坦索罗辛在输尿管下段结石ESWL后辅助排石中的作用

目的:探讨α1肾上腺素能受体阻滞剂坦索罗辛在输尿管下段结石ESWL后辅助排石中的效果.方法:64例输尿管下段结石患者随机分成两组,组Ⅰ为对照组,ESWL后应用消炎痛25 mg,3次/d,排石颗粒5 g,3次/d,未应用输尿管平滑肌松弛剂;组Ⅱ为实验组,ESWL后在对照组治疗方案基础上予以口服坦索罗辛0.4mg,1次/d.每例患者观察时间不超过2周.结果:在观察时间内两组排石率分别为42.3%和78.9%.两组比较差异有统计学意义(P＜0.01).观察时间内两组再次发生肾绞痛而需要镇痛药治疗的患者分别为15.4%和7.9%,两组比较差异有统计学意义(P＜0.01).组Ⅱ除1例发生头晕外,无其他不良反应发生.结论:坦索罗辛能提高输尿管下段结石ESWL后的排石率,减少再发生肾绞痛的机率.且安全有效.可作为输尿管下段结石ES-WL后的辅助排石方法.     

影响体外冲击波碎石术疗效的因素分析

目的　探讨影响体外冲击波碎石术(ESWL)疗效的因素。　方法　回顾ESWL治疗尿路结石患者234例的临床资料。分析患者性别、年龄、病程、结石大小、位置、X线形态及合并肾积水情况等因素与治疗成功率的关系。ESWL术后3个月接受KUB、IVU和B超检查,剩余结石<2mm为碎石成功, >2mm为治疗不成功。　结果　234例碎石成功率78. 6% (184 /234)。男性组和女性组治疗成功率分别为80. 3% (122 /152)和75. 6% (62 /82),P>0. 05。治疗不成功组与成功组病程分别为(1262. 6±1742. 1)d、(722. 9±1364. 6)d,P>0. 05;结石直径分别为(1. 1±0. 6)cm、(1. 0±0. 4)cm,P>0. 05;年龄分别为(58. 8±13. 6)岁、(42. 8±12. 2)岁,P<0. 05。肾盂结石(22. 7%, 10 /44)与肾盏结石(40. 0%, 8 /20),肾盂结石与输尿管结石( 18. 8%, 32 /170 ),输尿管上段结石( 15. 8%, 18 /114)与下段结石(25. 0%, 14 /56)间不成功率比较,差异无统计学意义(P>0. 05)。均匀高密度结石(20. 0%, 6 /30)与杂色结石(21. 6%, 44 /204)不成功率两组比较差异无统计学意义(P>0. 05)。结石直径0. 3~1. 0cm者(1. 9%, 2 /108), 1. 0 ~2. 0cm者(29. 8%, 28 /94), >2. 0cm者(62. 5%, 20 /32)不成功率3组两两比较P<0. 05。结石大小与治疗剂量呈正相关(r=0.28,P=0. 006)。     

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。     

Utility of ureteral stent for stone street after extracorporeal shock wave lithotripsy

We reviewed the records of the 530 patients with urinary stones (renal stones: 243; ureter stones 287) who received extracorporeal shock wave lithotripsy (ESWL) (MFL5000; Dornier), from January 1995 to July 2002, retrospectively and determined whether the ureteral stent affected the incidence rate of stone street (SS). We also assessed the effect of ureteral stent on the subsequent management for SS. Forty patients (7.5%) developed SS. Twenty patients were inserted a ureteral stent prior to ESWL (stent group), and 20 patients were performed ESWL without a ureteral stent (in situ group). In the stent group, the most common (80.0%) location for SS was in the upper third ureter, while in the in situ group, SS mostly developed in the distal third ureter (60.0%). The incidence of SS did not differ significantly between the two groups when the size of renal and ureter stones was below 30 and 20 mm, respectively. When the renal stones were larger than above 30 mm, the incidence of SS in the stent group was significantly higher than that in the in situ group. SS disappeared spontaneously with stone passage in 10 of the patients in in situ group, but in only 1 patient in the stent group. In the stent group, 15 patients were treated for SS by removal of ureteral stent regardless of stone diameter. We conclude that ESWL should be performed without a ureteral stent when the stone diameter is below 20 mm. When the ureteral stent is thought to interfere with the delivery of stone fragments, the decision to remove it should be made as soon as possible.     

Factors influencing radiation exposure during the extracorporeal shock wave lithotripsy

A prospective evaluation of 89 consecutive sessions of extracorporeal shock wave lithotripsy (ESWL) was undertaken to try and find the best way of minimising the amount of exposure to radiation. Forty-two patients were randomly allocated to undergo ESWL treatment by experienced surgeons (group A), and 47 to undergo the treatment by inexperienced surgeons (group B). The mean calculated entrance radiation exposure was 3.01 rads (group A: 2.64 (0.97) rads, range 1.00-4.48, group B: 3.38 (0.86) rads, range 1.11-5.75). Among factors that influenced radiation exposure, the tissue: air ratio should be borne in mind and the level of skill in controlling movement of gantry was the most important in reducing the exposure to radiation.     

