In situ extracorporeal shock wave lithotripsy for obstructing ureteral stones with acute renal colic.

In situ (no instrumentation) extracorporeal shock wave lithotripsy (ESWL*) was used to treat 49 patients with obstructing ureteral stones causing acute renal colic. Ureteral obstruction was diagnosed on the delayed films of an excretory urogram and was classified as severe (dilatation above and no contrast medium seen below the stone) in 17 patients and partial (dilatation above and contrast medium seen below the stone) in 32. Upper third ureteral stones were present in 41 patients (obstruction severe in 15 and partial in 26) and lower third ureteral stones were present in 8 (obstruction severe in 2 and partial in 6). ESWL was performed within 14 days of the onset of the acute renal colic because of persistent pain with an unmodified Dornier HM3 lithotriptor in 17 patients and a Medstone STS device in 32. With single stones the stone-free rate at 3 months, the repeat ESWL rate and the secondary procedure (stone basketing) rate were 92%, 6% and 8%, respectively, with severe obstruction, and 78%, 6% and 6%, respectively, with partial obstruction. No urinary drainage procedures for sepsis were required after ESWL. Obstructing ureteral stones, which presented mainly in the upper third of the ureter, were successfully treated with in situ ESWL without the need for either bypassing the stone with a ureteral stent or for pushing the stone back into the kidney before treatment with ESWL.     

移植肾尿路结石46例诊治体会

目的探讨肾移植术后尿路结石的诊断和治疗,提高长期存活率。方法回顾性分析1980年1月至2011年6月46例移植肾结石患者的临床资料。结果 35例为肉眼血尿,10例为体检时B超发现,1例为急性无尿发病,均无肾绞痛。移植肾结石24例,移植输尿管结石22例,结石大小0.7～2.0 cm,结石发病时间为术后3.5（0.4～15）年。42例行体外冲击波碎石（ES-WL）,其中3例无效行输尿管镜下钬激光碎石术和1例行经皮肾镜取石术（PCNL）,4例尿酸结石给予枸橼酸氢钾钠（友来特）药物治疗。随访3个月：42例ESWL中,结石排净36例（85.72%）,结石残留2例（4.76%）,4例（9.52%）无效改用腔镜治疗后结石排出;4例尿酸结石口服枸橼酸氢钾钠结石大部分排出。结论移植肾结石缺乏典型肾绞痛表现,体外冲击波碎石术是治疗移植肾结石安全、有效的主要方法。     

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.     

Surgical management of urinary calculi

Shock wave lithotripsy is the cornerstone of the modern management of urinary calculi and is the preferred treatment for most small renal stones. Percutaneous lithotripsy is preferred for large stones and in combination with ESWL for staghorn calculi. Upper ureteral stones should be pushed back to the kidney for ESWL, if possible; otherwise they should be treated in situ. Lower ureteral stones are preferentially managed with ureteroscopy, but ESWL may also be used. A variety of methods of power lithotripsy are available: ultrasound, electrohydraulic lithotripsy, and pulsed dye laser lithotripsy. Only 1% to 2% of stone patients require open surgery; it is an important judgment to identify these patients to avoid inappropriate use of newer techniques in cases where success is unlikely. It is apparent that modern management of the patient with a urinary calculus requires access to all methods of stone removal. The surgeon and internist should not forget that the goal is to remove the stone safely, efficaciously, and economically.     

急诊输尿管镜治疗输尿管结石并首次肾绞痛的疗效观察

目的 评价急诊输尿管镜治疗输尿管结石并首次肾绞痛的疗效.方法 本院2010年7月至2011年7月期间收治的140例输尿管结石患者纳入本研究范畴,其中60例输尿管结石患者首次肾绞痛时就诊,急诊行输尿管镜钬激光碎石,纳入第一组；80例患者对症处理后立即入院或肾绞痛再次发作入院并常规检查后再行输尿管镜钬激光碎石,纳入第2组.对两组患者的碎石效果、辅助治疗及相关并发症等指标进行比较,行统计学分析,得出结论.结果 140例患者均经输尿管镜检查,第1组结石大小0.80±0.31 cm,结石一次性清除率96.67％,无患者因结石疼痛再次就诊；第2组结石大小0.75±0.35 cm,结石一次性清除率95.00％,因结石疼痛再次就诊次数2.03±1.85,两组患者无严重并发症发生.结论 急诊输尿管镜治疗输尿管结石并首次肾绞痛安全可行,能及时解除疼痛.     

