Departments of Urology and Radiology (MAE-G), Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Departments of Urology and Radiology (MAE-G), Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
J Urol. 2014 Dec;192(6):1705-9. doi: 10.1016/j.juro.2014.06.074. Epub 2014 Jun 27.
We studied acute renal morphological and hemodynamic changes after shock wave lithotripsy of renal stones.
A total of 60 adult patients with a single renal stone 25 mm or less in a radiologically normal urinary tract were eligible for shock wave lithotripsy and included in analysis. Study exclusion criteria were hypertension, diabetes mellitus, previous recent stone management and other contraindications to shock wave lithotripsy. Renal perfusion and morphological changes were evaluated by dynamic magnetic resonance imaging before, and 2 to 4 hours and 1 week after lithotripsy.
In all cases there was a statistically significant decrease in renal perfusion 1 week after shock wave lithotripsy compared to before and 2 to 4 hours after lithotripsy (66% vs 71% and 72% of the aortic blood flow, respectively, p <0.05). At 1-week followup 39 unobstructed renal units (65%) showed no significant difference in renal perfusion at any time while 21 (35%) obstructed renal units showed a significant decrease in renal perfusion compared to before and 2 to 4 hours after lithotripsy (63% vs 76% and 75%, p = 0.003 and 0.005, respectively). Hematomas were observed in 7 cases (12%) 2 to 4 hours after lithotripsy, of which 5 were subcapsular and 2 were intrarenal. Three subcapsular hematomas resolved after 1 week. Localized loss of corticomedullary differentiation was observed in 2 patients (3.3%) with intrarenal hematoma 2 to 4 hours after treatment. Generalized loss of corticomedullary differentiation was observed 1 week after lithotripsy in 5 cases (8.3%).
Shock wave lithotripsy alone induces minimal, reversible acute renal morphological changes and does not induce significant changes in renal perfusion. Posttreatment obstruction has a major effect on renal perfusion on the treated side and must be managed urgently.
我们研究了冲击波碎石术治疗肾结石后急性肾形态和血流动力学的变化。
共纳入 60 例成人患者，其单一肾结石大小为 25mm 或以下且尿路影像学正常，符合冲击波碎石术条件并纳入分析。研究排除标准为高血压、糖尿病、近期结石治疗史及其他冲击波碎石术禁忌证。通过动态磁共振成像评估碎石术前后 2 至 4 小时和 1 周时的肾灌注和形态变化。
所有患者在冲击波碎石术后 1 周时肾灌注均显著低于碎石术前后 2 至 4 小时时（分别为主动脉血流的 66%、71%和 72%，p<0.05）。在 1 周随访时，39 个无梗阻的肾单位（65%）在任何时间的肾灌注均无显著差异，而 21 个（35%）梗阻的肾单位与碎石术前后 2 至 4 小时相比肾灌注显著降低（分别为 63%、76%和 75%，p=0.003 和 0.005）。7 例（12%）患者在碎石术后 2 至 4 小时出现血肿，其中 5 例为包膜下血肿，2 例为肾内血肿。3 例包膜下血肿在 1 周后消退。2 例治疗后 2 至 4 小时出现肾内血肿的患者观察到皮质髓质分界局部丧失，5 例患者在碎石术后 1 周时观察到皮质髓质分界普遍丧失。
单纯冲击波碎石术可引起轻微、可逆的急性肾形态学变化，不会引起肾灌注的显著变化。治疗后梗阻对受影响侧肾灌注有重大影响，必须紧急处理。
