Extracorporeal shockwave lithotripsy in the management of urinary stones: New concepts and techniques to improve outcomes

Objective: Extracorporeal shockwave lithotripsy (SWL) currently plays an important role in the treatment of urinary tract lithiasis. The purpose of this article was to describe new concepts and procedural strategies that would improve results using SWL as a treatment for urolithiasis, thereby achieving better clinical practice.Methods: A systematic review process was carried in PubMed/PMC from January 2003 to March 2023. A narrative synthesis of the most important aspects has been made.Results: The important recommendations for the adequate selection of the candidate patient for treatment with SWL are summarized, as well as the new strategies for a better application of the technique. Aspects about intraoperative position, stone localization and monitoring, analgesic control, machine and energy settings, and measures aiming at reduced risk of complications are described.Conclusion: To achieve the therapeutic goal of efficient stone disintegration without increasing the risk of complications, it is necessary to make an adequate selection of patients and to pay special attention to several important factors in the application of treatment. Technological development in later generation devices will help to improve current SWL results.

Cost-Effectiveness Analysis of Renalof® versus Extracorporeal Shockwave Lithotripsy (ESWL) for the Treatment of Kidney Stones ≤ 1 cm in Nicaragua

Objectives: To assess the efficiency in terms of cost-effectiveness (CE) of oral Renalof® treatment versus extracorporeal shockwave lithotripsy (ESWL) in the treatment of kidney stones ≤ 1 cm in Nicaragua. Methods: A cost-effectiveness economic evaluation was carried out based on the results obtained in the randomised, prospective, observational, single-blind, prospective, phase 2 clinical trial. Cost-effectiveness and the incremental cost-effectiveness ratio (ICER) were calculated. Economic data were obtained from the Economics Department of Clínica Senior in Managua, Nicaragua. The monetary cost was expressed in US dollars (USD). Results: Treatment with Renalof® yielded a CE of $1,323.08/% remission, while ESWL was $9,498.54/% remission. The ICER shows that, in order to achieve a high percentage of kidney stone remission with ESWL, an extra $4,734.70 per patient must be invested. Conclusions: The use of Renalof® is shown to be a more cost-effective option than ESWL. It is recommended for the treatment of kidney stones ≤ 1 cm in size.

Treatment of urinary lithiasis following kidney transplantation with extracorporeal shock-wave lithotripsy

Background The incidence of urinary lithiasis following kidney transplantation is very low, and decision-supporting data are not available. The aim of this study was to review the diagnosis and treatment of urinary lithiasis following kidney transplantation, which is of realistic significance to reduce urinary lithiasis following kidney transplantation, prolong the survival of renal allografts.Methods The incidence, diagnosis and treatment of urinary lithiasis in ten patients following kidney transplantation were analyzed retrospectively. Seven out of these patients had stones sized approximately 0.4-1.1 cm, and they were treated with low-voltage, low-frequency extracorporeal shock-wave lithotripsy （ESWL）. Two patients had stones sized ＜0.3 cm and they underwent cystoscopy and ureteroscopy. The ureteral catheter endoscopes were inserted in a retrograde manner to mobilize stones repeatedly. After elimination of obstruction, a ureteral double J stent was indwelt.One patient had a pelvic stone （1.2 cm）, which was removed surgically.Results The major clinical manifestations were hematuria, oliguria or anuria. Some patients were asymptomatic and they were diagnosed through laboratory tests and imaging examinations, e.g., ultrasonography. After elimination of obstruction, subjective symptoms disappeared in all patients, and the function of renal allografts recovered. A six-month follow-up indicated no remnant stones or lithiasis relapse.Conclusions The diagnosis and treatment of renal allograft lithiasis are challenging. After prompt and appropriate treatment, the prognosis was satisfactory, and permanent renal functional impairment did not occur in most patients.

