Andreoiu Matei, MacMahon Ross
Department of Urology, Indiana University, 535 N Barnhill Dr, Suite 420 Indianapolis, IN 46202, USA.
Urology. 2009 Oct;74(4):757-61. doi: 10.1016/j.urology.2009.03.054. Epub 2009 Aug 5.
To assess the reliability and accuracy of diagnostic investigations in differentiating urinary calculi from physiological hydronephrosis as the cause of renal colic. The appropriateness and efficacy of the treatments used were was also examined.
A retrospective review of 300 consecutive patients presenting to 2 local hospitals was carried out. Descriptive and correlational data on clinical presentation, diagnostic imaging, and interventions undertaken were analyzed. A total of 262 patients were included in the final analysis.
Most clinical or laboratory features were unhelpful in predicting the presence of a stone. Left-sided colic was more likely to indicate presence of stone (64.9% vs 46.6%, P = .003). The accuracy of ultrasound findings in predicting presence of stone improved (from 56.2% to 71.9%) when features of obstruction, such as ureteric jet absence and an elevated resistive index (RI), were included in the assessment. Spontaneous resolution occurred in a smaller proportion of patients with stone (63% vs 85%, P <.001). The need for intervention was more prevalent in patients with stones (29.2% vs 5.9%, P <.001). Stent insertion was the most common intervention and was usually completed successfully (95.5%). Ureteroscopy was safe and resulted in stone retrieval 88% of the time.
Most clinical signs and symptoms are unhelpful in determining the cause of colic symptoms. Left-sided colic is more likely to represent the presence of a stone. An enhanced ultrasound examination is a reasonably accurate initial study. The standard endoscopic interventions are more likely to be used in colic cases because of actual calculi, and are safe and effective throughout pregnancy.
评估诊断性检查在鉴别作为肾绞痛病因的尿路结石与生理性肾积水方面的可靠性和准确性。同时还检查了所用治疗方法的适宜性和疗效。
对两家当地医院连续收治的300例患者进行回顾性研究。分析了关于临床表现、诊断性影像学检查及所采取干预措施的描述性和相关性数据。最终分析纳入了262例患者。
大多数临床或实验室特征对预测结石的存在并无帮助。左侧绞痛更有可能提示结石的存在（64.9% 对46.6%，P = 0.003）。当评估中纳入梗阻特征，如输尿管喷射缺失和阻力指数（RI）升高时，超声检查预测结石存在的准确性有所提高（从56.2% 提高到71.9%）。结石患者中自发缓解的比例较小（63% 对85%，P < 0.001）。结石患者需要干预的情况更为普遍（29.2% 对5.9%，P < 0.001）。支架置入是最常见的干预措施，且通常成功完成（95.5%）。输尿管镜检查安全，结石取出成功率为88%。
大多数临床体征和症状无助于确定绞痛症状的病因。左侧绞痛更有可能提示结石的存在。增强超声检查是一项相当准确的初步检查。由于实际存在结石，标准的内镜干预措施更有可能用于绞痛病例，且在整个孕期都是安全有效的。
