尿管結石の臨床的検討

Abstract

A statistical study was performed on spontaneous passage of ureteral stones which we treated during the two-year period from 1974 to 1975. Stones spontaneously discharged were 100 (from 97 patiens) out of 288 stones (from 281 patients).The 100 ureteral stones were divided into four groups on the basis of their size on X-ray films; Group-1: Stones of 6mm or less in both minor and major axes. Group-2: Stones of 6mm or less in minor axis and 7 to 10mm in major axis. Group-3: Stones of 6mm or less in minor axis and 11mm or more in major axis. Group-4: Stones of 7 to 10m in both minor and major axes. X-ray examination was carried out to know whether stones were in the pelvic cavity or in the pelvic bone and/or lumbar region.Of 70 stones in the plvic cavity, 40 (57.1%) were spontaneously discharged within 30 days, 21 (30.0%) in 31 to 90 days and 6 (8.6%) in 91 to 180 days. Of 30 stones in the pelvic bone and/or lumbar region, 5 (16.7%) were spontaneously discharged within 30 days, 11 (36.9%) in 31 to 90 days and 6 (20.0%) in 91 to 180 days.There were 49 stones that were in the pelvic cavity and were classified into Group-1 (stones of 6mm or less in both minor and major axes). Among them, 29 stones (59.2%) were spontaneously discharged within 30 days, 14 (28.6%) in 31 to 90 days and 4 (8.2%) in 91 to 180 days. Of 17 Group-2 stones (as defined above) in the pelvic cavity, 9 (52.9%) were spontaneously discharged within 30 days, 5 (29.1%) in 31 to 90 days and 2 (11.8%) in 91 to 180 days. Of 3 Group-3 stones (as defined above) in the pelvic cavity, 2 (66.7%) were spontaneously discharged within 30 days and one (33.3%) in 31 to 90 days. A stone in the pelvic cavity of Group 4 (as defined above) was spontaneously discharged in 31 to 90 days (100%).Stones that were in the pelvic bone and/or lumbar region and belonged to Group-1 (as defined above) were 16, of which 4 (25.0%) were spontaneously discharged within 30 days, 8 (50.0%) in 31 to 90 days and 4 (25.0%) in 91 to 180 days. Of 8 Group-2 stones (as defined above) in the pelvic bone and/or lumbar region, one (12.5%) was spontaneously discharged within 30 days, 2 (25.0%) in 31 to 90 days and one (12.5%) in 91 to 180 days. Of 3 group-3 stones (as defined above) in the pelvic bone and/or lumbar region, one (33.3%) was spontaneously discharged in 31 to 90 days. For the remaining two stones, spontaneous passage occurred in 181 days or more. Three stones in the pelvic bone and/or lumbar region of Group-4 (as defined above) were all discharged spontaneously in 181 days or more (100%).The rate of stones spontaneously discharged from the pelvic cavity was similar among four groups that were defined in accordance with stone size (no statistically significant difference among groups). As to stones in the pelvic bone and/or lumbar region, those assigned to Croup 1 had the highest rate of spontaneous passage (with a statistically significant difference). An X-ray film showing site and size of ureteral stones may permit us to tell the time of their spontaneous passage in advance.Seventy-one patients with ureteral stones who had been treated in our department during the period from 1974 to 1975 were followed up for recurrence. Ureteral stones recurred in 26 of 71 patients (36.6%). The incidence was independent of sex, 36.7% in men and 36.4% in women. The incidenc of recurrence according to primary treatment was 31.8% after ureterolithotomy, 50 after removal by basket catheter method and 38.7% after spontaneous passage. Of 26 recurring cases, 15 (57.7%) had recurrence once, 6 (23.1%) twice, 2 (7.7%) three times and 3 (11.5%) four times or more. Thus, the average frequency of recurrence was 1.96. Of these 26 patients, 4 (15.4%) had a recurrence within a year after primary treatment, 10 (38.5%) within 2 years and 13 (50.0%) within 3 years. The interval between primary treatment and recurrence was 5 years and 5 months on the average.