Aktuelle Urol 2003; 34(5): 313-318
DOI: 10.1055/s-2003-42005
Übersichtsarbeit
© Georg Thieme Verlag Stuttgart · New York

Interventionelle Therapie von Harnsteinen

Minimally-Invasive Therapy of Urinary StonesT.  Knoll1 , L.  Trojan1 , A.  Haecker1 , M.  S.  Michel1 , K.  U.  Köhrmann1 , P.  Alken1
  • 1Urologische Klinik, Universitätsklinikum Mannheim
Further Information

Publication History

Publication Date:
11 September 2003 (online)

Zusammenfassung

Bis vor etwa 30 Jahren war die offene Operation die häufigste Therapieform für Harnsteine, heute spielt sie dagegen kaum noch eine Rolle bei der Steinbehandlung. Einen maßgeblichen Anteil an dieser Entwicklung hat die 1980 erstmals klinisch eingesetzte extrakorporale Stoßwellenlithotripsie (ESWL), welche heute eine führende Rolle in der Harnsteinbehandlung eingenommen hat. Daneben wurden endoskopische Verfahren wie Ureterorenoskopie (URS) und perkutane Nephrolitholapaxie (PCNL) weiterentwickelt, die eine optimale, minimalinvasive Ergänzung zur ESWL darstellen. Dieser Artikel gibt eine Übersicht über den heutige Stand der interventionellen Harnsteintherapie und diskutiert die Indikationen, Erfolgsraten und Komplikationen der jeweiligen Verfahren.

Abstract

Open surgery was the standard therapy for urinary calculi up to about 30 years ago. This changed upon introduction of extracorporeal shockwave lithotripsy (ESWL) in 1980, a procedure that is now the primary therapy for 70 % of the patients in western countries. Simultaneously, endourological procedures like ureterorenoscopy (URS) and percutaneous nephrolithotripsy (PCNL) have been improved, and now, modern small diameter and highly efficient instruments offer an ideal alternative to shockwave lithotripsy. Today, minimally-invasive stone treatment has replaced open stone surgery almost completely. This article introduces ESWL, URS and PCNL and discusses indications, outcomes and limitations.

