Bucci Stefano, Umari Paolo, Rizzo Michele, Pavan Nicola, Liguori Giovanni, Barbone Fabio, Trombetta Carlo
Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy.
Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy -
Minerva Urol Nefrol. 2018 Oct;70(5):526-533. doi: 10.23736/S0393-2249.18.03084-9. Epub 2018 May 14.
The aim of this study was to assess the efficacy of emergency extracorporeal shockwave lithotripsy (eSWL) as first-line treatment in patients with acute colic due to obstructive ureteral stone.
Seventy-four patients were randomized to emergency SWL within 12 hours (eSWL group) and deferred SWL later than 3 days (dSWL group). Follow-up included ultrasound, KUB (kidney-ureter-bladder) radiography and CT (computed tomography) scan at 24 hours, 7 days, 1 and 3 months from the treatment. When necessary, repeated SWL (re-SWL) or ureteroscopy (auxiliary-URS) was performed. Preoperative and postoperative data were compared and stone free rates (SFR) and efficiency quotients (EQ) were evaluated. Analyses were performed using SAS software.
Complete data of 70 patients were collected. 36 underwent eSWL and 34 dSWL. The mean patient age was 48.7. Mean stone size was 9.8 mm (CI 95%: 8.9-10.8). 25 (35.7%) were proximal and 45 (64.3%) distal. Mean SWL energy was 19.2 kV (CI 95%: 18.5-19.9) and mean number of shocks was 2657 (CI 95%: 2513-2802). eSWL patients needs less auxiliary-URS than dSWL patients (13.9% vs. 44.1%, P=0.039) and less re-SWL sessions (8.3% vs. 32.4%, P=0.093). SFR at 24 hours was 52.8% and 11.8% (P<0.001) and the EQ at 3 months was 79.1% and 57.5% in the eSWL and dSWL group respectively. Patients from the dSWL group spent more time in the hospital (2.21 vs. 1.36 days, P=0.046) and complication rates between the two groups were similar.
eSWL is a safe procedure and delivers high SFR even within 24 hours especially for <10 mm stones. It is able to reduce the number of auxiliary procedures and hospitalization.
本研究旨在评估急诊体外冲击波碎石术（eSWL）作为输尿管梗阻性结石所致急性绞痛患者一线治疗方法的疗效。
74例患者被随机分为12小时内接受急诊SWL治疗组（eSWL组）和3天后延迟SWL治疗组（dSWL组）。随访包括在治疗后24小时、7天、1个月和3个月时进行超声、KUB（肾脏-输尿管-膀胱）造影和CT（计算机断层扫描）扫描。必要时，进行重复SWL（re-SWL）或输尿管镜检查（辅助URS）。比较术前和术后数据，并评估结石清除率（SFR）和效率商（EQ）。使用SAS软件进行分析。
收集了70例患者的完整数据。36例接受eSWL治疗，34例接受dSWL治疗。患者平均年龄为48.7岁。平均结石大小为9.8mm（95%置信区间：8.9-10.8）。25例（35.7%）为近端结石，45例（64.3%）为远端结石。平均SWL能量为19.2kV（95%置信区间：18.5-19.9），平均冲击次数为2657次（95%置信区间：2513-2802）。eSWL组患者比dSWL组患者需要更少的辅助URS（13.9%对44.1%，P=0.039）和更少的重复SWL疗程（8.3%对32.4%，P=0.093）。eSWL组和dSWL组在24小时时的SFR分别为52.8%和11.8%（P<0.001），3个月时的EQ分别为79.1%和57.5%。dSWL组患者住院时间更长（2.21天对1.36天，P=0.046），两组间并发症发生率相似。
eSWL是一种安全的治疗方法，即使在24小时内也能实现较高的SFR，尤其是对于<10mm的结石。它能够减少辅助治疗程序的数量和住院时间。
