摘要肾结石是常见的泌尿系统疾病之一,其中无症状肾结石的自然进展仍不清楚。目前关于无症状肾结石的处理方法主要包括主动监测、药物溶石治疗、体外冲击波碎石(ESWL)、经皮肾镜碎石取石术(PCNL),以及逆行肾内手术(RIRS)。采取何种积极有效的治疗方法预防无症状肾结石的不良结局、促进患者康复、并减少潜在的不必要的治疗手段,成为泌尿外科临床医生的研究热点。通过检索Medline、Cochrane、PubMed以及Web of Science数据库,对无症状肾结石治疗相关的文献进行综述,详细阐述无症状肾结石的最新治疗进展,有助于指导泌尿外科医生的临床决策,从而为无症状肾结石患者提供更好的治疗方案。
Abstract：Kidney stones are one of the most common urinary tract diseases. Among them, the natural progression of asymptomatic kidney stones remains unclear. Current treatments for asymptomatic kidney stones include “Active Surveillance”, "Pharmacological Treatment", “Extracorporeal Shock Wave Lithotripsy (ESWL)”, “Percutaneous Nephrolithotomy (PCNL)” and “Retrograde Intrarenal Surgery (RIRS)". What kind of active and effective treatment should be adopted to prevent the adverse outcomes of asymptomatic kidney stones, promote the rehabilitation of patients, and reduce the potential unnecessary treatment? Which has become a research hotspot for urology clinicians? By searching Medline, Cochrane, PubMed and Web of Science databases, this study reviewed the literature on asymptomatic kidney stone treatment and detailed the latest treatment advances, which may help to guide the clinical decision-making of urologists, and provide better intervention for patients with asymptomatic kidney stones.
[1] HESSE A, BRÄNDLE E, WILBERT D, et al. Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000. Eur Urol, 2003,44(6): 709-713. [2] STAMATELOU KK, FRANCIS ME, JONES CA, et al.Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney Int, 2003,63(5):1817-1823. [3] ZENG G, MAI Z, XIA S, et al.Prevalence of kidney stones in China: an ultrasonography based cross-sectional study. BJU Int, 2017,120(1):109-116. [4] BANSAL AD, GOLDFARB DS.Asymptomatic nephrolithiasis detected by ultrasound. Clin J Am Soc Nephrol, 2009,4(3):680-684. [5] BOYCE CJ, PICKHARDT PJ, LAWRENCE EM, et al.Prevalence of urolithiasis in asymptomatic adults: objective determination using low dose noncontrast computerized tomography. J Urol, 2010,183(3):1017-1021. [6] HO WK, SANG KL, WON TK, et al.Natural history of asymptomatic renal stones and prediction of stone related events. J Urol, 2013,189(5):1740-1746. [7] BENJAMIN MD, RACHEL AM, SHARMA D, et al.The natural history of nonobstructing asymptomatic renal stones managed with active surveillance. J Urol, 2015,193(4):1265-1269. [8] MAITREY PD, YALLAPPA S, METCALFE J, et al.The natural history of asymptomatic calyceal stones. BJU Int, 2018,122(2):263-269. [9] GLOWACKI LS, BEECROFT ML, COOK RJ, et al.The natural history of asymptomatic urolithiasis. J Urol, 1992,147(2):319-321. [10] LI XH, WEI Z, LAM W, et al.Outcomes of long-term follow-up of asymptomatic renal stones and prediction of stone-related events. BJU Int, 2019,123(3):485-492. [11] SENER NC, BAS O, SENER E, et al.Asymptomatic lower Pole small renal stones: shock wave lithotripsy, flexible ureteroscopy, or observation? A prospective randomized trial. Urology, 2015,85(1):33-37. [12] GOLDBERG H, HOLLAND R, TAL R, et al.The impact of retrograde intrarenal surgery for asymptomatic renal stones in patients undergoing ureteroscopy for a symptomatic ureteral stone. J Endourol, 2013,27(8):970-973. [13] DAVID SH, BENJAMIN AC, DONGHEON L, et al.The durability of active surveillance in patients with asymptomatic kidney stones: a systematic review. J Endourol, 2019,33(7):598-605. [14] EMRAH Y, MURAT B, ERHAN S, et al.A prospective, randomized trial of management for asymptomatic lower Pole calculi. J Urol, 2010,183(4):1424-1428. [15] NEISIUS A, THOMAS C, ROOS FC, et al.