Schembri M, Pietropaolo A, Somani B K
Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
Scand J Urol. 2020 Aug;54(4):339-343. doi: 10.1080/21681805.2020.1793810. Epub 2020 Jul 20.
Treatment of smaller renal stones and the symptomatic value it offers to patients is often debated. We wanted to analyse surgical outcomes for treatment of small renal stones and whether treatment resulted in symptom resolution.
All patients who underwent ureterorenoscopy (URS) for isolated symptomatic small renal stones ≤10 mm over a 7-year period were retrospectively included and subdivided into those with stones of ≤7 mm (Group A) and stones of 8-10 mm (Group B). Patients with multiple renal stones, ureteric stones, or combined renal and ureteric stones were excluded. Based on the symptoms, the patient groups were those with pain, urinary tract infection (UTI) and haematuria. Resolution of symptoms was defined as no symptoms during the follow-up period.
A total of 109 patients with a single small renal stone ≤10 mm underwent URS and stone treatment, with mean age of 50 years and a male:female ratio of 1:1.2. The mean operative time was significantly longer in Group B (55.9 min vs 33.07 min, = 0.001). In total, 97.2% ( = 70) of patients in Group A and 83.7% ( = 31) of patients in Group B were stone free ( = 0.017). Complete resolution of symptoms was seen in 63 (92.6%), 24 (85.7%) and 13 (100%) patients with pain, UTI and haematuria, respectively. There were no statistically significant differences in symptom resolution between patients with stones ≤7 mm and those with stones 8-10 mm in size.
Ureteroscopic treatment is a feasible option for small symptomatic stones, since it may lead to symptom resolution. Based on our study we would recommend that patients with symptomatic small renal stones are offered endoscopic treatment.
较小肾结石的治疗及其为患者带来的症状改善价值一直存在争议。我们旨在分析小肾结石治疗的手术效果以及治疗是否能缓解症状。
回顾性纳入7年间因孤立性有症状的≤10毫米小肾结石接受输尿管肾镜检查(URS)的所有患者,并将其分为结石≤7毫米组(A组)和8 - 10毫米组(B组)。排除有多发性肾结石、输尿管结石或合并肾与输尿管结石的患者。根据症状,患者分组为疼痛组、尿路感染(UTI)组和血尿组。症状缓解定义为随访期间无症状。
共有109例单发≤10毫米的小肾结石患者接受了URS及结石治疗,平均年龄50岁,男女比例为1:1.2。B组平均手术时间显著更长(55.9分钟对33.07分钟,P = 0.001)。总体而言,A组97.2%(n = 70)的患者和B组83.7%(n = 31)的患者结石清除(P = 0.017)。疼痛组、UTI组和血尿组分别有63例(92.6%)、24例(85.7%)和13例(100%)患者症状完全缓解。结石≤7毫米的患者与8 - 10毫米的患者在症状缓解方面无统计学显著差异。
输尿管镜治疗对于有症状的小结石是一种可行的选择,因为它可能导致症状缓解。基于我们的研究,我们建议对有症状的小肾结石患者进行内镜治疗。