Marchini Giovanni S, Vicentini Fábio Carvalho, Monga Manoj, Torricelli Fábio César, Danilovic Alexandre, Brito Artur Henrique, Câmara Cesar, Srougi Miguel, Mazzucchi Eduardo
Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Urology. 2016 Jul;93:33-9. doi: 10.1016/j.urology.2016.02.042. Epub 2016 Mar 8.
To evaluate if renal function loss and hydronephrosis due to a silent ureteral stone might be reversed.
We prospectively selected patients with silent ureteral stones between January 2006 and January 2014. A silent case was considered if there were no specific or subjective symptoms related to the ureteral stone. Patient, stone, and kidney characteristics were evaluated preoperatively, 3 and 12 months postoperatively. Renal function was accessed in the same intervals with serum creatinine (SCr), glomerular filtration rate (GFR), and (99m)Tc-dimercaptosuccinic acid. Patients without complete pre- and postoperative evaluation were excluded. Primary end point was midterm progress of global and ipsilateral renal function. Secondary end points included the evaluation of renal and collecting system anatomy from diagnosis to 12 months after treatment. Analysis of variance with repeated measures and marginal homogeneity test were used to evaluate renal function and hydronephrosis progression.
Twenty-six patients met our inclusion criteria. Mean preoperative SCr and GFR were 1.24 mg/dL and 72.5 mL/min, respectively. At initial scintigraphy, mean renal function was 33.4%. Laser ureterolithotripsy was performed in 84.6% of cases and all patients were rendered stone free. Two patients (8%) developed ureteral stenosis. There was no difference regarding SCr (P = .89), GFR (P = .48), and renal function at scintigraphy (P = .19) during follow-up. Hydronephrosis significantly improved from preoperatively to 3 months postoperatively (P < .0001), but not from 3 to 12 months (P = .065).
Patients with silent ureteral stones present with significant impairment of ipsilateral renal function and hydronephrosis at diagnosis. On midterm follow-up evaluation, renal function of the affected unit remains stable whereas hydronephrosis improves after treatment.
评估无症状输尿管结石所致肾功能丧失和肾积水是否可逆转。
我们前瞻性地选取了2006年1月至2014年1月期间的无症状输尿管结石患者。如果没有与输尿管结石相关的特定或主观症状，则视为无症状病例。术前、术后3个月和12个月评估患者、结石和肾脏特征。在相同时间间隔内通过血清肌酐（SCr）、肾小球滤过率（GFR）和（99m）锝-二巯基丁二酸评估肾功能。排除术前和术后评估不完整的患者。主要终点是整体和同侧肾功能的中期进展。次要终点包括从诊断到治疗后12个月对肾脏和集合系统解剖结构的评估。采用重复测量方差分析和边际齐性检验评估肾功能和肾积水进展。
26例患者符合纳入标准。术前平均SCr和GFR分别为1.24mg/dL和72.5mL/min。在初始闪烁扫描时，平均肾功能为33.4%。84.6%的病例进行了激光输尿管碎石术，所有患者结石均清除。2例患者（8%）发生输尿管狭窄。随访期间，SCr（P = 0.89）、GFR（P = 0.48）和闪烁扫描时的肾功能（P = 0.19）无差异。肾积水从术前到术后3个月显著改善（P < 0.0001），但从3个月到12个月无改善（P = 0.065）。
无症状输尿管结石患者在诊断时同侧肾功能和肾积水有明显损害。在中期随访评估中，受影响单位的肾功能保持稳定，而肾积水在治疗后有所改善。
