Abstract

Purpose

To compare the outcome of shock wave lithotripsy (SWL) for upper lumbar ureteric stones using the alternating bidirectional approach versus the standard approach during the first session.

Methods

Our study was a randomized controlled trial including patients with single radio-opaque stone < 1 cm located in the upper lumbar ureter (from the ureteropelvic junction till the level medial to the lower margin of the kidney). SWL was conducted using electromagnetic Dornier Gemini Lithotripter. In group 1, patients were treated with the alternating under and over-table approach during the first session only and if other sessions were needed, the standard under-table approach was used. In group 2, patients were treated with the standard under-table approach during all sessions. Stone disintegration after the first session was assessed by kidney–ureter–bladder X-ray, renal ultrasonography and noncontrast computed tomography. Moreover, the incidence and severity of postoperative complications were evaluated.

Results

Forty-eight patients in each group completed the study. Patient demographics and stone characteristics were comparable in both groups. Complete disintegration was achieved in 41.7% of patients in group 1 versus 18.8% in group 2 (P = 0.021). Stone-free rate (SFR) was 58.3% and 20.8% in group 1 and 2 respectively (P = 0.001). The mean session time was 56.42 min in group 1 versus 46.35 min in group 2 (P < 0.001). There was no significant difference in postoperative complications.

Conclusion

Stone disintegration and SFR after the first SWL session are higher when using the alternating bidirectional approach for upper lumbar ureteric stones at the expense of longer procedural duration.

Trial registration

ClinicalTrials identifier (ID: NCT03243682), clinicaltrials.gov

中文翻译：

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上腰段输尿管结石冲击波碎石术中交替双向与标准方法的对比：一项随机对照试验

摘要

目的

比较在第一次治疗期间使用交替双向入路与标准入路对上腰部输尿管结石进行冲击波碎石术 (SWL) 的结果。

方法

我们的研究是一项随机对照试验，包括位于上腰部输尿管（从输尿管骨盆交界处到肾脏下缘内侧水平）的单个不透射线结石 < 1 cm 的患者。SWL 是使用电磁 Dornier Gemini Lithotripter 进行的。在第 1 组中，患者仅在第一次治疗期间接受桌下和桌下交替治疗，如果需要其他治疗，则使用标准桌下治疗。在第 2 组中，患者在所有治疗期间均采用标准桌下方法进行治疗。通过肾-输尿管-膀胱 X 射线、肾脏超声检查和非对比计算机断层扫描评估第一次治疗后的结石崩解情况。此外，还评估了术后并发症的发生率和严重程度。

结果

每组 48 名患者完成了研究。两组患者的人口统计学和结石特征具有可比性。第 1 组 41.7% 的患者完全崩解，第 2 组为 18.8%（P  = 0.021）。第 1 组和第 2 组的无结石率 (SFR) 分别为 58.3% 和 20.8% ( P  = 0.001)。第 1 组的平均会话时间为 56.42 分钟，第 2 组为 46.35 分钟（P  < 0.001）。术后并发症无显着差异。

结论

当使用交替双向方法治疗上腰段输尿管结石时，第一次 SWL 治疗后的结石崩解和 SFR 更高，但手术持续时间更长。

试用注册

ClinicalTrials 标识符（ID：NCT03243682），clinicaltrials.gov