Glowacki L S, Beecroft M L, Cook R J, Pahl D, Churchill D N
Department of Medicine, St. Joseph's Hospital, Hamilton, Ontario, Canada.
J Urol. 1992 Feb;147(2):319-21. doi: 10.1016/s0022-5347(17)37225-7.
An inception cohort of 107 patients was reviewed to establish the natural history of asymptomatic urolithiasis. With an over-all mean followup of 31.6 months, 73 patients (68.2%) remained asymptomatic and were censored at the time of the last clinical visit. A symptomatic event developed in 34 patients (31.8%). Spontaneous passage occurred in 16 patients (15.0%), endoureteral removal was done in 6 (5.6%), percutaneous nephrostolithotomy was done in 3 (2.8%) and 9 (8.4%) were referred for therapeutic lithotripsy. Cumulative 5-year probability of a symptomatic event developing was 48.5%. A linear association was identified between the development of a symptomatic event and the number of previous stones as well as the number of asymptomatic stones at identification. A significant burden of illness is associated with an expectant strategy as an approach to asymptomatic urolithiasis. Of the patients who had a symptomatic event 47% had spontaneous stone passage, while 26.5% required urological intervention and 26.5% were referred for therapeutic lithotripsy. Prophylactic extracorporeal shock wave lithotripsy, although often advocated, has associated risks and is not always a benign procedure. A randomized controlled trial is required to evaluate properly the role of prophylactic lithotripsy versus an expectant strategy.
对一个由107例患者组成的初始队列进行了回顾性研究，以确定无症状性尿路结石的自然病程。总体平均随访31.6个月，73例患者（68.2%）仍无症状，并在最后一次临床就诊时进行了截尾。34例患者（31.8%）出现了症状性事件。16例患者（15.0%）结石自行排出，6例（5.6%）进行了输尿管内取石术，3例（2.8%）进行了经皮肾镜取石术，9例（8.4%）被转诊接受治疗性碎石术。出现症状性事件的5年累积概率为48.5%。在症状性事件的发生与既往结石数量以及确诊时无症状结石数量之间发现了线性关联。作为无症状性尿路结石的一种处理方法，观察等待策略会带来显著的疾病负担。在出现症状性事件的患者中，47%的结石自行排出，而26.5%需要泌尿外科干预，26.5%被转诊接受治疗性碎石术。预防性体外冲击波碎石术虽然常被提倡，但存在相关风险，并不总是一种安全无害的操作。需要进行一项随机对照试验，以正确评估预防性碎石术与观察等待策略的作用。
