Современные подходы к выбору метода лечения пациентов с камнями в верхней трети мочеточника
- Авторы: Пачулия З.В.1, Паронников М.В.1, Протощак В.В.1
-
Учреждения:
- Военно-медицинская академия им. С.М. Кирова
- Выпуск: Том 15, № 1 (2025)
- Страницы: 89-99
- Раздел: Научные обзоры
- Статья получена: 07.04.2024
- Статья одобрена: 15.02.2025
- Статья опубликована: 07.05.2025
- URL: https://journals.eco-vector.com/uroved/article/view/630088
- DOI: https://doi.org/10.17816/uroved630088
- ID: 630088
Цитировать
Полный текст



Аннотация
Мочекаменная болезнь занимает одно из лидирующих мест в структуре урологических заболеваний. При этом уретеролитиаз наблюдается не менее чем в 50% случаев. Из всех локализаций камней в мочеточнике наиболее сложную проблему представляют камни в верхней трети, поскольку при данном расположении конкремента возможен выбор широкого спектра методик лечения, обладающих разной эффективностью и профилем безопасности. В обзор включены современные публикации по исследованиям эффективности консервативных и хирургических методов лечения пациентов с камнями в верхней трети мочеточника, в том числе литокинетической и литолитической терапии, дистанционной ударно-волновой литотрипсии, контактной уретеролитотрипсии, лапароскопической уретеролитотомии, а также описаны факторы, влияющие на выбор метода лечения. Были проанализированы результаты применения различных методов хирургического лечения уретеролитиаза, данные о вероятности дополнительных вмешательств, частоте, характере и степени интраоперационных и послеоперационных осложнений. Подчеркнуто, что внедрение новых технологий изменило подходы к выбору метода лечения пациентов с камнями верхней трети мочеточника, что позволило повысить его эффективность и снизить риск развития осложнений. При этом многие аспекты хиругического лечения больных с камнями верхней трети мочеточников остаются предметом дискуссий.
Полный текст

Об авторах
Заур Вячеславович Пачулия
Военно-медицинская академия им. С.М. Кирова
Email: pachuliya.zaur@gmail.com
ORCID iD: 0009-0008-7603-1491
MD
Россия, Санкт-ПетербургМихаил Валериевич Паронников
Военно-медицинская академия им. С.М. Кирова
Email: paronnikov@mail.ru
ORCID iD: 0009-0005-1762-6100
SPIN-код: 6147-7357
д-р мед. наук
Россия, Санкт-ПетербургВладимир Владимирович Протощак
Военно-медицинская академия им. С.М. Кирова
Автор, ответственный за переписку.
Email: protoshakurology@mail.ru
ORCID iD: 0000-0002-4996-2927
SPIN-код: 6289-4250
д-р мед. наук, профессор
Россия, Санкт-ПетербургСписок литературы
- LLC “Russian Society of Urologists”. Urolithiasis. Clinical recommendations of the Ministry of Health of the Russian Federation. Moscow; 2024. 118 p. (In Russ.)
- Skolarikos A, Jung H, Neisius A, et al. EAU Guidelines on urolithiasis. European Association of Urology; 2024.