输尿管镜联合钬激光治疗输尿管上段结石:附205例报告

目的 探讨输尿管镜联合钬激光治疗输尿管上段结石的效果和安全性.方法 回顾性分析205例输尿管上段结石患者行输尿管硬镜钬激光碎石治疗的临床资料,其中男91例,女114例,结石位于单侧188例,双侧17例,炎性息肉引起输尿管腔明显狭窄者12例.结石长径0.8～1.4 cm.结果 192例一次性碎石成功,单次碎石成功率为93.7%(192/205).9例有较大结石碎片(4～6 mm)残留于肾或输尿管内,4例在碎石过程中结石冲入肾内,其中1例较大结石(1.4 cm)移位至肾盂后改行PCNL,其余3例留置双J管改行ESWL,均治愈.19例合并炎性息肉同期行激光烧灼.手术时间15~90min,平均30 min.住院时间2~9 d,平均3.5 d.198例患者在门诊获得随访,随访时间3～24个月,平均6个月,结石均排尽.结论 输尿管镜联合钬激光治疗输尿管上段结石的一种比较理想的腔内碎石技术,其碎石成功率高,并发症发生率低,创伤小,患者术后恢复快,而且可同期处理结石合并炎性息肉和狭窄.     

体外冲击波碎石术与输尿管镜气压弹道碎石术治疗输尿管下段结石的疗效比较

目的　比较体外冲击波碎石术 (ESWL)与输尿管镜气压弹道碎石术 (pneumaticlithotripsy ,PL)治疗输尿管下段结石的疗效和安全性。 方法　总结ESWL和PL治疗输尿管下段结石 3 75例的临床资料 ,其中ESWL组 190例 ,PL组 185例。结果　ESWL组单次碎石成功率为 60 .5 %(115 /190 ) ,PL组为 96.2 %(178/185 ) ;ESWL组术后 4周结石排净率为 66.3 %(12 6/190 ) ,PL组为 98.3 %(175 /178)。结论　PL治疗输尿管下段结石的疗效明显优于ESWL。     

Rapid extracorporeal shock wave lithotripsy for proximal ureteral calculi in colic versus noncolic patients

OBJECTIVES: In delayed extracorporeal shock wave lithotripsy (ESWL) treatment, increasing stone impaction is associated with delayed stone clearance. Whether colic patients treated by rapid ESWL have the same time to stone clearance as noncolic patients, which supports the thesis that stones in both groups are nonimpacted, has not been investigated yet, and was the objective of this study. METHODS: A total of 82 patients were prospectively enrolled and treated with piezoelectric ESWL for a solitary proximal ureteral stone. Of these, 56 patients experienced at least one colic episode compared with 26 noncolic patients. Hydronephrosis has been assessed with the use of ultrasound and intravenous urography (IVU). Time to stone clearance after the first ESWL and stone-free rates after a follow-up period of 3 mo were recorded. RESULTS: In colic and noncolic patients, mean stone size was 7.8mm (p=0.7). Ultrasound-detected hydronephrosis was present in 88% versus 39% (p<0.0001), whereas IVU-detected hydronephrosis was present in 60% versus 7.7% (p=0.0001). Mean number of impulses applied was 8000+/-4000 versus 6700+/-3400 (p=0.1). Mean time to stone clearance was 9.5+/-12.1 d versus 4.6+/-3.8 d (p=0.1). Colic and noncolic patients were considered as treatment success in 83% and 81% after 3 mo of follow-up (p=0.9). CONCLUSIONS: Treatment outcome and time to stone clearance after rapid ESWL in colic patients compared with noncolic patients is comparable and independent of concomitant hydronephrosis. This finding suggests an absence of significant impaction in proximal ureteral stones treated within 24h after a first colic episode, enforcing the concept of performing rapid ESWL in patients harbouring proximal ureteral stones.     

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%.     

Noninvasive anesthesia,analgesia and radiation-free extracorporeal shock wave lithotripsy for stones in the most distal ureter: experience with 165 patients

