Department of Urology, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
Urolithiasis. 2017 Dec;45(6):597-601. doi: 10.1007/s00240-017-0973-2. Epub 2017 Mar 15.
The rates of extracorporeal shock wave lithotripsy (SWL) appear stable in the UK. However, there is little evidence on the natural history of these calculi if SWL fails. We set to look at the effectiveness of SWL in patients with a single, previously untreated renal stone and the natural history of those stones that failed treatment. We retrospectively reviewed all data from our prospectively collected database of patients undergoing a first treatment for a single renal stone between October 2010 and November 2013. Outcomes after SWL were categorised as success, subsequent intervention needed or conservative management. The medical records of patients managed conservatively were reviewed to determine whether further intervention was required and why. We further sought to define, in those patients where SWL failed, whether subsequent active intervention was needed. For the remainder, we examined whether conservative management was a reasonable management option. 313 patients fitted the inclusion criteria. Of these, 144 were treated successfully. Of the 170 patients with a residual stone, 51 went on to flexible ureteroscopy directly at their next clinical review mainly due to persistent symptoms. 79 patients were managed conservatively, and for 39 follow-up data were unavailable as their follow-up was at a different hospital. 63 patients (80%) were successfully managed conservatively with no recurrence of symptoms over the follow-up period (mean 2 years 4 months). 16 (20%) patients that were initially managed conservatively required subsequent intervention. Of these, 87% had a stone in an upper pole calyx. Conservative management of renal stones after failed SWL is a suitable option for asymptomatic patients with stones not located in the upper pole. For patients with upper pole stones, early intervention is warranted due to the high risk of requiring intervention.
体外冲击波碎石术 (SWL) 的比率在英国似乎保持稳定。然而，如果 SWL 失败，关于这些结石的自然史几乎没有证据。我们旨在研究单次治疗不成功的肾结石患者接受 SWL 的效果以及这些结石的自然史。我们回顾性地审查了 2010 年 10 月至 2013 年 11 月期间我们前瞻性收集的数据库中接受单次肾结石首次治疗的所有患者的数据。SWL 后的结果分为成功、需要进一步干预或保守治疗。对接受保守治疗的患者的病历进行了审查，以确定是否需要进一步干预以及原因。我们进一步试图确定在 SWL 失败的患者中，是否需要随后的积极干预。对于其余患者，我们检查了保守治疗是否是合理的管理选择。313 名患者符合纳入标准。其中，144 名患者治疗成功。在 170 名有残余结石的患者中，51 名患者因持续症状而在下一次临床复查时直接接受了软性输尿管镜检查。79 名患者接受保守治疗，由于随访在不同的医院，39 名患者的随访数据不可用。39 名患者的随访数据不可用。39 名患者的随访数据不可用。63 名患者（80%）接受保守治疗成功，在随访期间无症状复发（平均随访 2 年 4 个月）。16 名（20%）最初接受保守治疗的患者需要后续干预。其中，87%的患者结石位于上盏。SWL 失败后对无症状肾结石患者采用保守治疗是一种合适的选择，这些患者的结石不在上盏。对于上盏结石患者，由于需要干预的风险较高，因此应尽早进行干预。