- Kaprin AD, Apolikhin OI, Sivkov AV, et al. The incidence of urolithiasis in the Russian Federation from 2005 to 2020. Experimental and Clinical Urology. 2022;15(2)10–17. doi: 10.29188/2222-8543-2022-15-2-10-17 EDN: EATILC
- Protoshchak VV, Paronnikov MV, Orlov DN, et al. Medical and statistical characteristi of the incidence of urolithiasis in the Armed Forces. Military medical journal. 2020;341(11):11–18. doi: 10.17816/RMMJ82357 EDN: EAQQIE
- Apolikhin OI, Sivkov AV, Komarova VA, et al. Incidence of urolithiasis in the Russian Federation (2005–2016). Experimental and clinical urology. 2018;(4):4–14. EDN: VRTKIC
- Borumandnia N, Fattahi P, Talebi A, et al. Longitudinal trend of urolithiasis incidence rates among world countries during past decades. BMC Urol. 2023;23(1):166. doi: 10.1186/s12894-023-01336-0
- Moon YJ, Kim H-W, Kim JB, et al. Distribution of ureteral stones and factors affecting their location and expulsion in patients with renal colic. Korean J Urol. 2015;56(10):717–721. doi: 10.4111/kju.2015.56.10.717
- Hollingsworth JM, Canales BK, Rogers MA, et al. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ. 2016;355:i6112. doi: 10.1136/bmj.i6112
- Campschroer T, Zhu X, Vernooij RW, Lock MT. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev. 2018;4(4):CD008509. doi: 10.1002/14651858.CD008509.pub3
- Dutov VV. Dissolving kidney stones: for whom? When? How? Medical Council. 2016;(9):84–90. doi: 10.21518/2079-701X-2016-9-84-90. EDN: VJKRAN
- Alyaev YuG, Rudenko VI. Modern aspects of drug treatment of patients with kidney stone disease. Effective pharmacotherapy. 2016;(41):10–15. EDN: XWUPHR
- Frolova EA, Tsarichenko DG, Saenko VS, et al. Dissolution of uric acid stones in the ureter. Urologiia. 2022;(6):56–60. doi: 10.18565/urology.2022.6.56-60 EDN: MQKLAX
- Lai S, Jiao B, Diao T, et al. Optimal management of large proximal ureteral stones (>10 mm): A systematic review and meta-analysis of 12 randomized controlled trials. Int J Surg. 2020;80:205–217. doi: 10.1016/j.ijsu.2020.06.025
- Zeng G, Zhong W, Chaussy CG, et al. International alliance of urolithiasis guideline on shockwave lithotripsy. Eur Urol Focus. 2023;9(3):513–523. doi: 10.1016/j.euf.2022.11.013
- Suarez-Ibarrola R, Hein S, Reis G, et al. Current and future applications of machine and deep learning in urology: a review of the literature on urolithiasis, renal cell carcinoma, and bladder and prostate cancer. World J Urol. 2020;38(10):2329–2347. doi: 10.1007/s00345-019-03000-5
- Wu W, Zhang J, Yi R, et al. A simple predictive model with internal validation for assessment of stone-left after ureteroscopic lithotripsy in upper ureteral stones. Transl Androl Urol. 2022;11(6):786–793. doi: 10.21037/tau-22-22
- Abedi AR, Razzaghi MR, Allameh F, et al. Pneumatic lithotripsy versus laser lithotripsy for ureteral stones. J Lasers Med Sci. 2018;9(4):233–236. doi: 10.15171/jlms.2018.42
- Anan G, Kudo D, Matsuoka T. What are the predictors of residual stone after ureteroscopy for urolithiasis? Transl Androl Urol. 2022;11(8):1071–1073. doi: 10.21037/tau-22-438
- Xiong Y, Liu J, Zhao T. Application of flexible holmium laser sheath in rigid ureteroscopy for the treatment of impacted upper ureteral stones. Arch Esp Urol. 2023;76(1):50–55. doi: 10.56434/j.arch.esp.urol.20237601.4
- Mamedov EA, Dutov VV, Bazaev VV. Complications of contact ureteral lithotripsy. Urologiia. 2017;(4):113–119. doi: 10.18565/urol.2017.4.113-119 EDN: ZFVHVZ
