El-Assmy Ahmed, El-Nahas Ahmed R, Youssef Ramy F, El-Hefnawy Ahmed S, Sheir Khaled Z
Urology & Nephrology Center, Mansoura University, Mansoura, Egypt.
Scand J Urol Nephrol. 2007;41(3):208-13. doi: 10.1080/00365590601068892.
We conducted a prospective randomized study to investigate the relation between the degree of stone-induced hydronephrosis and the outcome of extracorporeal shock-wave lithotripsy (ESWL) in patients with lumbar ureter stones.
A total of 284 patients with solitary lumbar ureter stones with or without hydronephrosis were treated with ESWL. The degree of hydronephrosis was determined by means of renal ultrasound. Patients were divided into four groups according to the degree of stone-induced hydronephrosis. The results were analyzed by comparing stone-free rates, the number of shock waves, the number of sessions, the incidence of complications, secondary interventions and time to stone clearance.
The mean stone size was 11.4+/-2.6 mm. In the hydronephrotic group, the stone-free rate was 80.3%, compared to 89.1% in patients without hydronephrosis (p=0.12). The mean time to stone clearance was 13.8+/-9.8 days. Differences among the four groups in terms of stone size and treatment outcome were not significant. However, the presence of hydronephrosis was highly associated with repeat treatment (2.4 vs 1.7 treatments; p<0.001) and prolonged clearance time (16.2 vs 11.6 days; p<0.001).
In cases with solitary lumbar ureter stones, the degree of hydronephrosis caused by the stone does not affect the overall treatment success with ESWL. However, stones in obstructed systems are associated with a tendency for repeat treatment and a prolonged time for stone clearance.
我们进行了一项前瞻性随机研究，以探讨输尿管上段结石患者结石所致肾积水程度与体外冲击波碎石术（ESWL）治疗效果之间的关系。
共有284例单发输尿管上段结石患者接受了ESWL治疗，无论有无肾积水。通过肾脏超声确定肾积水程度。根据结石所致肾积水程度将患者分为四组。通过比较结石清除率、冲击波次数、治疗次数、并发症发生率、二次干预措施及结石清除时间来分析结果。
结石平均大小为11.4±2.6mm。肾积水组的结石清除率为80.3%，无肾积水患者的结石清除率为89.1%（p=0.12）。结石清除的平均时间为13.8±9.8天。四组之间在结石大小和治疗效果方面的差异不显著。然而，肾积水的存在与重复治疗（2.4次与1.7次治疗；p<0.001）及结石清除时间延长（16.2天与11.6天；p<0.001）高度相关。
对于单发输尿管上段结石病例，结石所致肾积水程度不影响ESWL的总体治疗成功率。然而，梗阻系统中的结石与重复治疗倾向及结石清除时间延长有关。
