Qin Cai Peng, Wang Fei, DU Yi Qing, Zhang Xiao Wei, Li Qing, Liu Shi Jun, Xu Tao
Department of Urology, Peking Univesity People's Hospital, Beijing 100044, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Oct 18;55(5):939-942. doi: 10.19723/j.issn.1671-167X.2023.05.025.
This paper analyzed the clinical data, diagnosis and treatment of 4 asymptomatic patients with ureteral calculi without hydrops in our hospital from October 2018 to January 2019, and comprehensively discussed the previous literature. The 4 patients in this group had no obvious clinical symptoms, no positive stones were found in the B-ultrasound of the urinary system, and no hydroureter and hydroureter of the affected side was found. Urinary CT scan confirmed ureteral stones. They were all located in the lower ureter, and the stones obstructed the lumen. The stones were round and smooth, and there was no obvious hyperplasia and edema in the surrounding mucosa. The lithotripsy was completed in the first-stage operation, and the DJ catheter was left behind for one month after the operation. Based on the clinical diagnosis and treatment process of the 4 cases of asymptomatic calculi in this group and the analysis of previous studies, these patients were mostly detected by imaging examinations or other systematic imaging examinations during the regular review of urinary calculi. Ureteral stones with obstruction did not necessarily have stone-related symptoms. The onset of renal colic involved an increase in intraluminal pressure, related stimulation of nerve endings, smooth muscle spasms caused by stretching of the ureteral wall, and systemic changes in cytokines and related hormones. Cascade reactions, etc., were associated with the movement of stones down. Ureteral stones without hydrops were mostly located in the lower ureter, which had a certain buffering effect on obstructive pressure. Asymptomatic ureteral calculi could also induce irreversible damage to renal function, and the proportion of damage increased with the diameter of the stone. Patients with a history of urinary calculi, especially those with asymptomatic stones for the first time, should be paid attention to during clinical follow-up. At present, there are few research reports on asymptomatic and non-accumulating ureteral calculi. We analyze the clinical diagnosis and treatment process and characteristics of this group of patients combined with previous literature to provide a reference for the diagnosis and treatment of such patients.
本文分析了2018年10月至2019年1月我院收治的4例无症状性输尿管结石且无肾积水患者的临床资料、诊断及治疗情况，并对既往文献进行了综合讨论。该组4例患者均无明显临床症状，泌尿系统B超未发现阳性结石，患侧无输尿管及肾盂积水。泌尿系CT扫描确诊为输尿管结石。结石均位于输尿管下段，堵塞管腔。结石呈圆形、光滑，周围黏膜无明显增生及水肿。一期手术完成碎石，术后留置DJ管1个月。基于该组4例无症状结石患者的临床诊治过程及既往研究分析，这些患者多在尿路结石定期复查时通过影像学检查或其他系统影像学检查发现。输尿管结石梗阻不一定有与结石相关的症状。肾绞痛的发作涉及管腔内压力升高、神经末梢的相关刺激、输尿管壁伸展引起的平滑肌痉挛以及细胞因子和相关激素的全身变化、级联反应等，与结石下移有关。无肾积水的输尿管结石多位于输尿管下段，对梗阻压力有一定缓冲作用。无症状性输尿管结石也可导致肾功能不可逆损害，损害比例随结石直径增大而增加。有尿路结石病史的患者，尤其是首次发现无症状结石的患者，临床随访时应予以关注。目前关于无症状非积水性输尿管结石的研究报道较少。我们结合既往文献分析该组患者的临床诊治过程及特点，为这类患者的诊治提供参考。
