馬來西亞北部輸尿管結石之診斷及處理
林永健
馬來西亞 亞羅士打 仁愛專科醫藥中心 泌尿外科
The diagnosis and management of ureter stones in northern Malaysia
Eng-Kian Lim
Division of Urology, Putra Medical Centre, Alor Setar, Malaysia
Purpose: This study is to introduce the presently clinical practice in regarding diagnosis tool and management of the ureter stones in northern Malaysia single hospital urology department.
Materials and Methods: Total 634 cases of ureter stones were enrolled in this study during June, 2011 to February 2016. Presenting S/S including: renal colic, hematuria, dysuria, etc. Average age of patients was 46.76 years old (15 years old to 88 years old). Male to female ratio were 462: 172. Mostly Renal Ultrasound and CT scan without enhancement and few KUB were used for diagnosis. Concerning lab tests and urine tests were done. All patient received ureteroscopic stone extraction by lithoclast with or without JJ stenting (Fr 6 X 26/24 cm JJ stent) under spinal anesthesia or general anesthesia.
Results: All the imaging study revealed obstructive hydronephrosis while obstructive uropathy was noted in 121 cases. Lab data revealed hyperuricemia in 261 cases. Urine test revealed hematuria in 322 cases. Left side ureter stone was noted in 301 cases while right side stone were 300 cases whereas bilateral side stones were 23 cases. 6 cases were ureteropelvic junction stones whereas 10 cases had concomitantly bladder stones (a 80 years old male received cystolithotomy for huge bladder stone 4 cm X 3 cm and right URSM + JJ stent concomitantly) and 1 had penile urethral stone whom received cystoscopy lithotripsy simultaneously. 2 cases had incidentally noted of papillary bladder TCC and bladder papilloma whom received biopsy with close surveillance. Average hospitalization was 1-2 days with minimal complication. Foley was keep for 1 day. Average JJ stent was left for 1-2 weeks whereas 1 month for renal pelvic stone .
Conclusion: Idiopathic uric acid nephrolithiasis appears to be increasing in prevalence as in our urolithiasis cases. Ultrasound is mostly used for the first line diagnostic tool in detecting nephrolithiasis or obstructive hydronephrosis. While CT scan without enhancement is more sensitive to detect ureter stone especially uric acid stone (radiolucent) without renal toxicity consequences.1 Further, CT scan is cheap (about NT 3500), fast and convenient. While it has long been known that low urine pH is associated with uric acid stones, alkalinization treatment will provide benefit in mostly cases.2 Reference:
1. Tin C Ngo and Dean G Assimos. Uric Acid Nephrolithiasis: Recent Progress and Future Directions. Rev Urol. 2007 Winter; 9(1): 17-27.
2. Bijan Shekarriz, Marshall L. Stoller. Uric Acid Nephrolithiasis: Current Concepts and Controversies. The Journal of Urology. Volume 168, Issue 4, part 1 October 2002, Pages 1307-1314.