Division of Urology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil; Stevan B. Streem Center for Endourology and Stone Disease, Glickman Urological and Kidney Institute (MM), Cleveland Clinic, Cleveland, Ohio.
Division of Urology, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil; Stevan B. Streem Center for Endourology and Stone Disease, Glickman Urological and Kidney Institute (MM), Cleveland Clinic, Cleveland, Ohio.
J Urol. 2015 Jun;193(6):2002-7. doi: 10.1016/j.juro.2014.12.026. Epub 2014 Dec 15.
We evaluated which variables impact fragmentation and clearance of lower pole calculi after shock wave lithotripsy.
We prospectively evaluated patients undergoing shock wave lithotripsy for a solitary 5 to 20 mm lower pole kidney stone between June 2012 and August 2014. Patient body mass index and abdominal waist circumference were recorded. One radiologist blinded to shock wave lithotripsy outcomes measured stone size, area and density, stone-to-skin distance, infundibular length, width and height, and infundibulopelvic angle based on baseline noncontrast computerized tomography. Fragmentation, success (defined as residual fragments less than 4 mm in asymptomatic patients) and the stone-free rate were evaluated by noncontrast computerized tomography 12 weeks postoperatively. Univariate and multivariate analysis was performed.
A total of 100 patients were enrolled in the study. Mean stone size was 9.1 mm. Overall fragmentation, success and stone-free rates were 76%, 54% and 37%, respectively. On logistic regression body mass index (OR 1.27, 95% CI 1.11-1.49, p = 0.004) and stone density (OR 1.0026, 95% CI 1.0008-1.0046, p = 0.005) significantly impacted fragmentation. Stone size (OR 1.24, 95% CI 1.07-1.48, p = 0.039) and stone density (OR 1.0021, 95% CI 1.0007-1.0037, p = 0.012) impacted the success rate while stone size (OR 1.24, 95% CI 1.04-1.50, p = 0.029), stone density (OR 1.0015, 95% CI 1.0001-1.0032, p = 0.046) and infundibular length (OR 1.1035, 95% CI 1.015-1.217, p = 0.015) impacted the stone-free rate. The best outcomes were found in patients with a body mass index of 30 kg/m(2) or less, stones 10 mm or less and 900 HU or less, and an infundibular length of 25 mm or less. The coexistence of significant unfavorable variables led to a stone-free rate of less than 20%.
Obese patients with higher than 10 mm density stones (greater than 900 HU) in the lower pole of the kidney with an infundibular length of greater than 25 mm should be discouraged from undergoing shock wave lithotripsy.
我们评估了冲击波碎石术（SWL）后哪些变量会影响下极结石的碎裂和清除。
我们前瞻性地评估了 2012 年 6 月至 2014 年 8 月期间接受 SWL 治疗的孤立性 5 至 20mm 下极肾结石患者。记录患者的体重指数和腹围。一名放射科医生在不知道冲击波碎石术结果的情况下，根据基线非增强计算机断层扫描（CT）测量结石大小、面积和密度、结石-皮肤距离、漏斗长度、宽度和高度以及漏斗-肾盂角。术后 12 周通过非增强 CT 评估碎裂、成功（定义为无症状患者残留碎片小于 4mm）和无石率。进行单变量和多变量分析。
共纳入 100 例患者。平均结石大小为 9.1mm。总体碎裂、成功和无石率分别为 76%、54%和 37%。在逻辑回归中，体重指数（OR 1.27，95%CI 1.11-1.49，p=0.004）和结石密度（OR 1.0026，95%CI 1.0008-1.0046，p=0.005）显著影响碎裂。结石大小（OR 1.24，95%CI 1.07-1.48，p=0.039）和结石密度（OR 1.0021，95%CI 1.0007-1.0037，p=0.012）影响成功率，而结石大小（OR 1.24，95%CI 1.04-1.50，p=0.029）、结石密度（OR 1.0015，95%CI 1.0001-1.0032，p=0.046）和漏斗长度（OR 1.1035，95%CI 1.015-1.217，p=0.015）影响无石率。在体重指数为 30kg/m2 或以下、结石大小为 10mm 或以下、密度为 900HU 或以下、漏斗长度为 25mm 或以下的患者中发现了最佳结果。显著不利变量的共存导致无石率低于 20%。
体重指数大于 30kg/m2、结石密度大于 10mm（大于 900HU）、下极漏斗长度大于 25mm 的肥胖患者，不建议行 SWL 治疗。
