Outcomes of long-term follow-up of asymptomatic renal stones and prediction of stone-related events
Outcomes of long-term follow-up of asymptomatic renal stones and prediction of stone-related events
复制标题
无症状肾结石长期随访结果及结石相关事件预测
DOI：
10.1111/bju.14565
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发表时间：
2019-03-01
影响因子：
4.5
通讯作者：
Zeng, Guohua
中科院分区：
文献类型：
--
作者：
Li, Xiaohang;Zhu, Wei;Zeng, Guohua
目的评价无症状肾结石患者接受观察的长期结局，并确定与结石相关事件相关的因素。方法回顾性分析选择主动监测结石的无症状肾结石患者。患者每年接受超声检查和临床访视，并提出关于结石症状或并发症发展的标准化问题。随访期间的自发结石排出、结石生长、结石相关症状的发展和需要干预被视为结石相关事件。结果在2007年至2017年期间，对293例患者进行了回顾，以评估无症状肾结石的自然史。平均随访4.2年。自发通过、结石生长、结石相关症状发展和需要干预的总体发生率分别为32.1%、16.7%、28.3%和12.3%。>5 mm的结石和下极结石自发排出的可能性明显较低。糖尿病（DM）、高尿酸血症或非下肾盏结石的患者更容易发生结石生长。>5 mm的结石或非下极结石更有可能出现症状。手术干预的重要预测因素是结石大小（>5 mm）和患者年龄（>60岁）。33例患者的主要治疗是体外冲击波碎石术，3例患者采用输尿管软镜术。结论：无症状肾结石的自然史很少需要干预，尽管它们在中期确实有稍高的症状性事件和增长率。尤其是结石>5 mm、糖尿病、高尿酸血症或非下肾盏结石的患者发生结石相关事件的风险更高，因此应建议定期随访。
Objectives To evaluate the long-term outcomes of patients undergoing observation of asymptomatic renal calculi and identify factors associated with stone-related events. Patients and Methods Patients with asymptomatic renal calculi electing active surveillance of their stones were retrospectively reviewed. Patients underwent annual ultrasonography and clinical visits with standardised questions regarding the development of symptoms or complications from calculi. Spontaneous stone passage, stone growth, development of stone-related symptoms, and requirement for intervention during follow-up were deemed as stone-related events. Results Between 2007 and 2017, 293 patients were reviewed to evaluate the natural history of asymptomatic renal calculi. The mean follow-up was 4.2 years. Overall incidences of spontaneous passage, stone growth, development of stone-related symptoms, and requirement of intervention were 32.1%, 16.7%, 28.3% and 12.3%, respectively. Stones >5 mm and lower pole stones were significantly less likely to pass spontaneously. Patients with diabetes mellitus (DM), hyperuricaemia or non-lower calyceal stone were more likely to experience stone growth. Stones >5 mm or non-lower pole stones were more likely to become symptomatic. Significant predictors of surgical intervention were stone size (>5 mm) and patients' age (>60 years). Primary therapy was extracorporeal shockwave lithotripsy in 33 patients and flexible ureteroscopy in three. Conclusion The natural history of asymptomatic renal stones rarely requires intervention, although they do have a slightly higher rate of symptomatic events and growth over the intermediate term. In particular, patients with stones >5 mm, DM, hyperuricaemia, or non-lower calyceal stones are at higher risk of developing stone-related events, and should therefore be recommended for regular follow-up.