Yoon Ji Hyung, Park Sejun, Kim Seong Cheol, Park Sungchan, Moon Kyung Hyun, Cheon Sang Hyeon, Kwon Taekmin
Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Transl Androl Urol. 2021 Apr;10(4):1588-1595. doi: 10.21037/tau-20-1397.
We evaluated the treatment outcomes of ureteral stones according to energy intensity generated by extracorporeal shock wave lithotripsy (ESWL).
We retrospectively analyzed 150 patients who underwent ESWL for treatment of ureteral stones between September 2018 and February 2020. All stones were confirmed by a computed tomography examination, and the size, location, skin-to-stone distance, and Hounsfield units (HU) of the stones were assessed. In addition, patient characteristics including body mass index and estimated glomerular filtration rate, which can affect treatment outcome, were also evaluated. The success or failure of ESWL was confirmed according to the session, and the factors affecting the treatment outcome were analyzed using a logistic regression model.
Of the 150 patients, 82 (54.7%) had stones in the proximal ureter, 5 (3.3%) in the mid, and 63 (42.0%) in the distal ureter. Patients underwent ESWL an average of 1.5 times, and the success rate according to session was 65.3% for the first, 83.3% for the second, and 90.0% for the third session. A multivariate analysis revealed that stone size [odds ratio (OR) 0.81, 95% confidence interval (CI), 0.66-0.99, P=0.049] and HU (OR 0.99, 95% CI, 0.98-0.99, P=0.001) were significant factors affecting the success rate after the first ESWL session; ESWL intensity was not related to success rate. Stone size (OR 0.78, 95% CI, 0.62-0.96, P=0.022) was the only significant factor affecting the success rate in the third session.
Stone size and HU affected the ESWL success rate. ESWL intensity was not significantly related to the success rate, so it should be adjusted according to patient pain and the degree of stone fragmentation.
我们根据体外冲击波碎石术（ESWL）产生的能量强度评估输尿管结石的治疗效果。
我们回顾性分析了2018年9月至2020年2月期间接受ESWL治疗输尿管结石的150例患者。所有结石均经计算机断层扫描检查确诊，并评估结石的大小、位置、皮肤至结石距离和亨氏单位（HU）。此外，还评估了包括体重指数和估计肾小球滤过率等可能影响治疗效果的患者特征。根据治疗疗程确认ESWL的成功或失败，并使用逻辑回归模型分析影响治疗效果的因素。
150例患者中，82例（54.7%）输尿管上段有结石，5例（3.3%）输尿管中段有结石，63例（42.0%）输尿管下段有结石。患者平均接受ESWL治疗1.5次，首次治疗的成功率为65.3%，第二次为83.3%，第三次为90.0%。多因素分析显示，结石大小[比值比（OR）0.81，95%置信区间（CI），0.66 - 0.99，P = 0.049]和HU（OR 0.99，95% CI，0.98 - 0.99，P = 0.001）是影响首次ESWL治疗后成功率的重要因素；ESWL强度与成功率无关。结石大小（OR 0.78，95% CI，0.62 - 0.96，P = 0.022）是影响第三次治疗成功率的唯一重要因素。
结石大小和HU影响ESWL成功率。ESWL强度与成功率无显著相关性，因此应根据患者疼痛程度和结石破碎程度进行调整。
