Fedullo L M, Pollack H M, Banner M P, Amendola M A, Van Arsdalen K N
Department of Radiology, University of Pennsylvania School of Medicine and Hospital, Philadelphia 19104.
AJR Am J Roentgenol. 1988 Dec;151(6):1145-7. doi: 10.2214/ajr.151.6.1145.
Stone fragments that develop after extracorporeal shock-wave lithotripsy (ESWL) may lodge within the ureter. This column of fragments is referred to as a "steinstrasse" (plural, steinstrassen). We evaluated the first 1000 patients treated with ESWL at our institution to determine the frequency of steinstrasse formation, the clinical course of patients with steinstrassen, and the types of intervention, if any, required. Steinstrassen were seen in 20% of 1000 patients treated with ESWL. In 65% of the patients studied, the steinstrassen passed spontaneously. Of the remaining patients, all but 3% required treatment for ureteral obstruction. Seventy-five percent were treated urologically (ureteroscopy, ureteral catheterization), but 25% required radiologically directed intervention, either percutaneous nephrostomy or fluoroscopically monitored retrograde ureteral catheter/stent placement. Twenty-seven percent of our patients with persistent steinstrassen had silent obstruction. In view of the insidious manner in which kidney function may be jeopardized by steinstrassen, they should be managed with great circumspection. Radiologists dealing with steinstrassen should be skillful in both antegrade and retrograde methods of urinary tract intervention.
体外冲击波碎石术（ESWL）后形成的结石碎片可能会停留在输尿管内。这一排碎片被称为“石街”（复数形式为steinstrassen）。我们评估了在我们机构接受ESWL治疗的首批1000例患者，以确定石街形成的频率、患有石街的患者的临床病程以及所需的干预类型（如有）。在接受ESWL治疗的1000例患者中，有20%出现了石街。在65%的研究患者中，石街自行排出。在其余患者中，除3%外，所有患者均需要治疗输尿管梗阻。75%的患者接受了泌尿外科治疗（输尿管镜检查、输尿管插管），但25%的患者需要放射学引导下的干预，即经皮肾造瘘术或荧光镜监测下逆行输尿管导管/支架置入术。在我们患有持续性石街的患者中，27%存在无症状梗阻。鉴于石街可能会以隐匿的方式损害肾功能，因此应对其进行极为谨慎的处理。处理石街的放射科医生应熟练掌握尿路干预的顺行和逆行方法。