Extracorporeal shock wave lithotripsy for pancreatic and large common bile duct stones

Extraction of large pancreatic and common bile duct(CBD)calculi has always challenged the therapeutic endoscopist.Extracorporeal shockwave lithotripsy(ESWL)is an excellent tool for patients with large pancreatic and CBD calculi that are not amenable to routine endotherapy.Pancreatic calculi in the head and body are targeted by ESWL,with an aim to fragment them to<3 mm diameter so that they can be extracted by subsequent endoscopic retrograde cholangio-pancreatography(ERCP).In our experience,complete clearance of the pancreatic duct was achieved in 76% and partial clearance in 17%of 1006 patients.Short-term pain relief with reduction in the number of analgesics ingested was seen in 84%of these patients.For large CBD calculi,a nasobiliary tube is placed to help target the calculi,as well as bathe the calculi in salinea simple maneuver which helps to facilitate fragmenta-tion.The aim is to fragment calculi to<5 mm size and clear the same during ERCP.Complete clearance of the CBD was achieved in 84.4%of and partial clearance in 12.3%of 283 patients.More than 90%of the patients with pancreatic and biliary calculi needed three or fewer sessions of ESWL with 5000 shocks being de-livered at each session.The use of epidural anesthesia helped in reducing patient movement.This,together with the better focus achieved with newer third-gen-eration lithotripters,prevents collateral tissue damage and minimizes the complications.Complications in our experience with nearly 1300 patients were minimal,and no extension of hospital stay was required.Similar rates of clearance of pancreatic and biliary calculi with minimal adverse effects have been reported from the centers where ESWL is performed regularly.In view of its high efficiency,non-invasive nature and low complication rates,ESWL can be offered as the first-line therapy for selected patients with large pancreatic and CBD calculi.

Epidural anesthesia is effective for extracorporeal shock wave lithotripsy of pancreatic and biliary calculi

AIM: To evaluate the efficacy of thoracic epidural analgesia for extracorporeal shock wave lithotripsy (ESWL). METHODS: ESWL is an effective, non-invasive technique for the treatment of difficult pancreatic and large bile duct calculi. The procedure is often painful and requires large doses of analgesics. Many different anesthetic techniques have been used. Patients with either large bile duct calculi or pancreatic duct calculi which could not be extracted by routine endoscopic methods were selected. Thoracic epidural anesthesia (TEA) was routinely used in all the subjects unless contraindicated. Bupivacaine 0.25% with or without clonidine was used to block the segments D6 to D12. The dose was calculated depending on the age, height and weight of the patient. It was usually 1-2 mL per segment blocked.RESULTS: Ninety eight percent of the 1509 patients underwent ESWL under TEA. The subjects selected were within American Society of Anesthesiologists grade Ⅰ to Ⅲ. ESWL using EA permitted successful elimination of bile duct or pancreatic calculi with minimal morbidity. The procedure time was shorter in patients with TEA than in those who underwent ESWL under total intravenous anesthesia. CONCLUSION: Almost all patients undergoing ESWL with EA had effective blocks with a single catheter insertion and local anesthetic injection.

Outcome of a session of extracorporeal shock wave lithotripsy before endoscopic retrograde cholangiopancreatography for problematic and large common bile duct stones

AIM To compare the efficacy of a session of extracorporeal shock wave lithotripsy(ESWL) before endoscopic retrograde cholangiopancreatography(ERCP) vs ERCP only for problematic and large common bile duct(CBD) stones.METHODS Adult patients with CBD stones for whom initial ERCP was unsuccessful because of the large size of CBD stones were identified. The patients were randomized into two groups,an "ESWL + ERCP group" and an "ERCP-only" group. For ESWL + ERCP cases,ESWL was performed prior to ERCP. Clearance of the CBD,complications related to the ESWL/ERCP procedure,frequency of mechanical lithotripsy use and duration of the ERCP procedure were evaluated in both groups.RESULTS There was no significant difference in baseline characteristics between the two groups. A session of ESWL before ERCP compared with ERCP only resulted in similar outcomes in terms of successful stone removal within the first treatment session(74.2% vs 71.0%,P = 0.135),but a higher clearance rate within the second treatment session(84.4% vs 51.6%,P = 0.018) and total stone clearance(96.0% vs 86.0%,P = 0.029). Moreover,ESWL prior to ERCP not only reduced ERCP procedure time(43 ± 21 min vs 59 ± 28 min,P = 0.034) and the rate of mechanical lithotripsy use(20% vs 30%,P = 0.025),but also raised the clearance rate of extremely large stones(80.0% vs 40.0%,P = 0.016). Post-ERCP complications were similar for the two groups.CONCLUSION Based on the higher rate of successful stone removal and minimal complications,ESWL prior to ERCP appears to be a safe and effective treatment for the endoscopic removal of problematic and large CBD stones.

