체외충격파쇄석술 후 요관석의 배출에 미치는 Tamsulosin과 Nifedipine의 효과

최낙영,안승현,한준현,장인호 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.2

Purpose: We evaluated the effect of tamsulosin and nifedipine on expulsion of ureteral stones after extracorporeal shock wave lithotripsy(ESWL). Materials and Methods: We evaluated 96 upper or lower ureteral stone patients. All patients received a single session of ESWL with a piezolith- 3000 and received twice-a-day oral treatment of 5mg trospium chloride. The patients were randomly divided into three groups. Group 1 received once a day oral therapy of 0.2mg tamsulosin. Group 2 received once a day oral therapy of 30mg nifedipine. Group 3 was used as the control group. All patients took oral medication for 2 weeks, and then we analyzed the stone expulsion rate, side effects, and mean numbers of emergency room(ER) visits for pain control. Results: There were no differences in the 3 groups in stone size, location, age, and sex. The total stone expulsion rate was significantly higher in group 1(84.4%) compared with group 3(60.6%)(p=0.032). Patients with lower ureteral stones in group 1 showed a higher expulsion rate(94.1%) than those of group 3(66.7%)(p=0.042). There was no difference in stone expulsion rates between group 2(67.7%) and group 3(60.6%). Conclusions: These result suggest that adjunctive medical therapy with tamsulosin after an ESWL increased the stone expulsion rate of ureteral stones, especially lower ureteral stones. (Korean J Urol 2008;49:150-154) Purpose: We evaluated the effect of tamsulosin and nifedipine on expulsion of ureteral stones after extracorporeal shock wave lithotripsy(ESWL). Materials and Methods: We evaluated 96 upper or lower ureteral stone patients. All patients received a single session of ESWL with a piezolith- 3000 and received twice-a-day oral treatment of 5mg trospium chloride. The patients were randomly divided into three groups. Group 1 received once a day oral therapy of 0.2mg tamsulosin. Group 2 received once a day oral therapy of 30mg nifedipine. Group 3 was used as the control group. All patients took oral medication for 2 weeks, and then we analyzed the stone expulsion rate, side effects, and mean numbers of emergency room(ER) visits for pain control. Results: There were no differences in the 3 groups in stone size, location, age, and sex. The total stone expulsion rate was significantly higher in group 1(84.4%) compared with group 3(60.6%)(p=0.032). Patients with lower ureteral stones in group 1 showed a higher expulsion rate(94.1%) than those of group 3(66.7%)(p=0.042). There was no difference in stone expulsion rates between group 2(67.7%) and group 3(60.6%). Conclusions: These result suggest that adjunctive medical therapy with tamsulosin after an ESWL increased the stone expulsion rate of ureteral stones, especially lower ureteral stones. (Korean J Urol 2008;49:150-154)

