Sivalingam Sri, Stormont Ian M, Nakada Stephen Y
1 Department of Urology, Glickman Urological Institute , Cleveland Clinic, Cleveland, Ohio.
2 Department of Urology, University of Wisconsin Hospitals and Clinics , Madison, Wisconsin.
J Endourol. 2015 Jun;29(6):736-40. doi: 10.1089/end.2014.0681. Epub 2015 Mar 19.
To elucidate current practice patterns among Endourological Society members for acutely obstructing ureteral stones necessitating intervention.
A practice pattern survey was sent to members of the Endourological Society using Survey Monkey. The following question stem was given: "Patient presents to the ER with acute renal colic and intractable pain, no signs of infection, i.e. afebrile and no pyuria. Stone is obstructing, and causing intractable pain; thus observation or medical expulsive therapy is not appropriate." A follow-up stem was provided for specific scenarios: "Calculus measuring x mm at x location. What is your preferred management option?" The options given for immediate management included shockwave lithotripsy (SWL), ureteroscopy (URS), stent placement, or percutaneous management.
Four hundred and sixteen complete responses of approximately 2000 were received. There was a significant difference in management choice based on stone location (P<0.001) and stone size (P<0.001). URS was the predominant modality used for urgent treatment of acute proximal ureteral stones from 5, 10, and 15 mm except for calculi of 20 mm, where the preference was for percutaneous management. Immediate URS was the preferred choice for all distal and midureteral stones, regardless of size. The use of stents vs percutaneous nephrostomy drainage was similar (18% vs 16%, respectively) for proximally obstructing calculi, while stent insertion was preferred over nephrostomy for mid and distal stones.
Current practice patterns among endourologists indicate a strong preference for immediate URS management over stent placement or SWL for acutely obstructing ureteral calculi. Not surprisingly, 20-mm stones in the proximal ureter had percutaneous management.
阐明腔内泌尿外科协会成员对于需要干预的急性梗阻性输尿管结石的当前治疗模式。
使用Survey Monkey向腔内泌尿外科协会成员发送了一份治疗模式调查问卷。给出了以下问题主干：“患者因急性肾绞痛和顽固性疼痛就诊于急诊室，无感染迹象，即无发热且无脓尿。结石造成梗阻并引起顽固性疼痛；因此观察或药物排石治疗不合适。”针对特定情况提供了后续主干：“结石位于x位置，大小为x毫米。您首选的治疗方案是什么？”立即治疗的选项包括冲击波碎石术（SWL）、输尿管镜检查（URS）、支架置入或经皮治疗。
在约2000份问卷中收到了416份完整回复。基于结石位置（P<0.001）和结石大小（P<0.001），治疗选择存在显著差异。URS是治疗5、10和15毫米急性近端输尿管结石紧急治疗的主要方式，但20毫米的结石除外，对于20毫米的结石，首选经皮治疗。无论大小，立即进行URS是所有远端和中段输尿管结石的首选。对于近端梗阻性结石，支架置入与经皮肾造瘘引流的使用情况相似（分别为18%和16%），而对于中段和远端结石，支架置入优于肾造瘘。
腔内泌尿外科医生目前的治疗模式表明，对于急性梗阻性输尿管结石，与支架置入或SWL相比，他们强烈倾向于立即进行URS治疗。不出所料，近端输尿管20毫米的结石采用经皮治疗。
