Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
Urolithiasis. 2022 Aug;50(4):481-485. doi: 10.1007/s00240-022-01332-3. Epub 2022 Jun 3.
The role of emergency shockwave lithotripsy (SWL) in persistent pain control in patients with ureteral stones is not well established. The aim of this study is to evaluate efficacy as well as the predicting variables for successful early SWL patients with symptomatic ureteral stones. Eighty-six patients with a persistent renal colic secondary to single ureteral stone (6-12 mm) were prospectively enrolled in this study. SWL was performed within 24 h of the onset of flank pain. Pain control and stone-free rate after emergency SWL session were 58.1% and 44.2%, respectively. Seven patients required post-SWL ureteroscopy and ureteral stent placement for uncontrolled pain. The overall 3-month stone-free rate after SWL monotherapy was 83.7%. On multivariate analysis, predictors for pain relief after emergency SWL were lower Hounsfield (HU) stone density, mild hydronephrosis (HN) at presentation and presentation during the first colic episode. Lower HU stone density was the single predictor of successful stone clearance after single emergency SWL session on multivariate analysis. In conclusion, early SWL is feasible and effective in management of ureteral stones presented by renal colic with low HU.
急诊冲击波碎石术（SWL）在控制输尿管结石患者持续性疼痛中的作用尚未得到充分证实。本研究旨在评估对于有症状的输尿管结石患者，早期成功进行 SWL 的疗效和预测因素。
本研究前瞻性纳入了 86 例因单一输尿管结石（6-12mm）而继发持续性肾绞痛的患者。SWL 在腰痛发作后 24 小时内进行。急诊 SWL 后疼痛控制和结石清除率分别为 58.1%和 44.2%。7 例患者因疼痛未得到控制而需要进行 post-SWL 输尿管镜检查和输尿管支架置入术。SWL 单一疗法后 3 个月的总体结石清除率为 83.7%。多变量分析显示，急诊 SWL 后疼痛缓解的预测因素为较低的亨氏单位（HU）结石密度、轻度肾积水（HN）和首次绞痛发作时就诊。多变量分析显示，HU 结石密度较低是单次急诊 SWL 后结石清除成功的唯一预测因素。
总之，对于低 HU 的肾绞痛患者，早期 SWL 是一种可行且有效的输尿管结石治疗方法。