요관결석에 대한 요관경하 배석술의 임상경험

정영봉,노준화,김상익 全南大醫大 2000 전남의대학술지 Vol.36 No.4

매복 요관석 치료에 있어서 요관경하배석술의 유용성

최은용,김동선 大韓泌尿器科學會 2000 Korean Journal of Urology Vol.41 No.2

상부 요석에서의 복강경 요관절석술의 유용성

김강섭,설종구,임재성 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.8

Purpose: Ureter stones are the most common urological disease. The principal objective of this study was to evaluate the results, efficacy, and safety rates of laparoscopic ureterolithotomy for the treatment of large, upper ureteral stones. Materials and Methods: Between April 2006 and February 2008, we conducted laparoscopic ureterolithotomy in 7 patients with upper ureter stones(L2-3). Laparoscopic ureterolithotomy was conducted in 5 patients as a salvage procedure after failed shock wave lithotripsy, in 1 patient as the primary procedure for a large stone(28mm), and in 1 patient for treatment of a radiolucent matrix stone. Laparoscopic ureterolithotomy was conducted via a transperitoneal approach. The mean stone size was 20.7±5.9mm. Results: Laparoscopic ureterolithotomy was successful in 7 patients, and none of the patients required an open procedure. All patients were rendered stone-free after a single procedure. The mean operative duration, mean postoperative hospital stay, and mean estimated blood loss were 142±49 min, 6±2.2 days and 85±29.5ml, respectively. Conclusions: Although the majority of patients with ureter stones can be rendered stone-free via shock wave lithotripsy and endourological procedures, open surgery is required for large and upper ureter stones. In cases of large and upper ureter stones, laparoscopic ureterolithotomy may be considered for a limited group, although many will require open surgery. Purpose: Ureter stones are the most common urological disease. The principal objective of this study was to evaluate the results, efficacy, and safety rates of laparoscopic ureterolithotomy for the treatment of large, upper ureteral stones. Materials and Methods: Between April 2006 and February 2008, we conducted laparoscopic ureterolithotomy in 7 patients with upper ureter stones(L2-3). Laparoscopic ureterolithotomy was conducted in 5 patients as a salvage procedure after failed shock wave lithotripsy, in 1 patient as the primary procedure for a large stone(28mm), and in 1 patient for treatment of a radiolucent matrix stone. Laparoscopic ureterolithotomy was conducted via a transperitoneal approach. The mean stone size was 20.7±5.9mm. Results: Laparoscopic ureterolithotomy was successful in 7 patients, and none of the patients required an open procedure. All patients were rendered stone-free after a single procedure. The mean operative duration, mean postoperative hospital stay, and mean estimated blood loss were 142±49 min, 6±2.2 days and 85±29.5ml, respectively. Conclusions: Although the majority of patients with ureter stones can be rendered stone-free via shock wave lithotripsy and endourological procedures, open surgery is required for large and upper ureter stones. In cases of large and upper ureter stones, laparoscopic ureterolithotomy may be considered for a limited group, although many will require open surgery.

자연 배출된 요관결석의 임상적 관찰

노용수 건국대학교 의과학연구소 1999 건국의과학학술지 Vol.9 No.-

Many factors have been concerned about spontaneous passage of ureteral stones. Patients of ureteral stone ask to doctor the day of passage of ureteral stone and then doctors cannot suggest satisfiable answer. I investigated the relation between duration and many factors which concerned about spontaneous passed out ureteral stones. One hundred fifty cases of spontaneous passed out ureteral stones were evaluated during 5 years between October, 1993 and October, 1998. We investigated relation between duration of spontaneous passage and size, position, shape, margin, density, IVP findings of ureteral stones. The size and position influenced the duration of spontaneous passage of ureteral stones and other factors showed no significant difference. Small size in same position and low position in same size of ureteral stones were passed out spontaneously more early. Average duration of spontaneous passed out ureteral stone was 2.9 days in 2mm, 5.1 days in 3mm, 4.3 days in 4mm, 7.2 days in 5mm and 2.7 days in ureterovesical junction(UVJ), 4.1 days in lower ureter, 7.6 days in upper ureteral stones. This investigation suggested average duration of spontaneous passed out ureteral stones for size and position and also suggested that many other factors showed no difference in spontaneous passage of ureteral stones. With this results, we can suggest relatively accurate duration of spontaneous passge of ureteral stone.

