Sumino Yasuhiro, Mimata Hiromitsu, Tasaki Yoshihisa, Ohno Hitoshi, Hoshino Tetsuji, Nomura Takeo, Nomura Yoshio
Department of Urology, Oita Medical University, Japan.
J Urol. 2002 Oct;168(4 Pt 1):1344-7. doi: 10.1016/S0022-5347(05)64445-X.
Lower pole renal stones are well known to show a poor stone clearance rate after extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Marietta, Georgia). In the current study we analyzed several anatomical factors as predictors of lower pole stone clearance that may be used to indicate the usefulness of ESWL in such patients.
Between January 1993 and October 2000, 63 patients with a unilateral single lower pole stone of 2 cm. or less were included in the study. Excretory urography was done to determine the lower infundibulopelvic angle, caliceal pelvic height, lower infundibular length and diameter, lower infundibular length-to-diameter ratio and number of lower pole minor calices. Stone-free status was assessed by x-ray.
The overall stone clearance rate was 54% (34 of 63 patients). While caliceal pelvic height, lower infundibular diameter, length, length-to-diameter ratio and number of minor calices were different in the stone-free and residual stone groups on univariate analysis, multivariate logistic analysis revealed that the lower infundibular length-to-diameter ratio, diameter and number of minor calices were independent predictors of successful stone clearance. The 13 patients (20.6%) who showed all 3 favorable anatomical factors (lower infundibular length-to-diameter ratio less than 7, diameter greater than 4 mm. and a single minor calix) achieved an impressive 84.6% stone clearance rate. In patients with only 1 or 2 favorable factors the stone clearance rate was still greater than 60%. In contrast, the stone clearance rate was only 6.7% in the 15 patients who showed none of these factors.
From this study it is apparent that successful ESWL is highly sensitive to the anatomy of the lower pole of the kidney. If a patient with a lower pole stone has at least 1 of the favorable factors identified in this study, ESWL may be advocated as first line therapy with a greater than 60% prospect of a successful outcome. Other treatment options should be considered in those without any of these predictive factors.
众所周知，体外冲击波碎石术（ESWL）（多尼尔医疗系统公司，佐治亚州玛丽埃塔）治疗下极肾结石的结石清除率较低。在本研究中，我们分析了几个解剖学因素作为下极结石清除的预测指标，这些因素可用于表明ESWL对此类患者的有效性。
1993年1月至2000年10月，63例单侧单个下极结石直径2 cm及以下的患者纳入本研究。进行排泄性尿路造影以确定下肾盂漏斗角、肾盂盏高度、下肾盂漏斗长度和直径、下肾盂漏斗长宽比以及下极小肾盂盏数量。通过X线评估结石清除情况。
总体结石清除率为54%（63例患者中的34例）。单因素分析显示，结石清除组和残留结石组的肾盂盏高度、下肾盂漏斗直径、长度、长宽比以及小肾盂盏数量存在差异，但多因素逻辑分析显示，下肾盂漏斗长宽比、直径和小肾盂盏数量是结石清除成功的独立预测指标。13例（20.6%）具有所有3个有利解剖学因素（下肾盂漏斗长宽比小于7、直径大于4 mm且仅有一个小肾盂盏）的患者结石清除率高达84.6%。仅有1个或2个有利因素的患者结石清除率仍大于60%。相比之下，15例无上述任何因素的患者结石清除率仅为6.7%。
从本研究可以明显看出，ESWL治疗成功对肾下极的解剖结构高度敏感。如果下极结石患者至少具有本研究中确定的1个有利因素，ESWL可作为一线治疗方法推荐，成功几率大于60%。对于没有任何这些预测因素的患者，应考虑其他治疗选择。
