Uguz Sami, Senkul Temucin, Soydan Hasan, Ates Ferhat, Akyol Ilker, Malkoc Ercan, Baykal Kadir Vehbi
Urology Department, GATA Haydarpasa Teaching Hospital, Uskudar, Istanbul, 34668, Turkey.
Urol Res. 2012 Dec;40(6):739-44. doi: 10.1007/s00240-012-0490-2. Epub 2012 Jul 5.
The objective is to compare immediate and delayed SWL as a treatment for ureter stones between 5 and 20 mm. Patients who applied to the emergency department with single, radio opaque ureteric stone of 5-20 mm size were included in the study. Patients were randomized into immediate and delayed SWL groups. SWL were carried out after pain relief in the delayed group. Maximum of three SWL sessions were applied to the patients with stones of 5 mm or bigger in diameter, leaving at least 3 days interval in-between. Stone-free rate after first session was similar in two groups. When CIRF was also considered as success, the success rate of SWL in the immediate SWL group was higher after first session (p = 0.02). Immediate SWL had a greater success rate in upper ureteric stones (p = 0.019). Overall average time required for elimination of stones was shorter in immediate SWL group than delayed SWL group (p = 0.033). The success rate after first SWL session (including CIRF) was 59 % for patients with chronic pain in the delayed group and 100 % for patients with acute pain in the immediate group. According to the hydronephrosis grade, success rates were 71 and 44.4 % for patients with grade 1 or no hydronephrosis in the immediate SWL group, and for patients with grade 2 or larger hydronephrosis in the delayed SWL group, respectively, after first SWL session. Immediate SWL insures stone-free status in a shorter time in cases with renal colicky pain and ureteral stones, particularly upper ureteral stones.
目的是比较即刻与延迟体外冲击波碎石术（SWL）治疗直径5至20毫米输尿管结石的效果。研究纳入了因5至20毫米大小的单发、不透X线输尿管结石而到急诊科就诊的患者。患者被随机分为即刻SWL组和延迟SWL组。延迟组在疼痛缓解后进行SWL。对于直径5毫米及以上结石的患者，最多进行三次SWL治疗，每次治疗间隔至少3天。两组首次治疗后的结石清除率相似。若将结石碎片率（CIRF）也视为成功，则即刻SWL组首次治疗后的SWL成功率更高（p = 0.02）。即刻SWL在上段输尿管结石中的成功率更高（p = 0.019）。即刻SWL组结石清除所需的总体平均时间比延迟SWL组短（p = 0.033）。延迟组慢性疼痛患者首次SWL治疗后（包括CIRF）的成功率为59%，即刻组急性疼痛患者的成功率为100%。根据肾积水分级，即刻SWL组1级或无肾积水患者首次SWL治疗后的成功率分别为71%，延迟SWL组2级或更严重肾积水患者的成功率为44.4%。对于肾绞痛和输尿管结石患者，尤其是上段输尿管结石患者，即刻SWL能在更短时间内确保结石清除状态。
