输尿管狭窄的腔内治疗

输尿管狭窄的腔内治疗技术分为气囊扩张术、输尿管内切开术、金属支架等。本文就各种腔内治疗技术的操作方式、优缺点、治疗效果、预后因素等方面作一综述。     

Endourologic management of malignant ureteral strictures

PURPOSE: This retrospective analysis assessed the efficacy of balloon dilatation, endoureterotomy, percutaneous ureteroneocystostomy with stenting, and insertion of Wallstents in the management of malignant ureteral strictures with an intact or compromised vascular supply. PATIENTS AND METHODS: A series of 127 patients with ureteral strictures secondary to malignancies were assessed after at least 2-year follow-up (range 2-5 years; mean 3.5 years). Balloon dilation (antegrade approach) was applied in 46 patients, endoureterotomy with temporary stenting in 37, percutaneous ureteroneocystostomy with stenting in 34, bougie and stents in 13, and Wallstents in 31. RESULTS: Balloon dilatation was successful in only two of four malignant midureteral stenoses with intact vascular supplies and was even less successful (10%) in midureteral strictures with a compromised vascular supply. Endoureterotomy failed in all cases to prevent ureteral obstruction. Percutaneous ureteroneocystostomy achieved patency in 11 of 34 patients (33%) having a compromised ureteral vascular supply. Wallstents were successful in 18 of 31 patients (58%) with stenoses of the pelvic ureter. CONCLUSIONS: Percutaneous ureteroneocystostomy with stenting meets the requirement for palliation in patients with obstruction secondary to pelvic neoplasms. Wallstents proved to be most successful when used in the pelvic ureter.     

Extracorporeal shock wave lithotripsy in the management of pediatric urolithiasis

The main objective of this paper was to evaluate the efficacy and safety of the management of pediatric urolithiasis by extracorporeal shock wave lithotripsy (ESWL). Between November 1988 and July 2000, 165 renal stones, 53 ureteral stones, and 5 bladder stones were treated in 126 pediatric patients using Siemens Lithostar lithotriptor. The ESWL treatments ranging from 1 to 7 were needed per patient (mean: 2.1). One ESWL session was performed for 49.6% of stones, two for 24.6%, three for 13.0 %, four for 5.6% and > 4 for 8.2%. The success rate for renal stone units (asymptomatic fragments less than 4 mm) was 88.2%, stone-free rate was 49.0%. The stone-free rate for ureteral stone units was 87.5%, but was 75% for bladder stones. The overall results of ESWL treatment in 126 children was satisfactory: the success rate was 90.5%, stone-free rate was 51.6%, residual fragments > 4 mm were 9.5%. General anesthesia was required in 65 children (136 treatments) under the age of 10, and only in 18 children (40 treatments) in the age 11–14. Auxiliary procedures, such as double J stent and percutaneous nephrostomy (PCN) were used in 19 and 7 patients, respectively. Perirenal hematoma in one patient and hematomas in enteric wall in another one patient were the only major complications managed conservatively without consequences. Low energy lithotripsy with the Siemens Lithostar in our series of pediatric patients was safe and relatively effective.     

泌尿系结石诊疗指南解读

近年来,中华医学会泌尿外科学分会组织泌尿外科各个领域专家编写《中国泌尿外科疾病诊断治疗指南》,规范泌尿外科疾病的诊断和治疗。结石学组在组长叶章群教授带领下,已编写出版《中国尿石症诊断治疗指南》和《鹿角形结石诊断治疗指南》。     

Medical treatment of pediatric urolithiasis

In recent years the incidence of pediatric stone disease has increased several fold, mostly due to hypercalciuria and hypocitraturia. The goal of medical treatment is to protect the patient from formation of new stones and expansion of existing ones. The non-pharmacological means to address stone disease include high fluid intake and, frequently, modification of nutritional habits. The pharmacological treatment is based on the chemical composition of the stone and the biochemical abnormalities causing its formation; hence, chemical analysis of the stone, urine and blood is of paramount importance and should be done when the first stone is detected. This review discusses the current options of medical treatment of pediatric urolithiasis.     

