急诊输尿管镜碎石术与ESWL治疗输尿管中下段结石并急性肾绞痛的疗效评价

目的 比较急诊输尿管镜下气压弹道碎石术（ureteroscopic lithotripsy,URSL）与体外冲击波碎石术（extracorporeal shock wave lithotripsy,ESWL）治疗输尿管中下段结石并急性肾绞痛的疗效.方法 回顾性分析本院近3年来45例急诊URSL（URSL组）以及51例急诊ESWL（ESWL组）治疗输尿管中下段结石并急性肾绞痛患者的临床资料,比较其疼痛缓解率、一次性碎石成功率、术后2周结石排净率、并发症发生率等指标.结果 URSL组和ESWL组疼痛缓解率分别为95.56％（43/45）和78.43％（40/51）（P＜0.05）,URSL组一次性碎石成功率和术后2周碎石排净率分别为93.33％ （42/45）、97.78％ （44/45）,明显优于ES-WL组的78.43％ （40/51）、82.35％（42/51）（P＜0.05）;URSL组术后有2例发生尿路感染,ESWL组术后有4例发生肉眼血尿,两组术后均未出现发热、输尿管穿孔、撕裂等并发症（P＞0.05）.结论 对于结石直径＞l0mm的输尿管中下段结石并急性肾绞痛患者,急诊输尿管镜术疗效优于体外冲击波碎石术;首选输尿管镜术治疗此类患者具备一定的临床推广价值.     

体外冲击波碎石、逆行输尿管镜或微创经皮输尿管镜碎石治输尿管上段结石的疗效比较

目的 总结输尿管上段结石的有效治疗方法. 方法回顾性分析体外冲击波碎石(ESwL)、逆行输尿管镜(URL)或微创经皮输尿管镜碎石(MPCNL)治疗397例输尿管上段结石患者的临床效果,统计学比较3种治疗方法的成功率及结石清除率.结果 397例患者中,ESWL治疗83例,结石横径0.8～1.5 cm,平均1.23 cm;改行URL或开放手术治疗13例(15.7%);单纯ESWL治疗术后1个月结石清除率为65.7%(46/70).URL治疗213例,结石横径0.7～1.8 cm,平均1.21cm;改行开放手术18例(8.5%);单纯URL治疗术后1个月结石清除率为88.2%(172/195).MPCNL治疗101例,结石横径0.9～2.5 cm,平均1.50 cm;改行开放手术治疗3例(3.0%);单纯MPCNL治疗术后1个月结石清除率为96.9%(95/98).结石横径≤1 cm者.ESWL治疗结石清除率低于URL和MPCNL治疗组(P=0.041),URL组与MPCNL组结石清除率比较差异无统计学意义(P=0.680);结石横径＞1 cm者,ESWL治疗结石清除率低于URL组和MPCNL组(P＜0.001),URL组结石清除率低于MPCNL组(P=0.005).结论 横径≤1 cm的输尿管上段结石首选ESWL治疗,＞1 cm的结石应选用URL或MPCNL治疗,MPCNL治疗的结石清除率更高.     

输尿管镜气压弹道碎石术与ESWL治疗输尿管结石的疗效比较

目的:比较输尿管镜气压弹道碎石术(URSL)与ESWL治疗输尿管结石的疗效及副作用。方法:分别使用URSL与ESWL治疗输尿管结石患者各200例,治疗后应用腹部平片或B超评估其疗效,随访3个月,了解结石清除率,观察并记录治疗后并发症。结果:URSL有效率为91.5%,明显高于ESWL治疗者的总有效率73.5%(P<0.01);其中上段结石有效率87.72%,低于ESWL的93.33%(P<0.05),中下段结石有效率93%,明显高于ESWL的65%(P<0.01);其肾绞痛、恶心、呕吐、发热低于后者(P<0.05)。接受URSL的患者1.5%有输尿管穿孔。结论:URSL治疗输尿管结石的疗效优于ESWL;URSL较适合于输尿管中、下段结石的治疗,而ESWL较适合于输尿管上段结石的治疗。     