[Asymptomatic kidney stones: active surveillance vs. treatment]. Aktuelle Urol, 2015,46(5):391-394. [16] INCI K, SAHIN A, ISLAMOGLU E, et al.Prospective long-term followup of patients with asymptomatic lower Pole caliceal stones. J Urol, 2007,177(6):2189-2192. [17] TELLI O, HAMIDI N, BAGCI U, et al.What happens to asymptomatic lower Pole kidney stones smaller than 10 mm in children during watchful waiting? Pediatr Nephrol, 2017,32(5):853-857. [18] STEFANOS K, PAPATSORIS A, BACH C, et al.The current role of percutaneous chemolysis in the management of urolithiasis: review and results. Urolithiasis, 2013,41(4):323-326. [19] RODMAN JS, PETERSON CM.Dissolution of uric acid calculi. J Urol, 1984,131(6):1039-1044. [20] EL-GAMAL EO, El-Bendary M, Ragab M.Role of combined use of Potassium citrate and tamsulosin in the management of uric acid distal ureteral calculi. Urol Res, 2012,40(3):219-224. [21] BRANDT B, OSTRI P, LANGE P, et al.Painful caliceal calculi. Scand J Urol Nephrol, 1993,27(1):75-76. [22] COLL DM, SMITH RC.Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol, 2002,178(1):101-103. [23] GAO XF, PENG YH, LING L, et al.Flexible ureteroscopy in management of asymptomatic calyceal calculi in flight attendants. Acad J Second Milit Med Univ, 2013,33(9):999-1002. [24] ZHENG CJ, YANG HM, JUN L, et al.Extracorporeal shock wave lithotripsy versus retrograde intrarenal surgery for treatment for renal stones 1-2 cm: a meta-analysis. Urolithiasis, 2015,43(6):549-556. [25] PREMINGER GM.Management of lower Pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy. Urol Res, 2006,34(2):108-111. [26] PEARLE MS, LINGEMAN JE, LEVEILLEE R, et al.Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol, 2008,179(5 Suppl):S69-S73. [27] ZHENG C, XIONG B, WANG H, et al.Retrograde intrarenal surgery versus percutaneous nephrolithotomy for treatment of renal stones >2 cm: a meta-analysis. Urol Int, 2014,93(4):417-424. [28] KARAKOYUNLU N, GOKTUG G, ŞENER NC, et al.A comparison of standard PCNL and staged retrograde FURS in pelvis stones over 2 cm in diameter: a prospective randomized study. Urolithiasis, 2015,43(3):283-287. [29] DONALDSON JF, LARDAS M, SCRIMGEOUR DA, et al.Systematic review and meta-analysis of the clinical effectiveness of shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy for lower-pole renal stones. Eur Urol, 2015,67(4):612-616. [30] KUMAR A, KUMAR N, VASUDEVA P, et al.A prospective, randomized comparison of shock wave lithotripsy, retrograde intrarenal surgery and miniperc for treatment of 1 to 2 cm radiolucent lower calyceal renal calculi: a single center experience. J Urol, 2015,193(1):160-164. [31] MI YY, REN KW, PAN HY, et al.Flexible ureterorenoscopy (F-URS) with Holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stone <2 cm: a meta-analysis. Urolithiasis, 2016,44(4):353-365. [32] ZHANG W, ZHOU T, WU TY, et al.Retrograde intrarenal surgery versus percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy for treatment of lower Pole renal stones: a Meta-Analysis and systematic review. J Endourol, 2015,29(7):745-759. [33] GERAGHTY R, ABOURMARZOUK O, RAI B, et al.Evidence for ureterorenoscopy and laser fragmentation (URSL) for large renal stones in the modern era. Curr Urol Rep, 2015,16(8):54. [34] STEPHAN S, KARL-DIETRICH S, LEE R, et al.A cost analysis of stenting in uncomplicated semirigid ureteroscopic stone removal. Int Urol Nephrol, 2017,49(5):753-761.
