上尿路结石体外冲击波碎石术预后的影响因素

目的探讨影响上尿路结石体外冲击波碎石术（ESWL）预后的相关因素,为临床干预提供依据。方法将2008年7月至2012年6月期间在我院行ESWL治疗的275例上尿路结石患者分为观察组（n=154）与对照组（n=121）,观察组患者结石完全排净,对照组未排出结石或有残留结石。相关因素采用x2检验、非条件Logistic回归进行分析。结果①x2检验结果显示两组患者病程、结石长度、结石宽度、结石数目相比差异有统计学意义（P〈0．05）。②非条件Logistic回归结果显示结石长度、结石宽度是独立危险因素（P〈0．05）。结论根据相关因素的分析结果,采取相应的干预措施以改善ESWL治疗上尿路结石患者的预后。     

体外冲击波碎石治疗单发输尿管结石及疗效预测

目的探讨体外冲击波碎石术（ESWL）治疗输尿管结石疗效的影响因素,并建立预测模型。方法2008年1月至2011年2月接受ESWL治疗的输尿管结石患者1116例,随访3个月。用X^2检验或t检验、秩和检验进行单因素分析来研究患者性别、年龄、身高、体重、病程、临床症状和结石特征等因素与疗效的关系,多因素分析采用Logistic逐步回归分析（Forward：LR法）,建立Logistic回归预测模型。结果ESWL单次治疗输尿管结石成功率84．3％（941／1116）。单因素分析发现结石部位、结石长短径及肾绞痛对疗效均有影响。Logistic回归分析则显示结石部位、结石长短径及肾绞痛决定治疗的成功率,预测模型对碎石成功率的解释力良好（X^2=117．434,P〈0．001）,并通过拟合优度检验（X^2=5．261,P=0．729）,预测总体准确率为83．8％。结论结石部位、结石长短径及肾绞痛是ESWL治疗输尿管结石成功率的重要决定因素。     

CT平扫预测体外冲击波碎石的效果

评价CT平扫测定尿路结石衰减值在预测体外冲击波碎石（ESWL）治疗效果中的作用。112例肾或上段输尿管单个结石患者入组行ESWL治疗，结石大小0．5～2．0cm。所有患者在120kV和240mA条件下行螺旋CT平扫。每次ESWL治疗中，冲击波3000次，电压最高为3．0kV。最后一次碎石后12周行KUB检查。结石〈5mm判定为临床无明显残留结石（CIRF）。结石成分通过X线衍射技术测定。分析结石平均密度（CT值，单位HU）和碎石次数和结石清除效率的关系。结果：82例（76％）患者结石完全粉碎，26例（24％）患者无明显残石。     

体外冲击波碎石术后输尿管石街74例临床分析

体外冲击波碎石术（extracorporeal shock wave lithotripsy，ESWL）能及时解除结石引起的肾绞痛，减少肾功能损害，具有创伤小、恢复快、费用低、疗效可靠等优点，是目前治疗上尿路结石的首选方法。输尿管石街是ESWL治疗复杂上尿路结石常见的并发症，严重者可引起输尿管梗阻、肾功能受损。现总结分析青州市人民医院2001年10月～2007年10月1800例肾结石、输尿管结石患者行ESWL后发生的74例（4．1％）输尿管石街患者资料，旨在探讨ESWL术后输尿管石街的防治措施。     

体外冲击波治疗>1 cm输尿管上段结石失败的预测模型建立

目的 建立并验证预测>1 cm的输尿管上段结石体外冲击波碎石（ESWL）治疗失败的模型。方法 回顾性收集2019年1月至2021年6月南京医科大学第一附属医院泌尿外科收治经ESWL治疗的>1 cm输尿管上段单一结石的病例,分析其临床及影像学资料。临床资料包括性别、年龄、体质量指数（BMI）及结石患侧。影像学资料包括结石大小,结石密度,结石处输尿管壁最大厚度（UMT）、积水程度及结石上段输尿管内径（PUD）。其中结石大小包括结石最大上下径（MCD）、横径最大值（MATD）及横径最小值（MITD）及结石体积（SV）;结石密度包括结石平均CT值（MESD）、最大CT值（MASD）、密度标准差（SDSD）及密度变异系数（VCSD）。采用单因素及多因素Logistic回归分析筛选预测>1 cm输尿管上段结石ESWL治疗失败的独立预测因子并建立模型。使用分辨度及符合度评价模型的预测效能。结果 共纳入355例患者,失败组100例,成功组255例。单因素分析结果显示年龄,结石大小（包括MCD、MATD、MITD和SV）、结石密度（包括MESD、VCSD）、UMT、积水程度、PUD差异...     

