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Management des Uretersteins

Management of ureteral stones

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Zusammenfassung

Harnleitersteine werden in der Regel durch Koliken oder Flankenschmerzen klinisch symptomatisch. Die Abklärung des akuten Flankenschmerzes mit Hilfe der bildgebenden Diagnostik ist auf die sichere Abgrenzung der Verdachtsdiagnose „Harnleiterstein“ von anderen Differenzialdiagnosen ausgerichtet. Weiterhin dient die Bildgebung mittels nativer Computertomographie oder Ausscheidungsurographie als Grundlage zur Therapieplanung. In Abhängigkeit von Größe und Lage des Harnleitersteins kommt ein spontaner Steinabgang, eine medikamentöse expulsive Therapie, eine extrakorporale Stoßwellentherapie, eine endoskopische Steinentfernung oder zunächst nur ein einfaches Stenting in Betracht. Ziel des Beitrags ist es, dem Leser die erforderlichen Auswahlkriterien zur optimalen Versorgung seines Patienten an die Hand zu geben.

Abstract

Ureteral stones are normally clinically symptomatic as colic or flank pain. The investigation of acute flank pain by diagnostic imaging targets on the confirmation of the suspected ureteral stone and the exclusion of other diseases. Furthermore, imaging using unenhanced computed tomography (NCCT) or excretory urography (IVU) serves as a basis for treatment planning. Depending on the size and location of ureteral stones a spontaneous stone passage, medical expulsive therapy (MET), extracorporeal shock wave lithotripsy (SWL), ureterorenoscopy (URS) or initially just simple stenting can be considered. The aim of this review is to provide the reader with the necessary decision criteria for optimal care of patients in the daily routine.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: M. Straub ist als Berater der Firma Richard Wolf Endoskope sowie der Firma Sanochemia Pharmazeutika AG tätig.

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Authors and Affiliations

  1. Klinikum rechts der Isar, Urologische Klinik und Poliklinik, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    M. Straub

  2. Urologische Klinik und Poliklinik, Klinikum Großhadern , Ludwig-Maximilians-Universität München, München, Deutschland

    M. Bader & F. Strittmatter

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  1. M. Straub
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  2. M. Bader
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  3. F. Strittmatter
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Correspondence to M. Straub.

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 ______

Der Abschnitt „Wie funktioniert die MET, und was darf man von ihr erwarten?“ wurde von F. Strittmatter verfasst, der Abschnitt „To stent or not to stent?” von M. Bader.

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Straub, M., Bader, M. & Strittmatter, F. Management des Uretersteins. Urologe 52, 415–426 (2013). https://doi.org/10.1007/s00120-013-3122-8

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