Fankhauser Christian D, Hermanns Thomas, Lieger Laura, Diethelm Olivia, Umbehr Martin, Luginbühl Thomas, Sulser Tullio, Müntener Michael, Poyet Cédric
Department of Urology, University Hospital, University of Zurich, Zurich, Switzerland.
Department of Urology, City Hospital Triemli of Zurich, Zurich, Switzerland.
Clin Kidney J. 2018 Jun;11(3):364-369. doi: 10.1093/ckj/sfx151. Epub 2018 Jan 25.
The reported success rates for treatments of kidney stones with either extracorporeal shock wave lithotripsy (ESWL) or flexible ureterorenoscopy (URS) are conflicting. We aimed to compare the efficacy and safety of ESWL and URS for previously untreated renal calculi.
All patients treated with ESWL or URS at our tertiary care centre between 2003 and 2015 were retrospectively identified. Patients with previously untreated kidney stones and a stone diameter of 5-20 mm were included. Stone-free, freedom from reintervention and complication rates were recorded. Independent predictors of stone-free and freedom from reintervention rates were identified by multivariable logistic regression and a propensity score-matched analysis was performed.
A total of 1282 patients met the inclusion criteria, of whom 999 (78%) underwent ESWL and 283 (22%) had URS. During post-operative follow-up, only treatment modality and stone size could independently predict stone-free and freedom from reintervention rates. After propensity score matching, ESWL showed significantly lower stone-free rates [ESWL (71%) versus URS (84%)] and fewer patients with freedom from reintervention [ESWL (55%) versus URS (79%)] than URS. Complications were scarce for both treatments and included Clavien Grade 3a in 0.8% versus 0% and Grade 3b in 0.5% versus 0.4% of ESWL and URS treated patients, respectively.
Treatment success was mainly dependent on stone size and treatment modality. URS might be the better treatment option for previously untreated kidney stones 5-20 mm, with similar morbidity but higher stone-free rates and fewer reinterventions than ESWL.
关于体外冲击波碎石术（ESWL）或软性输尿管肾镜检查（URS）治疗肾结石的报道成功率存在矛盾。我们旨在比较ESWL和URS治疗既往未治疗的肾结石的疗效和安全性。
回顾性确定2003年至2015年期间在我们三级医疗中心接受ESWL或URS治疗的所有患者。纳入既往未治疗的肾结石且结石直径为5 - 20毫米的患者。记录结石清除率、无需再次干预率和并发症发生率。通过多变量逻辑回归确定结石清除和无需再次干预率的独立预测因素，并进行倾向评分匹配分析。
共有1282例患者符合纳入标准，其中999例（78%）接受了ESWL治疗，283例（22%）接受了URS治疗。术后随访期间，只有治疗方式和结石大小能够独立预测结石清除率和无需再次干预率。倾向评分匹配后，ESWL的结石清除率显著低于URS [ESWL（71%）对URS（84%）]，且无需再次干预的患者少于URS [ESWL（55%）对URS（79%）]。两种治疗的并发症都很少，ESWL和URS治疗的患者中分别有0.8%对0%发生Clavien 3a级并发症，0.5%对0.4%发生3b级并发症。
治疗成功主要取决于结石大小和治疗方式。对于既往未治疗的5 - 20毫米肾结石，URS可能是更好的治疗选择，其发病率相似，但结石清除率更高，再次干预更少，优于ESWL。
