신녹각석에서 요관부목없이 ESWL단독치료 중 발생한 요관폐색에 대한 고찰
Review of Ureteral Obstruction during ESWL Monotherapy without Ureteral Stenting for Staghorn Calculi
안희, 민권식, 손운목,
소속 상세정보
안희 ( )
인제대학교 의과대학 부속병원
민권식 ( )
인제대학교 의과대학 부속병원
손운목 ( )
인제대학교 의과대학 부속병원
KMID : 0358319960370050559
Abstract
ESWL monotherapy has been consideredd a valid initial treatment for stagdhorn calculi. In an effort to reduce post-ESWL obstruction, many urologists plasce ureteral stents before ESWL. The use of ureteral stents has proved to contribute to
successful
stone passage and to reduce post-ESWL morbidity but there also have been reports of complications that might have been caused by indwelling ureteral stents. From January 1989 to December 1995, we reviewed 29 patients with ureteral obstruction
after
ESWL
(EDAP LT-01 & 02) monotherapy without ureteral stenting in 47 patients with staghorn calculi. Ureteral obstruction was occurred in 29 patients (61.7%); 16 (55.2%) in the upper ureter, 11 (37.9%) in the lower ureter, and 2 (6.9%) in the
mid-ureter.
Steinstrasse was occurred in 13 patients (13/29, 44.8%); 8 (61/5%) in the lower ureter, 4 (30.7%) in the upper ureter, and 1 (7.7%) in the mid-ureter. Ureteral obstruction was occurred regardless of the size of the staghorn calculi(length,
breadth,
volume). The method of resolving ureteral obstruction was additional ESWL (21 patients, 72.4%), and auxillary procedures including PCN (4 patients, 13.8%), push up procedure (1 patient, 3.4%), push up & double J stenting (1 patient, 3.4%), and
ureterolithotomy (2 patient, 6.9%). Mean number of session of ESWL resolving ureteral obstruction was 3.27. Overall complete stone-free rate of staghorn calculi was 55.3%(26 patients).
Our results indieate that postoperative ureteral obstrucion is easily relieved without major complicaton by additional ESWL or auxillary procedures. Therefore, we believe that ESWL monotherapy without ureteral stenting may be adequate treatment
modality
of staghorn calculi.
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