患肾不显影输尿管结石的输尿管镜下钬激光碎石术治疗

输尿管结石梗阻常致患肾静脉造影不显影，严重者可导致肾功能完全毁损衰竭、危及生命。传统治疗方法是膀胱镜逆行插管引流、经皮肾穿刺造瘘、开放性取石术等方法。近年来，输尿管镜腔内碎石术已逐浙取代传统手术。2005年10月至2007年8月，笔者对25例输尿管结石致患侧肾不显影者采用输尿管镜下钬激光碎石术方法治疗后，IVU随访患肾重新显影，肾功能恢复。现报告如下。     

输尿管镜气压弹道碎石术治疗输尿管结石154例

目的探讨输尿管镜气压弹道碎石术的疗效。方法 2006年3月~2010年3月,输尿管结石154例,腰麻联合硬膜外麻醉,取截石位,输尿管镜在F4导管引导下进入输尿管,到达结石部位后,直视下气压弹道碎石探针(德国Storz公司,1 mm)原位碎石,直径3 mm的结石取出或放入膀胱,小结石冲入膀胱,然后于输尿管内置入双J管,留置尿管。结果手术时间30~120 min,平均50 min。一次碎石排净率96.1%(148/154);4例输尿管结石部分上行入肾盂,输尿管镜碎石术后2周,配合ESWL1~2次,14~30 d结石排净;2例因输尿管下段狭窄输尿管镜无法通过转开放手术。无输尿管穿孔和输尿管黏膜剥脱。152例双J管拔除后随访3个月,KUB+IVU提示149例原结石影消失,肾积水消失,肾功能完全恢复,无结石残留及复发,无输尿管继发性狭窄;3例术前患侧肾、输尿管均不显影者仍有轻度积水,患侧肾显影,肾功能明显恢复。结论输尿管镜气压弹道碎石术治疗输尿管中下段结石、部分ESWL难处理的结石、ESWL术后石街形成有一定的优势。     

套石篮治疗输尿管结石致输尿管全程闭锁1例报告

患者，女，31岁。既往有瘢痕体质病史。3年前因右侧输尿管中段结石行套石篮治疗，套出结石1枚（0．6cm×0．8cm）治愈出院。近1年来，渐感右侧腰部胀痛，症状加重1个月。B超检查提示右肾中度积水。IVU示右肾盂显影延迟，右侧输尿管不显影，未发现阳性结石影，行患例肾盂穿刺造影显示右侧肾益输尿管连接处完全梗阻。膀脱镜检查示患侧输尿管膀脱开口隐约可见，但无喷尿，导管亦不能插入。拟诊为右侧输尿管全程闭锁。行回肠代输尿管术，术中见患侧输尿管全程僵硬、增粗，呈条索状，直径约1．0cm，切开输尿管内呈实性。行输尿管全程切除术。病…     

急诊输尿管结石的ESWL治疗体会

目的 总结急诊输尿管结石ESWL治疗的临床经验。方法 采取B超定位。对输尿管上段结石采取仰卧位，中下段采取俯卧位。治疗过程中利用B超动态观察结石粉碎情况及碎石后结石排空时间。结果 125例150枚结石，1.0cm以内的结石一次粉碎成功率98％，结石排空时间为7～10天；＞1．5cm的结石排空时间为15天。结论输尿管结石急诊就诊者可因肾内压骤增而引起肾功能损害，尤其是双侧者短时间内的梗阻致肾功能受损是可逆的，及时解除梗阻可使患者肾功能恢复，ESWL是有效的措施。     

输尿管镜气压弹道碎石术治疗输尿管结石梗阻并发急性肾功能衰竭——附18例报告

目的探讨输尿管镜气压弹道碎石术治疗输尿管结石梗阻并发急性肾功能衰竭的临床疗效。方法分析应用气压弹道碎石术治疗输尿管结石梗阻并发急性肾功能衰竭18例的临床资料。结果18例33侧结石均一次性解除梗阻，成功率100％，1周内结石排净率84.5％(28／33)。5侧结石残留，均为上段结石占15．5％。其中3例体外行震波碎石术(ESWL)、1例经皮肾镜取石术(PCL)、1例溶石治愈。并发症：输尿管穿孔2例，占6．7％，经保守治愈。结论气压弹道碎石术具有适应症广、损伤小、见效快、并发症少的特点；能有效清除结石，解除梗阻，挽救肾功能。     

