PDF(Pubmed)
Abstract：
To evaluate the optimal duration of Medical Expulsive Therapy (MET) application for distal ureteric stones on a time period based manner. 89 patients with 5-10 mm distal ureter stones received tamsulosin (0.4 mg) for MET and diclofenac sodium (75 mg) for analgesia. Patients were evaluated once a week for 4 weeks. Radiologic stone passage was evaluated by kidney ureter bladder (KUB) and ultasonography where non-contrast computed tomography (NCCT) was also performed if needed. While 23 cases (28.4%) were SF after first week, 23 were SF (28.4%) after 2 weeks, 9 cases (11.1%) after 3 and lastly 7 cases (8.6%) became SF after four weeks. Nineteen (23.5%) cases were not SF after 4 weeks. A positive relationship was found between the time period elapsed for stone passage and ureteral wall thickness (UWT) along with the degree of hydronephrosis. In addition, mean number of renal colics and emergency department (ED) visits were found to be higher in patients passing stones in the 4th week along with the ones who could not despite MET. SFR for distal ureteric stones sizing 5-10 mm was higher within the first 3 weeks under MET application. Thus, waiting for a longer period of time may result in increased analgesic and unnecessary MET treatment with increased risk of emergency department visits and additional costs as well. We believe that other options could be considered in such cases who are not SF at the end of the first 3 weeks.
摘要：
以时间段为基础的方式评估输尿管远端结石的医学强迫性治疗（MET）应用的最佳持续时间。89例输尿管远端5-10mm结石患者接受坦索罗辛（0.4mg）用于MET，双氯芬酸钠（75mg）用于镇痛。患者每周评估一次，持续4周。通过肾输尿管膀胱（KUB）和超声检查评估放射学结石通道，必要时还进行非对比计算机断层扫描（NCCT）。而23例（28.4%）在第一周后为SF，2周后SF23例（28.4%），3周后9例（11.1％），4周后7例（8.6％）成为SF。19例(23.5%)患者4周后未获得SF。发现结石通过的时间与输尿管壁厚度（UWT）以及肾积水的程度之间存在正相关关系。此外,发现在第4周内通过结石的患者以及尽管MET仍无法通过结石的患者的平均肾绞痛和急诊科（ED）就诊次数较高。在MET应用的前3周内，大小为5-10mm的输尿管远端结石的SFR较高。因此，等待更长的时间可能导致镇痛和不必要的MET治疗增加,同时增加急诊就诊风险和额外费用.我们认为，在前3周结束时不是SF的情况下，可以考虑其他选择。