体外冲击波碎石失败后输尿管镜术与单独输尿管镜术临床疗效比较

目的 通过对体外冲击波碎石(ESWL)治疗失败后进一步输尿管镜(ESWL-URSL)与单独应用输尿管镜(URSL)治疗输尿管结石临床疗效的比较,探讨输尿管结石治疗方法的选择.方法 对136例ESWL失败者进一步采用输尿管镜术治疗,同期对189例输尿管结石直接行输尿管镜术治疗,将两组患者临床资料进行对比分析.结果 ESWL-URSL组行URSL时的平均手术时间和疗程明显长于URSL组.ESWL-URSL组术中发现息肉和穿孔转开放手术率为34.6%、5.88%,高于URSL组的28.3%、1.59%.两组间结石排净率差异无统计学意义.结论 在一定条件下,对于存在ESWL不利因素的输尿管结石可首选输尿管镜治疗.     

输尿管上段结石的微创手术治疗

目的：探讨输尿管上段结石的治疗方法。方法：回顾性分析输尿管镜下气压弹道碎石(URSL），后腹腔镜输尿管切开取石(RLU)、经皮肾穿刺取石(PCNL)治疗输尿管上段结石患者的临床资料。其中URSL组25例，RLU组20例。PCNL组9例。结果：URSL组碎石成功18例；7例不成功，其中3例改为开放手术，1例改为后腹腔镜取石。2例行ESWL术，1例仅留置双J管。术后1个月拔管后自行排出。2例并发输尿管穿孔。RLU组取石成功18例，2例滑入肾内，经配合输尿管镜和腹腔镜直视下经皮肾穿刺取石成功，术后15例有伤口漏尿。PCNL组成功9例，无并发症。结论：USRL创伤小。术后恢复快。是治疗输尿管上段结石的较为满意的治疗方法。PCNL创伤小，取石成功率高，在结石靠近肾盂、儿童输尿管上段结石并同侧肾结石和结石以下输尿管狭窄时应优先考虑。但技术难度较大。RLU可作为URSL不成功后的辅助治疗方法。     

Treatment options for ureteral calculi: endourology or extracorporeal shock wave lithotripsy

Two therapeutic methods, endourology and extracorporeal shock wave lithotripsy (ESWL), can be used in the treatment of ureteral calculi. In a retrospective analysis during a 2-year period 236 patients treated with endourological procedures and 71 who underwent ESWL with a Siemens Lithostar were analyzed as to the success rate, effectiveness quotient, complication rate and hospitalization. The mean stone size was 1.12 cm. in the endourology group and 1.03 cm. in the ESWL group. Complete removal of all stone fragments was achieved in 93.6% of the patients treated endourologically and without retreatment. In the ESWL group success was obtained in 90.1%, with an 11.2% retreatment rate. The retreatment rate was higher (25.0%) for calculi in the mid ureter. The group treated endourologically had a better success rate and no retreatment was necessary. On the other hand, the group treated with ESWL had a shorter hospitalization and a lower complication rate. Followup ranged from 11 to 60 months (mean 48 months) in the endourology group and 7 to 29 months (mean 11 months) in the ESWL group. These observations showed that in situ ESWL therapy with the Siemens Lithostar device is the method of choice for upper ureteral stones. Lower ureteral calculi should be treated endoscopically. Mid ureteral stones larger than 1 cm. had better results with endoscopic procedures and those smaller than 1 cm. had better results with ESWL.     

Extracorporeal shock wave lithotripsy for ureteral calculi.

