Nielsen Tommy Kjærgaard, Jensen Jørgen Bjerggaard
Department of Urology, Hospitalsenheden Vest, Holstebro, Denmark.
BMC Urol. 2017 Jul 27;17(1):59. doi: 10.1186/s12894-017-0249-8.
Extracorporeal shockwave lithotripsy (ESWL) is the management of choice for renal stones 20 mm or smaller, with a stone clearance rate of up to 89%. The purpose of the present is to investigate the efficacy of a commercialised ESWL service, being performed as an outsourced treatment using a mobile lithotripsy system on an outpatient basis. Furthermore, the study aims to evaluate the risk of needing treatment with an internal ureteral double-J stent (JJ) after ESWL treatment.
During an eight-year period, 461 patients with a total of 589 renal stones were treated using a mobile lithotripsy system at a single Danish institution. A commercial company performed all treatments using a Storz Modulith SLK® system. Each stone was prospectively registered according to size, intra renal location and the presence of a JJ at the time of treatment. The number of required ESWL treatments and auxiliary procedures were retrospectively evaluated.
The success rate after the initial ESWL procedure was 69%, which increased to an overall success rate of 93% after repeated treatment. A negative correlation was found between stone size and the overall success rate (r = -0.2, p < 0.01). The upper calyx was associated with a significantly better success rate, but otherwise intra renal stone location was not predictive for treatment success. A total of 17 patients (2.9%) required treatment with a JJ after the ESWL procedure. No significant difference was observed between the stone size or intra renal location and the risk of needing treatment with JJ after ESWL.
Commercialised ESWL treatment can achieve an overall success rate of more than 90% using a mobile lithotripsy system. As expected, an inverse relation between stone size and success rate was found. Patients who do not require treatment with a JJ prior to ESWL will only rarely need treatment with a JJ after ESWL, irrespective of stone size and intra renal stone location.
体外冲击波碎石术（ESWL）是治疗20毫米及以下肾结石的首选方法，结石清除率高达89%。本研究的目的是调查一项商业化ESWL服务的疗效，该服务使用移动碎石系统在门诊进行外包治疗。此外，该研究旨在评估ESWL治疗后需要使用输尿管内双J支架（JJ）治疗的风险。
在八年期间，丹麦一家机构使用移动碎石系统对461例患者共589颗肾结石进行了治疗。一家商业公司使用Storz Modulith SLK®系统进行所有治疗。根据结石大小、肾内位置以及治疗时是否存在JJ对每颗结石进行前瞻性登记。对所需的ESWL治疗次数和辅助程序进行回顾性评估。
首次ESWL治疗后的成功率为69%，重复治疗后总体成功率提高到93%。发现结石大小与总体成功率呈负相关（r = -0.2，p < 0.01）。上肾盏的成功率明显更高，但肾内结石位置对治疗成功与否并无预测性。共有17例患者（2.9%）在ESWL治疗后需要使用JJ进行治疗。在结石大小或肾内位置与ESWL治疗后需要使用JJ治疗的风险之间未观察到显著差异。
使用移动碎石系统进行商业化ESWL治疗的总体成功率可超过90%。正如预期的那样，发现结石大小与成功率呈反比关系。ESWL治疗前不需要使用JJ治疗的患者，无论结石大小和肾内结石位置如何，ESWL治疗后很少需要使用JJ治疗。
