Tavakkoli Tabasi Kamyar, Baghban Haghighi Mehri
Department of Urology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Urol J. 2007 Fall;4(4):221-5.
The aim of this study was to compare the results and complications of extracorporeal shock wave lithotripsy (SWL) plus retrograde ureteroscopic lithotripsy using laser and pneumatic lithotriptors with SWL monotherapy for renal pelvic calculi between 2 cm and 3 cm.
A total of 55 patients with 2- to 3-cm pelvic calculi were assigned into groups 1 and 2, including 22 and 33 patients, respectively. Patients in group 1 first underwent laser pneumatic lithotripsy and insertion of a double-J ureteral catheter and then underwent SWL 2 to 4 weeks thereafter. In group 2, the patients underwent SWL after double-J ureteral catheter insertion. The stone-free rate, complications, and cost effectiveness were evaluated 3 months postoperatively.
Five patients (22.7%) in group 1, had their calculi completely fragmented after ureteroscopy and retrograde lithotripsy without any need for further SWL. In 9 patients (40.9%), after a single session of SWL, and in 3 (13.6%), after 2 sessions, fragmentation was completed. In group 2, successful treatment was achieved after 1 and 2 SWL sessions in 6 (18.2%) and 8 (24.2%) patients, respectively. The stone-free rate was significantly higher in the patients of group1 than those in group 2 (77.3% versus 42.4%, respectively; P = .01). The period of anesthesia was 23.1 minutes (during ureteroscopy) in group 1 and 13.2 minutes in group 2 (during cystoscopy or ureteroscopy and insertion of ureteral catheter). No significant complication was reported in neither of the groups. The mean costs of the treatment were US $ 400 and US $ 370 in groups 1 and 2, respectively.
Ureteroscopic lithotripsy before SWL is a rational method for the treatment of the rather large renal pelvic calculi with fairly acceptable costs.
本研究的目的是比较体外冲击波碎石术（SWL）联合使用激光和气压弹道碎石器的逆行输尿管镜碎石术与单纯SWL治疗2至3厘米肾盂结石的结果和并发症。
总共55例患有2至3厘米肾盂结石的患者被分为1组和2组，分别包括22例和33例患者。1组患者首先接受激光气压弹道碎石术并插入双J输尿管导管，然后在2至4周后接受SWL。2组患者在插入双J输尿管导管后接受SWL。术后3个月评估结石清除率、并发症和成本效益。
1组中有5例患者（22.7%）在输尿管镜检查和逆行碎石术后结石完全破碎，无需进一步SWL。9例患者（40.9%）在单次SWL后，3例患者（13.6%）在2次SWL后结石破碎完成。2组中，分别有6例（18.2%）和8例（24.2%）患者在1次和2次SWL后成功治疗。1组患者的结石清除率显著高于2组（分别为77.3%和42.4%；P = .01）。1组的麻醉时间为23.1分钟（输尿管镜检查期间），2组为13.2分钟（膀胱镜检查或输尿管镜检查及输尿管导管插入期间）。两组均未报告严重并发症。1组和2组的平均治疗费用分别为400美元和370美元。
SWL前进行输尿管镜碎石术是治疗较大肾盂结石的合理方法，成本相当可接受。
