Sheir Khaled Z, Madbouly Khaled, Elsobky Emad, Abdelkhalek Mohamed
Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Urology. 2003 Jul;62(1):10-5; discussion 15-6. doi: 10.1016/s0090-4295(03)00369-8.
To present our experience with extracorporeal shock wave lithotripsy (ESWL) in patients with anomalous kidneys and to determine the factors that may influence the stone-free rate in such patients.
From February 1989 to February 2000, 198 patients were treated for urolithiasis in anomalous kidneys using ESWL. The mean patient age (SD) was 40.48 (11.53) years. The kidneys were horseshoe in 49 (24.7%), malrotated in 120 (60.6%), and duplex in 29 (14.7%). All patients were treated on an outpatient basis using two second-generation lithotripters (Dornier MFL 5000 and Toshiba Echolith). Pretreatment auxiliary measures were required in 6 patients (3%). Follow-up data were recorded at 3 months. The statistical analysis was performed using the chi-square and Mann-Whitney U tests, with differences considered statistically significant if P <0.05.
The mean stone length (SD) was 13.54 (5.49) mm. The stones were single in 148 (74.7%), of new onset in 155 (78.3%), and on the right side in 82 (41.4%). All stones, but 5 (2.5%), were radiopaque. The overall stone-free rate was 72.2%. Neither the type of renal anomaly nor the type of lithotripter had any impact on the stone-free rate (P >0.05). Stone burden (length and number) had a significant influence on the stone-free rate (P <0.05). No extraordinary complications were recorded. Steinstrasse developed in 7 patients (3.5%). No deterioration of renal function or configuration was detected.
ESWL is safe and reliable for treatment of urolithiasis in anomalous kidneys. It should be the primary therapy when the stones are less than 20 mm. The ESWL outcome is comparable for normal and anomalous kidneys when the calculus size is considered.
介绍我们在异位肾患者中进行体外冲击波碎石术（ESWL）的经验，并确定可能影响此类患者无石率的因素。
1989年2月至2000年2月，198例异位肾尿路结石患者接受了ESWL治疗。患者平均年龄（标准差）为40.48（11.53）岁。其中马蹄肾49例（24.7%），旋转异常120例（60.6%），重复肾29例（14.7%）。所有患者均在门诊使用两台第二代碎石机（多尼尔MFL 5000和东芝Echolith）进行治疗。6例患者（3%）需要术前辅助措施。在3个月时记录随访数据。采用卡方检验和曼-惠特尼U检验进行统计学分析，P<0.05认为差异有统计学意义。
结石平均长度（标准差）为13.54（5.49）mm。结石单发148例（74.7%），初发155例（78.3%），右侧82例（41.4%）。除5例（2.5%）外，所有结石均为不透X线结石。总体无石率为72.2%。肾脏异常类型和碎石机类型均对无石率无影响（P>0.05）。结石负荷（长度和数量）对无石率有显著影响（P<0.05）。未记录到特殊并发症。7例患者（3.5%）出现石街。未检测到肾功能或肾脏形态恶化。
ESWL治疗异位肾尿路结石安全可靠。结石小于20mm时应作为首选治疗方法。考虑结石大小后，正常肾和异位肾的ESWL治疗效果相当。
