Galli Riccardo, Sighinolfi Maria C, Micali Salvatore, Martorana Eugenio, Rosa Marco, Mofferdin Alessandro, Bianchi Giampaolo
Urology Department, University of Modena & Reggio Emilia, Modena, Italy.
Urology Department, University of Modena & Reggio Emilia, Modena, Italy -
Minerva Urol Nefrol. 2017 Apr;69(2):189-194. doi: 10.23736/S0393-2249.16.02741-7. Epub 2016 Oct 21.
Extracorporeal shock wave lithotripsy (ESWL) for distal ureteral stones can be performed in prone or supine position. The aim of this study was to investigate the advantages brought by the supine transgluteal ESWL approach for distal ureteral stones treatment using real-time ultrasound (US), and to show how computerized tomography (CT) scan parameters may be related to the outcomes.
Seventy consecutive supine transgluteal ESWL of distal ureteral stones were performed. All patients had a pre-treatment CT scan. The following parameter were evaluated: stone size, Hounsfield Units, skin-to-stone distance, sciaticum majus foramen width, stone to ureteral ostium distance, fragmentation and expulsion perception during the treatment, and the stone-free status. Stone focusing was obtained US, which allows a real-time visualization of stone location and fragmentation. Follow-up included a kidney ureter bladder (KUB) film and US examination at 2-3 weeks after treatment (median time: 18 days). Stone-free condition was defined as the complete absence of stone fragments. A linear regression analysis was used to assess the possible variables mostly related to stone-free status. P<0.05 was considered as significant.
Median number of SWL sessions for patient was 1 (IQR: 1-1), mean 1.2±0.5. The re-treatment rate for stone-free patients was 18.3%. Stone-free rate was 85.7%. A clear and real time US stone fragmentation was perceived by the surgeon during the treatment in 42/70 (60%) of patients and correlated to the definitive stone-free status (P=0.04). Stone to ureteral ostium distance was the only variable affecting the stone-free condition (P=0.01).
Supine transgluteal SWL of distal ureteral stones provide satisfactory outcomes in terms of stone-free rate. The distance of the stone to the ureteral ostium, measured by CT, appeared to be the only significant variable connected to SWL success.
体外冲击波碎石术（ESWL）治疗输尿管下段结石可采用俯卧位或仰卧位。本研究的目的是探讨仰卧经臀肌ESWL治疗输尿管下段结石时，实时超声（US）引导所带来的优势，并展示计算机断层扫描（CT）扫描参数与治疗结果之间的关系。
对70例输尿管下段结石患者连续进行仰卧经臀肌ESWL治疗。所有患者在治疗前均进行CT扫描。评估以下参数：结石大小、亨氏单位、皮肤至结石距离、坐骨大孔宽度、结石至输尿管口距离、治疗过程中的碎石及排石情况，以及结石清除状态。通过超声实现结石聚焦，可实时观察结石位置及碎石情况。随访包括治疗后2 - 3周（中位时间：18天）的肾脏输尿管膀胱（KUB）平片及超声检查。结石清除定义为完全无结石碎片残留。采用线性回归分析评估与结石清除状态最相关的可能变量。P<0.05被认为具有统计学意义。
患者的ESWL治疗次数中位数为1次（四分位间距：1 - 1），平均为1.2±0.5次。结石清除患者的再次治疗率为18.3%。结石清除率为85.7%。42/70（60%）的患者在治疗过程中，外科医生通过超声清晰实时观察到结石破碎，且这与最终的结石清除状态相关（P = 0.04）。结石至输尿管口距离是影响结石清除状态的唯一变量（P = 0.01）。
仰卧经臀肌ESWL治疗输尿管下段结石，结石清除率令人满意。CT测量的结石至输尿管口距离似乎是与ESWL治疗成功相关的唯一重要变量。
