Netto Júnior N R, Claro J F
Service d'Urologie, Université de Campinas, Sao Paulo, Brésil.
Prog Urol. 1993 Feb;3(1):48-53.
Two therapies, ureterolithotripsy (URL) and extracorporeal shock wave lithotripsy (ESWL) can be used in the treatment of lower ureteral calculi. In a retrospective analysis ureterolithotripsy and extracorporeal shock wave lithotripsy for lower ureteral calculi were compared to evaluate morbidity. During a 3 year period 161 patients treated with ureterolithotripsy and 71 who underwent extracorporeal shock wave lithotripsy (Siemens Lithostar) were analysed as to the success rate, effectiveness quotient, complication rate and length of hospitalization. Followup consisted of ultrasound and a plain film of the kidneys, ureteres and bladder 1 day and 1 to 3 months postoperatively. Complete removal of all stone fragments was achieved in 95.5% of the patients treated endourologically with a 1.2% retreatment rate. In the group treated with extracorporeal shock wave lithotripsy success rate was 82.1% with a 19.6% retreatment rate. Among the patients who underwent ureteroscopy and stone removal 16.1% had complications compared to 10.7% in the ESWL group. The mean stone diameter was 0.8 cm in the endourological group and 0.7 cm in the ESWL group. Stone size was not a determining factor for the stone free rate and effectiveness quotient in the patients treated endourologically. Indeed, in patients who underwent ESWL for large stones the stone-free rate and effectiveness quotient decreased to 78.9% and 57.7%. Ureterolithotripsy will continue to have a primary role in the management of lower ureteral stones. As extracorporeal shock wave lithotripsy is an effective noninvasive procedure, requiring no anesthesia and hospitalization as routine, it may be considered an alternative either primarily or after failed ureteroscopy.
输尿管镜碎石术（URL）和体外冲击波碎石术（ESWL）这两种疗法可用于治疗输尿管下段结石。在一项回顾性分析中，对输尿管镜碎石术和体外冲击波碎石术治疗输尿管下段结石的情况进行了比较，以评估发病率。在3年期间，对161例行输尿管镜碎石术的患者和71例行体外冲击波碎石术（西门子Lithostar）的患者的成功率、有效率、并发症发生率和住院时间进行了分析。术后1天及1至3个月通过超声和肾脏、输尿管及膀胱平片进行随访。经腔内泌尿外科治疗的患者中，95.5%的患者结石碎片完全清除，再次治疗率为1.2%。在接受体外冲击波碎石术的组中，成功率为82.1%，再次治疗率为19.6%。接受输尿管镜检查和取石的患者中，16.1%出现并发症，而体外冲击波碎石术组为10.7%。腔内泌尿外科治疗组的平均结石直径为0.8cm，体外冲击波碎石术组为0.7cm。结石大小不是腔内泌尿外科治疗患者结石清除率和有效率的决定因素。事实上，对于接受体外冲击波碎石术治疗大结石的患者，结石清除率和有效率分别降至78.9%和57.7%。输尿管镜碎石术在输尿管下段结石的治疗中仍将发挥主要作用。由于体外冲击波碎石术是一种有效的非侵入性手术，通常无需麻醉和住院，它可被视为主要治疗方法或输尿管镜检查失败后的替代方法。