Literatur

  • 1 Chaussy C, Schmeidt E, Jochman D. et al . First clinical experience with extracorporeally induced destruction of kidney stones by shock waves.  J Urol. 1982;  131 417
  • 2 Newman D, Coury T, Lingeman J, Mertz J H, Mosbaugh P G, Steele R E, Knapp P U. Extracorporal Shockwave lithotripsy experience in children.  J Urol. 1986;  136 238
  • 3 Guidelines European Association of Urology .2001
  • 4 Ehreth J T, Drach G W, Arnett M L. et al . Extracorporal shockwave lithotripsy: Multicenter study of kidney and upper ureter versus middle and lower ureter treatments.  J Urol. 1994;  152 1379
  • 5 Smith A D. Smiths Textbook of Endourology. St. Louis, MO, USA: Quality Medical Publishing Inc. 1996
  • 6 Bierkens A F, Hendrikx A JM, de Kort V JW. et al . Efficiacy of second generation lithotriptors: A multicenter comparative study of 2,206 extracorporeal shock wave lithotripsy treatments with the Siemens Lithostar, Dornier HM 4, Wolf Piezolith 2300, Direx Tripter X-1 and Breakstone Lithotriptors.  J Urol. 1992;  148 1052
  • 7 Rassweiler J, Henkel T, Köhrmann K. Lithotripter technology: Present and future.  J Endourol. 1992;  6 1
  • 8 Parr N J, Pye S D, Ritchie A WS, Tolley D A. Mechanisms responsible for diminished fragmentation of ureteral calculi: An experimental and clinical study.  J Urol. 1992;  148 1079
  • 9 Mobley T B, Myers D A, Jenkins J M, Grine W B, Jordan W R. Effects of stents on lithotripsy of ureteral calculi: treatment results with 18,825 calculi using the Lithostar lithotriptor.  J Urol. 1994;  152 53-56
  • 10 Danuser H, Ackermann D K, Marth D C, Studer U E, Zingg E J. Extracorporal shock wave lithotripsy in situ or after push-up for upper ureteral calculi: A prospective randomized trial.  J Urol. 1993;  150 824-826
  • 11 Erturk E, Herrman E, Cockett A T. Extracorporeal shock wave lithotripsy for distal ureteral stones.  J Urol. 1993;  149 1425
  • 12 Kapoor D A, Leech J E, Yap W T, Rosw J F, Kabler R, Mowad J J. Cost and efficacy of extracorporeal shock wave lithotripsy versus ureteroscopy in the treatment of lower ureteral calculi.  J Urol. 1992;  148 1095
  • 13 Lingeman J E, Coury T A, Newman D M. et al . Comparison of results and morbidity of percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy.  J Urol. 1987;  138 485
  • 14 Ramsay J WA, Crosker R P, Ball A J. et al . Urothelial reaction to ureteric intubation.  Br J Urol. 1987;  60 504
  • 15 Müller J. Extrakorporale Stoßwellen Lithotripsie: Monozentrische Ergebnisse nach Ultraschall- und Röntgenortung am Universitätsklinikum Mannheim. Medizinische Dissertation 2002
  • 16 Segura J H, Patterson D E, LeRoy A J. et al . Percutaneous removal of kidney stones. Review of 1000 cases.  J Urol. 1985;  134 1077
  • 17 Turk T M, Jenkins A D. A comparison of ureteroscopy to in situ extracorporeal shock wave lithotripsy for the treatment of distal ureteral calculi.  J Urol. 1999;  161 45-47
  • 18 Preminger G M. Technique versus technology: What is the most approbriate method for the removal of ureteral calculi?.  J Urol. 1991;  146 5-9
  • 19 Bierkens A F, Hendrikx A JM, de la Rosette J J. et al . Treatment of mid- and lower ureteric calculi: extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness.  Br J Urol. 1998;  81 31-35
  • 20 Hosking D H, Bard R J. Ureteroscopy with intravenous sedation for treatment of distal ureteral calculi: a safe and effective alternative for shock wave lithotripsy.  J Urol. 1996;  156 899-902
  • 21 Harmon W J, Sershon P D, Blute M L, Patterson D E, Segura J W. Ureteroscopy: current practice and long-term complications.  J Urol. 1997;  157 28-32
  • 22 Elashry O M, Elbahnasy A M, Rao G S, Nakada S Y, Clayman R V. Flexible ureteroscopy: Washington University expermience with the 9.3 F and 7.5 F flexible ureteroscopes.  J Urol. 1997;  157 2074-2080
  • 23 Segura J W. Ureteroscopy for lower ureteral stones.  Urology. 1993;  42 356-357
  • 24 Michel M S, Knoll T, Ptashynk T, Kohrmann K U, Alken P. Flexible ureterorenoscopy for the treatment of lower pole calyx stones: influence of different lithotripsy probes and stone extraction tools on scope deflection and irrigation flow.  Eur Urol. 2002;  41 312-317
  • 25 El Gabry E A, Bagley D H. Retrieval capabilities of different stone basket designs in vitro.  J Endourol. 1999;  13 305-307
  • 26 Gould D L. Retrograde flexible ureteroscopic holmium-YAG laser lithotripsy: the new gold standard.  Tech Urol. 1998;  4 22-24
  • 27 Ptashnyk T, Cueva-Martinez A, Michel M S, Alken P, Kohrmann K U. Comparative investigations on the retrieval capabilities of various baskets and graspers in four ex vivo models.  Eur Urol. 2002;  41 406-410
  • 28 Teichman J M, Rao R D, Rogenes V J, Harris J M. Ureteroscopic management of ureteral calculi: electrohydraulic versus holmium:YAG lithotripsy.  J Urol. 1997;  158 1358-1361
  • 29 Segura J W, Preminger G M, Assimos D G. et al . Ureteral stones clinical guidelines panel summary report on the management of ureteral calculi.  J Urol. 1997;  158 1915-1921
  • 30 Tawfiek E R, Bagley D H. Management of upper urinary tract calculi with ureteroscopic techniques.  Urology. 1999;  53 23-25
  • 31 Jackman S V, Hedican S P, Peters C A, Docimo S G. Percutaneous nephrolithotomy in infants and preschool age children: experience with a new technique.  Urology. 1998;  52 697-701
  • 32 Lingeman J E, Siegel Y I, Steele B, Nyhuis A W, Woods J R. Management of lower pole nephrolithiasis: a critical analysis.  J Urol. 1994;  151 663-667
  • 33 Khan R I. Percutaneous approach for ureteral stones.  Prob Urol. 1993;  7 547-555
  • 34 Netto Jr N R, Claro J F, Lemos G C, Cortado P L. Renal calculi in lower pole calices: what is the best method of treatment?.  J Urol. 1991;  146 721-723
  • 35 Lenz W. Die perkutane Nephrolitholapaxie: Monozentrische Ergebnisse am Universitätsklinikum Mannheim. Medizinische Dissertation 1999

Dr. med. T. Knoll

Urologische Universitätsklinik Mannheim

Th.-Kutzer-Ufer 1 - 3

68135 Mannheim

Phone: 0621/383-4029

Fax: 0621/383-4001

Email: thomas.knoll@uro.ma.uni-heidelberg.de

    >