PURPOSE: Spontaneous ureteral stone passage often causes severe renal colic, especially when the stone passes through the narrow ureteral orifice. In these situations noninvasive anesthesia-free, analgesia-free and radiation-free extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Marietta, Georgia) is a valuable tool. It can be performed at any time without needing any further patient preparation. MATERIALS AND METHODS: A total of 165 patients underwent ESWL using the Lithostar Ultra device (Siemens, Erlangen, Germany). Only ureteral calculi within 5 cm. of the ureterovesical junction were included in this study. Patients were treated while supine and stones were localized by ultrasound through the filled bladder without x-ray exposure. Treatment was started without anesthesia or analgesia and analgesics were administered only at patient request during treatment. RESULTS: Of the patients 93% were treated without anesthesia or analgesia and 7% required a single intravenous dose of 25 mg. pethidine. Postoperatively renal colic developed in 40 patients (24%). In 4 cases (2.4%) renal drainage was required for analgesia resistant pain or obstructive pyelonephritis. On day 1 after ESWL 90% of the patients were stone-free or had fragments 2 mm. or less, while 10% had residual fragments 3 mm. or greater. Of all patients 7% were re-treated once. At 3 months postoperatively 129 of the 130 evaluable patients (99%) were stone-free. CONCLUSIONS: ESWL of stones located in the most distal ureter using the Lithostar Ultra device is effective, safe and radiation-free. It is done without anesthesia and in most cases without analgesics. This simple and noninvasive procedure is an excellent first line treatment modality for prevesical stones and it represents a valid alternative to conservative management or invasive endoscopy.     

急诊输尿管镜钬激光碎石与体外冲击波碎石治疗输尿管结石并急性肾绞痛的疗效比较

目的比较急诊输尿管镜钬激光碎石（URL）与急诊体外冲击波碎石（ESWL）两种方法治疗输尿管结石引起的急性肾绞痛的疗效。方法2006年1月至2008年9月，采用Storz8／9F硬质输尿管镜、钬激光碎石机和DornierCompactS型低能量电磁式碎石机分别急诊治疗输尿管结石并肾绞痛175例和110例。所有病例均先行药物治疗症状无缓解后在急诊初诊12h之内接受急诊URL或急诊ESWL。结果对于输尿管上段结石，术后疼痛缓解率URL组虽优于ESWL组（93．94％和66．67％，P〈O．05），但碎石成功率（84．85％和83．33％，P〉0．05）及二周结石排净率（81．81％和77．78％，P〉0．05）均无显著差异。而对于输尿管中下段结石，术后疼痛缓解率（98．59％和92．39％）、碎石成功率（98．59％和91．30％）以及二周结石排净率（97．18％和94．78％）URL组均优于ESWL组fP〈0．05）。最大径10mm以内的结石URL组碎石成功率优于ESWL组（96．38和88．10％，P〈0．05）。最大径10mm以上的结石，术岳疼痛缓解率及2周排净率URL组均优于ESWL组（97．30％和69．23％，91．89％和61．23％，P〈0．05）。5RL及ESWL组并发症率分别为3．46％和2．73％（P〉0．05）。结论急诊URL和急诊ESWL均是输尿营结石并急性肾绞痛的安全、有效的治疗方法，对于输尿管上段结石或最大径不超过10mm的结石二首效果相当，而对于输尿管中下段结石或直径大于10rllm的结石来说，URL疗效优于ESWL。     

Comparison of extracorporeal shock wave lithotripsy and ureteroscopy in the treatment of ureteral calculi: a prospective study.

146 patients whose ureteral stones did not pass spontaneously participated in a prospective study on optimal management. Patients were offered two treatment options: extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS). The stone was treated with the technique preferred by the patient. In case of treatment failure after first-line therapy, patients again could decide on how to proceed. Stone analysis could be obtained from 72.6% patients. ESWL was the primary treatment in 66.4% patients. In 2 patients, ESWL was the secondary treatment after failed URS. URS was the first-line therapy in 33.6% patients. In 29 patients URS was done after failed ESWL. For analgesia, sedoanalgesia or spinal anesthesia were used. Analgesia was required in 74.2% ESWL and 100% URS sessions. Following ESWL, 70.1% patients became stone free. In 29.9% ESWL failed. Distal stones had a higher failure rate than proximal or mid-ureteral calculi. Distal stones treated without success were significantly larger than those treated successfully. Failures were switched to URS. Stone analysis could be obtained in 26 patients with failed ESWL: 23/26 consisted of pure whewellite or mixed whewellite stones. Clinically relevant complications were not observed. After URS, 94.9% of the patients became stone free. In distal stones, the stone-free rate was 97.5%. There was only 1 relevant complication: a proximal ureteral lesion requiring surgical repair. Our study demonstrates that URS is a safe and highly effective treatment option for ureteral stones. In patients with distal ureteral stones, it should be offered as a first-line treatment. When whewellite is expected as the stone mineral, URS is the treatment of choice.     

