Mohayuddin Nazim, Malik Hamad Afzal, Hussain Manzoor, Tipu Salman Ahmed, Shehzad Asad, Hashmi Altaf, Naqvi Syed Ali Anwar, Rizvi Syed Adibul Hasan
Sindh Institute of Urology and Transplantation (SIUT), Civil Hospital, Karachi, Pakistan.
J Pak Med Assoc. 2009 Mar;59(3):143-6.
To compare the outcome of Extra corporeal shockwave lithotripsy for a renal pelvic stone with and without JJ stent.
A comparative cross sectional study was carried out at Sindh Institute of Urology and Transplantation from January 2007 to January 2008. Eighty patients with renal pelvic stone measuring 2cm +/- 2mm were selected for treatment with Extra Corporeal Shockwave Lithotripsy (ESWL). All of these patients were adults with normal renal function and had unilateral renal stones with negative urine cultures. Patients with renal failure and children were excluded. They were divided into two groups of 40 each. Group A patients underwent ESWL without a JJ stent and in Group B a JJ stent was placed before ESWL. SLX F2 electromagnetic ESWL machine was used to impart shock waves. 3000 shockwaves were given in a session. Both the groups were compared for renal colic, steinstrasse, fever, lower urinary tract symptoms (LUTS) emergency room visits and hospital admissions, stone clearance, number of ESWL sessions, auxilliary procedures, (percutaneous nephrostomy or ureterorenoscopy) and cost.
Ureteric colic occurred in 13 (32.5%) patients in group A and in 3 (7.5%) patient in group B. Steinstrasse developed in 4 (10%) patients with out JJ stent and in 3 (7.5%) patients with JJ stent. Fever was encountered in 1 (2.5%) patient in group A and in 3 (7.5%) patient in group B. Mean emergency room visits were 2.1 per patient in group A and 0.7 per patient in group B. Stone clearance occurred in 33 (82.5%) patients in group A and 31 (77.5%) in group B. In group B lower urinary tract symptoms were found in 50% versus 20% in group A. Auxillary procedure was performed in one (2.5%) patient each in both groups.
Pre ESWL JJ stenting for a 2 cm +/- 2 mm renal stone was not beneficial in terms of steinstrasse, fever, stone clearance and number of ESWL sessions. However ureteric colic was significantly less in the stented group. Lower urinary tract symptoms (LUTS) was also significantly high in the patients having a JJ stent. The cost of the treatment doubled in the stented group which is an important factor in our country. JJ stenting does not prove to be a cost effective procedure when compared to the reduction in complications.
比较有或无双J支架情况下体外冲击波碎石术治疗肾盂结石的效果。
2007年1月至2008年1月在信德泌尿与移植研究所开展了一项比较性横断面研究。选取80例肾盂结石大小为2cm±2mm的患者接受体外冲击波碎石术（ESWL）治疗。所有这些患者均为肾功能正常的成年人，患有单侧肾结石且尿培养阴性。排除肾衰竭患者和儿童。将他们分为两组，每组40例。A组患者在无双J支架的情况下接受ESWL，B组患者在ESWL前放置双J支架。使用SLX F2电磁式ESWL机施加冲击波。每次治疗给予3000次冲击波。比较两组患者的肾绞痛、石街形成、发热、下尿路症状（LUTS）、急诊就诊和住院情况、结石清除率、ESWL治疗次数、辅助操作（经皮肾造瘘术或输尿管肾镜检查）及费用。
A组13例（32.5%）患者发生输尿管绞痛，B组3例（7.5%）患者发生输尿管绞痛。无双J支架的患者中有4例（10%）形成石街，有双J支架的患者中有3例（7.5%）形成石街。A组1例（2.5%）患者出现发热，B组3例（7.5%）患者出现发热。A组患者平均急诊就诊次数为每人2.1次，B组为每人0.7次。A组33例（82.5%）患者结石清除，B组31例（77.5%）患者结石清除。B组50%的患者出现下尿路症状，而A组为20%。两组各有1例（2.5%）患者接受了辅助操作。
对于大小为2cm±2mm的肾结石，ESWL术前放置双J支架在石街形成、发热、结石清除率及ESWL治疗次数方面并无益处。然而，放置支架组的输尿管绞痛明显较少。放置双J支架的患者下尿路症状（LUTS）也明显较多。放置支架组的治疗费用翻倍，这在我国是一个重要因素。与并发症减少相比，放置双J支架并非具有成本效益的治疗方法。
