Rückblick auf 50 Jahre Steintherapie

Zusammenfassung

Die Urolithiasis ist das Brot-und-Butter-Geschäft des Urologen. Kaum eine urologische Praxis oder Klinik kann auf die Therapie von Harnsteinen verzichten. Dieser Artikel stellt die Entwicklungen der letzten 50 Jahre auf dem Gebiet der Urolithiasis dar. In der bildgebenden Diagnostik hat sich die Computertomografie gegenüber der konventionellen Röntgenbildgebung durchgesetzt. Konservative Therapien wie die „medical expulsive therapy“ (MET) hatten sich etabliert, sind aber zuletzt wieder in die Diskussion geraten. Die größten Fortschritte hat in den letzten 50 Jahren sicherlich die interventionelle Therapie gezeigt. War in den 70er-Jahren noch die offene Steinchirurgie der Therapiestandard, so hat sich diese bis heute vollständig zu Minimal-Invasivität gewandelt. Die Entwicklung der perkutanen Nephrolithotomie (PCNL), dann der extrakorporalen Stoßwellenlithotripsie (ESWL) und schließlich der Ureterrenoskopie (URS) ermöglichen heute individualisierte Therapiekonzepte, wobei die URS sicherlich das am häufigsten eingesetzte Verfahren ist. Wünschenswert sind die gleichen Fortschritte auf dem Gebiet der Steinmetabolik und -prävention, wo die diagnostischen Verfahren und Therapieempfehlungen keine wirkliche Entwicklung gezeigt haben.

Abstract

Urolithiasis is an urologist’s daily business. This article provides an overview of the developments in the management of urinary stone disease since the 1970s. While conventional KUB X-rays and intravenous pyelography were standard imaging procedures in the past, computed tomography is the first choice today. Conservative treatments such as medical expulsive therapy were established to facilitate ureteral stone passage, but have come into discussion in the past few years. Fifty years ago, open stone surgery was the standard procedure to access renal stones. This has been superseded by minimally-invasive procedures ranging from percutaneous nephrolithotomy (PCNL) to extracorporeal shock-wave lithotripsy (ESWL) and ureteroscopy (URS), which is today’s standard for most upper urinary tract stones. It would have been desirable if such enormous efforts and progress had been made in the evaluation of stone pathogenesis and the improvement of preventative measures. Unfortunately, the knowledge on stone formation has hardly improved compared to 1970.

Schlüsselwörter

Harnsteine - Steinchirurgie - ESWL - URS - PCNL

Keywords

urinary calculi - open stone surgery - URS - ESWL - PCNL

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