超声引导椎旁联合骶管阻滞在预防体外碎石术肾绞痛中的应用

目的研究超声引导椎旁联合骶管阻滞在预防输尿管结石体外碎石术肾绞痛中的应用。方法回顾性分析本院2018年6月至2019年1月因输尿管结石行体外冲击波碎石患者100例。观察组为超声引导椎旁联合骶管阻滞后体外碎石患者53例;对照组为直接进行体外碎石患者47例。收集所有纳入研究的患者的性别、年龄、结石大小、肾绞痛、血尿、感染、治疗中断、结石清除率等资料进行分析。结果两组患者在年龄、结石大小、性别比例、治疗后1个月结石清除率上差异无统计学意义(P>0.05),观察组1周结石清除率稍高于对照组,但差异无统计学意义。在肾绞痛及其他并发症方面,观察组术中无肾绞痛发生(对照组7例,P=0.004)。术后观察组10例患者、对照组14例患者发生肾绞痛。两组术后一过性肉眼血尿、低热、眩晕、恶心呕吐、胸闷发生率差异均无统计学意义。结论椎旁阻滞联合骶管内麻醉预防ESWL中肾绞痛的发生。     

Ureteroscopic treatment of multiple distal-ureteral stones

BACKGROUND AND PURPOSE: Ureteroscopic intracorporeal lithotripsy for solitary distal-ureteral stones may be considered a first-line therapy. However, few reports that mention ureteroscopic procedures for multiple ureteral stones were found in the literature. Retrospectively, we reviewed our patients who were treated by ureteroscopy for multiple distal-ureteral stones. PATIENTS AND METHODS: Fifteen patients underwent ureteroscopic pneumatic lithotripsy for unilateral multiple distal-ureteral stones. Ten patients had two stones, four patients had three stones, and another patient had five stones. The average stone number per ureteral unit was 2.44, and the average stone size was 9.7 mm (range 3-23 mm). RESULTS: Eighty percent of the patients (12/15) who had unilateral stones were stone free after the first session of ureteroscopic pneumatic lithotripsy. Two patients underwent a second ureteroscopy procedure for the remaining stone or failure of ureteral access. Overall, 93.3% of the patients (14/15) were stone free. Ureteral perforation as a major complication occurred in one patient (6.6%), who was treated by open surgery. We did not routinely use Double-J ureteral stents after ureteroscopy. Only one patient required stenting because of failure of ureteral access. Steinstrasse was observed in three patients, but it resolved spontaneously in the early postoperative period. CONCLUSION: Ureteroscopic pneumatic lithotripsy has a high success rate with few complications for the treatment of unilateral multiple distal-ureteral stones. Ureteroscopic pneumatic lithotripsy seems very effective for such stones.     

Do upper ureteral stones need to be manipulated (push back) into the kidneys before extracorporeal shock wave lithotripsy?

The current practice for the management of upper ureteral stones is to push the stone back into the renal pelvis before extracorporeal shock wave lithotripsy (ESWL*). The results in 903 patients with an upper third ureteral stone pushed back before ESWL were compared to those of 815 with an upper third ureteral stone treated by ESWL in situ with a ureteral stent bypassing the stone. The stone size in the in situ group was larger than in the push back group. More shocks at a higher kilovoltage were required to treat the in situ group. The retreatment rate and post-ESWL secondary procedure rate for the push back group with single stones were 4% and 1.5%, respectively, compared to 5% and 7.5%, respectively, for the in situ group. The stone-free rate with single stones at 3 months was 73% in the push back group and 79% in the in situ group. There appears to be little advantage in manipulating a ureteral stone into the kidney (push back) before treatment by ESWL.     

输尿管镜与后腹腔镜手术治疗输尿管上段结石的疗效比较

目的 比较输尿管镜碎石取石术与后腹腔镜输尿管切开取石术治疗单侧输尿管上段结石的疗效,探讨两种术式的适应证及技术要点.方法 收治64例单侧输尿管上段结石患者,随机分成两组,32例行腰硬麻下输尿管镜钬激光碎石取石术,32例行气管全麻下后腹腔镜输尿管切开取石术,两组术中均留置双J管,比较两组的手术时间、术后住院时间、结石清除率及手术并发症.结果 两组手术均取得成功,无一例中转开放手术.输尿管镜组与后腹腔镜组的平均手术时间为51.0±10.8 minVS 43.8±8.1 min(t=3.02,P=0.0037),住院时间为3.0±1.3 d VS 3.1t±0.9 d (t=-0.36,P=0.7217),一次手术结石清除率为87.5％ (28/32) VS 100％ (32/32),输尿管镜组术中4例发生结石上移,术后配合ESWL清除结石.两组术后随访3个月以上,未见输尿管狭窄等并发症.结论 对于单侧输尿管上段结石,后腹腔镜输尿管切开取石术较输尿管镜碎石取石术一次手术结石清除率高,手术时间短,是一种安全、有效的方法.     

