近位尿管結石に対する尿管鏡下空気圧結石破砕術と体外衝撃波結石破砕術の比較

Comparison of Ureteroscopic Pneumatic Lithotripsy and Extracorporeal Shock Wave Lithotripsy for Proximal Ureteral Calculi.

• Muhammad Fazal Ur Rehman
• Muhammad Adnan
• Ali Hassan
• Fawad Humayun Akhtar
• Naseem Javed
• Farman Ali

抄録

目的 本試験の目的は、近位尿管結石を有する患者の管理における尿管鏡下空圧結石破砕術（URS）と体外衝撃波結石破砕術（SWL）の有効性と合併症を比較することであった。方法 この試験では、2018年11月から2019年11月までにNishter Hospital Multanの泌尿器科で近位尿管結石を呈した患者150人を、URSまたはSWLを受けるために1:1に割り付けた。追跡調査で4mm未満の結石片が存在することを無結石とみなした。試験のアウトカムには、1回目、2回目、3回目の治療セッション後の無結石率と腎臓への結石逆流率が含まれていた。結果 総勢75名の患者がそれぞれURSとSWLを受けた。SWLとURSの平均施術時間はそれぞれ61.61±3.21分、85.01±6.75分（P=0.000）、平均施術回数はそれぞれ1.51±0.49回、1.01±0.42回（P=0.000）であった。SWLの1回目、2回目、3回目の施術後の無結石率はそれぞれ64％、77.3％、94.7％であったが、URSの1回目、2回目、3回目の施術後の無結石率はそれぞれ86.7％、92％、100％であった。腎臓への結石の逆流率は、SWL群で0％、URS群で6.7％であった（P=0.000）。結論 近位尿管結石患者の無結石率は、SWL群と比較してURS群の方が有意に高かった。治療費と入院期間はSWL群で低かったが、合併症率は同程度であった。

Objective The goal of this study was to compare the effectiveness and complications of ureteroscopic pneumatic lithotripsy (URS) and extracorporeal shock wave lithotripsy (SWL) in the management of patients with proximal ureteral stones. Methods In this trial, 150 patients presenting with proximal ureteral stones at the Department of Urology of Nishter Hospital Multan from November 2018 to November 2019 were allocated 1:1 to undergo URS or SWL. The presence of stone fragments <4 mm on follow-up was regarded as being stone free. The study outcomes included stone-free rates after first, second, and third treatment sessions and stone retropulsion into the kidneys. Results A total of 75 patients each underwent URS and SWL. The mean procedure times for SWL and URS were 61.61± 3.21 and 85.01±6.75 minutes, respectively (P=0.000), and the mean numbers of procedures were 1.51±0.49 and 1.01±0.42, respectively (P=0.000). Stone-free rates after the first, second, and third sessions of SWL were 64%, 77.3%, and 94.7%, respectively, whereas stone-free rates after the first, second, and third sessions of URS were 86.7%, 92%, and 100%, respectively. Rates of stone retropulsion into the kidneys in the SWL and URS groups were 0% and 6.7%, respectively (P=0.000). Conclusion Compared with SWL, URS had significantly higher stone-free rates in patients with proximal ureteral stones. Treatment costs and hospital stay were lower in the SWL group, whereas complication rates were comparable.

Copyright © 2020, Ur Rehman et al.