Chang Ki Don, Lee Joo Yong, Park Sung Yoon, Kang Dong Hyuk, Lee Hyung Ho, Cho Kang Su
Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2017 Sep;58(5):1000-1005. doi: 10.3349/ymj.2017.58.5.1000.
To evaluate predictors of the success rate for one session of shock wave lithotripsy (SWL), focusing on the relationships between pretreatment hydronephrosis grade and one-session SWL success rates.
The medical records of 1824 consecutive patients who underwent an initial session of SWL for treatment of urinary stones between 2005 and 2013 were reviewed. After exclusion, 700 patients with a single, 4-20 mm diameter radiopaque calculus were included in the study.
The mean maximal stone length (MSL) and skin-to-stone distance were 9.2±3.9 and 110.8±18.9 mm, respectively. The average values for mean stone density (MSD) and stone heterogeneity index (SHI) were 707.0±272.1 and 244.9±110.1, respectively. One-session success rates were 68.4, 75.0, 75.1, 54.0, and 10.5% in patients with hydronephrosis grade 0, 1, 2, 3, and 4, respectively. Patients were classified into success or failure groups based on SWL outcome. Multivariate logistic regression analyses revealed that MSL [odds ratio (OR) 0.888, 95% confidence intervals (CI): 0.841-0.934, p<0.001], MSD (OR 0.996, 95% CI: 0.995-0.997, p<0.001), SHI (OR 1.007, 95% CI: 1.005-1.010, p<0.001), and pretreatment hydronephrosis grade (OR 0.601, 95% CI: 0.368-0.988, p=0.043) were significantly associated with one-session success.
Pretreatment grades 3 or 4 hydronephrosis were associated with failure of SWL in patients with a single ureteral stone. In the presence of severe hydronephrosis, especially hydronephrosis grade 4; physicians should proceed cautiously in choosing and offering SWL as the primary treatment for ureteral stone.
评估单次冲击波碎石术（SWL）成功率的预测因素，重点关注治疗前肾积水分级与单次SWL成功率之间的关系。
回顾了2005年至2013年间1824例连续接受初次SWL治疗尿路结石患者的病历。排除后，700例患有单个直径4 - 20毫米不透X线结石的患者纳入研究。
平均最大结石长度（MSL）和皮肤至结石距离分别为9.2±3.9毫米和110.8±18.9毫米。平均结石密度（MSD）和结石异质性指数（SHI）的平均值分别为707.0±272.1和244.9±110.1。肾积水0级、1级、2级、3级和4级患者的单次成功率分别为68.4%、75.0%、75.1%、54.0%和10.5%。根据SWL结果将患者分为成功或失败组。多因素逻辑回归分析显示，MSL [比值比（OR）0.888，95%置信区间（CI）：0.841 - 0.934，p<0.001]、MSD（OR 0.996，95% CI：0.995 - 0.997，p<0.001）、SHI（OR 1.007，95% CI：1.005 - 1.010，p<0.001）和治疗前肾积水分级（OR 0.601，95% CI：0.368 - 0.988，p = 0.043）与单次成功显著相关。
治疗前3级或4级肾积水与单个输尿管结石患者SWL失败相关。在存在严重肾积水，尤其是4级肾积水的情况下，医生在选择并将SWL作为输尿管结石的主要治疗方法时应谨慎行事。
