The Oxford Stone Group, The Churchill Hospital, Oxford, OX3 7LF, UK.
Urolithiasis. 2013 Jun;41(3):231-4. doi: 10.1007/s00240-013-0549-8. Epub 2013 Mar 3.
Use of extracorporeal lithotripsy is declining in North America and many European countries despite international guidelines advocating it as a first-line therapy. Traditionally, lithotripsy is thought to have poor efficacy at treating lower pole renal stones. We evaluated the success rates of lithotripsy for lower pole renal stones in our unit. 50 patients with lower pole kidney stones ≤15 mm treated between 3/5/11 and 19/4/12 were included in the study. Patients received lithotripsy on a fixed-site Storz Modulith SLX F2 lithotripter according to a standard protocol. Clinical success was defined as stone-free status or asymptomatic clinically insignificant residual fragments (CIRFs) ≤3 mm at radiological follow-up. The mean stone size was 7.8 mm. The majority of stones (66 %) were between 5 and 10 mm. 28 % of stones were between 10 and 15 mm. For solitary lower pole stones complete stone clearance was achieved in 63 %. Total stone clearance including those with CIRFs was achieved in 81 % of patients. As expected, for those with multiple lower pole stones the success rates were lower: complete clearance was observed in 39 % and combined clearance including those with CIRFs was 56 %. Overall, complete stone clearance was observed in 54 % of patients and clearance with CIRFs was achieved in 72 % of patients. Success rate could not be attributed to age, stone size or gender. Our outcome data for the treatment of lower pole renal stones (≤15 mm) compare favourably with the literature. With this level of stone clearance, a non-invasive, outpatient-based treatment like lithotripsy should remain the first-line treatment option for lower pole stones. Ureteroscopy must prove that it is significantly better either in terms of clinical outcome or patient satisfaction to justify replacing lithotripsy.
尽管国际指南主张将体外碎石术作为一线治疗方法,但在北美和许多欧洲国家,该方法的使用率正在下降。传统上,碎石术被认为在治疗下极肾结石方面效果不佳。我们评估了我们单位使用碎石术治疗下极肾结石的成功率。 研究纳入了 2011 年 3 月 5 日至 2012 年 4 月 19 日期间接受治疗的 50 例直径≤15mm 的下极肾结石患者。患者根据标准方案在固定部位的 Storz Modulith SLX F2 碎石机上接受碎石术治疗。临床成功定义为影像学随访时结石无残留或无症状的临床意义不大的残片(CIRFs)≤3mm。结石的平均大小为 7.8mm。大多数结石(66%)在 5 至 10mm 之间。28%的结石在 10 至 15mm 之间。对于单个下极结石,完全清除结石的比例为 63%。包括 CIRFs 在内的总结石清除率为 81%。不出所料,对于多发性下极结石,成功率较低:完全清除率为 39%,包括 CIRFs 的联合清除率为 56%。总体而言,54%的患者实现了完全结石清除,72%的患者实现了带 CIRFs 的结石清除。成功率与年龄、结石大小或性别无关。我们治疗下极肾结石(≤15mm)的结果数据与文献相比表现良好。有了这种结石清除率,碎石术作为一种非侵入性的门诊治疗方法,应该仍然是下极结石的一线治疗选择。输尿管镜检查必须证明其在临床结果或患者满意度方面有显著优势,才能证明其替代碎石术的合理性。