目的：回顾可能影响在资源充足的三级中心实现本指南建议的能力的因素。根据当前的国家健康与护理卓越研究所（NICE）指南，对于诊断后48小时内不太可能通过结石的有症状的肾绞痛患者,应进行明确治疗(原发性输尿管镜检查(URS)或冲击波碎石术(ESWL)).
方法：回顾性回顾了2019年1月至12月到急诊科诊断为输尿管或肾结石的所有患者。紧急干预率，比较接受初次确定性手术治疗的患者与接受初次确定性手术治疗的患者的干预和结局的危险因素。仅通过尿道支架置入术缓解主要症状。
结果：共有244例患者因有症状的输尿管绞痛而需要手术治疗，但没有尿路感染的症状。其中,92例患者（37.7％）接受了原发性URS（82例）或ESWL（9例）的明确治疗。该过程的平均时间为25.5小时(范围:1-118)。与主要支架组相比，接受主要确定性治疗的患者更有可能患有较小和远端结石。与紧急支架置入术相比，在有监督的环境下进行原发性输尿管镜检查的可能性更大。
结论：虽然明确的治疗成功率很高，在一个高容量的三级转介中心，将其提供给所有患者可能是不可行的，与紧急支架提供了一个安全和快速的临时措施。决定提供最终治疗能力的因素是结石位置，石头的大小和剧院的居民监督。
OBJECTIVE: To review the factors that may influence the ability to achieve the present
guidelines\' recommendations in a well-resourced tertiary centre. According to current National Institute for Health and Care Excellence (NICE)
guidelines, definitive treatment (primary ureteroscopy (URS) or shock wave lithotripsy (ESWL)) should be offered to patients with symptomatic renal colic that are unlikely to pass the stone within 48 h of diagnosis.
METHODS: Retrospective review of all patients presenting to the emergency department between January and December 2019 with a ureteric or renal stone diagnosis. The rate of emergency intervention, risk factors for intervention and outcomes were compared between patients who were treated by primary definitive surgery vs. primary symptom relief by urethral stenting alone.
RESULTS: A total of 244 patients required surgical management for symptomatic ureteric colic without symptoms of urinary infection. Of those, 92 patients (37.7%) underwent definitive treatment by either primary URS (82 patients) or ESWL (9 patients). The mean time for the procedure was 25.5 h (range: 1-118). Patients who underwent primary definitive treatment were likelier to have smaller and distally located stones than the primary stenting group. Primary ureteroscopy was more likely to be performed in a supervised setting than emergency stenting.
CONCLUSIONS: Although definitive treatment carries high success rates, in a high-volume tertiary referral centre, it may not be feasible to offer it to all patients, with emergency stenting providing a safe and quick interim measure. Factors determining the ability to provide definitive treatment are stone location, stone size and resident supervision in theatre.