초음파 조준장치를 이용한 중부요관결석의 정위치 체외충격파쇄석술

정일형,양대열,김하영 大韓泌尿器科學會 2003 Korean Journal of Urology Vol.44 No.2

요관결석의 2년간의 치료 경험: 충격파쇄석술과 요관경하배석술의 비교

박민수,박형근,박태한 大韓泌尿器科學會 1998 Korean Journal of Urology Vol.39 No.9

ESWL을 이용한 Proximal, Mid Ureteral Stone의 쇄석시 각 조건에 대한 쇄석율의 비교 측정

강광수,이상복,이준행 한국방사선학회 2010 한국방사선학회 논문지 Vol.4 No.1

A urolithiasis, also called calculus, is one of the brutal illnesses, which has constantly harassed humanbeings from time immemorial. However, there is no appropriate method of prevention so far. So, Urological therapy must be followed upon those patients. The biggest problem of urolithiasis is usually causing harsh pain, fever, and throw up. The pain would be more intensified when something came through the ureter or the moment of convulsion caused beyond transmission of urinary calculus. Even strong painkillers, such as fentanyl and Pethidine, can not handle those harshly pain easily. Therefore, a prompt action of medical check up and its therapy must be required to those patients. This thesis paper has put the accent on the specific therapy, known as ESWL (Extracorpereal Shock Wave Lithotripsy), which have generated quite optimum resolution to patients, who received harsh pain from Proximal ureteral stone and Mid ureteral stone and because of its low provability of pulverization. The results of the experiment confirmed that the stone, located between Proximal and Mid ureter, has lower provability of pulverization than distal ureter, because its accuracy rate on shock wave, in respect of breathing, are low. However, decrease in discharge interval have enhanced provability of pulverization. it can also intensify probability of pulverization and its safety by discharging high power with appropriate intervals, and that is more efficient than discharging low power with frequent time. 요석은 고대 인류부터 지금 현재 인류까지 끊임없이 인간을 괴롭히고 있는 질병중의 하나이다. 하지만 딱히 예방법이 없어 문제가 생기면 비뇨기과적 치료가 절대적으로 필요한 질병이다. 이런 요석의 가장 큰문제점은 상당한 통증 과 구토, 발열등을 유발한다는 것이다. 통증은 요관을 통과 할 때나 요관이 요석으로 인한 심한 경련이 일어날 때 크게 일어난다. 이 통증은 마약성분이 강한 펜타닐 이나 페치딘 같은 강한 진통제에도 잘 잡히지 않는 경향이 있어 신속한 검사와 치료가 요구된다. 본 논문에서는 ESWL(Extracorpereal Shock Wave Lithotripsy)을 이용한 요석 치료시 특히 분쇄율은 낮고 환자의 통증은 심한 Proximal ureteral stone 과 Mid ureteral stone에 대해 각각의 여러 조건을 적용하여 최적의 치료방법과 최고의 분쇄율에 대하여 실험 과 연구를 하여 보았다. 실험결과 Proximal과 Mid ureter에 위치한 stone은 호흡에 의한 충격파의 적중률이 낮아 분쇄율이 distal ureter보다 낮았으나 방전interval을 줄임으로써 분쇄율을 높일 수 있었고, 낮은 방전 Power로 여러번 분쇄하는 것보다는 높은 방전 Power와 적절한 방전횟수로 분쇄를 하였을 때 ureter도 보호하면서 분쇄율이 높다는 것을 알 수 있었다.

요관경하배석술 치험 255례의 임상경험 고찰

김준용,김경헌,임지석,이성한,심봉석,박영요,권성원 梨花女子大學校 醫科大學 醫科學硏究所 2000 EMJ (Ewha medical journal) Vol.23 No.1

Objectives : We retrospectively reviewed the cases of ureteroscopic stone removal at our hospital from January, 1994 to August, 1999 and defined the efficiency and complications of ureteroscopic stone removal. Methods : Ureteroscopic stone removal was in 255 cases of ureteral stone from January, 1994 to August, 1999. Patients were 142 males and 113 females, and mean age was 42.5 years. 20 stones were located in the upper ureter, 29 stone in the mid ureter, 206 stones in the lower ureter. The stone size was less than 5㎜ in 95 cases, from 5 to 10㎜ in 117 cases and more than 10㎜ in 43 cases. Ureteroscpic stone ramoval was performed with 7.5Fr, 9.5Fr rigid ureteroscope under general, spinal, and epidural anesthesia. Results : 255 cases of ureteroscopic stone removal were performed and over all success rate of ureteroscopic stone removal was 97 percent. The success rates of upper, mid and lower ureteral stones were 85, 93 and 99 percent. According to the size, the success rate was 99 percent in stones less than 5㎜, 98 percent in stones of 5 to 10㎜ and 90 percent in stones more than 10㎜. There were 8 cases of complication and over all complication rate was 3.1 percent. Complications consisted of severe mucosal injury(3 cases), ureteral perforation(3 cases), gross hematuria(1 case), urinary tract infecion(1 case). Complications were treated successfully with conservative treatment except 1 case of severe mucosal injury that required ureteral reimplantaton.

요관석에 대한 In-situ 체외충격파쇄석술 시 조영제의 정맥 주사에 의한 요석 위치 선정

한지엽,임성욱,송기근,문영태 大韓泌尿器科學會 1999 Korean Journal of Urology Vol.40 No.3