妊娠期顽固性肾绞痛的腔内处理

目的探讨腔内诊治妊娠期肾积水合并顽固性肾绞痛的安全性和有效性。 方法回顾性分析2017年3月至2018年9月我院收治的78例妊娠期肾积水合并顽固性肾绞痛患者的病例资料。根据顽固性肾绞痛持续时间将患者分为A组（6 h以内16例）,B组（6～12 h 53例）和C组（12 h以上9例）。 结果58例术中发现输尿管结石,16例（27.6%）术前彩超未见输尿管结石,行输尿管镜碎石取石和留置输尿管双J管。输尿管结石清除率87.9%（51/58）。20例未发现输尿管结石但合并肾盂结石患者,术中留置输尿管双J管。9例（11.5%）有先兆流产表现,其中A组1例（6.25%）,B组4例（7.55%）,C组4例（44.4%）。C组先兆流产的发生率高于A和B组（P<0.05）。1例（6.25%）患者出现尿源性脓毒血症,抗感染等对症处理后痊愈。所有患者均成功通过围产期并生产健康婴儿。 结论对于妊娠期肾积水合并顽固性肾绞痛的患者,早期输尿管镜腔内处理是有效安全的诊断和治疗手段,可降低孕妇和胎儿的风险。     

钬激光碎石术与体外冲击波碎石术治疗输尿管结石的疗效比较

目的　比较输尿管镜钬激光碎石术与体外冲击波碎石术 (ESWL)治疗输尿管结石的有效性和安全性。　方法　采用输尿管镜钬激光碎石术治疗输尿管结石 15 9例 16 8侧 ,其中结石直径≥ 1cm者 76侧 ,<1cm者 92侧。ESWL治疗输尿管结石 319例 334侧 ,其中结石直径≥ 1cm者 14 3侧 ,<1cm者 191侧。比较两组手术时间 结石排净率 手术并发症发生率指标的差异。　结果　对直径≥ 1cm和 <1cm的输尿管结石钬激光碎石术治疗平均手术时间分别为 5 8min和 4 3min ,短于ESWL的平均手术时间 6 8min和 5 6min(P <0 .0 1) ;钬激光碎石术对直径≥ 1cm的输尿管结石 3个月结石排净率为 92 % ,高于ESWL的 6 1% (P <0 .0 1) ;对直径 <1cm的输尿管结石钬激光碎石术和ESWL的 3个月结石排净率分别为 95 %和 85 % (P >0 .0 5 )。钬激光碎石术组并发症发生率为 4 .8%( 8/ 16 8) ,ESWL组无明显并发症发生。　结论　输尿管镜钬激光碎石术治疗直径≥ 1cm的输尿管结石疗效明显优于ESWL ,而直径 <1cm的结石二者疗效差异无显著性 ,ESWL为直径 <1cm结石的首选治疗方法     

Extracorporeal shockwave lithotripsy of distal ureteral calculi

To date, the use of extracorporeal shockwave lithotripsy (ESWL) has been limited to renal calculi and ureteral calculi above the pelvic brim. Modifying the position of the patient on the support of the Dornier lithotripter HM3, we were able to localize and treat distal ureteral calculi. Until April 1986, 43 patients with stones in the lower ureter underwent contact-free lithotripsy. Treatment was successful in 39 patients (90%), 2 of these requiring 2 sessions. In 4 patients treatment failed and stone removal was accomplished using ureteroscopy or open surgery. No complications or adverse side effects were encountered in the whole series. ESWL is now the method of choice for the treatment of distal ureteral calculi in our department.     

患肾不显影输尿管结石的ESWL治疗

目的　总结由输尿管结石梗阻引起患侧肾脏不显影者行ESWL治疗的临床经验。　方法　输尿管结石致急性绞痛患者 16 8例 ,ESWL术前行KUB和IVU检查明确诊断输尿管结石而患侧肾脏不显影。结石位于髂骨缘以上者采用仰卧位 ,髂骨缘以下者采用俯卧位治疗。对 10 4例病史 <1个月、年龄 <6 0岁者于结石排空后行IVU ,观察其肾功能恢复情况。　结果　 16 8例患者全部于 2周内排空结石 ,其中 10 4例在结石排空后 1周～ 1年复查IVU ,患侧肾均已显影 ,2例仍有肾盂轻度积水。　结论　输尿管结石急性发病时 ,可因肾内压力骤增而引起肾功能受损 ,表现为患侧肾不显影。这种损害是可逆的 ,及时解除梗阻可使患肾功能得到恢复 ,ESWL是有效措施之一