Torricelli Fabio Cesar Miranda, Mazzucchi Eduardo, Danilovic Alexandre, Coelho Rafael Ferreira, Srougi Miguel
Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Rev Col Bras Cir. 2013 May-Jun;40(3):227-33. doi: 10.1590/s0100-69912013000300011.
Bladder stones are rare and most cases occur in adult men with bladder outlet obstruction. Currently, there are few data on the best treatment of this disease. The aim of this review is to discuss some aspects of pathogenesis and treatment approaches for bladder lithiasis. A comprehensive search of the database of the "National Library of Medicine" /pubmed was conducted with the following key words and descriptors: "bladder" or "vesical" associated with "calculus", "stone" or "lithiasis", and "cistolithotripsy ". One hundred and seventy-one articles were identified. The articles were independently assessed by two reviewers with expertise in urolithiasis. They were included in the study when the results, complications and follow-up were clearly reported. In the end, 32 studies met the inclusion criteria. Several options for the treatment of bladder lithiasis are available, but no randomized trials comparing them. Different rates of calculus-free patients are described in each of them, as follows: extracorporeal shock wave lithotripsy (75-100%), transurethral cistolithotripsy (63-100%), percutaneous cistolithotripsy (89-100%) and open surgery (100 %). The percutaneous approach has lower morbidity, with similar results to the transurethral treatment, while extracorporeal lithotripsy has the lowest rate of elimination of calculi and is reserved for patients at high surgical risk.
膀胱结石较为罕见，多数病例发生于患有膀胱出口梗阻的成年男性。目前，关于该疾病最佳治疗方法的数据较少。本综述的目的是探讨膀胱结石发病机制和治疗方法的某些方面。使用以下关键词和描述符对“国立医学图书馆”/pubmed数据库进行了全面检索：与“结石”“石头”或“结石症”相关的“膀胱”或“膀胱的”，以及“膀胱碎石术”。共识别出171篇文章。由两名尿路结石领域的专家独立评估这些文章。当结果、并发症和随访情况清晰报告时，将其纳入研究。最终，32项研究符合纳入标准。膀胱结石的治疗有多种选择，但尚无比较这些方法的随机试验。每种方法中结石清除患者的比例不同，具体如下：体外冲击波碎石术（75 - 100%）、经尿道膀胱碎石术（63 - 100%）、经皮膀胱碎石术（89 - 100%）和开放手术（100%）。经皮治疗方法的发病率较低，结果与经尿道治疗相似，而体外碎石术的结石清除率最低，适用于手术风险高的患者。