Second generation tubless lithotriptors allow for easy prone positioning of patients, resulting in increased use of extracorporeal shock wave lithotripsy (ESWL) for calculi in the ureter, especially in the mid and lower third portions. The 3-month stone-free rate with single stones using a Dornier HM3 and a Medstone STS lithotriptor in the upper ureter was 79% (316 patients) and 81% (188), respectively, while in the mid ureter it was 60% (20 patients) and 81% (32), respectively, and in the lower ureter it was 80% (5 patients) and 85% (26), respectively. The retreatment rate with single stones using the Dornier HM3 and the Medstone STS devices was 5% and 4%, respectively, in the upper ureter, 13% and 12%, respectively, in the mid ureter, and 0% and 5%, respectively, in the lower ureter. The second procedure rate after ESWL with single stones using the Dornier HM3 and the Medstone STS units was 6% and 6%, respectively, in the upper ureter, 15% and 16%, respectively, in the mid ureter, and 0% and 17%, respectively, in the lower ureter. Expectant management is still an acceptable method to treat small ureteral stones, and it is questionable whether ESWL is the appropriate treatment for lower third ureteral stones compared to equally effective and less expensive ureteroscopy.     

Clinical experience of extracorporeal shock wave lithotripsy for cystine calculi

Thirty patients (16 men and 14 women) with cystine urinary stones were treated by extracorporeal shock wave lithotripsy (Dormer HM-3) from December 1984 through October 1989. The average patient age was 35.2 years with a range of 14 to 59 years. Seventy per cent of these subjects had had previous open surgical operations for stones. The cases consisted of 7 ureteral stones and 37 renal stones, including 15 staghorn calculi. An average of 1.3 session of ESWL was carried out to treat ureteral stones. Thirty-seven renal units with renal stone required 96 sessions of lithotripsy (average 2.6 sessions per unit). Seven patients with ureteral stones required auxiliary procedures, i.e., one transurethral lithotripsy (TUL), two percutaneous nephrostomies (PNS) and one open surgery. Thirty-seven renal stones, including staghorn calculi was treated by ESWL and auxiliary treatment of 21 TUL procedures, one PNS, 16 PNL procedures and one chemical chemolysis. Successful fragmentation (residual debris less than or equal to 4 mm) was achieved in 85.7% of ureteral stones, 90.9% of renal stones and 73.3% of staghorn calculi. The stone free rates of patients with ureteral stones, renal stones and staghorn calculi were 71.4%, 50.0% and 53.5%, respectively, at 3 months after ESWL. No serious complications were seen in this series. Fever above 38.5 degrees C was the most common complications (13.5%). Ureteral perforation was encountered once in TUL procedures. Transfusion and selective arterial embolization were needed for one case treated by PNL procedures. Although cystine stone is harder to be fragmented by ESWL than other stone composition, ESWL and endourology may be effective and safe procedures for cystine stone patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Treatment of ureteral calculi by extracorporeal shock wave lithotripsy

We reviewed 465 cases of ureteral calculi treated at J?m? Urological Hospital using a Dornier HM3 lithotripter during the period from October 1985 to February 1989. The 336 men and 122 women ranged from 11 to 78 years old with a mean age of 42.2. The stone size ranged from 4 mm to 30 mm with a mean length of 10.6 mm. Complete stone elimination by ESWL was achieved in 431 of the 465 cases (92.7%). The success rate was best for stones in the lower ureter, which was 98.1 per cent (53/54). For upper and mid ureteral calculi it was 92.4 per cent (363/393) and 83.3 per cent (15/18), respectively. ESWL after push up made 100 per cent (30/30) of patients completely free of stones, while ESWL after bypass 93.0 percent (106/114) and ESWL in situ 91.9 per cent (295/321). The rate of residual stone increases in proportion to the age of patients. Minor side effects such as fever and pain were observed. Our results suggest that ESWL currently is the first therapeutic option for the majority of ureteral calculi.     

