Reina Ruiz C, Quintero Rodríguez R, Espinosa Olmedo J, Arrabal Martín M, Campoy Martínez P, Salazar Murillo R, García Pérez M
Servicio de Urología, Hospital Universitario de Valme, Sevilla.
Actas Urol Esp. 1995 Nov-Dec;19(10):742-54.
The treatment of ureteral lithiasis has undergone a revolution since the arrival of new techniques offering different therapeutical choices for which time is gradually elucidating the indications for each of the new procedures; although, to a large extent, a degree of controversy still persists. This paper reviews the different methods for ureteral lithiasis; spontaneous ejection and medical treatment, surgery, early endoscopic manoeuvres, backward and forward urethroscopy and, finally, extracorporeal lithority. This therapeutical experience in 3 series of ureteral lithiasis addressed with different criteria are revised together with 182 obstructive calculi of the lumbar ureter. We believe that grading the ureteral calculi according to their anatomical and functional features improves the results, since improved adjustment can be achieved for the indications of the various methods. Also it is noted that support endourology for extracorporeal lithotrity does not improve the results of treatment in lumbar calculi under 2 cm, and therefore our current approach is towards "in situ" treatment without complementary manoeuvres. Finally we show the therapeutic algorithm we are following actually to manage ureteral litiasis.
自新技术出现以来，输尿管结石的治疗发生了变革，这些新技术提供了不同的治疗选择，随着时间的推移，人们逐渐明确了每种新手术的适应症；尽管在很大程度上，一定程度的争议仍然存在。本文回顾了输尿管结石的不同治疗方法：自然排出和药物治疗、手术、早期内镜操作、逆行和顺行尿道镜检查，以及最后提到的体外碎石术。本文对3组采用不同标准治疗的输尿管结石的治疗经验进行了回顾，并涉及182例腰段输尿管梗阻性结石。我们认为，根据输尿管结石的解剖和功能特征进行分级可改善治疗效果，因为这样可以更好地调整各种治疗方法的适应症。此外，还指出对于直径小于2 cm的腰段结石，腔内泌尿外科技术辅助体外碎石术并不能提高治疗效果，因此我们目前的方法是采用“原位”治疗，无需辅助操作。最后，我们展示了我们目前用于处理输尿管结石的治疗方案。