Clinical experience with pediatric urolithiasis

Our clinical experience with 47 pediatric patients with stones is reviewed. Surgical therapy was standard with successful stone manipulation in 12 of 13 patients. In 91 per cent of our patients factors causing or predisposing to stone disease were discovered. A thorough metabolic evaluation, including an oral calcium loading test in 20 children, proved to be helpful. A new patient subgroup relating unexplained hematuria to eventual stone formation is described. Our protocol for metabolic evaluation and recommendations for treatment based on the results of such an evaluation are given. We have found the metabolic evaluation of the child with stones meaningful and particularly helpful in planning subsequent therapy for these patients.     

Treatment update on pediatric urolithiasis

At the doorstep of the twenty-first century the role of extracorporeal shock-wave lithotripsy (ESWL) as the treatment of choice for more than 80% of all stones in children is established. ESWL is safe and effective, with very few differences in success rates being observed among different lithotriptors. The present problem with ESWL appears to be the residual stone fragment, which has a proven clinical significance. A thorough metabolic evaluation and metaphylaxis is in-dicated in all children, and this will enable physicians to deal with the residual fragments in a more cause-specific manner and prevent regrowth. Another subject that needs prospective randomized studies to be unveiled is the assumption that a specific or universal metaphylaxis, possibly with alkaline citrates, will enhance stone clearance, lower the incidence of residual stone fragments, and optimize the ESWL results. Finally, both percutaneous nephrolithotomy and ureteroscopic stone removal have been established in children as safe and effective treatment options. This gives the clinician the opportunity to choose from a wide range of treatment alternatives, including open surgery, and only this approach will ensure 100% stone removal in individual patients along with the prevention of recurrence and, thus, the elimination of long-term morbidities in this vulnerable patient population.     

Pediatric urolithiasis: 15 years of local experience with minimally invasive endourological management of pediatric calculi

PURPOSE: We sought to identify whether changes in technology and local practice have improved outcomes in the minimally invasive management of pediatric stone disease. MATERIALS AND METHODS: We reviewed retrospectively case notes and imaging from 1988 to 2003, noting treatment modality, stone-free rates, ancillary therapy and complications. RESULTS: A total of 122 children (140 renal units) with a mean age of 7.7 years underwent 209 extracorporeal shock wave lithotripsy (SWL) sessions. Stone size ranged from 6 to 110 mm. Stone-free rates were 84% for cases involving stones smaller than 20 mm, and 54% for those involving stones 20 mm or greater. For complex calculi 40% of patients were stone-free and 45% required ancillary procedures, with an overall complication rate of 26%. A total of 37 children (43 renal units) with a mean age of 6.4 years underwent 46 percutaneous nephrolithotomies (PCNLs). Stone size ranged from 8 to 155 mm. The overall stone-free rate was 79%. Of these patients 34% required ancillary procedures, with a major complication rate of 6%. A total of 35 children (35 renal units) with a mean age of 5.9 years underwent 53 ureteroscopies. Holmium laser was the most effective treatment modality in this group, with a 100% stone-free rate and no complications. CONCLUSIONS: For most renal stones smaller than 20 mm SWL was the most effective primary treatment modality. There was no statistical difference between the 2 lithotriptors for stone-free or ancillary procedure rate. The stone-free rate was dependent on stone size rather than type of lithotriptor. For renal stones 20 mm or greater and staghorn calculi we switched from SWL to PCNL as primary treatment, as stone-free rates were higher and the ancillary procedure and re-treatment rates were lower with PCNL. Electrohydraulic lithotripsy and pulse dye laser were initially used to treat ureteral stones. However, with the introduction of holmium laser technology we achieved higher stone-free rates and lower complication rates. Holmium laser lithotripsy is now used as a primary treatment modality for ureteral stones.     

The management of urolithiasis

The incidence and prevalence of urolithiasis is on the rise; though inevitably the increasing availability of cross-sectional imaging has some contribution to this rise in diagnoses, it cannot take all the blame. Urolithiasis is now more commonly being recognized as a symptom of a more systemic disease which has a constellation of presenting signs and complaints. The authors aim to outline the precipitating causes of urolithiasis, along with a comprehensive discussion of the current operative trends available to the practising endourologist. Despite largely being tailored to trainees within Core Training, in parts the discussion will head beyond that what is expected during basic surgical training and move into topics of debate within higher specialist training.     

