Changing modality of the treatment in upper urinary tract calculi. Percutaneous nephrolithotripsy and transurethro-ureteral lithotripsy

1984年3月から1985年4月までの間に超音波破砕により経皮的に治療した上部尿路結石70例(73腎単位)の成績を報告する.腎瘻を介して53例中49例に, 経尿道的尿管操作により12例中11例の結石除去に成功した.合併症としては血尿と発熱が主で, 3例に輸血を必要とした.経皮的超音波結石破砕法(PNL)は経尿道的尿管操作法(URS)とともに従来の手術法に代わる上部尿瘻結石治療法として有用であることが判明した.ESWL(体外衝撃波結石破砕法)の適応となる腎結石症例に対してはESWLとPNLの両治療法のあることを説明し, 患者にその選択をゆだねるべきであると思われる
From March, 1984 to April, 1985, 70 cases of upper urinary tract calculi (73 renal units) were treated by percutaneous nephrolithotripsy or transurethro-ureteral lithotripsy, mainly utilizing ultrasonic lithotrite. While in the early period of treatment, two stage procedure of creation of nephrostomy tract and percutaneous nephrolithotripsy was performed for renal and upper or middle part of the ureteral calculi, one stage procedure, nephrostomy tract formation followed by ultrasonic nephrolithotripsy is commonly used in recent cases. During this period, conventional stone surgery was seen in 6 cases of pyelolithotomy and 2 of ureterolithotomy, while 52 cases of stone surgery were performed during the earlier period (from January, 1983 to February, 1984). Renal and upper or middle part of ureteral calculi were successfully removed in 49 out of 58 cases (84.5%). Most of the patients required 1 or 2 trials of percutaneous nephrolithotripsy. Middle or lower part of ureteral calculi were removed in transurethro-ureteral approach in 11 of the 12 cases. Hematuria and fever were most common complications after treatment and 3 patients required blood transfusion after 3 or 4 sessions of nephrolithotripsy. Percutaneous nephrolithotripsy and transurethro-ureteral lithotripsy are now widely used for treatment of upper urinary tract calculi, replacing the conventional surgical treatment. Moreover, very recently, extracorporeal shock wave lithotripsy is available in Japan. To the patients with renal calculi indicative of this treatment, both percutaneous nephrolithotripsy and extracorporeal shock wave lithotripsy are introduced and either way of treatment can be chosen by the patient himself.