Management of ureteral stones by extracorporeal shock wave lithotripsy. 3 years of experience

From April 1985 to March 1987 181 patients with ureteral stones were treated by means of extracorporeal shock wave lithotripsy (ESWL). Management for proximal calculi changed from in situ ESWL treatment (group n = 27) or placement of a ureteral catheter below calculi (group II, n = 30) to retrograde stone manipulation into renal pelvis (group IV, n = 52) or ESWL treatment under intraoperative irrigation of saline in cases where repositioning failed (group III, n = 50). The best stone-free rate for upper ureteral stones was obtained in group IV with 96% after 6 weeks, presenting also the shortest hospital stay (4.2 days) and lowest quota of postoperative auxiliary procedures (2%). Stones, not being dislodged into renal pelvis (49%), could be treated successfully in 86% by irrigation with saline during ESWL (group III). The stone-free rate decreased in patients with in situ treatment (group I: 67%) or ureteral catheter placement (group II: 83%). Treatment of these stones increased the need of postoperative ancillary procedures to approximately 30%. For distal ureteral stones ESWL and preoperative Zeiss placement achieved a stone-free rate of 95%.     

Extracorporeal shock-wave lithotripsy (ESWL) monotherapy for stones in lower ureter.

Extracorporeal shock-wave lithotripsy (ESWL) has been accepted as the method of choice for most upper urinary tract calculi. However, in cases of stones in the lower ureter, ureteroscopic procedures have generally been preferred. Using the Dornier HM3 lithotriptor with modifications in the patient's position, we were able to successfully treat 155 unselected cases of lower ureteral calculi. The average stone size was 9.6 mm (range 5-23 mm). One hundred forty-three patients had stones located below the lower margin of the sacroiliac joint. These patients were placed in a supine position. The stones were visualized radiologically without use of a ureteral catheter in 78 percent of the patients; in 22 percent a ureteral catheter was inserted prior to ESWL to aid in stone localization. In 145 patients (94%) treatment was completed in one session; 10 patients (6%) required two sessions. Of the patients, 38 percent were free of stones one day after ESWL; 97 percent became stone free within three months, and only 3 patients required endoscopic manipulation, after ESWL. Twelve patients had stones in the midureter overlying the sacroileum. They were placed in the prone position, and the calculi were visualized with the aid of a ureteral catheter. All these patients became free of stones one month after treatment. There were no significant treatment-related complications except for bacteremia in 1 case. In view of the remarkable efficacy, negligible complication rate, and shorter hospital stay as compared to ureteroscopic stone manipulations, we recommend high energy ESWL as the primary monotherapy of mid and lower ureteral stones.     

Piezoelectric lithotripsy of ureteral stones: influence of shockwave frequency on sedation and therapeutic efficiency.

OBJECTIVE: The aim of this randomized study was to assess the relation between shockwave frequency, sedation, and efficiency in piezoelectric extracorporeal shockwave lithotripsy (SWL) for ureteral calculi. METHODS: A random sample of 114 patients aged between 15 and 74 (mean 45) years were treated at the shockwave frequencies of 1 (N = 57) or 4 (N = 57) per second using the EDAP LT 02 lithotripter at maximum energy. The stones' largest diameter ranged from 5 to 18 mm (mean 7.6 mm). Lower ureteral stones were treated with the patient in the prone position and upper ureteral stones in supine position. The duration of SWL sessions and stone measurements were statistically similar for patients treated at low and high frequencies. The levels of required sedation (none, intramuscular analgesia, intravenous sedation-analgesia) and stone-free rates after one session were analyzed by Student's t-test or Fisher's exact test. RESULTS: Sedation did not differ statistically with SWL frequency for mid and lower ureteral calculi. However, the use of intravenous sedation-analgesia was less common for patients with upper ureteral stones treated at low rather than high frequency (19% and 100%, respectively; P < 0.0001). The success rate was significantly lower (P = 0.04) for lower ureteral calculi treated at low v high frequency (65 % and 89%, respectively) but was not statistically affected by frequency for upper ureteral stones. CONCLUSION: We recommend high frequency for piezoelectric SWL of lower ureteral calculi, especially for stones with a maximum diameter > or =8 mm. On the other hand, low-frequency SWL appears to be suitable for the treatment of upper ureteral stones.     

