Optimization of Extracorporeal Shock Wave Lithotripsy Delivery Rates Achieves Excellent Outcomes for Ureteral Stones: Results of a Prospective Randomized Trial
Optimization of Extracorporeal Shock Wave Lithotripsy Delivery Rates Achieves Excellent Outcomes for Ureteral Stones: Results of a Prospective Randomized Trial
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DOI：
10.1016/j.juro.2015.01.110
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发表时间：
2015-08-01
影响因子：
6.6
通讯作者：
Roth, Beat
中科院分区：
文献类型：
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作者：
Nguyen, Daniel P.;Hnilicka, Stefanie;Roth, Beat
目的：输尿管结石的治疗仍然存在争议。为了确定优化体外冲击波碎石率是否能改善孤立输尿管结石的治疗效果，我们在一项前瞻性随机试验中比较了两种碎石率的结果。材料和方法：自2010年7月至2012年10月，连续254例患者被随机分成两组，分别以每分钟60次和90次/分钟的冲击波碎石。主要研究终点是3个月随访时的结石排净率。次要终点为结石碎裂、治疗时间、并发症和二次治疗率。描述性统计用于比较两组的终点。结果：冲击波频率为90次/min的体外冲击波碎石术患者术后3个月结石排净率显著高于冲击波频率为60次/min的患者(91%比80%，P=0.01)。输尿管上段结石(100%vs83%，p=0.005)和输尿管中段结石(96%vs73%，p=0.03)与输尿管下段结石(81%vs80%，p=0.90)有显著差异。两组治疗时间、并发症及二次治疗率无明显差异。多因素分析显示，冲击波频率为90次/min、结石近端位置、结石密度、结石大小和未置入双J(R)支架是影响碎石成功率的独立因素。结论：优化体外冲击波碎石速度可获得较好的治疗效果。
Purpose: Management of ureteral stones remains controversial. To determine whether optimizing the extracorporeal shock wave lithotripsy delivery rate would improve the treatment of solitary ureteral stones we compared the outcomes of 2 delivery rates in a prospective randomized trial.Materials and Methods: From July 2010 to October 2012, 254 consecutive patients were randomized to extracorporeal shock wave lithotripsy at a shock wave delivery rate of 60 and 90 pulses per minute in 130 and 124, respectively. The primary study end point was the stone-free rate at 3-month followup. Secondary end points were stone disintegration, treatment time, complications and the rate of secondary treatments. Descriptive statistics were used to compare end points between the 2 groups. The adjusted OR and 95% CI were calculated to assess predictors of success.Results: The stone-free rate at 3 months was significantly higher in patients who underwent extracorporeal shock wave lithotripsy at a shock wave delivery rate of 90 pulses per minute than in those who received 60 pulses per minute (91% vs 80%, p = 0.01). Patients with proximal (100% vs 83%, p = 0.005) and mid ureteral stones (96% vs 73%, p = 0.03) accounted for the observed difference but not those with distal ureteral stones (81% vs 80%, p = 0.9, respectively). Treatment time, complications and the rate of secondary treatments were comparable between the 2 groups. On multivariable analysis the shock wave delivery rate of 90 pulses per minute, proximal stone location, stone density, stone size and an absent indwelling Double-J (R) stent were independent predictors of success.Conclusions: Optimizing the extracorporeal shock wave lithotripsy delivery rate can achieve excellent results for ureteral stones.