上尿路梗阻性肾积脓的外科处理

目的：探讨上尿路梗阻性肾积脓的外科处理方法。方法：对64例上尿路梗阻性肾积脓患者均行外科处理,再配合以抗生素治疗。结果：手术解除梗阻而保肾的44例患者,经1个月～5年随访(平均26个月),IVU：5～15min显影良好者为28例(63．6％),16～30min显影良好者10例(22．7％),30min以后显影为6例(13．7％)。18例肾切除术者对侧。肾功能均正常。2例因拒绝手术经输尿管导管引流后症状好转出院。结论：上尿路梗阻性肾积脓以结石梗阻为主(78．1％)。积极的外科手术能解除梗阻保留肾功能,肾实质造瘘加双J管内支架引流是比较有效的治疗手段。     

输尿管镜钬激光碎石术治疗上尿路结石并梗阻性急性肾功能衰竭(附28例报告)

输尿管结石致急性肾功能衰竭是泌尿外科的急诊之一,需快速解除上尿路梗阻,抢救肾功能。贵州省沿河土家族人民医院泌尿外科于2010年3月至2013年7月,对28例输尿管结石并急性肾功能衰竭患者采用输尿管镜下钬激光碎石术,效果较好,现报告如下:临床资料28例患者,男18例、女10例,年龄16~71岁。21例为双侧输尿管结石,其中7例为一侧肾脏重度积水,另一侧急性梗阻,对侧肾萎缩无功能4例,对侧肾切除     

上尿路结石治疗后再住院原因分析

目的探讨肾和输尿管结石治疗后再住院与首次治疗方法之间的关系。方法分析166例上尿路结石再住院患者的临床资料，首次治疗方法包括：体外冲击波碎石(ESWL)，手术取石、ESWL 手术取石，ESWL 输尿管镜取石及输尿管镜取石。对上述方法的疗效和再住院原因进行对比研究。结果ESWL治疗103例次，手术取石44例，输尿管镜取石18例，术中发现肾盂输尿管连接部梗阻13例，ESWL后碎石颗粒嵌入黏膜8例，输尿管息肉5例，本组患侧肾功能丧失9例。结论无论采用何种方法治疗上尿路结石，事前对病史及患侧肾功能应有充分了解。如有解剖及代谢异常者须做相应处理。对于较复杂的结石应采取综合治疗措施，最大限度地保护肾功能。     

静滴造影定位体外碎石治疗输尿管阴性结石

目的 探讨输尿管阴性结石经体外冲击波碎石(ESWL)治疗的定位方法.方法 对45例输尿管阴性结石患者,采用静滴造影辅助定位后行ESWL治疗,碎石前经B超或者CT证实结石存在.结果 本组病例经过1～2次ESWL治疗后,结石完全排出,B超及IVU检查梗阻消失.结论 输尿管阴性结石因X线不显影,而又没有条件行B超定位时,静滴...     

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。     

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.     

Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones

OBJECTIVE: To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. PATIENTS AND METHODS: From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. RESULTS: Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13). CONCLUSION: Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.     

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.     

A new method for the management of ureteral colic after extracorporeal shock wave lithotripsy

In ten patients, who underwent ESWL of renal calculi and had severe ureteral colic due to acute obturation of the ureteral lumen by larger stone fragments, i.v. glucagon injections combined with laevulose infusion were applied. All patients reported relief of pain and discomfort within 15-20 minutes after glucagon injection. Position of the stones in the ureter was regularly checked. No particular adverse effects of glucagon were noted. Glucagon increases GFR and diuresis and exhibits spasmolytic effect on the smooth muscle of the ureteral wall, thus facilitating the passage of stone fragments after ESWL. In certain cases and with certain indications we recommend the method as highly effective.     

Noninvasive management of obstructing ureteral stones using electromagnetic extracorporeal shock wave lithotripsy

Background Extracorporeal shock wave lithotripsy (ESWL) represents noninvasive management of urolithiasis. Since the first HM3 model, technological progress has improved the efficacy and safety of this treatment. The current study aimed to evaluate the role of ESWL as a first-line emergency therapy of renal colic due to ureteral stone with impaired renal function. Methods This prospective study enrolled all the patients admitted from the emergency room with acute renal colic meeting the following criteria: serum creatinine level ranging from 1.5 to 2.5 mg/dl, hydronephrosis, ureteral stones 6 to 15 mm in size, body mass index less than 30, normal renal function at baseline, and no evidence of urinary tract infection. The patients were submitted to a single-session emergency treatment using Dornier Litothripter S. Follow-up assessment, performed at 24 and 72 h, included radiologic and ultrasound examinations with renal function serum assessment. The end points were a decrease in creatinine level and a stone-free condition. Results A total of 40 patients were eligible for the study. The mean creatinine level at admission was 1.93 ± 0.26 mg/dl. After the treatment, renal function recovery occurred for 34 subjects (85%), with a significant global decrease in creatinine levels (p = 0.00). The global stone-free rate 72 h after SWL was 67.5% (27/40). The patients with residual fragments were managed using re-SWL (n = 7) and endoscopic technique (n = 6). Conclusions Emergency SWL represents an effective tool in the treatment of ureteral stones with hydronephrosis and slight renal impairment. Although complete stone clearance after one treatment still remains a difficult target, the actual role of SWL in the management of acute obstruction is to obtain ureteral canalization and renal function recovery. An erratum to this article can be found at     

