Department of Urology, Private Safa Hospital, Istanbul, Turkey.
Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey.
Urolithiasis. 2021 Feb;49(1):51-56. doi: 10.1007/s00240-020-01186-7. Epub 2020 Apr 11.
The aim of the study was to analyze the factors predicting success for the treatment of proximal ureteral stones larger than 1 cm with extracorporeal shockwave lithotripsy (SWL) in adult patients. Between January 2014 and December 2018, 480 adult patients in total underwent SWL and data were retrospectively evaluated. Patients with multiple ureteral stones, solitary kidney, congenital abnormality, skeletal system abnormality, history of previous urinary system surgery and SWL, renal insufficiency, patients who could not tolerate SWL and pediatric patients were excluded from the study. The remaining 415 patients were divided into two groups as success (Group 1, n = 307) and failure (Group 2, n = 108). The overall success rate was 73.9%. The values of stone size, Hounsfield Unit (HU), skin to stone distance (SSD), ureteral wall thickness (UWT), proximal ureter diameter, renal pelvis diameter, hydronephrosis grade, and duration of renal colic were significantly higher in Group 2 compared to Group 1. In binary logistic regression analyses, HU, UWT, and proximal ureter diameter were found to be independent predictors. HU, UWT, and proximal ureter diameter had sensitivity and specificity of 92-92%, 88-23%, and 87-46%, with cutoff values of 740 HU, 2.5 mm and 8.5 mm, respectively. The area under the curve values were 0.96, 0.97, and 0.96 for HU, UWT, and proximal ureter diameter, respectively. The CT-based parameters, including HU, UWT, and proximal ureter diameter are independent predictive factors with excellent accuracy for the treatment of proximal ureteral stones larger than 1 cm with SWL in adult patients. Based on these factors, SWL can be considered for proximal ureteral stones larger than 1 cm.
本研究旨在分析成人患者接受体外冲击波碎石术（SWL）治疗大于 1cm 的近端输尿管结石的成功因素。2014 年 1 月至 2018 年 12 月，共有 480 例成年患者接受了 SWL，回顾性评估了这些患者的数据。患有多发性输尿管结石、孤立肾、先天性异常、骨骼系统异常、既往泌尿系统手术和 SWL 史、肾功能不全、不能耐受 SWL 以及儿科患者的患者被排除在本研究之外。其余 415 例患者分为两组，成功组（Group 1，n=307）和失败组（Group 2，n=108）。总体成功率为 73.9%。与 Group 1 相比，Group 2 的结石大小、Hounsfield 单位（HU）、皮肤到结石距离（SSD）、输尿管壁厚度（UWT）、近端输尿管直径、肾盂直径、肾积水程度和肾绞痛持续时间均显著更高。在二元逻辑回归分析中，HU、UWT 和近端输尿管直径被发现是独立的预测因子。HU、UWT 和近端输尿管直径的敏感性和特异性分别为 92-92%、88-23%和 87-46%，截断值分别为 740 HU、2.5mm 和 8.5mm。HU、UWT 和近端输尿管直径的曲线下面积值分别为 0.96、0.97 和 0.96。HU、UWT 和近端输尿管直径等 CT 指标是成人患者接受 SWL 治疗大于 1cm 的近端输尿管结石的独立预测因子，具有良好的准确性。基于这些因素，对于大于 1cm 的近端输尿管结石可以考虑采用 SWL 治疗。