- Mustafa M, Al Zabadi H, Mansour S, Nabulsi A. Endoscopic management of upper and lower ureteric stones using pneumatic lithotripter: A retrospective medical records review. Res Rep Urol. 2023;15:77–83. doi: 10.2147/RRU.S392881
- Wang Q, Guo J, Hu H, et al. Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis. PLoS One. 2017;12(2):e0171478. doi: 10.1371/journal.pone.0171478
- Wang Y, Zhong B, Yang X, et al. Comparison of the efficacy and safety of URSL, RPLU, and MPCNL for treatment of large upper impacted ureteral stones: a randomized controlled trial. BMC Urol. 2017;17(1):50. doi: 10.1186/s12894-017-0236-0
- Wu T, Duan X, Chen S, et al. Ureteroscopic lithotripsy versus laparoscopic ureterolithotomy or percutaneous nephrolithotomy in the management of large proximal ureteral stones: a systematic review and meta-analysis. Urol Int. 2017;99(3):308–319. doi: 10.1159/000471773
- Topaloglu H, Karakoyunlu N, Sari S, et al. A comparison of antegrade percutaneous and laparoscopic approaches in the treatment of proximal ureteral stones. Biomed Res Int. 2014;2014:691946. doi: 10.1155/2014/691946
- Prakash J, Singh V, Kumar M, et al. Retroperitoneoscopic versus open mini-incision ureterolithotomy for upper- and mid-ureteric stones: a prospective randomized study. Urolithiasis. 2014;42(2): 133–139. doi: 10.1007/s00240-013-0624-1
- Kumar A, Vasudeva P, Nanda B, et al. A prospective randomized comparison between laparoscopic ureterolithotomy and semirigid ureteroscopy for upper ureteral stones >2 cm: a single-center experience. J Endourol. 2015;29(11):1248–1252. doi: 10.1089/end.2013.0791
- Torricelli FC, Monga M, Marchini GS, et al. Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta-analysis of randomized controlled trials. Int Braz J Urol. 2016;42(4):645–654. doi: 10.1590/S1677-5538.IBJU.2015.0696
- Kallidonis P, Ntasiotis P, Knoll T, et al. Minimally invasive surgical ureterolithotomy versus ureteroscopic lithotripsy for large ureteric stones: A systematic review and meta-analysis of the literature. Eur Urol Focus. 2017;3(6):554–566. doi: 10.1016/j.euf.2017.04.006
- Popov SV, Guseinov RG, Gadjiev NK, et al. Percutaneous antegrade ureterolithotripsy for proximal ureteral stones: overview own experience use. Urology Herald. 2021;9(2):92–99. doi: 10.21886/2308-6424-2021-9-2-92-99 EDN: XGLSCC
- Taguchi K, Hamamoto S, Osaga S, et al. Comparison of antegrade and retrograde ureterolithotripsy for proximal ureteral stones: a systematic review and meta-analysis. Transl Androl Urol. 2021;10(3):1179–1191. doi: 10.21037/tau-20-1296
- Bhat A, Singh V, Bhat M, et al. Comparison of antegrade percutaneous versus retrograde ureteroscopic lithotripsy for upper ureteric calculus for stone clearance, morbidity, and complications. Indian J Urol. 2019;35(1):48–53. doi: 10.4103/iju.IJU_89_18
- Tiwari AK, Sarkar D, Pal DK. Emergency extracorporeal shock wave lithotripsy: A study on feasibility and efficacy in stone clearance and reducing morbidity in ureteric and renal stones with colic. Urologia. 2023;90(3):516–521. doi: 10.1177/03915603221140444
- Grabsky AM. The effectiveness of extracorporal shock wave lithotripsy of urinary stones with different chemical composition. Experimental and clinical urology. 2016;(3):112–115. EDN: YHTWSJ
- Patrashkov T, Mikhailov P, Lilov A, Nikolov S. Treatment of renal and ureteral stones by extracorporeal shock wave lithotripsy. Urology and Nephrology. 1988;(6):9–11. (In Russ.)
- Al-Shukri SH, Tkachuk VN, Dubinsky VY. Remote shockwave lithotripsy at different clinical forms of nephrolithiasis. Saint Petersburg: NIIH SPbSU Publ.; 1997. 190 p. (In Russ.)
