患者对无症状15毫米结算的管理的偏好 - - 避免风险或最大限度地提高成功?
Mohamed Omar1, Hemant Chaparala1, Abdullahi Abdulwahab-Ahmed1
1Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Urology practice
|August 18, 2023
概括
患者根据优先事项选择结石治疗:通过皮肤进行结石切除以获得成功,冲击波结石术以获得最小的风险. 尿路透镜提供了一个平衡,指导泌尿科医生咨询.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 患者为中心的护理
背景情况:
- 无症状的15毫米结石存在管理方面的挑战.
- 患者的偏好显著影响治疗决策.
研究的目的:
- 评估患者对无症状15毫米结石的治疗偏好.
- 确定影响患者在治疗选择中的决策因素.
主要方法:
- 一项调查评估了103名患者在体外冲击波石术,尿路透镜和皮肤穿透性腎石切除术之间做出选择.
- 考虑的患者提供了每个手术的成功率,风险和发病率.
- 统计分析使用了费舍尔精确和威尔科克森签名的等级测试.
主要成果:
- 56%的患者更喜欢尿路透镜,其次是皮肤透 (25%) 和冲击波石 (19%).
- 冲击波石偏好与优先考虑最小风险 (74%) 相相关.
- 穿皮瘤切除术的偏好与优先考虑的高成功率 (81%) 相相关.
- 尿路透镜患者对成功和风险的评价均为中等.
结论:
- 患者对结石治疗的选择是由不同的优先事项驱动的:最大限度地提高成功率 (透皮结石切除术) 或最大限度地降低风险 (冲击波结石).
- 尿路透镜对许多患者来说是一个平衡的选择.
- 了解这些决策因素有助于泌尿科医生在患者咨询和预期管理中发挥作用.
相关概念视频
Urinary Tract Calculi III: Medical Management
9
The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
9
Urinary Tract Calculi V: Nursing Management
14
AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
14
Urinary Tract Calculi VI: Surgical Management
10
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
10
Urinary Tract Calculi IV: Nutrition Therapy and Prevention
11
Management of renal calculi focuses on effective strategies like tailored nutrition and hydration therapy. Adjusting diet and fluid intake reduces stone formation and recurrence, making these interventions simple yet powerful in kidney stone prevention and management.Understanding Kidney StonesKidney stones form when calcium, oxalate, uric acid, and cystine concentrate and crystallize in urine. Factors contributing to their formation include genetic predisposition, certain medical conditions,...
11
Urinary Tract Calculi I: Introduction
16
Renal calculi, or kidney stones, are solid deposits of minerals and salts formed inside the kidneys. In medical terminology, "calculus" refers to the stone itself, while "lithiasis" describes the process of stone formation. Depending on their location within the urinary system, these stones may be classified as either urolithiasis, when situated within the urinary tract, or nephrolithiasis, when located within the kidneys. Each term signifies the specific impact of the stone.Predisposition...
16
Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
13
Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
13


