Mustafa Mahmoud, Ali-El-Dein Bedier
Osmaniye State Hospital, Urology Department, Osmaniye State Hospital, Osmaniye/Turkey.
J Pak Med Assoc. 2009 Mar;59(3):141-3.
To prospectively evaluate the role of double J (DJ) stent in enhancing the passage of fragments in patients undergoing extracorporeal shockwave lithotripsy (SWL) for renal stones with diameters less than 2.5 cm.
Between November 2005 and January 2007, 38 patients with an average age of 47.05 years (range 16-73) were included and underwent SWL for renal stones. The inclusion criteria were radio-opaque renal stone not located in the lower pole, complete disintegeration of the stone, normal renal function, no metabolic abnormalities, no major renal abnormalities and no symptomatic urinary tract infection. The patients were randomized to either a stented (11 patients) or stentless (27 patients) group. The average stone diameters in stentless and stented groups were 1.54 cm and 1.77 cm, respectively (p > 0.05). Double J stent was removed when there was no further passage of the fragments for 6 weeks after stone disintegration. All patients were given non-steroidal anti-inflammatory drugs for one week after ESWL treatment. Stone passage and the data of DJ were determined with plain X-ray of the urinary tract (UTP). The severity of lower urinary tract symptoms, loin pain and the need for intravenous or intramuscular analgesics were recorded.
The overall stone-free rate at 3 months was 92.1%. Two patients in the stented and one patient in the stentless group were partially free of stones. Steinstrasse were observed in two patients (5.3%); one patient in the stentless group and another one after the removal of DJ stent. Only one patient in the stented group had severe lower urinary tract symptoms which responded neither to oral nor to other forms of analgesics, and therefore DJ stent was removed. The remaining patients were in no need for analgesics other than the oral therapy.
Placement of DJ stent for the purpose of improving free stone rate or enhancing the passage of the fragments during SWL is unnecessary in renal stone with diameters less than 2.5 cm. However, further prospective trials should be designed to define the criteria for stented SWL.
前瞻性评估双J（DJ）支架在直径小于2.5 cm肾结石体外冲击波碎石术（SWL）患者中促进结石碎片排出的作用。
2005年11月至2007年1月，纳入38例平均年龄47.05岁（范围16 - 73岁）的肾结石患者并接受SWL治疗。纳入标准为不透X线的肾结石不在下极、结石完全碎裂、肾功能正常、无代谢异常、无重大肾脏异常且无症状性尿路感染。患者被随机分为置支架组（11例）和无支架组（27例）。无支架组和置支架组的平均结石直径分别为1.54 cm和1.77 cm（p>0.05）。结石碎裂后6周若不再有碎片排出则取出DJ支架。所有患者在ESWL治疗后给予非甾体类抗炎药一周。通过泌尿系统平片（UTP）确定结石排出情况及DJ支架相关数据。记录下尿路症状的严重程度、腰痛情况以及静脉或肌肉注射镇痛药的需求。
3个月时总体无石率为92.1%。置支架组有2例患者、无支架组有1例患者结石部分排出。观察到2例患者出现石街（5.3%）；1例在无支架组，另1例在取出DJ支架后。置支架组仅1例患者有严重下尿路症状，口服及其他形式的镇痛药均无效，因此取出DJ支架。其余患者除口服治疗外无需其他镇痛药。
对于直径小于2.5 cm的肾结石，为提高无石率或在SWL期间促进碎片排出而放置DJ支架并无必要。然而，应设计进一步的前瞻性试验以明确SWL置支架的标准。
