Vivaldi B, Fernández M I, López J F, Fuentes F, Urzúa C, Krebs A, Domenech A, Figueroa P A, Pizzi P, Westendarp M, Zambrano N, Castro M, Coz L F
Servicio de Urología, Hospital Militar de Santiago, Chile.
Actas Urol Esp. 2011 Oct;35(9):529-33. doi: 10.1016/j.acuro.2011.04.008.
The aim of this study was to identify predictive factors of success following a single-session of shock wave lithotripsy (SWL) at 3 weeks of follow-up in our center.
The medical records of 116 patients with solitary urinary calculi who underwent single-session SWL in our department between October 2007 and August 2009 were reviewed. All preoperative unenhanced computed axial tomographies were reviewed by two radiologists blinded to clinical outcome. Success was defined as complete clearance or the persistence of fragments ≤ 2 mm on a plain film at 3 weeks of follow-up. The impact of clinical and radiological factors on success was assessed by univariate and multivariate analyses.
The single-session SWL success rate at 3 weeks was 49.1%. Stone size <8 mm, stone area < 30 mm(2), stone location (mid- and distal ureter), stone density <1000 HU and intraoperative fragmentation showed a significant association with SWL success in the univariate analysis (p<0.05). Stone area (OR 2.9), ureteral stone location (OR 3.4) and intraoperative fragmentation (OR 4.2) were the only predictors of success in the multivariate analysis.
Stone area and ureteral stone location provide important information when deciding about the indication of a SWL in a patient with stone disease. However, successful resolution of only half of the cases after a single session at 3 weeks in our series undermines the relevance of informing patients about the potential need for additional treatment.
本研究的目的是确定在我们中心进行单次冲击波碎石术（SWL）后3周随访时成功的预测因素。
回顾了2007年10月至2009年8月间在我们科室接受单次SWL治疗的116例孤立性尿路结石患者的病历。两位对临床结果不知情的放射科医生对所有术前未增强的计算机断层扫描进行了评估。成功定义为在随访3周时平片上结石完全清除或残留碎片≤2mm。通过单因素和多因素分析评估临床和放射学因素对成功的影响。
3周时单次SWL成功率为49.1%。在单因素分析中，结石大小<8mm、结石面积<30mm²、结石位置（输尿管中下段）、结石密度<1000HU和术中碎石与SWL成功显著相关（p<0.05）。多因素分析中，结石面积（OR 2.9）、输尿管结石位置（OR 3.4）和术中碎石（OR 4.2）是成功的唯一预测因素。
在决定对结石病患者进行SWL治疗指征时，结石面积和输尿管结石位置提供了重要信息。然而，在我们的系列研究中，单次治疗3周后仅一半病例成功解决，这削弱了告知患者可能需要额外治疗的相关性。
