Gross Andreas J, Knipper Sophie, Netsch Christopher
Department of Urology, Asklepios Hospital Barmbek, 22291 Hamburg, Germany.
Indian J Urol. 2014 Jan;30(1):92-8. doi: 10.4103/0970-1591.124214.
The natural course of untreated asymptomatic caliceal calculi has not been clearly defined, especially in terms of disease progression, and the indications for and outcomes of surgical intervention are not precise. Caliceal stones may remain asymptomatic but, in case of migration, ureteral calculi can cause acute ureteric colic with severe complications. The decision for an active treatment of caliceal calculi is based on stone composition, stone size and symptoms. Extracorporal shock-wave lithotripsy (ESWL) has a low complication rate and is recommended by the current guidelines of the European Association of Urology as a first-line therapy for the treatment of caliceal stones <2 cm in diameter. However, immediate stone removal is not achieved with ESWL. The primary stone-free rates (SFR) after ESWL depend on stone site and composition and, especially for lower pole calculi, the SFR differ widely from other caliceal stones. Minimally-invasive procedures including percutaneous nephrolithotomy and ureteroscopy are alternatives for the treatment of caliceal stones, associated with low morbidity and high primary SFR when performed in centers of excellence.
未经治疗的无症状肾盏结石的自然病程尚未明确界定，尤其是在疾病进展方面，手术干预的指征和结果也不确切。肾盏结石可能一直无症状，但一旦发生移动，输尿管结石可导致急性输尿管绞痛并引发严重并发症。对肾盏结石进行积极治疗的决策基于结石成分、结石大小和症状。体外冲击波碎石术（ESWL）并发症发生率低，欧洲泌尿外科学会现行指南推荐其作为直径<2 cm肾盏结石的一线治疗方法。然而，ESWL无法立即清除结石。ESWL后的首次无石率（SFR）取决于结石部位和成分，尤其是下极结石，其SFR与其他肾盏结石差异很大。包括经皮肾镜取石术和输尿管镜检查在内 的微创手术是治疗肾盏结石的替代方法，在专业中心进行时，发病率低且首次SFR高。
