Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2017 Sep;80(9):551-557. doi: 10.1016/j.jcma.2016.11.010. Epub 2017 Aug 9.
Patients suffering from renal or ureteral stones can undergo significant discomfort, even when timely diagnosed and treated. The aim of this study was to assess the risk factors and safety of outpatient Extracorporeal Shock Wave Lithotripsy (ESWL) in the management of patients with renal or ureteral stones.
In this study, our cohort consisted of 844 outpatients who underwent outpatient ESWL treated between February 2012 and November 2014 at Taipei Veterans General Hospital. Patients who visited the emergency room (ER) within 48 h after Outpatient ESWL were included in this article. This article analyzes the stone size, stone shape (long to short axis ratio), stone location, previous medical management, urinalysis data, complications and treatment received in the emergency department.
Among the 844 initial consecutive patients who underwent outpatient ESWL a total of 1095 times, there were 22 (2%) patients who sought help at our emergency room within 48 h after the outpatient ESWL. Of those 22 patients, the mean age was 54.3 ± 12.6 years, and the BMI was 25.9 ± 3.2. The most common complication complaint was flank pain (55.2%). Other complications included hematuria (13.8%), fever (17.2%), nausea with vomiting (6.9%), acute urinary retention (3.4%) and chest tightness with cold sweating (3.4%). In 22 patients who went back to the ER, 7 patients were admitted to the ward and 1 patient again returned to the ER. All patients received medical treatment without ESWL or surgical management. The meaningful risk factor of ER-visiting rate following outpatient ESWL within 48 h was stone location, and the renal stones showed statistic significant (p = 0.047) when compared to ureteral stones.
Our study indicated that renal stone contributed to a significantly higher risk of ER-visiting rate to patients than did ureteral stone, following outpatient ESWL within 48 h. This study confirmed that Outpatient ESWL is a safe treatment for renal or ureteral stones, while inpatient ESWL is not absolutely necessary.
患有肾结石或输尿管结石的患者即使及时诊断和治疗，也可能会经历显著的不适。本研究旨在评估门诊体外冲击波碎石术（ESWL）治疗肾结石或输尿管结石患者的风险因素和安全性。
本研究的队列包括 2012 年 2 月至 2014 年 11 月在台北荣民总医院接受门诊 ESWL 治疗的 844 名门诊患者。本文分析了结石大小、结石形状（长轴与短轴之比）、结石位置、既往医疗管理、尿液分析数据、并发症和在急诊科接受的治疗。
在 844 例接受门诊 ESWL 的连续患者中，共有 22 例（2%）在门诊 ESWL 后 48 小时内到急诊科就诊。在这 22 例患者中，平均年龄为 54.3±12.6 岁，BMI 为 25.9±3.2。最常见的并发症是腰痛（55.2%）。其他并发症包括血尿（13.8%）、发热（17.2%）、恶心伴呕吐（6.9%）、急性尿潴留（3.4%）和胸闷伴冷汗（3.4%）。在 22 例返回急诊科的患者中，7 例被收治入院，1 例再次返回急诊科。所有患者均接受了药物治疗，未接受 ESWL 或手术治疗。门诊 ESWL 后 48 小时内急诊就诊率的有意义危险因素是结石位置，与输尿管结石相比，肾结石的统计结果具有显著差异（p=0.047）。
我们的研究表明，与输尿管结石相比，门诊 ESWL 后 48 小时内肾结石导致患者急诊就诊率显著升高。本研究证实，门诊 ESWL 是治疗肾结石或输尿管结石的一种安全方法，而住院 ESWL 并非绝对必要。
