Noh Tae Il, Pyun Jong Hyun, Shim Ji Sung, Kang Seok Ho, Cheon Jun, Kang Sung Gu
Department of Urology, Anam Hospital, Korea University College of Medicine, 73, Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Korea.
Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Sci Rep. 2023 Feb 16;13(1):2757. doi: 10.1038/s41598-023-29866-5.
To investigate the characteristics and impact of asymptomatic (silent) ureteral stones on renal function and compare them with those of symptomatic stones. We retrospectively reviewed the medical records of 677 patients who underwent ureteroscopic lithotripsy or laparoscopic ureterolithotomy for ureteral stones between 2016 and 2020. Patients were divided into two groups according to the presence of recognizable symptoms. We investigated the characteristics and impact of silent stones on post-treatment renal function recovery and compared them with those of symptomatic stones. Among the 677 patients, 43 (6.4%) had asymptomatic ureteral stones, and 634 (93.6%) had symptomatic ureteral stones. Compared to symptomatic stones, asymptomatic stones were larger (11.4 mm vs. 9.6 mm, p = 0.003), more commonly present in the upper ureter (62.7% vs. 48.0%, p = 0.04), and more commonly associated with high-grade hydronephrosis (32.8% vs. 12.3%, p < 0.001); however, no difference in metabolite composition was observed between the two group of stone. In the asymptomatic stone group, the mean preoperative estimated glomerular filtration rate (eGFR) was 77.37 ± 23.54 mL/min/1.73 m, and the mean postoperative eGFR indicated no significant improvement at 1 day, 7 days, 3 months, and 12 months (76.66 ± 21.45, 77.89 ± 20.87, 77.29 ± 22.22, and 76.71 ± 24.21 mL/min/1.73 m, respectively; p = 0.567, p = 0.613, p = 0.924, and p = 0.202, respectively). In the symptomatic stone group, the mean preoperative eGFR was 78.17 ± 28.25 mL/min/1.73 m; the mean postoperative eGFRs at 1 day, 7 days, 3 months, and 12 months were 81.24 ± 26.38, 86.16 ± 25.61, 89.11 ± 25.43, and 89.50 ± 26.01 mL/min/1.73 m, respectively and demonstrated significant improvement (p = 0.002, p < 0.001, p < 0.001, and p < 0.001, respectively). Silent stones irreversibly impaired renal function, even after proper management. Therefore, active treatment strategies are required for all patients who are hesitant to receive treatment for silent stones because of their asymptomatic status to prevent permanent renal impairment.
为研究无症状（静止性）输尿管结石的特征及其对肾功能的影响，并与有症状结石进行比较。我们回顾性分析了2016年至2020年间677例行输尿管镜碎石术或腹腔镜输尿管切开取石术治疗输尿管结石患者的病历。根据是否有可识别症状将患者分为两组。我们研究了静止性结石对治疗后肾功能恢复的特征和影响，并与有症状结石进行比较。在677例患者中，43例（6.4%）有无症状输尿管结石，634例（93.6%）有有症状输尿管结石。与有症状结石相比，无症状结石更大（11.4毫米对9.6毫米，p = 0.003），更常见于输尿管上段（62.7%对48.0%，p = 0.04），且更常合并重度肾积水（32.8%对12.3%，p < 0.001）；然而，两组结石的代谢物组成无差异。在无症状结石组，术前平均估计肾小球滤过率（eGFR）为77.37±23.54毫升/分钟/1.73平方米，术后1天、7天、3个月和12个月的平均eGFR无显著改善（分别为76.66±21.45、77.89±20.87、77.29±22.22和76.71±24.21毫升/分钟/1.73平方米；p分别为0.567、0.613、0.924和0.202）。在有症状结石组，术前平均eGFR为78.17±28.25毫升/分钟/1.73平方米；术后1天、7天、3个月和12个月的平均eGFR分别为81.24±26.38、86.16±25.61、89.11±25.43和89.50±26.01毫升/分钟/1.73平方米，均有显著改善（p分别为0.002、<0.001、<0.001和<0.001）。即使经过适当治疗，静止性结石也会对肾功能造成不可逆损害。因此，对于所有因无症状而对静止性结石治疗犹豫不决的患者，需要采取积极的治疗策略，以防止永久性肾功能损害。