ACUPUNCTURE ANAESTHESIA IN TREATING URINARY TRACT STONE WITH EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

The anaesthetic effect of acupuncture on 40 patients during extracorporeal shockwave lithotripsy was observed in this study.The anaesthetic rate in 20 eases under manual acupunc-ture was 85％,and that in the other 20 patients under electro-acupuncture anaesthesia was 90％.Under the anaesthesia the patients were conscious and in normal physical conditions.The observationsindicate that the electro-acupuncture anaesthesia is safe,economical and effective.Additionally.it lib-erates acupuncturists from heavy needling manipulation.The relationship between the analgesic ef-fects antI the ages is analysed as well.

Efficacy of Extracorporeal Shock Wave Lithotripsy (ESWL) versus Pneumatic Ureteroscopic Lithotripsy (URSL) for Lower Ureteral Stones Therapy in Asia: A Meta-Analysis

Objective: To assess the efficacy and safety of extracorporeal shock wave lithotripsy or pneumatic ureteroscopic lithotripsy for lower ureteral stones therapy, we sought to identify and summarize randomized controlled trials that were used to treat distal ureteral stone. Methods: Eligible studies were identified from electronic databases. Database search, quality assessment, and data extraction were performed by two reviewers independently. Our primary outcome was the stone-free rate. Secondary outcomes were the fragmentation rate, complications and the rate of re-treatment and secondary procedures. The results were assessed by Review Manager 5.0. Publication bias was evaluated by Stata 11.0. Results: 13 trials were included. Meta-analysis of pooled data showed that pneumatic ureteroscopic lithotripsy demonstrated a significant advantage over extracorporeal shock wave lithotripsy (OR = 0.14, 95% CI [0.09, 0.23], P < 0.00001) in the stone-free rate;the extracorporeal shock wave lithotripsy had statistical disadvantages over pneumatic ureteroscopic lithotripsy in the fragmentation rate of ureteral stones (OR = 0.14, 95% CI [0.05, 0.39], P = 0.0002);and the rate of re-treatment and secondary procedure was lower in pneumatic ureteroscopic lithotripsy than in extracorporeal shock wave lithotripsy (OR = 5.37, 95% CI [2.61, 11.07], P < 0.00001). Our pooled results showed that there was no statistical difference between extracorporeal shock wave lithotripsy and pneumatic ureteroscopic lithotripsy in hematuresis, ureteral stricture and urosepsis or fever. Finally extracorporeal shock wave lithotripsy had a higher incidence of colic pain than pneumatic ureteroscopic lithotripsy. Conclusion: The present meta-analysis suggested that pneumatic ureteroscopic lithotripsy had large advantages over extracorporeal shock wave lithotripsy in the treatment of lower ureteral stones.

