A comparative sutdy of various means for the treatment of upper urinary tract calculi (report of 3218 cases ) / 中华泌尿外科杂志

ABSTRACT

Objective To study and evaluate various therapeutic means for upper urinary tract calculi. Methods 3 218 cases of upper urinary tract calculi were reviewed.1 365 were pure kidney stones,651 complicated kidney stones,558 group Ⅰ ureteral stones,452 group Ⅱ ureteral stones and 192 group Ⅲ ureteral stones. Results ESWL (extracoporeal shock wave lithotripsy) has been the treatment of choice for pure kidney stones and for groupⅠ ureteral stones.Open surgery has been the best for complicated kidney stones and group Ⅱ,Ⅲ ureteral stones.1 164 patients underwent lithotomy and 1 923 ESWL.131 cases of group Ⅱ ureteral stones in the middle or lower segment of ureter were treated by ureteroscopic lithotripsy.Of the complicated kidney stones,residual stones were observed in 57 (8.8%).1.8%( n =12) of such cases underwent nephrectomy.The complete stone elimination rate in 3 months after ESWL was 81.6% whereas open operation was needed in 18.4%.Ure teroscopic lithotripsy yielded the poorest outcome,nephrectomy being undertaken afterwards in 0.8% and lithotomy in 6.1%. Conclusions ESWL,ureteroscopic lithotripsy,ballast lithotripsy or the combined use of 2 methods makes the surgical management of upper urinary tract calculi easier with less suffering to the patients.The use of double internal stent could reduce the surgical complications.Stone street after ESWL should be well taken care of and inflammation should be well controlled.Skilled technique is needed for ureteroscopic lithotripsy.