Seitz Christian, Fritsche Hans-Martin, Siebert Thomas, Martini Thomas, Wieland Wolf Ferdinand, Pycha Armin, Burger Maximilian
Department of Urology, General Hospital Bolzano, Bolzano, Italy.
J Urol. 2009 Oct;182(4):1424-9. doi: 10.1016/j.juro.2009.06.045. Epub 2009 Aug 15.
We compared the treatment efficacy and safety of the novel Lithoskop electromagnetic extracorporeal shock wave lithotriptor for upper urinary tract stones with and without prior ureteral stent placement.
A total of 665 consecutive patients harboring single renal or ureteral stones underwent shock wave lithotripsy between August 2006 and July 2008. In 75 and 46 patients with renal and ureteral stones, respectively, stents were placed before the first shock wave lithotripsy session. Treatment outcome was assessed in relation to stent placement. All data were derived from a prospectively maintained database.
The mean size of nonstented vs stented renal and ureteral stones was 8.6 vs 12.5 mm (p <0.0001) and 7.1 vs 7.3 mm (p = 0.6), respectively. The stone-free rate in nonstented vs stented renal and ureteral stone cases was 76.3% vs 77.3% and 91.4% vs 93.5%, respectively (each p >0.99). The total energy applied per stone was 110 +/- 83 vs 150 +/- 89 J (p <0.0001) and 183 +/- 131 vs 209 +/- 125 J (p = 0.1), respectively. Auxiliary measures were required after shock wave lithotripsy for renal and ureteral stones in 5.4% and 10.8% of nonstented, and in 1.3% and 4.3% of stented cases, respectively. No complications were detected in stented renal and ureteral stone cases compared to 2.9% and 6.9% in nonstented cases, respectively.
A high success rate and a low complication rate were achieved in renal and ureteral stone cases with and without prior ureteral stent placement. Total energy needed to achieve a stone-free state did not differ between stented and nonstented ureteral cases, suggesting the absence of a significant influence of the stent. Overall stents decreased complications necessitating hospitalization and auxiliary invasive measures.
我们比较了新型Lithoskop电磁体外冲击波碎石机对有或没有预先放置输尿管支架的上尿路结石的治疗效果和安全性。
2006年8月至2008年7月期间，共有665例患有单个肾或输尿管结石的连续患者接受了冲击波碎石术。分别有75例和46例患有肾和输尿管结石的患者在首次冲击波碎石术之前放置了支架。根据支架放置情况评估治疗结果。所有数据均来自前瞻性维护的数据库。
未放置支架与放置支架的肾和输尿管结石的平均大小分别为8.6mm对12.5mm（p<0.0001）和7.1mm对7.3mm（p = 0.6）。未放置支架与放置支架的肾和输尿管结石病例的无石率分别为76.3%对77.3%和91.4%对93.5%（各p>0.99）。每颗结石施加的总能量分别为110±83J对150±89J（p<0.0001）和183±131J对209±125J（p = 0.1）。未放置支架的肾和输尿管结石在冲击波碎石术后分别有5.4%和10.8%需要辅助措施，而放置支架的病例分别为1.3%和4.3%。放置支架的肾和输尿管结石病例未检测到并发症，而未放置支架的病例分别为2.9%和6.9%。
无论是否预先放置输尿管支架，肾和输尿管结石病例均取得了高成功率和低并发症率。放置支架和未放置支架的输尿管病例实现无石所需的总能量没有差异，这表明支架没有显著影响。总体而言，支架减少了需要住院治疗的并发症和辅助侵入性措施。