Evaluation of Extracorporeal Shockwave Lithotripsy in the Management of Renal and Ureteral Calculi

Aim: To evaluate the efficacy of extracorporeal lithotripsy in the management of renal and ureteric calculi in a urology center in Douala, Cameroon. Materials and Methods: This is a retrospective study carried out over six years, between January 2014 and December 2020. All the patients were treated using a Direx Integra lithotripter, with the number of shockwaves ranging from 1200 to 3500, without anaesthesia and were discharged a few hours after the procedure on the same day. In a majority (63.75%) of the cases, the calculi were incidental findings. A Double-J stent was indicated in two patients and preceded extracorporeal lithotripsy because of renal colic and signs of urinary tract infection. Results: We recruited a total of 122 patients with a mean age of 42.19 ± 13.08. We had 65 (53.3%) males and all patients had at least one calculus confirmed by CT scan with a mean size of 13.84 ± 4.17 mm, 85 (69.7%) patients became completely stone-free after a maximum of four sessions of extracorporeal lithotripsy (ESWL). 21 (17.2%) patients had intermediate results, being asymptomatic and/or having less than three residual fragments that measured less than 4 mm. The failure rate was 13.9%, with 17 patients still having more than three fragments measuring more than 4 mm after 4 ESWL sessions. 1 (0.8%) had septic shock as a post ESWL complication while 6 (4.9%) benefitted from a complimentary medical and/or surgical treatment (double J stent placement). Conclusion: The management of renal and ureteral calculi through extracorporeal lithotripsy in adults seems to be particularly effective for renal calculi measuring less than 20 mm and ureteral calculi measuring less than 15 mm. Extracorporeal lithotripsy, which can be performed on an outpatient basis (and without anaesthesia) is associated with minimal complications, and remains the option of choice for most upper urinary tract calculi.

Effect of extracorporeal shock wave lithotripsy for the postoperative residual bilestone of choledocholithiasis

Objective To explore the effect of extracorporeal shock wave lithotripsy(ESWL) for the postoperative residual bilestone of choledocholithiasis.Method Inject contrast medium of biligrafin via T tube.After accurate apposition with X ray,take lithotripsy with extracorporeal shock wave. In some cases T tube washing and transcutaneous choledochoscope were used to take out bilestones.Results The lithotripsies were successful in all the 48 patients and the lithotriptic rate was 100%.The removing rate of bilestones was over 90% with washing method.Choledochoscope was used in 6 cases,and 48 patients were completely healed.In them 24 suffered from slight expanding pain in right upper abdomen or nausea and no any complications and sequelae in others.Conclusion ESWL is an effect method to heal patients with the postoperative residual bilestones of choledocholithiasis.

Extracorporeal shockwave lithotripsy for lower ureteral stone through greater sciatic foramen：report of 61 cases

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The use of an artificial neural network in the evaluation of the extracorporeal shockwave lithotripsy as a treatment of choice for urinary lithiasis

Objective:Artificial neural networks(ANNs)are widely applied in medicine,since they substantially increase the sensitivity and specificity of the diagnosis,classification,and the prognosis of a medical condition.In this study,we constructed an ANN to evaluate several parameters of extracorporeal shockwave lithotripsy(ESWL),such as the outcome and safety of the procedure.Methods:Patients with urinary lithiasis suitable for ESWL treatment were enrolled.An ANN was designed using MATLAB.Medical data were collected from all patients and 12 nodes were used as inputs.Conventional statistical analysis was also performed.Results:Finally,716 patients were included in our study.Univariate analysis revealed that diabetes and hydronephrosis were positively correlated with ESWL complications.Regarding efficacy,univariate analysis revealed that stone location,stone size,the number and density of shockwaves delivered,and the presence of a stent in the ureter were independent factors of the ESWL outcome.This was further confirmed when adjusted for sex and age in a multivariate analysis.The performance of the ANN at the end of the training state reached 98.72%.The four basic ratios(sensitivity,specificity,positive predictive value,and negative predictive value)were calculated for both training and evaluation data sets.The performance of the ANN at the end of the evaluation state was 81.43%.Conclusion:Our ANN achieved high score in predicting the outcome and the side effects of the ESWL treatment for urinary stones.

