Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.
J Endourol. 2010 Jul;24(7):1169-73. doi: 10.1089/end.2010.0124.
The aim of this study was to evaluate the effect of stone attenuation value on the effectiveness of extracorporeal shockwave lithotripsy (SWL) for upper urinary tract stones.
In this prospective study, 99 patients underwent SWL for solitary renal and upper ureteral stones from January 2007 to March 2009. All patients underwent CT scan before SWL. The mean attenuation value of stones in our study was 1213.3 +/- 314.5 Hounsfield units (HU). Group A consisted of 42 patients with stones of attenuation value <1200 HU and group B had 57 patients with stones of attenuation value >1200 HU. Stone size, location, requirement of number of shockwaves, shock intensities (power), retreatment rate, complication rate, auxiliary procedure rate, and effectiveness quotient (EQ) ratio were studied.
The mean total number of shocks required to fragment the stones in groups A and B were 1317.1 +/- 345.3 and 1646.5 +/- 610.8, respectively (p = 0.001), with a mean shock intensity of 12.2 +/- 0.7 and 12.4 +/- 0.5 kV, respectively (p = 0.03). Retreatment was not required in patients of group A, but 14.03% patients in group B required retreatment (p < 0.0001). Clearance rate in group A was 88.1%, whereas in group B it was 82.5% (p = 0.35). Auxiliary procedure rates were 9.5% and 10.5% in groups A and B (p = 0.22), respectively. EQ was 80.4% and 66.2% in groups A and B (p = 0.03), respectively. Complication rates were similar with 2.4% and 3.5% in groups A and B, respectively (p = 0.37). Significant correlation was recorded for total number and intensity of shocks with stone attenuation value.
The EQ of SWL for upper urinary tract stones was significantly better for stones with lower attenuation value. The number and intensity of shocks required to fragment these stones with lower attenuation value were also significantly lower.
本研究旨在评估结石衰减值对上尿路结石体外冲击波碎石（SWL）效果的影响。
本前瞻性研究纳入了 2007 年 1 月至 2009 年 3 月间因单发肾结石和上段输尿管结石而接受 SWL 的 99 例患者。所有患者在 SWL 前均接受 CT 扫描。本研究中结石的平均衰减值为 1213.3 ± 314.5 亨氏单位（HU）。A 组包括 42 例衰减值<1200 HU 的结石患者，B 组包括 57 例衰减值>1200 HU 的结石患者。研究了结石大小、位置、所需冲击波数量、冲击波强度（功率）、再次治疗率、并发症率、辅助治疗率和有效率（EQ）比值。
A 组和 B 组碎裂结石所需的总冲击波数分别为 1317.1 ± 345.3 和 1646.5 ± 610.8（p = 0.001），平均冲击波强度分别为 12.2 ± 0.7 和 12.4 ± 0.5 kV（p = 0.03）。A 组患者无需再次治疗，但 B 组中有 14.03%的患者需要再次治疗（p<0.0001）。A 组的清除率为 88.1%，而 B 组为 82.5%（p = 0.35）。A 组和 B 组的辅助治疗率分别为 9.5%和 10.5%（p = 0.22）。A 组和 B 组的 EQ 分别为 80.4%和 66.2%（p = 0.03）。A 组和 B 组的并发症发生率分别为 2.4%和 3.5%（p = 0.37）。总冲击波数和强度与结石衰减值呈显著相关。
SWL 治疗上尿路结石的 EQ 对于衰减值较低的结石更好。对于衰减值较低的结石，所需的冲击波数量和强度也显著较低。
