Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchatewi, Bangkok 10400, Thailand.
Nat Rev Urol. 2011 Feb;8(2):81-5. doi: 10.1038/nrurol.2010.209. Epub 2010 Dec 7.
Several explanations have been suggested to account for the failure of extracorporeal shockwave lithotripsy (ESWL) treatment in patients with urinary stones, including large stone volume, unfavorable stone location or composition and the type of lithotriptor used. Unfavorable stone composition is considered a major cause of failure of ESWL treatment, and consequently knowledge of the stone composition before treatment is initiated is desirable. Plain abdominal radiographs cannot accurately determine either stone composition or fragility, and although the CT attenuation value in Hounsfield units (HU) (that is, normalized to the attenuation characteristics of water) is useful, this parameter has limited value as a predictor of stone composition or the response to ESWL treatment. By contrast, stone morphology as visualized by CT correlates well with both fragility and susceptibility to fragmentation by ESWL. For patients prone to recurrent calculi, analyses of stone composition are especially important, as they may reveal an underlying metabolic abnormality. The development of advanced imaging technologies that can predict stone fragility is essential, as they could provide extra information for physicians, enabling them to select the most appropriate treatment option for patients with urinary stones.
已经提出了几种解释来解释体外冲击波碎石术 (ESWL) 治疗尿路结石患者失败的原因，包括结石体积大、结石位置或成分不利以及碎石机的类型。不利的结石成分被认为是 ESWL 治疗失败的主要原因，因此在开始治疗之前了解结石成分是理想的。普通腹部 X 光片不能准确确定结石成分或易碎性，尽管亨氏单位 (HU) 的 CT 衰减值（即，归一化为水的衰减特性）很有用，但该参数作为预测结石成分或对 ESWL 治疗反应的指标价值有限。相比之下，通过 CT 观察到的结石形态与易碎性和对 ESWL 碎裂的易感性密切相关。对于容易复发结石的患者，分析结石成分尤为重要，因为这可能揭示潜在的代谢异常。开发能够预测结石易碎性的先进成像技术至关重要，因为它们可以为医生提供额外的信息，使他们能够为尿路结石患者选择最合适的治疗方案。
