身體質量指數可預測不同位置輸尿管結石
對於體外震波碎石處置之成功率
林鉅棟1、黃旭澤1、廖俊厚1、楊弘如2、楊登凱2
天主教耕莘醫院新店總院 泌尿科1天主教耕莘醫院永和分院 外科部2
Body mass index (BMI) were independent predictors of extracorporeal shock wave lithotripsy (SWL) disintegration failure for different level of ureteral calculi
Shu-Che Huang1, Chun-Hou Liao1, Hungju Yang2, Teng-Kai Yang2
Division of Urology, Department of Surgery, Cardinal Tien Hospital, Taipei, Taiwan.;
1Department of Surgery, Yonghe branch, Cardinal Tien Hospital, New Taipei City, Taiwan
Purpose: Effective stone disintegration of extracorporeal shockwave lithotripsy (ESWL) may depend on patient-related factors and stone-related factors. We investigate predictors of disintegration failure in ESWL for solitary ureteral calculi.
Materials and Methods: From July 2008 to May 2010, 203 patients who underwent ESWL for solitary and radiopaque ureteral calculi were enrolled. ESWL disintegration failure was defined as the presence of radiopaque stone fragments in the KUB. Clinical and radiologic data were collected, and factors related to ESWL failure were analyzed.
Results: Fifty-two patients (25.6%) showed ESWL failure, with a mean follow-up of 41 days. Forty patients (19.7%) required retreatment. Patients with ESWL failure had significantly higher body weight, body mass index (BMI), and buttock circumference (BC) than patients for whom ESWL was successful. Univariate analysis showed that stone burden (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03-1.06) and BC (OR, 1.06; 95% CI, 1.01-1.11) were predictors of ESWL failure, while BMI was a potential predictor with borderline significance (OR, 1.09; 95% CI, 0.99-1.20). Multivariate analysis showed that stone burden (OR, 1.04; 95% CI, 1.03-1.06) was a significant predictor for all patients. On stratifying patients according to the level of ureteral calculi, BC was found to be an independent predictor (OR, 1.35; 95% CI, 1.02-1.80) for ESWL failure for middle/lower ureteral calculi and BMI (OR, 1.47; 95% CI, 1.13-1.91) for upper ureteral calculi.
Conclusion:
Stone burden is the main predictor of ESWL failure for all patients with ureteral calculi. BC
and BMI are independent predictors for ESWL failure for middle/lower ureteral calculi and upper ureteral calculi, respectively.