Current perspectives on urolithiasis management in China.
Current perspectives on urolithiasis management in China.
复制标题
中国尿石症治疗的现状展望。
DOI：
10.1007/s00345-019-03026-9
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发表时间：
2019
影响因子：
3.4
通讯作者：
Xiong Yunhe
中科院分区：
文献类型：
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作者：
Yang Sixing;Song Chao;Xiong Yunhe
尊敬的编辑：几十年来，中国在尿石症的治疗方面取得了巨大的成功[1]。然而，中国泌尿科医生是否以及如何遵循公认的指南[2-5]尚不清楚。为了回答这个问题，我们在中国进行了一项全国性的调查。在这里，我们简要报告的结果，指出目前的问题，并提出建议，在中国尿石症的管理。2019年4月至6月，向中国三级/教学，省/市和县医院的690名泌尿外科医生发送了38项问卷，其中683名（98.9%）回答，681名（68.7%）返回有效回答。如表1所示，对于0.6 - 1.0 cm的首次非复杂性上尿路结石，397名（58.4%）泌尿科医生建议体外冲击波碎石术（ESWL），而279名（41.0%）建议生活方式调整（n= 64，9.4%）或药物驱逐治疗（n= 215，31.6%）。对于1.0 ~ 2.0cm的结石，287名（42.2%）泌尿科医生推荐ESWL，280名（41.2%）推荐输尿管镜激光碎石术，67名（9.9%）推荐经皮肾镜取石术（PCNL）。对于1.0 ~ 2.0cm的结石，468名（68.8%）泌尿科医生推荐PCNL，127名（18.7%）推荐激光碎石。大多数（658，96.8%）泌尿科医生承认指南的重要性，并愿意遵循它们。根据调查，沿着我们的经验，我们了解到大多数泌尿科医生按照中国发布的指南处理尿石症[5]。然而，存在若干问题。首先，没有完全遵循指南中建议的纳入和排除标准。例如，不同的医院甚至同一医院的不同泌尿科医生对同一患者可能采用不同的管理方法，亚洲泌尿外科协会强调了这一点[3]。因此，建议所有泌尿外科医生都应了解推荐标准，并应重视ESWL和药物驱逐治疗。其次，部分泌尿科医师未对结石的病因进行研究，对结石复发的预防重视不够。我们会鼓励泌尿科医生采取更多的努力来调查结石的原因。第三，一些医院的先进技术和设备不足，这是未能遵守准则的原因之一。因此，医疗资源，包括先进的技术和设备，应提供给所有有资格处理尿石症的医院。第四，应考虑中国患者在民族、遗传、饮食和环境因素方面的独特性。例如，由于尿路直径较小，中国患者需要更薄的柔性或刚性肾镜。最后，中国泌尿外科医生应该更加创新，帮助开发先进的技术和设备，例如尖端带有压力监测装置的精细经皮肾镜，更好的人工智能体外冲击波碎石机，以避免肾脏损伤，以及激光碎石机可以打破结石而不会对肾脏造成热损伤。我们相信，我们的调查结果和我们的意见是有价值的，以全面评估目前的临床实践和更好地遵守指南的尿石症在中国的管理。
Dear Editor Great success has been achieved in the management of urolithiasis in China over the decades [1]. However, whether and how Chinese urologists follow the accepted guidelines [2–5] is unknown. To answer the question, we performed a nationwide survey in China. Here we briefly report the results, point out current issues, and propose recommendations on urolithiasis management in China. Between April and June 2019, a 38-item questionnaire was sent to 690 urologists at tertiary/teaching, provincial/municipal, and county hospitals in China, of whom 683 (98.9%) responded, and 681 (68.7%) returned valid responses. As shown in Table 1, for the first-time uncomplicated upper urinary tract stones between 0.6 and 1.0 cm, 397 (58.4%) urologists recommended extracorporeal shockwave lithotripsy (ESWL), whereas 279 (41.0%) recommended lifestyle adjustment (n= 64, 9.4%) or medical expulsive therapy (n= 215, 31.6%). For the stones between 1.0 and 2.0 cm, 287 (42.2%) urologists recommended ESWL, and 280 (41.2%) recommended ureteroscopic laser lithotripsy, whereas 67 (9.9%) recommended percutaneous nephrolithonomy (PCNL). For the stones between 1.0 and 2.0 cm, 468 (68.8%) urologists recommended PCNL, and 127 (18.7%) recommended laser lithotripsy. Most (658, 96.8%) urologists acknowledged the importance of the guidelines and would like to follow them. Based on the survey, along with our experience, we have learned that most urologists managed urolithiasis following the guidelines published in China [5]. However, several issues existed. First, the recommended inclusion and exclusion criteria in the guidelines were not fully followed. For example, different management approaches may be applied by different hospitals or even by different urologists at the same hospitals for the same patients, as highlighted by theUrological Association of Asia [3]. Thus, the recommended criteria should be made known to all urologists, and more attention be paid to ESWL and medical expulsive therapy. Second, some urologists did not search for the etiology and paid little attention to stone recurrence prevention. We would encourage urologists to take more efforts to investigate the causes of the stones. Third, advanced technology and equipment were insufficient at some hospitals, which was one of the reasons for failing to comply with the guidelines. Thus, medical resources, including advanced technology and equipment, should be provided to all hospitals qualified to manage urolithiasis. Fourth, the unique characteristics of Chinese patients, in terms of ethnical, genetic, dietary and environmental factors, should be considered. For example, thinner flexible or rigid nephroscopes are required for Chinese patients due to smaller diameters of the urinary tract. Finally, Chinese urologists should be more innovative and help develop advanced techniques and equipment, such as a fine percutaneous nephroscope with a pressure-monitoring device in the tip, a better extracorporeal shock wave lithotripter with artificial intelligence to avoid the kidney injuries, and a laser lithotripter that can break the stones without thermal damage to the kidney. We believe that the findings of our survey and our opinions are of value for a comprehensive evaluation on current clinical practice and better compliance with the guidelines for urolithiasis management in China.