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.     

体外冲击波碎石治疗头孢曲松钠所致婴幼儿上尿路结石30例

目的探讨体外冲击波碎石（extracorporeal shock wave lithotripsy,ESWL）治疗头孢曲松钠所致婴幼儿上尿路结石的疗效。方法2011年6月～2012年6月,我院采用ESWL治疗30例头孢曲松钠所致婴幼儿上尿路结石。结果30例经1次碎石治疗,术后24小时内均有排石,碎石后1周复查泌尿系超声或CT,30例结石全部排出,排净率100％。8例治疗前肾功能受损者均恢复正常。术后肉眼血尿1—4次,均为淡血性。术后门诊B超随访,10例1个月,20例6—12个月,未发现肾包膜下血肿及肾萎缩等严重并发症。结论ESWL治疗头孢曲松钠所致婴幼儿上尿路结石安全有效,可迅速解除尿路梗阻,有效保护肾功能。     

输尿管结石并肾绞痛153例微创治疗分析

目的探讨外科微创治疗对输尿管结石并肾绞痛的临床应用价值。方法对153例输尿管结石并肾绞痛患者行急诊体外冲击波碎石术（ESWL）或输尿管镜气压弹道碎石术（URSL）。其中ESWL组97例,URSL组56例。结果 ESWL组碎石1次成功93例,占95.88%;2次成功3例,占3.09%;1例改开发手术;治疗成功率为98.97%（96/97）。URSL组1次击碎或直接钳夹结石54例,2例接受ESWL辅助治疗,治疗成功率为96.43%（54/56）。两组疗效比较差异无显著性（P〉0.05）。结论 ESWL或URSL都是输尿管结石并肾绞痛安全、高效、微创伤的治疗方法,但ESWL更具有无需麻醉、非侵入性、无需住院和治疗费用相对低廉等优点,可作为外科干预治疗时优选的治疗方法。     

ESWL治疗上尿路结石临床体会(附1847例报告)

目的 总结ESWL治疗上尿路结石的经验. 方法 2006年1月～2011年10月,采用国产HB-ESWL-VG型低能量碎石机治疗上尿路结石1 847例并随访. 结果 第一次治疗成功碎石排石1 445例,有效率为78.2％,第二次治疗成功碎石排石370例,有效率为20.0％,治疗三次以上或转为手术等其他治疗方法的32例(1.7％).术后两周复查1 847例,随访率100％.6周内结石排净率为98％(1 810/1 847).并发症:患者术后均出现肉眼血尿,均轻微,肾结石患者术后12 ～ 24h内消失,输尿管结石患者术后血尿12h内消失；输尿管绞痛25例(1.4％),经静脉补液、解痉、止痛后缓解；输尿管石街形成12例(0.6％),经再次ESWL石街消失. 结论 ESWL治疗上尿路结石疗效确切,损伤较小,是一种安全、有效的治疗方法,值得推广.     

