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Nierenkelchsteine

Calyceal stones

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Zusammenfassung

Der Verlauf unbehandelter, asymptomatischer Kelchsteine ist hinsichtlich des Progressions- und Interventionsrisikos ungeklärt. Die Entscheidung zur aktiven Therapie von Nierenkelchsteinen basiert auf Aspekten wie Harnsteinzusammensetzung und -größe sowie Beschwerden. Die extrakorporale Stoßwellenlithotripsie (ESWL) weist eine niedrige Komplikationsrate auf und wird in den aktuellen Leitlinien der Deutschen Gesellschaft für Urologie (DGU) und der Europäischen Gesellschaft für Urologie (EAU) als First-line-Therapie bei Nierenkelchsteinen bis 2 cm Durchmesser empfohlen. Bei der ESWL wird keine sofortige Steinfreiheit erreicht. Zudem unterscheiden sich die primären Steinfreiheitsraten (SFR) der ESWL, abhängig von Lokalisation und Harnsteinzusammensetzung, erheblich. Minimal-invasive Verfahren wie die perkutane Nephrolitholapaxie und die Ureterorenoskopie stellen Alternativen zur Behandlung von Nierenkelchsteinen dar, die in Zentren eine niedrige Morbidität und hohe primäre SFR aufweisen.

Abstract

The natural course of untreated, asymptomatic calyceal calculi has not yet been clearly defined regarding disease progression and risk of surgical interventions. The decision for an active treatment of calyceal calculi is based on stone composition, stone size and symptoms. Extracorporeal shockwave lithotripsy (ESWL) has a low complication rate and is recommended by the current guidelines of the German (DGU) and European (EAU) Associations of Urology as a first-line therapy for the treatment of calyceal stones <2 cm in diameter. However, immediate removal of stones is not achieved with ESWL. The primary stone-free rates (SFR) after ESWL depend on stone location and stone composition and can show remarkable differences. Minimally invasive procedures, such as percutaneous nephrolitholapaxy and ureteroscopy are alternatives for the treatment of calyceal stones which have low morbidity and high primary SFR when performed in centres of excellence.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. C. Netsch und A.J. Gross geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland

    C. Netsch & A.J. Gross

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  2. A.J. Gross
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Correspondence to C. Netsch.

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Netsch, C., Gross, A. Nierenkelchsteine. Urologe 52, 1135–1148 (2013). https://doi.org/10.1007/s00120-013-3239-9

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