急性梗阻结石治疗策略问卷调查.pdfVIP

JOURNAL OF ENDOUROLOGY Volume 29, Number 6, June 2015 ª Mary Ann Liebert, Inc. Pp. 736–740 DOI: 10.1089/end.2014.0681 Contemporary Practice Patterns in the Management of Acute Obstructing Ureteral Stones 1 2 2 Sri Sivalingam, MD, Ian M. Stormont, MD, and Stephen Y. Nakada, MD Abstract Purpose: To elucidate current practice patterns among Endourological Society members for acutely obstructing ureteral stones necessitating intervention. Methods: A practice pattern survey was sent to members of the Endourological Society using Survey Monkey. The following question stem was given: ‘‘Patient presents to the ER with acute renal colic and intractable pain, no signs of infection, i.e. afebrile and no pyuria. Stone is obstructing, and causing intractable pain; thus observation or medical expulsive therapy is not appropriate.’’ A follow-up stem was provided for specific scenarios: ‘‘Calculus measuring x mm at x location. What is your preferred management option?’’ The options given for immediate management included shockwave lithotripsy (SWL), ureteroscopy (URS), stent placement, or percutaneous management. Results: Four hundred and sixteen complete responses of approximately 2000 were received. There was a significant difference in management choice based on stone location (P 0.001) and stone size (P 0.001). URS was the predominant modality used for urgent treatment of acute proximal ureteral stones from 5, 10, and 15 mm except for calculi of 20 mm, where the preference was for percutaneous management. Immediate URS was the preferred choice for all distal and midureteral stones, regardless of size. The use of stents vs percu- taneous nephrostomy drainage was similar (18% vs 16%, respectively) for proximally obstructing calculi, while stent inser