Alterations in renal morphology and function after ESWL therapy: evaluation with dynamic contrast-enhanced MRI

Contrast-enhanced gradient-echo MRI was used to evaluate morphological and functional alternations in the kidneys after extracorporeal shock wave lithotripsy (ESWL). Dynamic MRI with a temporal resolution of 10 s per image was performed by repeated imaging in the coronal plane after administration of gadolinium-DTPA (0.1 mmol/kg) before and after ESWL for renal calculi in 25 patients. Before ESWL 22 patients had normally functioning kidneys, characterised by a marked decrease in signal intensity in the renal medulla 30–40 s after the onset of cortical perfusion. After ESWL 8 patients had functional abnormalities: in 2 cases the medullary signal decrease was disturbed throughout the whole organ, while 6 kidneys demonstrated regional loss of concentrating ability in the medulla. Morphological alterations (oedema with blurred contours and loss of corticomedullary differentiation; parenchymal haemorrhage and haemorrhage in a cortical cyst; subcapsular, perirenal and pararenal haematoma) were detected in 9 cases. Haemorrhage was encountered more often after administration of more than 2500 shock waves; however, no such correlation was seen in the kidneys with functional disturbances following ESWL therapy. MRI proved to be a sensitive method for the assessment of morphological and functional alterations after ESWL, but longer follow-up studies are required to identify the clinical impact of these early changes.     

ESWL治疗输尿管结石150例疗效观察

目的探讨ESWL治疗输尿管结石的效果。方法采用深圳慧康公司生产的ESWL-V型液电式电磁式体外冲击波碎石机对2008年150例诊断为输尿管结石患者，行ESWL的资料，进行回顾性分析。结果150例输尿管结石，碎石成功148例，其中，130例治愈，28例有效，2例无效。均无严重并发症。结论ESWL是治疗无梗阻输尿管结石的首选，但要严格筛选碎石患者，准确的定位，是碎石成功的关键。为提高治疗效果，严格掌握碎石的适应症和禁忌症，以提高碎石的成功率。     

复式脉冲体外碎石机治疗泌尿系结石1206例小结

目的:总结新碎石设备-复式脉冲体外碎石机治疗泌尿系结石的经验.方法:应用该机治疗泌尿系结石患者1206例,其中肾结石508例,输尿管结石603例,膀胱结石95例.结石大小0.4cm×0.5cm～2.5cm×2.5cm.碎石机工作电压4.0～8.5 kV,放电次数2 000～3 000.结果:肾结石治愈率达58.3%,输尿管结石为72.7%,膀胱结石82.4%.其中986例(81.8%)ESWL后有不同程度的肉眼血尿,164例(13.6%)出现肾绞痛,14例出现高热,2例出现肾被膜下血肿,经对症处理均消失.结论:体外复式脉冲碎石技术仍然是泌尿系结石的首选治疗方法.     

Rapid extracorporeal shock wave lithotripsy treatment after a first colic episode correlates with accelerated ureteral stone clearance

OBJECTIVES: To investigate the relationship between delay in extracorporeal shock wave lithotripsy (ESWL) after a first colic and subsequent time to complete stone clearance. METHODS: This prospective, non-randomized study included 94 patients treated with ESWL for unilateral solitary proximal ureteral stones after at least one episode of colic pain. Time between the first onset of colic pain and ESWL and stone clearance was recorded. The pretherapeutic degree of hydronephrosis has been assessed using ultrasound. RESULTS: Mean stone size was 7.9 +/- 2.3 mm and mean time before ESWL after a first colic was 93.4 +/- 143.5 h. At 3 months, 3 patients were lost to follow-up. In 76.9% of patients stones were completely cleared and a further 3.3% harbored residual fragments < or =3 mm. Delay in treatment after a first colic correlated with subsequent time to stone clearance (p < 0.0001). Mean time to stone clearance in patients treated within 24h was 6.4 +/- 6.3 days compared with 16.0 +/- 17.8 days for those treated later (p = 0.008). Maximum stone diameter correlated with time to stone clearance (p = 0.031), but the degree of hydronephrosis did not. CONCLUSIONS: Rapid ESWL after a first onset of colic pain resulted in accelerated stone clearance independent of the degree of hydronephrosis but had no impact on the need for auxiliary procedures.     