ESWL与输尿管镜碎石联合处理上尿路结石

目的：探讨对部分上尿路结石采用ESWI．与输尿管镜碎石联合处理的方法。方法：对70例上尿路结石患者采用ESWI。与输尿管镜下钬激光碎石（URS）联合交替治疗。其中输尿管结石48例,。肾结石22例。结果：结石总排净率为91．4％00（64／70）,其中输尿管结石排净率为95．8％（46／48）,肾结石排净率为81．8％（18／22）。3例治疗失败,其中1例输尿管结石因输尿管狭窄无法入镜;另2例肾结石,1例因交替治疗次数过多中途停止治疗,1例因结石硬度过大ESWI,不佳,均改为PCNL术。结论：ESW[。与URS联合交替进行的疗法处理上尿路结石,避免了创伤性治疗,扩大了ESWI,治疗范围,降低了URS手术难度,缩短了URS操作时间,提高了结石排净率,患者创伤微小、恢复快、并发症少,是治疗上尿路结石,特别是部分复杂性上尿路结石较理想的方法之一。     

Efficacy of in situ extracorporeal shock wave lithotripsy for upper ureteral calculi

In contrast to the majority of renal calculi, in situ extracorporeal shock wave lithotripsy (ESWL) for upper ureteral stones is still controversial. Some centers recommend retrograde mobilization of the calculus into the renal pelvis prior to ESWL as a routine procedure (UC + ESWL). To evaluate the efficiency of in situ ESWL for upper ureteric stones, we initiated a prospective clinical trial. From July 1985 to January 1986, 122 patients presented with upper ureteral calculi, necessitating a total of 146 different procedures: 88 in situ ESWL; 31 UC + ESWL; 15 antegrade ureteroscopies (URS); 6 retrograde URS; 2 open surgery (ureterolithotomy, nephrectomy), and 4 patients were managed conservatively. Of all 99 patients treated at the lithotripter, 80 patients received in situ ESWL (no emergency case, no location problems): in 60 patients (75%) the stone could be disintegrated in one session; 8 patients (10%) required a second ESWL session due to partial fragmentation. Retrograde mobilization using a ureteral catheter or URS was necessary in 9 patients due to failure of in situ ESWL (11%) and, in only 3 patients, we had to remove the stone by antegrade URS (4%). In conclusion, 96% of all upper ureteric stones suitable for primary ESWL could be treated by a noninvasive (in situ ESWL) or minimally invasive (UC + ESWL) procedure. Therefore we recommend in situ ESWL for these calculi. Primary retrograde mobilization is only indicated in case of location problems (stone close to the spine, obesity, skeleton deformation) or emergency cases (colic, hydronephrosis). Antegrade URS should be performed if retrograde mobilization fails or in emergency cases (acute pyelonephritis, following percutaneous nephrostomy, after clinical stabilization). The rate of open surgery is below 2%.     

Comparison of transurethral ureteroscopy and extracorporeal shock wave lithotripsy for treatment of ureteral calculi

Ureteral calculi were treated by transurethral uretereoscopy and extracorporeal shock wave lithotripsy (ESWL), and the results were compared. Rigid transurethral ureteroscopy was performed in 50 patients, and 10 of 22 stones located in the upper ureter and 25 of 29 stones located in the lower ureter were successfully extracted. On the other hand, we treated 88 patients with upper ureteral stones by ESWL and achieved a success rate of 89.8%. We therefore conclude that for upper ureteral stones, ESWL is the more effective treatment and, for lower ureteral stones, transurethral ureteroscopy.     