Extracorporeal Shock Wave Lithotripsy in the Treatment of Single Ureteric Stone. Initial Data from Iraq

Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not invasive procedure and can be done on outpatient basis without anesthesia and with few complications which is most probably temporary and treatable. The objective of this study is to evaluate the efficiency and safety of ESWL in treatment of ureteric stone in Iraq. Materials and Methods: A total of 112 Iraqi patients with ureteric stones were participated in this prospective observational study in which patients scheduled for ESWL treatment for a period of 6 months. Patients were divided into 2 groups: 1) Group 1: 52 patients with proximal ureteric stone;2) Group 2: including 60 patients with distal ureteric stone. Preoperatively all patient underwent bowel preparation and were asked to fast for 8 hours before the procedure. Results: The age ranged between 22 and 55 with mean of 42 (SD = 5) years. Around 46% had proximal ureteric stone and the rest were in distal ureter. Around 44% needed one session and 40% needed two sessions to be stone-free respectively. In regards to associated symptoms, 74% had ureteric colic, 3% haematuria, 43% microhematuria and 12% UTI. Mild hydronephrosis was found in 90% of the cases and 30 reported had previous intervention. Success rate was 90%. Conclusions: ESWL is safe and effective in treatment of ureteric stone with few complications and must be regarded first choice after conservative treatment in a patient with uncomplicated ureteric stone.

Changes of serum β2-MG, Cys C and urine mAlb levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy and their clinical significance

Objective:To investigate the changes of serumβ2 microglobulin(β2-MG),cystatin C(CysC)and urine microalbumin(mAlb)levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy and their clinical significance.Methods Sixty-eight patients with ureteral calculi admitted to the hospital between June 2018 and June 2019 were selected as the observation group.35 volunteers who received physical elimination in the hospital during the same period were selected as the control group.Levels ofβ2-MG,Cys C and urine mAlb in the observation group were compared before and after treatment,and compared with those in the control group.Changes in serumβ2-MG,Cys C and urine mAlb levels and renal function indicators[blood urea nitrogen(BUN),serum creatinine(SCr)]in patients with different prognosis in the observation group after treatment were analyzed.The value of serumβ2-MG,Cys C and urine mAlb levels in the diagnosis and treatment of ureteral calculi was analyzed with ROC curve.The correlations between serumβ2-MG,Cys C and urine mAlb levels and renal function indexes were analyzed.Results Serumβ2-MG,Cys C and urine mAlb levels in the observation group before treatment were significantly higher than those in the same group after treatment or those in the control group(P<0.05).Serumβ2-MG,Cys C and urine mAlb levels,BUN and SCr in patients with residual stones were significantly higher than those in patients without(P<0.05).ROC curve analysis showed that the sensitivity and the area under the curve of combined detection of serumβ2-MG,Cys C and urine mAlb levels for evaluating the curative effect of extracorporeal shock wave lithotripsy on ureteral calculi were significantly higher/larger than those of single detection of the three(P<0.05).Partial correlation analysis showed that serumβ2-MG,Cys C and urine mAlb levels were positively correlated with BUN and SCr(P<0.05).Conclusion There are obvious changes of serumβ2-MG,Cys C and urine mAlb levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy.The combined detection of the three indexes is helpful for the early diagnosis of ureteral calculi and the evaluation of renal function after lithotripsy.They can provide reference for protecting renal function in patients with ureteral calculi treated by extracorporeal shock wave lithotripsy.

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR URINARY CALCULI: 18 YEARS EXPERIENCE

Objective To report our experience of extracorporeal shock wave lithotripsy （ESWL） for patients with urinary calculi. Methods From Jun. 1987 to Dec. 2005, a total of 10100 patients with urinary calculi in the kidney or ureter accepted ESWL. The kidney stones were sorted by FDA standard. The ureteric stone was sorted by its site and retrograde pyelography. At the same time, we summarized the recurrence of kidney stone and its relationship between extracorporeal shock wave lithotripsy （ ESWL ） and hypertension. Results The efficacy for class I kidney stone was 91.2% that for class II 86. 5% and class III 72.3% , the healing rate for ureteric stone was 84. 5%. Combined retrograde pyelography and ESWL couM improve the efficacy. If ESWL failed, the ureteric stone could still be removed by operation or ureterscopy （ 1.1% ）. The rate of recurrence of kidney stone was 6. 1% and the incidence of hypertension post-treatment reached 7. 9%. Conclusion ESWL is a preferred approach to treat urinary calculi.