ESWL治疗孤立肾并上尿路结石的疗效观察

目的:探讨孤立肾并上尿路结石ESWL治疗的临床经验。方法:回顾性分析154例孤立肾并上尿路结石患者经ESWL治疗的临床资料。结果:本组154例患者中,有效粉碎150例(97.4%),治愈96例(62.3%)。治疗后154例(100%)均出现肉眼血尿,24例(15.6%)发生肾绞痛,3例(1.95%)出现高热,2例(1.3%)出现石街,12例(7.8%)肾功能受损,全组无心脑血管并发症发生。结论:ESWL治疗孤立肾并上尿路结石高效安全,是孤立肾并上尿路结石的重要治疗方法之一。     

Clinical experiences of renal and ureteral stones by extracorporeal shock-wave lithotripsy (ESWL). IV: 3-year clinical experience of cases treated with ESWL

We report our 3-year experience with extracorporeal shock wave lithotripsy (ESWL) since we first used it for upper urinary tract stones on September 1st, 1984. A total of 1,225 patients (1,320 cases) underwent 1,647 sessions with ESWL; They consisted of 855 males (70%) and 370 females (30%). Treated stone locations were 593 renal stones, which contained 112 complete staghorn calculi, 504 ureteral stones, 110 renoureteral stones, and 1 bladder stone. ESWL monotherapy was performed on 90% of cases with renal and ureteral stones, and 46% of cases with complete staghorn calculi. In all the cases so far observed for more than 12 weeks after ESWL, 84.9% of the former showed complete discharge of the stones, and 0.7% showed no change. Only 48.9% of the later showed the complete discharge of the stones, 43.3% of which had residual stones, and 7.8% had fragments of the size of small beans. Complications, which were fever and pain, were noticed in 33.6% of the cases with renal and ureteral stones, and 64.3% of the cases with complete staghorn calculi. After ESWL, hematuria was noticed in almost cases, but the average volume of hemorrhage was 28 +/- 33 ml/day. The only contraindication of ESWL was severe obesity, and in the cases in which spontaneous stone discharge can be expected.     

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%.     

Evaluation of acute renal colic: a comparison of non-contrast CT versus 3-T non-contrast HASTE MR urography

With the introduction of a 3-T scanner, magnetic resonance urography (MRU) may be an alternative imaging modality for evaluation of acute renal colic. We performed a prospective study to compare the performance of computed tomography (CT) with half-Fourier single shot turbo spin-echo (HASTE) MRU in the evaluation of patients with suspected renal colic. Patients presenting to the emergency department with acute renal colic were eligible for inclusion. Following a standard CT stone evaluation, patients underwent a non-contrast HASTE MRU study with a 3-T scanner. The presence of perinephric fluid, hydronephrosis, ureteral obstruction, and calculus was assessed. A total of 22 patients completed the study. Twenty (91 %) were diagnosed with an upper tract stone by radiographic findings. MRU detected a discrete stone in 50 % of the patients with stones detected by CT. Perinephric fluid was noted in 12 MRUs, compared to 7 CTs. Using CT as the reference standard, the combination of stone or perinephric fluid and ureteral dilation gave MRU a sensitivity of 84 %, specificity of 100 %, and accuracy of 86 % (95 % CI 0.72–1.0). HASTE MRU with a 3-T MR scanner can reliably detect the presence of upper urinary tract obstruction. Although CT imaging remains the superior modality with which to detect calculi, MRU detects a greater number of secondary signs of upper tract obstruction. For situations in which the use of ionizing radiation is undesirable, MRU is a reasonable imaging alternative.     

Imaging characteristics of indinavir calculi

PURPOSE: Indinavir sulfate is an effective protease inhibitor of the human immunodeficiency virus type 1. Use is associated with a significant incidence of crystallization and stone formation in the urinary tract, and these calculi are not visible on plain radiographs. Previously all urinary stones, including uric acid and matrix, were believed to be radiodense on computerized tomography (CT). We conducted a retrospective study to evaluate the radiographic appearance of indinavir calculi. MATERIALS AND METHODS: Retrospective chart review of 36 patients taking indinavir sulfate and presenting with renal colic was performed with attention to presentation, urinalysis, radiographic evaluation and management. Specifically, imaging characteristics on CT were addressed. RESULTS: All patients complained of ipsilateral flank pain and 35 had nausea and/or vomiting. Of 30 patients with dysuria or urgency the majority had hematuria, and most had pyuria and/or proteinuria. No stones were visualized on abdominal radiography. Diagnosis was confirmed on 1 of 13 excretory urograms and 4 of 11 renal ultrasounds. None of 12 CT scans was diagnostic of renal lithiasis. CONCLUSIONS: Indinavir sulfate is a protease inhibitor with poor solubility and significant urinary excretion. Crystallization and stone formation are demonstrated in as many as 20% of patients taking the medication. Most patients present with flank pain, nausea or vomiting and hematuria. Previously CT was thought to identify all urinary calculi with clarity but it cannot reliably confirm the presence of indinavir calculi.     