Ultrastructural changes on sperm after extracorporeal shock wave lithotripsy in patients with distal ureteral stone

Theoretically, ESWL can cause several side effects on the male reproductive system. We determined here the long-term effects of ESWL on sperm with transmission electron microscopy (TEM) in patients with distal ureteral stone. Fifteen men with stones in the distal ureter applied to our clinic formed the group of study. The other 15 men with renal or upper ureter stones formed the group of control. The ESWL sessions, including maximum 19 kW energy level and 3000 shock waves, were performed with Siemens Lithostar (electromagnetic; Siemens Medical Systems, Erlangen, Germany) lithotriptor. We examined the semen samples from all patients on the day before and 90 days after ESWL. The semen samples were examined with transmission electron microscopy (TEM) to detect ultrastructural changes on the day before and 90 days after ESWL. All the statistical analyses were realized with SPSS 10.0 (SPSS Inc., Chicago, USA) statistical package program. When the control and study groups were compared for initial and day 90 sperm concentration and motility, a significant decrease was found in the study group. Although there was no important anomaly in the control group, we determined some damage on sperm structure in 5 patients (33.3%) who are in the study group 3 months after ESWL. It can reduce sperm concentration and motility permanently. It can also cause severe ultrastructural defects on sperm after a long term period in patients with lower ureteral stone. Therefore, we suggest other treatment modalities for young men with distal ureteral stones to prevent the development of male infertility.     

Management of upper ureteral calculi with extracorporeal shock wave lithotripsy

The results of 471 extracorporeal shock wave lithotripsy treatments in 465 patients with solitary ureteral stones managed by several different techniques are reported. In situ treatment was performed in 123 cases without instrumentation and in 47 after placement of a ureteral catheter. Retrograde stone manipulation was performed in 245 cases immediately before extracorporeal shock wave lithotripsy and an additional 56 were manipulated with ureteral stent placement at least 1 week before extracorporeal shock wave lithotripsy. The success rate was significantly greater if the stone was manipulated into the kidney before extracorporeal shock wave lithotripsy. Significantly less energy (p less than 0.0001) was required for complete disintegration if the stone was free floating in the kidney. The need for subsequent procedures was significantly less (p less than 0.0001) for stones manipulated successfully into the kidney. Complications were infrequent, with the most common being ureteral perforation in 5.1 per cent of the cases, all of which were managed conservatively. Extracorporeal shock wave lithotripsy is the treatment of choice for proximal ureteral calculi because it is less morbid than percutaneous approaches and provides significantly better results than ureteroscopy. An attempt at manipulation of proximal ureteral calculi back into the kidney should be made before extracorporeal shock wave lithotripsy.     

Treatment of lower ureteral calculi with extracorporeal shock wave lithotripsy

A group of 70 patients presenting with stones in the lower third of the ureter was treated with extracorporeal shock wave lithotripsy using a Dornier HM3 lithotriptor. For adequate radiological stone visualization a sitting position was used in 68 patients, while 2 with calculi overlying the sacroiliac joint required placement in the prone position. All but 1 patient had additional endoscopic maneuvers before treatment, consisting of the passage of a Zeiss sling around the stone in 40 and, when this was not possible, a ureteral stent in 29. The over-all success rate was 94.2 per cent (66 of 70 patients) with 3 patients having retained fragments and 1 requiring an open operation. The combination of new positioning techniques and relatively simple endoscopic maneuvers makes treatment of lower ureteral stones feasible and safe with the Dornier lithotriptor.     

Ultrasound stone localisation for extracorporeal shock wave lithotripsy

An extracorporeal shock wave lithotriptor using an ultrasound scan head pantograph location system has been designed. The shock wave ellipsoid reflector position is adjusted to the stone with a computer assisted positioning device. Seven dogs with stones implanted into the renal pelvis were treated and stone fragmentation occurred in all cases. Subsequently, 45 patients with stones were treated. The stones ranged in size from 5 to 29 mm (mean 16). Radio-opaque as well as poorly opaque or radiolucent stones were treated and fragmentation was achieved in 85% of cases. An additional endoscopic procedure was performed in four cases. No fragmentation occurred in four patients. Further shock wave treatment was necessary in two patients who presented with stones larger than 2 cm. Both radio-opaque and poorly opaque stones can be treated with this system. Ultrasound localisation and the ellipsoid positioning device avoid the need for expensive fluoroscopic equipment and a hydraulic patient positioning system.     

