石头残留碎片:对定义的系统审查,诊断标准
O F Çavdar1, A Aydin2,3,4, T Tokas5,6
1Necmettin Erbakan University, Urology, Konya, Türkiye.
World journal of urology
|March 28, 2025
概括
治疗结石后的剩余石块碎片 (RSF) 缺乏标准化的定义,影响患者的治疗结果. 本综述提出了标准化定义和成像协议,以更好地管理RSF.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 腎臟病學 (nephrology) 是一種醫學專業.
- 医疗成像医学成像
背景情况:
- 石头残留碎片 (RSF) 对于评估尿病治疗成功至关重要.
- 目前对RSF的定义和诊断方法在不同治疗方式之间缺乏共识.
- 标准化是必要的,以提高可比性和患者的结果.
研究的目的:
- 系统地审查和评估RSF的定义和诊断方法.
- 在治疗模式中标准化RSF定义和诊断.
- 为RSF患者提出风险分层模型和管理方法.
主要方法:
- 根据PRISMA指南,在Embase,MEDLINE和Cochrane数据库中进行了系统的文献搜索.
- 包括29项研究,按治疗方式分类:体外冲击波石 (ESWL),逆行性内手术 (RIRS) 和皮肤穿透性腎石切除术 (PCNL).
- 使用Quadas评分系统评估研究质量;根据新出现的类别开发了一个风险分层模型.
主要成果:
- RSF的定义各不相同,通常使用<2毫米,<4毫米或<5毫米的值,通常不包括阻塞或感染的碎片.
- 计算机断层扫描 (CT) 是最常见的诊断成像方式.
- 报告的RSF发生率差异很大:ESWL的21-59%,RIRS的20-60.5%,PCNL的20-60%.
结论:
- 在定义RSF方面存在重大不一致,影响治疗结果的可比性.
- CT是RSF评估的首选成像方式.
- 建议采用标准化定义和成像协议,以提高可比性和患者的治疗结果,特别是对于4毫米以上或在下极的碎片.
相关概念视频
01:28Urinary Tract Calculi I: Introduction
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...
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
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...
01:30Urinary Tract Calculi III: Medical Management
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)...
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention
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,...
01:28Urinary Tract Calculi V: Nursing Management
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...
01:25Urinary Tract Calculi VI: Surgical Management
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...