- Darenkov AF, Dzeranov NK, Chudnovskaya MV, et al. Influence of stone chemical composition on contact lithotripsy. In: Proceedings of the IV All-Union urology congress. Moscow; 1999. P. 33–34. (In Russ.)
- Li W-M, Wu W-J, Chou Y-H, et al. Clinical predictors of stone fragmentation using slow-rate shock wave lithotripsy. Urol Int. 2007;79(2):124–128. doi: 10.1159/000106324
- Ibrahim A, Elatreisy A, Khogeer A, et al. Can we predict the ancillary treatments after extracorporeal shockwave lithotripsy for renal and upper ureteral stones? Arch Ital Urol Androl. 2022;94(4):439–442. doi: 10.4081/aiua.2022.4.439
- Al-Naemi RSM, Aldosky HYY, Shukri BSA. By-products of lithotripsy: Are they related to abdominal fat and wave characteristics? J Taibah Univ Med Sci. 2019;14(2):156–162. doi: 10.1016/j.jtumed.2019.01.003
- Kaya C, Kaynak Y, Karabag A, Aykaç A. The predictive role of abdominal fat parameters and stone density on SWL outcomes. Curr Med Imaging Rev. 2020;16(1):80–87. doi: 10.2174/1573405614666180927112127
- Ishii H, Couzins M, Aboumarzouk O, et al. Outcomes of systematic review of ureteroscopy for stone disease in the obese and morbidly obese population. J Endourol. 2016;30(2):135–145. doi: 10.1089/end.2015.0547
- Alsmadi JK. Shock Wave Lithotripsy outcomes for upper and lower ureteral stones in non-obese and non-pre-stented adults: Is one session sufficient? Cureus. 2022;14(9):e29592. doi: 10.7759/cureus.29592
- Li K, Lin T, Zhang C, et al. Optimal frequency of shock wave lithotripsy in urolithiasis treatment: a systematic review and meta-analysis of randomized controlled trials. J Urol. 2013;190(4)1260–1267. doi: 10.1016/j.juro.2013.03.075
- Skuginna V, Nguyen DP, Seiler R, et al. Does stepwise voltage ramping protect the kidney from injury during extracorporeal shockwave lithotripsy? Results of a prospective randomized trial. Eur Urol. 2016;69(2):267–273. doi: 10.1016/j.eururo.2015.06.017
- Manzoor S, Hashmi AH, Sohail MA, et al. Extracorporeal shock wave lithotripsy (ESWL) vs. ureterorenoscopic (URS) manipulation in proximal ureteric stone. J Coll Physicians Surg Pak. 2013;23(10):726–730. doi: 10.2013/JCPSP.726730
- Mittal V, Srivastava A, Kappor R, et al. Standardized grading of shock wave lithotripsy complications with modified Clavien system. Urol Int. 2016;97(3):273–278. doi: 10.1159/000446968
- Abdelbary AM, Al-Dessoukey AA, Moussa AS, et al. Value of early second session shock wave lithotripsy in treatment of upper ureteric stones compared to laser ureteroscopy. World J Urol. 2021;39(8):3089–3093. doi: 10.1007/s00345-020-03560-x
- Drake T, Grivas N, Dabestani S, et al. What are the benefits and harms of ureteroscopy compared with shock-wave lithotripsy in the treatment of upper ureteral stones? A systematic review. Eur Urol. 2017;72(5):772–786. doi: 10.1016/j.eururo.2017.04.016
- Jia B, Liu J, Hu B, Chen Z. Using retroperitoneal laparoscopic ureterolithotomy in the treatment of impacted upper ureteric calculi. Transl Androl Urol. 2022;11(1):104–109. doi: 10.21037/tau-21-115
- Sharma G, Pareek T, Tyagi S, et al. Comparison of efficacy and safety of various management options for large upper ureteric stones a systematic review and network meta-analysis. Sci Rep. 2021;11(1):11811. doi: 10.1038/s41598-021-91364-3
Дополнительные файлы