钬激光治疗ESWL失败的输尿管上段结石78例分析

目的探讨输尿管镜钬激光碎石术治疗体外冲击波碎石（extracorporeal shockwave lithotripsy,ESWL）失败的输尿管上段结石的临床效果。方法回顾性分析应用输尿管镜钬激光碎石术治疗ESWL失败的输尿管上段结石78例患者资料。结果输尿管上段结石并发炎性息肉者67例（86%）,碎石同时钬激光消融息肉。有输尿管扭曲、狭窄者16例（21%）。一次碎石成功63例,成功率81%。1周内结石排净46例,其余17例4周内结石排净。无输尿管穿孔、撕脱等严重并发症。11例结石冲回肾盂,经EWSL或经皮肾镜钬激光碎石术成功。4例置镜失败,行开放手术治愈。结论输尿管镜钬激光碎石安全有效,可作为ESWL治疗失败的输尿管上段结石首选治疗方法。     

体外冲击波碎石联合中药治疗泌尿系结石效果观察

目的探讨体外冲击波碎石（ESWL）联合中药治疗泌尿系结石的疗效和安全性。方法选择2008-02～2011-02在该院住院的泌尿系结石患者138例随机分为治疗组（70例）和对照组（68例）,治疗组行ESWL联合中药治疗,对照组单独行ESWL治疗,对比分析两组的结石清除率和术后情况。结果138例结石患者结石清除均获成功,无严重并发症发生。治疗组结石清除率、术后止痛药应用率、发热率以及住院时间与对照组比较差异有统计学意义（P〈0．05）。结论ESWL联合中药治疗泌尿系结石,能有效清除各类结石,明显提高ESWL手术效率,值得临床推广应用。     

Semen quality after extracorporeal shockwave lithotripsy for the management of lower ureteric stones: a review of the literature

Extracorporeal Shockwave Lithotripsy has long been an important tool in the urologists' armamentarium for the treatment of distal ureteric stones. Several studies have been conducted on the morbidity and adverse effects of ESWL on human tissues but the effect of lithotripsy on semen and testes remains inconclusive. Impact on semen analysis and testes is important because the seminal vesicles and testes are exposed to the shock waves due to their anatomical proximity to the distal ureter. This article has reviewed all the published literature in English language on semen analysis after lithotripsy.     

Do hydronephrosis and extracorporeal shock wave lithotripsy affect carbohydrate antigens?

Objectives

To investigate carbohydrate antigen (CA 19-9, CA 15-3, and CA 125) levels in the patients who had hydronephrosis with renal stones and in whom Extracorporeal shock wave lithotripsy (ESWL) was performed.

Materials and Methods

This prospective study included 20 people with no known disease for control group and 30 patients who had hydronephrosis with renal stones and in whom ESWL was performed between January 2005 and January 2006. None of patients had urinary infection and malignancy. The blood for carbohydrate antigens was taken pre-ESWL and 30 min after ESWL in both groups. CA 19-9, CA 15-3, and CA 125 in the serum were tested with the electro-immunoassay method on the Roche^® E-170 apparatus with the original Roche^® kit.

Results

The CA 19-9 and CA 125 values in the patients group were found to be statistically significant when compared with the control group but the CA 15-3 was not found to be significant. However, CA 19-9, CA 15-3, and CA 125 values of post-ESWL were not statistically significant when compared with pre-ESWL group (P > 0.05).

Conclusions

The average serum values of CA 125 and CA 19-9 in patients were found to be significantly high. However, serum values of CA 19-9, CA 15-3, and CA 125 were not affected by ESWL.

     

肾结石ESWL疗效判定研究

目的：对肾结石ESWL疗效判断影响因素进行研究和探讨。方法：以对我院2006年9月至2012年9月收治的287例行ESWL治疗的肾结石患者为研究对象,对结石特征与疗效关系进行回顾性分析,比较各组行ESWL术后3个月的疗效情况。结果：本组287例患者中碎石成功221例,成功率为77．01％,结石长径〈1．0em清石率为（157／175）89．7l％;结石长径在1．0cm-2．0cm清石率为（51／72）70．83％;结石长径〉2．0em清石率为（13／40）32．50％;三组清石率比较差异具有统计学意义（P〈0．05）。肾盏结石组与肾盂结石组清石率（69．11％和82．93％）差异具有统计学意义（P〈0．05）;多发结石与单发结石清石率（60．21％和85．71％）差异具有统计学意义（P〈0．05）。结论：患者肾结石长径大小、结石数量及结石位置对肾结石ESWL疗效具有重要影响。