输尿管镜下气压弹道碎石治疗输尿管结石的临床分析

目的：总结896例输尿管镜下气压弹道碎石术（URSL）治疗输尿管结石的临床效果和操作体会。方法：回顾性分析896例932侧输尿管结石行USRL的临床资料。结果：932侧输尿管结石中，864例治疗成功，成功率为92.7%，并发症发生率为8.7%；上段、中段、下段输尿管结石的治疗成功率分别为65.7%、90.7%和95.8%。结论：URSL的疗效不断得到提高，可作为中、下段输尿管结石的首选疗法。操作中应尽量采用碎石技术而避免频繁套石和钳取；尽量采用输尿管导管作指引而避免应用金属安全导丝；URSL术后不必常规留置双J管作内引流，轻微损伤，留置粗的输尿管导管3－5天已足够。     

输尿管镜术与ESWL治疗输尿管远端结石的疗效对比

目的:比较输尿管镜术(URSL)与体外冲击波碎石(ESWL)治疗输尿管远端结石的临床疗效。方法:对942例输尿管远端结石采用ESWL治疗,同期对234例直接行输尿管镜术治疗,将两组患者资料进行对比分析。结果:ESWL组成功治疗806例,136例失败者128例改URSL治疗成功,8例开放手术。URSL组治疗成功230例,4例开放手术。两组间结石排净率差异无统计学意义。结论:复杂输尿管结石的治疗首选URSL,ESWL失败后配合URSL治疗可提高复杂输尿管结石治愈率。     

输尿管镜气压弹道碎石术治疗输尿管结石

目的：探讨输尿管镜气压弹道碎石术治疗输尿管结石的疗效。方法：采用输尿管镜气压弹道碎石术治疗输尿管结石患者128例，其中5例为ESWL后输尿管石街形成，6例并发急性梗阻性肾功能不全。结果：128例中，一次性碎石成功117例，占91．4％。碎石失败11例，占8．6％，其中6例输尿管上段结石移位至肾盂，留置双J管后行ESWL治愈，另外2例输尿管穿孔和3例进镜失败患者均立即改行开放手术治愈。6例并发急性梗阻性肾功能不全患者碎石术后即进入多尿期，2周后复查肾功能恢复正常。结论：输尿管镜气压弹道碎石术治疗输尿管结石具有微创、安全、效果好等优点，可作为输尿管中、下段结石的首选治疗方法。     

钬激光结合输尿管镜治疗泌尿系结石

目的:探讨钬激光结合输尿管镜腔内治疗泌尿系结石的安全性、有效性。方法:采用钬激光联合输尿管镜治疗泌尿系结石380例。结果:单次手术结石粉碎率达90.8%(345/380),其中肾结石成功率为81.8%(54/66),输尿管上段结石单次碎石成功率为93.1%(284/305),中、下段结石为97.9%(91/93),膀胱结石及尿道结石为100%(9/9)。结论:钬激光联合输尿管镜碎石术治疗泌尿系结石安全、有效,手术技巧容易掌握;尤其适用于结石合并输尿管狭窄、结石合并息肉形成或结石嵌顿包裹,以及体外冲击波碎石失败的患者。     

钬激光碎石术治疗泌尿系结石(附1 216例报告)

目的探讨钬激光碎石术治疗泌尿系结石的疗效及其安全性。方法应用输尿管肾镜和膀胱镜联合钬激光碎石术治疗1216例泌尿系结石，其中输尿管结石1006例（上段302例，中段364例，下段340例），膀胱结石210例。结果l例输尿管上段结石因前列腺增生症致置镜困难改体外冲击波碎石（extracorporeal shock wave lithotripsy,ESWL）治疗。l006例输尿管结石单次碎石成功率95．5％（961／1006）），其中上、中、下段结石单次碎石成功率分别为89．4％（270／302）、96．4％（351／364）和100％（340／340），术中发生6例输尿管穿孔。膀胱结石单次碎石成功率为100％（210／210），无出血和膀胱穿孔发生。881例输尿管结石术后随访0．5—40个月，平均18．6月，输尿管上、中、下段结石排净率分别为91．1％（224／246）、98.5％（318／323）、100％（312／312），总结石排净率为96．9％（854／881）；6例发生输尿管狭窄。187例膀胱结石术后随访0.5～31个月，平均12．4月，结石排净率98．4％（184／187）。结论钬激光碎石术治疗泌尿系结石疗高效、微创、安全，是输尿管结石和膀胱结石首选治疗方法。