PDF(Pubmed)
Abstract：
Extracorporeal shock wave lithotripsy (ESWL) is a safe and efficient treatment option for urinary stone disease. The overall stone-free rate (SFR) varies significantly. This study aimed to assess the influence of stone size, location, stone density, and skin-to-stone distance (SSD), on the outcome of ESWL. We assessed whether pre-treatment non-contrast-enhanced CT scan (NCCT) confers significant advantages compared to kidney-ureter-bladder film (KUB) only. We reviewed the medical records of 307 cases (165 men, 142 women) with renal and ureteral stones treated consecutively at our institution with ESWL between 2020 and 2023. 44 of these underwent a NCCT. The outcome of ESWL was defined in two ways: visible stone fragmentation on KUB, and the need for further treatment. Overall success of fragmentation was 85% (261 patients). 61% of patients (n = 184) didn\'t need any further treatment. Stone size and location correlated significantly with treatment outcomes regarding the need for further treatment (p = 0.004) and stone fragmentation (p = 0.016), respectively. Unlike mean SSD (p = 0.462), the mean attenuation value (MAV) significantly correlated with the need for retreatment (p = 0.016). MAV seems to be a better predictor of treatment success (AUC of the ROC curve: 0.729), compared to stone size (AUC: 0.613). The difference between groups (with and without NCCT) in both treatment outcomes did not reach statistical significance. During decision-making, information regarding SSD and MAV can be useful in more dubious scenarios. However, it appears that their inclusion doesn\'t provide substantial advantages when compared to relying solely on KUB.
摘要：
体外冲击波碎石术（ESWL）是一种安全有效的泌尿系结石疾病治疗方法。总体无石率（SFR）差异显著。这项研究旨在评估石头大小的影响，location,石材密度,和皮肤到石头的距离（SSD），关于ESWL的结果。我们评估了与仅肾输尿管膀胱膜（KUB）相比，治疗前非对比增强CT扫描（NCCT）是否具有显着优势。我们回顾了307例(165例男性，142名妇女）患有肾和输尿管结石，在2020年至2023年期间在我们的机构接受ESWL连续治疗。其中44人接受了NCCT。ESWL的结果以两种方式定义：KUB上可见的结石碎片，以及进一步治疗的需要。碎片的总体成功率为85％（261名患者）。61%的患者（n=184）不需要任何进一步的治疗。结石大小和位置与需要进一步治疗（p=0.004）和结石碎片（p=0.016）的治疗结果显着相关，分别。与平均SSD(p=0.462)不同，平均衰减值(MAV)与是否需要再治疗显著相关(p=0.016).MAV似乎是治疗成功的更好预测指标（ROC曲线的AUC：0.729），与结石大小相比（AUC：0.613）。两组（有和没有NCCT）在两种治疗结果中的差异均未达到统计学意义。在决策过程中,有关SSD和MAV的信息在更可疑的情况下可能很有用。然而,与仅仅依靠KUB相比，它们的加入似乎没有提供实质性的优势。
