Department of Urology, Chungnam National University School of Medicine, Daejeon, Korea.
J Endourol. 2010 Oct;24(10):1681-5. doi: 10.1089/end.2010.0092.
We assessed the role of the unenhanced helical computed tomography (UHCT) for prediction of concurrent ureteral lesions associated with small impacted stones presenting in distal ureter.
From May 2004 to June 2009, we evaluated 30 cases with impacted distal ureteral stones <5 mm. All of the patients were evaluated with unenhancing UHCT, and the secondary signs on UHCT were graded on a scale of 0 to 3. All of the patients were treated by ureteroscopic pneumatic lithotripsy. Ureteral lesions associated with impacted stones were characterized on the basis of the ureteroscopic findings.
Ureteroscopic procedures showed that impacted distal ureteral stones <5 mm had concurrent ureteral lesions such as severe mucosal edema, strictures, ureteral polyps, or submucosal stones. Long-term stone impaction and the UHCT findings of a higher degree of the tissue rim sign, hydronephrosis, and perinephric fat stranding were associated with a higher likelihood of the presence of underlying ureteral lesions.
The secondary signs on UHCT such as high degree of tissue rim sign, hydronephrosis, and perinephric fat stranding seem to be useful signs in predicting the presence of concurrent ureteral lesions. In those cases, early intervention might have better outcomes than conservative therapy.
我们评估了未增强螺旋 CT(UHCT)在预测与小的嵌顿性结石相关的并发输尿管病变中的作用,这些结石位于输尿管远端。
自 2004 年 5 月至 2009 年 6 月,我们评估了 30 例直径<5mm 的嵌顿性输尿管远端结石患者。所有患者均接受 UHCT 平扫,根据 0-3 级评分评估 UHCT 的次要征象。所有患者均采用输尿管镜气压弹道碎石术治疗。根据输尿管镜检查结果,对伴有嵌顿结石的输尿管病变进行特征描述。
输尿管镜检查显示,直径<5mm 的嵌顿性输尿管远端结石伴有严重的黏膜水肿、狭窄、输尿管息肉或黏膜下结石等并发输尿管病变。长期结石嵌顿和 UHCT 表现出较高程度的组织边缘征、肾盂积水和肾周脂肪条纹,与存在潜在输尿管病变的可能性更高相关。
UHCT 的次要征象,如高度组织边缘征、肾盂积水和肾周脂肪条纹,似乎是预测并发输尿管病变存在的有用征象。在这些情况下,早期干预可能比保守治疗有更好的效果。