Endourologic management of duodenal calculi in pancreas-kidney transplantation

Duodenal stones formed during pancreas-kidney transplantation are usually associated with nonabsorbable sutures or staples. We report on the delayed formation of a struvite duodenal stone not attributed to foreign material, managed successfully with intracorporeal electrohydraulic lithotripsy.     

The management of urolithiasis

The incidence and prevalence of urolithiasis is on the rise; though inevitably the increasing availability of cross-sectional imaging has some contribution to this rise in diagnoses, it cannot take all the blame. Urolithiasis is now more commonly being recognized as a symptom of a more systemic disease which has a constellation of presenting signs and complaints. The authors aim to outline the precipitating causes of urolithiasis, along with a comprehensive discussion of the current operative trends available to the practising endourologist. Despite largely being tailored to trainees within Core Training, in parts the discussion will head beyond that what is expected during basic surgical training and move into topics of debate within higher specialist training.     

Characteristics of pediatric urolithiasis in south-east Anatolia

BACKGROUND: Urolithiasis is endemic in Turkey and characteristics of urolithiasis vary in different regions of the world. The aim of the present study was to evaluate the etiological and clinical characteristics and course of pediatric urolithiasis in south-east Turkey. METHODS: The study population consisted of 81 children (52 girls) with urolithiasis at a mean age of 6.2 +/- 4.2 years who were followed up for 1-32 months. RESULTS: Metabolic disorders, anatomical defects and infection stones were found to be the etiological factor in 34.6, 29.6 and 22.2% of patients, respectively, while 13.6% of patients were considered idiopathic. Of all patients, 28.4% were admitted with acute renal failure (ARF) and 72.8% had urinary tract infection. Recurrence was seen in 19.8% of patients at presentation. The localization of the stone was found to be in the upper urinary tract, the lower urinary tract or both in 65.4, 14.8% and 17.3% of patients, respectively. Patients with multiple and bilateral stones had a higher risk for ARF than the others. The risk for chronic renal failure was significantly higher in children with multiple, bilateral or recurrent stones and with ARF at presentation. CONCLUSIONS: Early diagnosis and management of renal stones and urinary tract infections is necessary to prevent the development of ARF or chronic renal failure and to improve the quality of a patient's life.     

Results of shockwave lithotripsy for pediatric urolithiasis

BACKGROUND AND PURPOSE: Shockwave lithotripsy (SWL) is widely practiced in the management of pediatric urolithiasis. However, the efficacy, need for ancillary procedures, and treatment-related complications are not as clearly defined as in the adult population. We reviewed the outcomes of SWL in the pediatric population at our lithotripsy unit. PATIENTS AND METHODS: A retrospective review of all patients 相似文献   

经皮肾输尿管镜下气压弹道碎石术治疗儿童肾结石

目的探讨经皮肾输尿管镜下气压弹道碎石术治疗儿童肾结石的疗效与安全性。方法肾结石患儿15例,均为14岁以下,其中单侧8例,双侧7例,共22个肾脏。全部病例使用全身麻醉下经皮肾输尿管镜下气压弹道碎石术治疗。术后行X线摄片观察疗效,术后48h查血红蛋白。所有病例均行代谢评估,术后使用枸橼酸钾预防结石复发。术后随访2～3年。结果20个肾脏（91％）的结石完全清除。2个有残石的肾脏经体外冲击波碎石术治疗,结石完全清除。14例患儿术后有轻、中度发热（〈39℃,〈2d）,1例术后高热（〉39℃,〉2d）。患儿术后血红蛋白较术前平均下降10．0g／L。无输血病例。平均住院5．2d。全部病例术后半年行静脉肾盂造影检查,肾功能均平稳或有改善。无远期并发症。结论对儿童肾结石行经皮肾输尿管镜下气压弹道碎石术安全、有效。