Hall M Kennedy, Samson Patrick C, Kessler Ross, Lehnhardt Kris, Easter Benjamin, Thiel Jeff, Wessells Hunter, Bailey Michael R, Harper Jonathan D
Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington.
Department of Urology, Weill Medical College of Cornell University, New York, New York.
J Am Coll Emerg Physicians Open. 2020 Jun;1(3):252-256. doi: 10.1002/emp2.12047. Epub 2020 Mar 25.
Renal colic encounters are common; in the United States alone, they represent greater than one million annual emergency department (ED) visits. Most of these stones are managed conservatively with a trial of passage. However, some lead to repeat colic episodes, secondary ED visits, increased anxiety, and increased cost. Of the 5%-10% of symptomatic stones that become lodged at the ureteropelvic junction and are larger than 5 mm, most require operative intervention. In the process of executing a NASA-funded study of ultrasonic repositioning of kidney stones, the subject was administered fluid to dilate the collecting system, placed in Trendelenburg bed positioning, and rolled to both sides. During this process a symptomatic, obstructing 9-mm ureteropelvic junction stone moved back into the kidney's lower pole/infundibulum and symptoms were immediately resolved. The patient remained asymptomatic for a period of 5 weeks at which point elective intervention was scheduled. This case demonstrates that ureteropelvic junction stones may be repositioned in a non-invasive manner, turning a stone that requires urgent intervention into one that can be managed electively.
肾绞痛很常见；仅在美国，每年就有超过100万人因肾绞痛前往急诊科就诊。大多数此类结石通过试行排出进行保守治疗。然而，一些结石会导致反复绞痛发作、再次前往急诊科、焦虑加剧以及费用增加。在有症状的结石中，5% - 10%会在输尿管肾盂连接处嵌顿且直径大于5毫米，大多数需要手术干预。在执行一项由美国国家航空航天局资助的肾结石超声复位研究过程中，给受试者输注液体以扩张集合系统，将其置于头低脚高位，并向两侧翻身。在此过程中，一颗有症状的、阻塞性的9毫米输尿管肾盂连接处结石移回到肾下极/肾小盏，症状立即缓解。患者在5周内一直无症状，此时安排了择期干预。该病例表明，输尿管肾盂连接处结石可以通过非侵入性方式重新定位，将一颗需要紧急干预的结石转变为一颗可以择期处理的结石。
