The remaining four patients underwent additional procedures.
Ureteroscopy is an effective modality for the treatment of distal ureteral stones. However, when unsuccessful, a salvage procedure may be necessary. Extracorporeal lithotripsy is a less invasive procedure with comparable success rates in the distal ureter. This report suggests that salvage SWL is an appropriate option for patients in whom distal ureteroscopic stone extraction fails.
当需要进行干预时，对于输尿管远端结石的最佳治疗方式仍存在争议。一般来说，输尿管镜检查比体外冲击波碎石术（SWL）更受青睐，是输尿管远端结石的首选治疗方法。虽然不常见，但传统上输尿管镜检查失败后需要再次进行输尿管镜检查以取出残留的结石碎片。我们评估了在社区环境中挽救性SWL治疗原发性输尿管远端镜检查失败的疗效。
1989年12月至2000年12月，6099例患者在我们机构接受了多尼尔HM4碎石机的SWL治疗。我们回顾性地确定了31例输尿管远端镜检查失败后接受SWL治疗的患者。
这些患者的平均结石大小为9.4mm，从输尿管镜检查到SWL的平均时间间隔为17.2天，平均冲击波发射次数为2386次。所有患者在输尿管镜检查后均放置了支架。27例患者（87%）在一次SWL治疗后结石负荷得到缓解。其余4例患者接受了额外的治疗。
输尿管镜检查是治疗输尿管远端结石的有效方法。然而，当治疗失败时，可能需要采取挽救性措施。体外碎石术是一种侵入性较小的手术，在输尿管远端的成功率相当。本报告表明，挽救性SWL是输尿管远端结石取出失败患者的合适选择。