Significance of age on prognosis in patients treated by extracorporeal shock wave lithotripsy

PURPOSE: To investigate the effect of patient age on the stone-free rate (SFR) in patients with urinary stones treated by extracorporeal shock wave lithotripsy (ESWL). PATIENTS AND METHOD: 138 patients with renal calculi and 463 patients with ureteral calculi were treated using the Siemens Lithostar Multiline. Multiple logistic regression was used to investigate the effect of age and other possible predicting factors, i.e., gender, location, size, side, grade of hydronephrosis, symptom at onset and history of urolithiasis, on the SFR at 3 months after treatment. RESULTS: The overall SFR was 77.2%. The SFRs of aged< = 39, 40-49, 50-59, 60-69 and 70 = < years were 87.4%, 84.4%, 75.0%, 71.1% and 66.3%, respectively. The elder patients complained less frequency of pain at onset and showed more frequency of hydronephrosis. Multiple logistic regression analysis revealed that patient age (younger) as well as stone location (middle and distal ureter), size (small), hydronephrosis (mild or less) and symptom (painful) at onset were a independent (better) prognostic factors determining stone clearance after ESWL of upper urinary tract stones. CONCLUSION: The SFR of elder patients showed lower than that of younger ones, however, the former less needed analgesia for ESWL session than the latter. ESWL is convenient, relatively useful for elder patients.     

Calyceal stones: Fate of shock wave therapy with respect to stone localization

In a retrospective analysis the results of extracorporeal shock wave lithotripsy (ESWL) treatment were evaluated in patients with renal stones according to calyceal localization of treated stones. The 198 patients who underwent ESWL with the Dornier MPL 9000 were analyzed for success rate, complication rate, residual fragments, regrowth and recurrence rates. Totally 210 calyceal calculi located in different portions of the kidney have been comparatively evaluated. No major complications were noted during or after ESWL. Some minor complications such as flank pain, renal colic, haematuria were observed. Flank pain was observed during ESWL treatment especially in patients with upper calyceal stones. Although stone-free and residual fragment rates were similar in pelvic, upper and middle calyces, patients with lower calyceal and pelvicalyceal stones had high residual fragment rate and lower stone-free rate. Patients with stones in the lower calyces or pelvicalyces had high recurrence and regrowth rates (p<0.05). ESWL has been considered as the optimal treatment modality for most upper urinary tract calculi. It is especially effective in patients with pelvic, upper and middle calyceal stones. Patients with lower calyceal stones often failed to eliminate the fragments, hence had high recurrence and regrowth rates.     

Treatment of ureteral stone disease: the role of ESWL and endourology

Summary In recent years, extracorporeal shockwave lithotripsy (ESWL) has proved a safe and easily reproducible method for the treatment of calculi in the upper urinary tract above the iliac crest. Current indications for ESWL as single therapy encompass approximately 60%–70% of all stones. The use of endourological methods as auxiliary procedures can enhance the range of indications to 95% of all renal stones and 85% of all ureteral stones. In the last year, 1340 patients have been successfully treated for urinary calculi at our department. Evaluation of all stone cases shows that ESWL alone, ESWL combined with percutaneous techniques, or percutaneous techniques alone were performed on 93% of all patients. Only 7% of patients had to undergo open surgical treatment, 1% for renal stones and 15% for ureteral stones. Ureteral stones are still among the problem stones for ESWL, in many cases requiring time-consuming combined procedures with either of the percutaneous methods. Furthermore, ureteral obstruction caused by stone particles as a complication after ESWL-treatment of large renal stones has to be relieved using percutaneous techniques. In this report we describe our approach in detail and discuss our results.