Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Urology, Nagoya City University West Medical Center, Nagoya, Japan.
Int J Urol. 2022 Sep;29(9):1054-1060. doi: 10.1111/iju.14984. Epub 2022 Jul 23.
To evaluate the efficacy of ultrasound-assisted monitoring during shock wave lithotripsy for kidney and proximal ureteral calculi.
We retrospectively reviewed 535 patients who initially underwent shock wave lithotripsy for renal or proximal ureteral calculi between January 2012 and December 2021. The patients were divided into the X-ray group (n = 294) and ultrasound plus X-ray group (n = 241) based on the methods of targeting and monitoring calculi during shock wave lithotripsy. Because of differences in patient backgrounds, 1:1 propensity score-based matching was performed. The primary endpoint was the stone-free rate.
In the final 1:1 matched cohort, 192 kidney stone cases and 162 proximal ureteral stone cases were analyzed. For patients with kidney calculi, the stone-free rate of the ultrasound plus X-ray group was significantly higher than that of the X-ray group (66.7% vs. 47.9%; P = 0.013). In the multivariate analysis, a large stone area (odds ratio 2.37), lower caliceal stones (odds ratio 3.37), and X-ray monitoring alone (odds ratio 0.49) were independently associated with shock wave lithotripsy failure. For patients with proximal ureteral stones, there was no significant difference in the stone-free rate between the ultrasound plus X-ray group and X-ray group (71.6% and 58.0%, respectively; P = 0.100). During the multivariate analysis, high computed tomography attenuation (odds ratio 2.31) and large stone area (odds ratio 2.18) were independent factors associated with residual stones after shock wave lithotripsy.
Ultrasound-assisted monitoring may contribute to a higher stone-free rate for patients with kidney calculi, but not for those with proximal ureteral calculi.
评估超声辅助监测在冲击波碎石治疗肾结石和输尿管上段结石中的疗效。
我们回顾性分析了 2012 年 1 月至 2021 年 12 月期间初次接受冲击波碎石治疗的 535 例肾结石或输尿管上段结石患者。根据冲击波碎石过程中结石的定位和监测方法，将患者分为 X 射线组（n=294）和超声联合 X 射线组（n=241）。由于患者背景存在差异，采用 1:1 倾向评分匹配。主要终点是结石清除率。
在最终的 1:1 匹配队列中，分析了 192 例肾结石病例和 162 例输尿管上段结石病例。对于肾结石患者，超声联合 X 射线组的结石清除率明显高于 X 射线组（66.7%比 47.9%；P=0.013）。多因素分析显示，结石面积大（优势比 2.37）、下盏结石（优势比 3.37）和单独 X 射线监测（优势比 0.49）与冲击波碎石失败独立相关。对于输尿管上段结石患者，超声联合 X 射线组和 X 射线组的结石清除率无显著差异（分别为 71.6%和 58.0%；P=0.100）。多因素分析显示，CT 值高（优势比 2.31）和结石面积大（优势比 2.18）是冲击波碎石后结石残留的独立因素。
超声辅助监测可能有助于提高肾结石患者的结石清除率，但对输尿管上段结石患者无效。