Factors influencing the efficacy of extracorporeal shock wave lithotripsy

To evaluate the factors which influence the efficacy of extracorporeal shock wave lithotripsy (ESWL).Methods The data of 234 patients with urinary calculi who underwent ESWL were reviewed.The correlation of age,gender,disease course,stone size,location,X-ray findings and hydronephrosis with curative success rate was analyzed.Three months after ESWL,the patients underwent KUB,IVU and B-US examinations.If the residual stones were <2 mm in diameter,ESWL was considered successful;by contrast,ESWL was considered unsuccessful with the residual stones >2 mm in diameter.Results The overall success rate of fragmentation was 78.6% (184/234),and for male and female groups the success rates were 80.3%(122/152) and 75.6% (62/82),respectively (P>0.05).The differences of gender,disease course [(1262.6±1742.1) d vs (722.9±1364.6) d],stone diameter [(1.1±0.6) cm vs (1.0±0.4) cm] between failure group and success group were not statistically significant (P>0.05).The difference of age [(58.8±13.6) years vs (42.8±12.2) years] between failure group and success group were statistically significant (P<0.05).The difference of failure rates between pelvic stones (22.7%,0/44) and caliceal stones (40.0%,8/20),pelvic stones and ureteral stones (18.8%,32/170),upper ureteral stones (15.8%,18/14) and lower ureteral stones (25.0%,14/56);high density stones (20.0%,6/30) and mixed density stones (21.6%,44/204) were not statistically significant (P>0.05).The differences of failure rate between mild-moderate hydronephrosis group (18.5%,40/216) and severe hydronephrosis group (55.6%,10/18);3 groups of different stone size [0.3-1.0 cm (1.9%,2/108),1.0-2.0 cm (29.8%,28/94),>2.0 cm (62.5%,20/23) in diameter] were statistically significant (P<0.05).Stone size was positive correlated with therapeutic dosage (r=0.28,P=0.006).Conclusion Age,stone size and concomitant hydronephrosis may be important factors influencing the efficacy of ESWL.5 refs.

能谱CT结石成分分析在泌尿系结石体外冲击波碎石中的应用

目的:探讨能谱CT结石成分分析在泌尿系结石体外冲击波碎石(ESWL)中的应用效果。方法:选取2022年5月—2023年8月惠州市中心人民医院门诊治疗的160例泌尿系结石患者,按照随机数表法将其分为两组,各80例。两组均接受ESWL治疗,在此之前,对照组采用常规CT平扫进行结石密度计算,试验组采用能谱CT进行结石成分评估。比较两组手术相关情况、结石清除率及并发症发生率。结果:试验组一次碎石成功率高于对照组,平均体外冲击波次数、最高工作电压平均值低于对照组,平均碎石时间短于对照组,差异有统计学意义(P<0.05)。试验组结石清除率为95.00%,高于对照组的83.75%,差异有统计学意义(P<0.05)。试验组>24 h肉眼血尿发生率均低于对照组,差异有统计学意义(P<0.05);但两组其余并发症发生率比较,差异无统计学意义(P>0.05)。结论:在泌尿系结石ESWL中应用能谱CT结石成分分析能为手术创造有利条件,确保一次碎石成功,提高术后结石清除率,并减少平均体外冲击波次数,缩短手术时间,降低>24 h肉眼血尿发生率。

