身體質量指數不會影響以第三代體外震波碎石機治療單一輸尿管結石之結果
鍾慧明、廖永明、蔡維明、蔡永成
基督教花蓮門諾會醫院泌尿科
Obesity has no impacts on the treatment outcome for a solitary ureteral stone when using a third generation lithotripter
Hui-Ming Chung, Yung-Min Liao, Wei-Min Tsai, Yung-Chen Tsai
Department of Urology, Mennonite Christian Hospital, Hualien
Taiwan
Purpose: We investigated the impact of obesity, measured by body mass index (BMI), waist circumference (WC) and buttock circumference (BC), on the treatment outcome for a solitary ureteral stone using a third generation lithotripter.
Materials and Methods: From August 2014 to July 2015, we enrolled 84 patients who underwent extracorporeal shock wave lithotripsy (ESWL) for a solitary ureteral stone, with a mean (range) size of 6.9 (4-15) mm, in this community hospital. ESWL failure was defined as when treatable stones (stone > 3 mm) or ureteral obstruction were present 30 days after the ESWL, or when repeat treatment with ESWL or curative ureteroscopy was performed 30 days within the initial ESWL due to intractable pain or signs of obstruction. BMI, WC, BC, stone size and localization, and treatment parameters were evaluated for their prognostic relevance on therapy success. Logistic regression was used to calculate the odds ratios, and p-value < 0.05 was considered statistically significant.
Results: Twenty-eight patients (33%) experienced ESWL failure, with a mean (range) follow-up of 28.2 (4-50) days. There was no significant difference between the two groups with or without ESWL failure in terms of mean BMI, WC, and BC. The three indices for obesity were not predictors for ESWL failure in the univariate analysis. The only significant predictor for ESWL failure was stone length. Compared to those with stone length < 10 mm, the odds ratio (OR) was 8.41, (95% confidence interval [CI], 2.36 -29.91, p <0.001) for those with stone >= 10 mm. The results remained unchanged after multivariate adjustment.
Conclusions: Stone length is the major predictor for ESWL failure. Using a third generation lithotripter, obesity has no impact on the treatment outcome for ureteral stones. ESWL using the newest third generation lithotripter should be considered as the first-line treatment in patients with ureter stones, regardless of their obese status.