Ureteral stone manipulation before extracorporeal shock wave lithotripsy

We randomized 75 patients with solitary ureteral calculi that could not be dislodged by ureteral catheterization to receive instillation of saline, 2 per cent lidocaine viscous solution or dilute surgical lubricant before repeat stone manipulation with ureteral catheters. Of the stones irrigated with saline 76 per cent were returned to the pelvis along with 60 per cent of the lidocaine group and 48 per cent of the surgical lubricant treated stones. There was no statistical significance among the 3 groups. The success rates for upper, mid and lower ureteral stones were 80, 54 and 30 per cent, respectively. Of stones 0.5 cm. or less and between 0.6 and 1.0 cm. 77 and 72 per cent, respectively, were manipulated successfully but only 38 per cent of the stones larger than 1.0 cm. could be dislodged. Extracorporeal shock wave lithotripsy was successful in treating pelvic and ureteral stones, although higher kilovolt settings and additional shocks were necessary to fragment the ureteral stones completely. Percutaneous nephrostomy or ureteral meatotomy was required in 10 per cent of the patients with impacted ureteral stones following in situ extracorporeal shock wave lithotripsy but in only 4 per cent of the patients with stones successfully returned to the pelvis. Of the ureteral stones 17 per cent were treated with repeat extracorporeal shock wave lithotripsy. No patient with pelvic stones required repeat treatment. Retrograde manipulation of ureteral stones is an effective adjunctive procedure before extracorporeal shock wave lithotripsy.     

Elective treatment of ureteral stones with extracorporeal shock wave lithotripsy

Extracorporeal shock wave lithotripsy was used as an elective treatment in 128 ureteral stones. Of the 108 with adequate follow-up, 88% were successfully disintegrated. Ureteral catheters proved to be particularly useful for more precise stone localization and as a mechanical means to push the calculi inside the renal cavities or to create a fluid interface around them, in order to increase the efficiency of the shock waves. When ureteral catheters were used a success rate of 95.5% was observed, as opposed to 82.8% when stents were not used (p less than 0.05).     

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     

ESWL后影响肾下盏结石排空的解剖学因素

目的 探讨肾下盏解剖学因素对ＥＳＷＬ后结石排空的影响。方法 １９９５年４月～１９９９年１１月应用Ｓｔｏｒｚ Ｍｏｄｕｌｉｔｈ ＳＬ２０型碎石机治疗肾下盏结石１４５例,测量碎石前ＩＶＵ片肾下盏４项解剖指标,包括结石所在肾下盏肾孟夹角,肾下盏长度,盏颈宽度及肾下盏形状（简单或复杂）。随访３个月,碎石后第１天、２、４周及３个月时复查Ｂ超及ＫＵＢ,分析肾下盏解剖因素与结石排空的关系。结果 ３个月总结石排空     

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.     

An investigation of factors associated with failure of extracorporeal shock wave lithotripsy for ureteral calculi

In this study, we attempted to determine which patients with ureteral calculi are likely to have an unsuccessful outcome for extracorporeal shock wave lithotripsy (ESWL). The records of 388 patients with ureteral calculi treated with ESWL at Ijinkai Takeda General Hospital between January 1997 and December 1998 were retrospectively reviewed. Three hundred seventeen patients had been treated with ESWL alone (single session 156, multiple sessions 161) and 71 with transurethral ureterolithotripsy (TUL) due to failure of ESWL. We compared these two groups by multivariate logistic regression analysis, which revealed that (1) middle and lower ureteral calculi, (2) stones > 8 mm, (3) moderate to severe hydronephrosis and (4) failure of the first session ESWL were factors associated with poor outcome of ESWL. Although each predictive value of these factors was relatively low (29.6-38.6%), the rate of failure of ESWL was 85.0% when patients had all four factors. We therefore recommend an early change in treatment modality to TUL for patients with ureteral calculi when all four risk factors listed above are present.     

Efficacy of extracorporeal shock wave lithotripsy for solitary lower calyceal stone: a statistical model

OBJECTIVE: To evaluate the effect of inferior calyceal radiographic anatomy, number of extracorporeal shock wave lithotripsy (ESWL) sessions and stone size on the successful clearance of solitary inferior calyceal calculi after ESWL. PATIENTS AND METHODS: In a prospective study between January 2001 and November 2002, 66 renal units with a solitary inferior calyceal calculus of < or = 2 cm were treated with electrohydraulic ESWL. The infundibulopelvic angle (two definitions), infundibulovertebral angle, inferior calyceal infundibular diameter, infundibular length, cortical thickness over the lower pole, number of minor calyces and stone size were determined from intravenous urography before treatment. The number of ESWL sessions was also included in the analysis. Treatments which produced residual fragments not clearing within 3 months of satisfactory fragmentation were considered as failures. All patients in whom the treatment failed were treated successfully by percutaneous nephrolithotomy. The data were then analysed using two different statistical methods; first by intravariable differences using the test of proportion (Fisher's test) and then all the variables together using logistic regression. RESULTS: At 3 months 78.8% of the renal units were clear of stone. All intravariable differences were statistically significant except stone size (<1 cm, 1-2 cm). In a multivariate analysis of all variables, only stone size was the most important predictor for successful stone clearance (P = 0.03). CONCLUSIONS: ESWL is the initial treatment of choice in selected patients with inferior calyceal stones. The stone size appears to be the most important predictor for stone clearance.