清热活血排石汤结合体外冲击波碎石术对输尿管结石患者中医证候积分的影响

目的 探究清热活血排石汤结合体外冲击波碎石术对输尿管结石患者中医证候积分的影响。方法 回顾性选取2021年1月—2023年12月松原市中心医院收治的98例输尿管结石患者的临床资料,以不同治疗方法分为对照组、研究组,各49例,两组均应用体外冲击波碎石术治疗,在此基础上,术后对照组应用常规药物治疗,研究组在对照组基础上应用清热活血排石汤,比较两组治疗效果、中医证候积分、肾功能指标(血肌酐、尿素氮)、排石情况(开始排石时间、排石周期)及不良反应发生率。结果 研究组治疗总有效率为97.96%(48/49),高于对照组的83.67%(41/49),差异有统计学意义(χ^(2)=4.404,P<0.05)。治疗前两组中医证候积分、血肌酐、尿素氮比较,差异无统计学意义(P均>0.05);治疗后,研究组中医证候积分、血肌酐、尿素氮均低于对照组,差异有统计学意义(P均<0.05)。研究组开始排石时间、排石周期均短于对照组,差异有统计学意义(P均<0.05)。研究组结石清除率高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 在输尿管结石患者体外冲击波碎石术及常规药物治疗基础上,联合应用清热活血排石汤,可提升治疗效果,降低中医证候积分,减轻肾功能损伤,提升结石清除率,且安全性良好。

尿石净丸对尿路结石患者体外冲击波碎石术后促排石效果及复发率的影响

目的:探究尿石净丸对尿路结石患者体外冲击波碎石术(extracorporeal shock wave lithotripsy,ESWL)后促排石效果及复发率的影响。方法:将120例尿路结石患者按随机数字表法分为对照组与研究组,每组各60例。两组均行ESWL治疗,对照组术后给予常规西药治疗,研究组在对照组治疗的基础上给予尿石净丸治疗。比较两组临床疗效、结石排净及复发情况、中医证候积分、尿微量白蛋白(microalbuminuria,mAlb)、血清胱抑素C(cystatin C,Cys C)、术后并发症发生情况。结果:研究组有效率为96.49%,对照组有效率为82.76%,研究组有效率高于对照组,差异有统计学意义(P<0.05)。研究组术后第7天、第14天结石排净率分别为57.89%、87.72%,对照组术后第7天、第14天结石排净率分别为37.93%、70.69%,研究组结石排净率高于对照组,差异有统计学意义(P<0.05);研究组结石复发率为3.51%,对照组结石复发率为15.52%,研究组结石复发率低于对照组,差异有统计学意义(P<0.05)。研究组术后第7天中医证候积分、mAlb、Cys C低于对照组,差异有统计学意义(P<0.05)。研究组术后并发症发生率为10.53%,对照组术后并发症发生率为27.59%,研究组术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:尿石净丸可提升尿路结石患者ESWL术后促排石效果,明显减少术后肾损伤,降低结石复发率及术后并发症发生率。

输尿管结石伴感染患者不同手术治疗时机的选择及作用分析

分析体外冲击波碎石(extracorporeal shock wave lithotripsy,ESWL)治疗无效的输尿管结石伴感染患者不同手术治疗时机的选择及其具体作用。选取2021年1月—2023年6月贵州省瓮安县人民医院经ESWL治疗无效的82例输尿管结石伴感染患者为研究对象,将患者按照不同手术治疗时机以及患者病情进行分组,分为两组,每组各41例。观察组患者在ESWL治疗无效后立即行逆行经尿道输尿管镜碎石取石术(ureteroscopic lithotripsy,URL)治疗,对照组患者在ESWL治疗无效后7天行URL治疗,比较两组患者治疗效果。结果显示,观察组患者治疗总有效率和结石清除率高于对照组(P<0.05),并发症总发生率低于对照组(P<0.05);术后,观察组患者IPSS评分低于对照组(P<0.05),血清学指标和生活质量评分优于对照组(P<0.05);观察组患者临床症状消失时间短于对照组(P<0.05)。研究发现,对ESWL治疗无效的输尿管结石伴感染患者立即行URL治疗,可提高结石清除率,减少术后并发症,改善患者前列腺症状和生活质量,缩短患者临床症状消失时间,优化患者血清学指标。