Seitz Christian, Fajković Harun, Remzi Mesut, Waldert Matthias, Ozsoy Mehmet, Kramer Gero, Marberger Michael
Department of Urology, Medical University of Vienna, Austria.
Eur Urol. 2006 Jun;49(6):1099-105; discussion 1105-6. doi: 10.1016/j.eururo.2005.12.003. Epub 2005 Dec 28.
To investigate the relationship between delay in extracorporeal shock wave lithotripsy (ESWL) after a first colic and subsequent time to complete stone clearance.
This prospective, non-randomized study included 94 patients treated with ESWL for unilateral solitary proximal ureteral stones after at least one episode of colic pain. Time between the first onset of colic pain and ESWL and stone clearance was recorded. The pretherapeutic degree of hydronephrosis has been assessed using ultrasound.
Mean stone size was 7.9 +/- 2.3 mm and mean time before ESWL after a first colic was 93.4 +/- 143.5 h. At 3 months, 3 patients were lost to follow-up. In 76.9% of patients stones were completely cleared and a further 3.3% harbored residual fragments < or =3 mm. Delay in treatment after a first colic correlated with subsequent time to stone clearance (p < 0.0001). Mean time to stone clearance in patients treated within 24h was 6.4 +/- 6.3 days compared with 16.0 +/- 17.8 days for those treated later (p = 0.008). Maximum stone diameter correlated with time to stone clearance (p = 0.031), but the degree of hydronephrosis did not.
Rapid ESWL after a first onset of colic pain resulted in accelerated stone clearance independent of the degree of hydronephrosis but had no impact on the need for auxiliary procedures.
探讨首次肾绞痛发作后体外冲击波碎石术（ESWL）延迟与后续结石完全清除时间之间的关系。
这项前瞻性、非随机研究纳入了94例在至少一次肾绞痛发作后接受ESWL治疗单侧孤立性近端输尿管结石的患者。记录首次肾绞痛发作至ESWL及结石清除的时间。术前使用超声评估肾积水程度。
平均结石大小为7.9±2.3mm，首次肾绞痛发作后至ESWL的平均时间为93.4±143.5小时。3个月时，3例患者失访。76.9%的患者结石完全清除，另有3.3%的患者残留碎片≤3mm。首次肾绞痛发作后治疗延迟与后续结石清除时间相关（p<0.0001）。24小时内接受治疗的患者结石清除平均时间为6.4±6.3天，而稍后接受治疗的患者为16.0±17.8天（p=0.008）。结石最大直径与结石清除时间相关（p=0.031），但肾积水程度与之无关。
首次肾绞痛发作后快速进行ESWL可加快结石清除，且与肾积水程度无关，但对辅助治疗的需求无影响。
