Department of Urology, Columbia University, New York, New York, USA.
J Urol. 2010 Feb;183(2):580-4. doi: 10.1016/j.juro.2009.10.025. Epub 2009 Dec 16.
ESWL is a minimally invasive, efficacious therapy for most renal stones. However, an optimal voltage treatment protocol ensuring effective stone comminution while minimizing tissue injury is not well established. We performed a prospective, randomized trial of the stone-free rate and renoprotective effect of an escalating vs a fixed voltage treatment strategy during ESWL.
Between February 2006 and June 2008 we enrolled 45 patients undergoing ESWL for a renal stone in this institutional review board approved trial. A Dornier DoLi 50 lithotriptor was used. Patients were randomized to receive the escalating strategy of 500 shocks at 14k V, 1,000 at 16 kV and 1,000 at 18 kV or the fixed strategy of 2,500 shocks at 18 kV. Abdominal x-ray was done to determine the stone-free rate at 1 month. Voided urine was analyzed for beta2-microglobulin and microalbumin before, immediately after and 1 week after ESWL to evaluate renal damage.
Median patient age was 48 years. Median stone size was 8 mm. Of patients in the escalating group 81% were stone-free vs 48% in the fixed group (p <0.03). There was a significant difference between microalbumin and beta2-microglobulin 1 week after the procedure (p = 0.046 vs 0.045). There was trend toward a difference in microalbumin and beta2-microglobulin immediately after the procedure (p = 0.17 and 0.25, respectively).
This prospective, randomized study shows that an escalating voltage treatment strategy produces better stone comminution than a fixed strategy. The study suggests that there may be a protective effect against damage caused by ESWL with an escalating treatment strategy.
ESWL 是一种微创、有效的治疗大多数肾结石的方法。然而，一种确保有效碎石而最小化组织损伤的最佳电压治疗方案尚未得到很好的建立。我们进行了一项前瞻性、随机试验，比较了递增电压与固定电压治疗策略在 ESWL 中对无结石率和肾脏保护作用的影响。
在 2006 年 2 月至 2008 年 6 月期间，我们在这项机构审查委员会批准的试验中招募了 45 名接受 ESWL 治疗肾结石的患者。使用 Dornier DoLi 50 碎石机。患者被随机分配接受递增策略（500 次冲击，电压 14kV；1000 次冲击，电压 16kV；1000 次冲击，电压 18kV）或固定策略（2500 次冲击，电压 18kV）。腹部 X 线检查在 1 个月时确定无结石率。在 ESWL 前、后即刻和 1 周时分析尿液中的β2-微球蛋白和微量白蛋白，以评估肾脏损伤。
患者中位年龄为 48 岁，中位结石大小为 8mm。递增组 81%的患者无结石，而固定组为 48%（p<0.03）。术后 1 周时，微白蛋白和β2-微球蛋白之间存在显著差异（p=0.046 对 0.045）。术后即刻时，微白蛋白和β2-微球蛋白之间也存在差异趋势（分别为 p=0.17 和 0.25）。
这项前瞻性、随机研究表明，递增电压治疗策略比固定策略产生更好的碎石效果。该研究表明，递增治疗策略可能对 ESWL 引起的损伤有保护作用。