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。     

Is intravenous urography a prerequisite for renal shockwave lithotripsy?

PURPOSE: To determine whether intravenous urography (IVU) is a prerequisite for shockwave lithotripsy (SWL) of renal stones by addressing whether using non-contrast-enhanced CT (NCCT) instead of IVU for delineating urinary tract anatomy is associated with post-SWL complications. PATIENTS AND METHODS: Thirty-eight patients treated by SWL (Econolith 2000) for radiopaque renal stones underwent either IVU or NCCT. Twenty patients with normal urinary tracts or with mild hydronephrosis proximal to the stone on urography comprised the IVU group. Eighteen patients who underwent NCCT and plain abdominal (KUB) films and had urinary tract systems similar in appearance to the IVU group comprised the NCCT group. The two groups were of similar mean age (45.75 years, range 24-73 years; and 49.0 years, range 26-72 years, respectively) and had a similar mean stone size (10.1-10.2 mm). Patients with internal ureteral or nephrostomy catheters were excluded. Information on episodes of intractable renal colic, urinary tract infections, and hospitalization was recorded at follow-up 2 to 6 weeks post-SWL. RESULTS: The IVU and NCCT patients had similar mean stone fragmentation rates (80% and 74%, respectively) at 2 to 6 weeks post-SWL. Four IVU patients (20%) had intractable renal colic. One NCCT patient (5.5%) had a urinary infection. Complication and hospitalization rates in the two groups were not significantly different (P = 0.34; Fisher' exact test). CONCLUSIONS: Using only NCCT before SWL was not associated with higher complication rates. Thus, IVU is not a prerequisite for SWL of radiopaque renal stones in patients with a normal urinary tract anatomy as seen on NCCT.     

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%.     

合用阿托品输尿管逆行造影联合IVU定位行ESWL治疗输尿管阴性结石疗效观察(附138例报告)

目的:探讨合用阿托品输尿管逆行造影联合IVU定位行ESWL治疗输尿管阴性结石的临床效果。方法:术前138例患者经B超、IVU、CT检查确诊输尿管阴性结石。采用IVU联合应用阿托品针、碘海醇针合剂经输尿管导管持续微泵泵入,行逆行造影(RGU)辅助,经X线定位后,明确结石的部位及大小后行ESWL治疗。留置输尿管导管综合排石治疗3～5天,观察临床碎石效果。结果:本组138例患者经1次ESWL治疗后2～4周,121例(87.8%)结石完全排净,第2次ESWL治疗结石排净10例(7.2%),第3次ESWL治疗结石排净2例(1.4%);2例(1.4%)形成"石街",需行输尿管镜取石;无效3例(2.2%),行开放手术取石,证实结石有炎性肉芽包裹。结论:合用阿托品输尿管逆行造影联合IVU定位行ESWL治疗输尿管阴性结石临床疗效确切,术后留置输尿管导管逆行灌注冲洗利于排石。     

输尿管镜气压弹道碎石术治疗输尿管结石

目的评价输尿管镜气压弹道碎石术（URSL）治疗输尿管结石的临床疗效。方法使用输尿管镜下气压弹道碎石术治疗输尿管结石170例，输尿管上段结石10例，输尿管中段结石42例，输尿管下段结石118例，结石最大直径2．2cm，平均1．0cm，合并患侧肾积水80例，伴肾绞痛77例，平均病史为24周。结果一次性碎石成功率90．5％（154例）；10例输尿管壁残留小结石，术后1个月复查静脉肾盂造影（IVU），残石已排净；2例较大残余结石上移至肾盂行体外冲击波碎石（ESWL），1个月内结石排净；4例改开放手术，2例为结石被息肉严重包裹碎石失败，2例结石远端严重狭窄；均无输尿管穿孔、撕裂、假道、撕脱等并发症；随访9—12个月，肾积水病例积水情况明显改善；伴肾绞痛病例症状消失；未见结石复发病例。结论输尿管镜气压弹道碎石术治疗输尿管结石疗效确切、安全。