Ahmed Abul-Fotouh, Gabr Ahmed H, Emara Abdel-Aziz, Ali Mahmoud, Abdel-Aziz Al-Sayed, Alshahrani Saad
Department of Urology, Al-Azhar University, Cairo, Egypt ; Department of Urology, Salman Bin Abdul-Aziz University, Al-kharj, Saudi Arabia.
Department of Urology, Salman Bin Abdul-Aziz University, Al-kharj, Saudi Arabia ; Department of Urology, Minia University, Minia, Egypt.
Arab J Urol. 2015 Jun;13(2):84-90. doi: 10.1016/j.aju.2014.11.004. Epub 2014 Dec 6.
To evaluate the outcome of the expectant management of ureteric stones and to determine the factors predictive of the spontaneous passage of stones.
We retrospectively reviewed the medical records of patients who had ureteric stones of ⩽10 mm and who were treated conservatively at our institutions during the period 2008-2013. The stone-passage rate and time, and different clinical, laboratory and radiological variables, were analysed.
In all, 163 patients with ureteric stones were enrolled in the study, of whom 127 (77.9%) passed their stones spontaneously, with a mean (SD) passage time of 24.0 (8.09) days. The cumulative stone-passage rate was 1.6%, 15%, 41.7%, 72.4%, 89.8% and 98.4% at 7, 14, 21, 28, 35 and 42 days from the first presentation, respectively. Patients with a high pain-scale score, stones of ⩽5 mm, a lower ureteric stone, a high white blood cell count and those with absent computed tomography (CT) findings of perinephric fat stranding (PFS) and tissue-rim sign (TRS) had a higher likelihood of spontaneous stone passage. Patients with stones of ⩽5 mm, stones in the lower ureter and those with no PFS had a shorter spontaneous passage time. In a multivariate analysis the absence of PFS and TRS were the only significant predictors for spontaneous stone passage (P < 0.001 and 0.002, respectively).
The spontaneous ureteric stone-passage rate and time varies with different factors. The absence of CT findings of PFS and TRS are significant predictors for stone passage, and should be considered when choosing the expectant management.
评估输尿管结石期待治疗的结果，并确定预测结石自然排出的因素。
我们回顾性分析了2008年至2013年期间在我院接受保守治疗的输尿管结石直径≤10 mm患者的病历。分析结石排出率、排出时间以及不同的临床、实验室和影像学变量。
共有163例输尿管结石患者纳入本研究，其中127例（77.9%）结石自然排出，平均（标准差）排出时间为24.0（8.09）天。自首次就诊起7、14、21、28、35和42天的累计结石排出率分别为1.6%、15%、41.7%、72.4%、89.8%和98.4%。疼痛评分高、结石直径≤5 mm、输尿管下段结石、白细胞计数高以及计算机断层扫描（CT）检查无肾周脂肪条纹（PFS）和组织边缘征（TRS）表现的患者结石自然排出的可能性更高。结石直径≤5 mm、输尿管下段结石且无PFS的患者自然排出时间较短。多因素分析显示，无PFS和TRS是结石自然排出的唯一显著预测因素（P值分别<0.001和0.002）。
输尿管结石自然排出率和排出时间因不同因素而异。CT检查无PFS和TRS表现是结石排出的重要预测因素，在选择期待治疗时应予以考虑。
