El-Assmy Ahmed, Harraz Ahmed M, Eldemerdash Yasser, Elkhamesy Mohammed, El-Nahas Ahmed R, Elshal Ahmed M, Sheir Khaled Z
Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Arab J Urol. 2016 Apr 3;14(2):108-14. doi: 10.1016/j.aju.2016.02.004. eCollection 2016 Jun.
To investigate the effect of stone fragmentation on late stone recurrence by comparing the outcome of extracorporeal shockwave lithotripsy (ESWL) and non-fragmenting percutaneous nephrolithotomy (PCNL), and to investigate factors contributing to recurrent calculi.
We evaluated stone recurrence in 647 patients who initially achieved a stone-free status after ESWL and compared the outcomes to 137 stone-free patients treated with PCNL without stone fragmentation. Patients were evaluated every 3 months during the first year and every 6 months thereafter to censorship or time of first new stone formation. Stone recurrence rates were calculated using the Kaplan-Meier method. The effects of demographics, stone characteristics, and intervention on the recurrence rate were studied using the log-rank test and the Cox-regression analysis.
For ESWL the recurrence rates were 0.8%, 35.8% and 60.1% after 1, 5 and 10 years, which were comparable to the 1.5%, 35.5% and 74.9%, respectively found in the PCNL group (P = 0.57). Stone burden (>8 mm) and a previous history of stone disease were significantly associated with higher recurrence rates regardless of the method of stone intervention (P = 0.02 and P = 0.01, respectively). In the ESWL group, a stone length of >8 mm showed a higher recurrence rate (P = 0.007). In both the ESWL and PCNL groups, there was a significant shift from baseline stone location, with an increased tendency for most new stones to recur in the calyces as opposed to the pelvis.
In comparison with PCNL, ESWL does not increase long-term stone recurrence in patients who become stone-free. The stone burden appears to be the primary factor in predicting stone recurrence after ESWL.
通过比较体外冲击波碎石术（ESWL）和非碎石性经皮肾镜取石术（PCNL）的结果，研究结石碎裂对结石后期复发的影响，并探讨结石复发的相关因素。
我们评估了647例最初经ESWL治疗后达到无结石状态的患者的结石复发情况，并将结果与137例接受无结石碎裂的PCNL治疗的无结石患者进行比较。在第一年中，每3个月对患者进行一次评估，此后每6个月评估一次，直至审查或首次形成新结石的时间。使用Kaplan-Meier方法计算结石复发率。使用对数秩检验和Cox回归分析研究人口统计学、结石特征和干预措施对复发率的影响。
ESWL术后1年、5年和10年的复发率分别为0.8%、35.8%和60.1%，与PCNL组分别为1.5%、35.5%和74.9%的复发率相当（P = 0.57）。无论结石干预方法如何，结石负荷（>8 mm）和既往结石病史均与较高的复发率显著相关（分别为P = 0.02和P = 0.01）。在ESWL组中，结石长度>8 mm显示出较高的复发率（P = 0.007）。在ESWL和PCNL组中，结石的基线位置均有显著变化，大多数新结石复发于肾盏的趋势增加，而非肾盂。
与PCNL相比，ESWL不会增加达到无结石状态患者的长期结石复发率。结石负荷似乎是预测ESWL术后结石复发的主要因素。
