尿管結石およびシスチン結石にたいするESWL

Abstract

1)尿管結石の長径1 cm以下の場合, 1～2 cmの非嵌頓の場合には無処置ESWL, それ以外の結石ではTUL等との併用を行うべきである.2)シスチン結石の破砕はやや困難であるが, 1回の衝撃波数を増やさず, 治療回数を増し, 経口投与による結石融解を併用したESWLが可能になる

We report our experience with extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral and cystine stones, which are known to be difficult to treat by this method. First, in order to determine the effectiveness of the ureteral catheter in the destruction of ureteral stones, we compared the clinical results of 121 patients treated without the catheter and 141 patients inserted with the catheter. There was no significant difference in the success rate between the two groups regardless of stone size, which indicates that the use of the ureteral catheter had no effect on the outcome of treatment. We then studied the clinical results of impacted ureteral stones which are especially difficult to destroy. Excretory urography was performed to non-invasively diagnose these stones, and those without visualization in the ureter below the stone were diagnosed as impacted stones and treated by ESWL without the ureteral catheter. Among the stones with a diameter of 1 to 2 cm, the success rate was significantly lower in impacted stones compared to non-impacted stone. These findings suggest that ESWL treatment without the ureteral catheter may be effective for ureteral stones with a diameter of less than 1 cm and non-impacted stones with a diameter of 1 to 2 cm, while combination therapy with other methods such as TUL may be better for other stones. We also performed ESWL on 6 patients with renal stones and 2 patients with ureteral stones which were cystine stones. Renal stones required an average 4.1 treatment with an average of 1, 875 shocks per treatment, and ureteral stones required 1.5 treatment with an average of 1, 833 shocks.(ABSTRACT TRUNCATED AT 250 WORDS)