{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T03:22:18Z","timestamp":1764645738091,"version":"3.28.0"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aktuelle Urol"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\n   Harnsteine der oberen, ableitenden Harnwege erf\u00fcllen durch ihre hohe Inzidenz und Pr\u00e4valenz sowie auch in gesundheitspolitisch-finanzieller Hinsicht die Kriterien f\u00fcr eine Volkskrankheit. Ein erheblicher Anteil der neu diagnostizierten Nierensteine sind Unterpolsteine, betreffen also die untere Kelchgruppe des Nierenbeckenkelchsystems. Diese werden h\u00e4ufig als Zufallsbefund diagnostiziert, also als Zufallsbefund im Rahmen von Ultraschall- oder CT-Diagnostik aus anderen Gr\u00fcnden, oder als \u201eZweit-Steine\u201c bei der diagnostischen Aufarbeitung von symptomatischen Harnsteinen an anderen Lokalisationen. Eine weitere, quantitativ bedeutende Gruppe wird durch Rest-Desintegrate nach extrakorporaler Sto\u00dfwellenlithotripsie (ESWL) oder endoskopischer Steintherapie. Diese zuf\u00e4llig entdeckten Unterpolsteine zeichnen sich oft durch ihre geringe Gr\u00f6\u00dfe und die fehlende Symptomatik aus. Nun liegt es nahe, dass ein Teil dieser kleinen, asymptomatischen Unterpolsteine nicht immer klein und asymptomatisch bleibt, und dass eine Therapie mit zunehmender Gr\u00f6\u00dfe eher aufwendiger wird.\n    <\/jats:p><jats:p>\n    Interessanterweise finden sich im Verlauf der letzten 20 Jahre erstaunlich wenig publizierte Studien auf hohem Evidenzniveau, die imstande sind, die Fragestellung dieser \u00dcbersichtsarbeit schl\u00fcssig und reproduzierbar zu beantworten.\n    <\/jats:p><jats:p>\n    Kleine, asymptomatische Steine k\u00f6nnen beobachtet werden. Symptomatische und schnell wachsende sollten behandelt werden. Valide Risikofaktoren, die die Identifikation von Subgruppen erlauben, die man prophylaktisch schon im asymptomatischen Stadium behandeln sollte, fehlen nach wie vor.\n    <\/jats:p><jats:p>\n    Bei der aktiven Therapie gilt genau wie vor 10 oder 20 Jahren der Grundsatz: Steinfreiheit in einer Therapiesitzung wird mit einer erh\u00f6hten Komplikationsrate bezahlt, wobei zunehmende Miniaturisierung in der Endourologie (retrograd und perkutan) sowie die immer effektiver werdende Laser-Desintegration dieses Grundprinzip mehr und mehr zugunsten von flexibler URS und (mini, micro) PCNL verschieben. Der Indikationsbereich f\u00fcr die ESWL wird ohne Zweifel immer kleiner, dies gilt auch f\u00fcr Unterpolsteine. Die Ergebnisse einer laufenden, allerdings mit Rekrutierungsproblemen k\u00e4mpfenden, prospektiv randomisierten Studie zum Vergleich der verschiedenen Behandlungsmodalit\u00e4ten stehen noch aus.\n    <\/jats:p>","DOI":"10.1055\/a-2290-7250","type":"journal-article","created":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T23:35:05Z","timestamp":1713915305000},"page":"243-249","source":"Crossref","is-referenced-by-count":1,"title":["Der 1 cm UKG-Stein: ESWL, URS oder Mini-PCNL? Leitlinien versus Realit\u00e4t"],"prefix":"10.1055","volume":"55","author":[{"given":"Peter Jochen","family":"Olbert","sequence":"additional","affiliation":[{"name":"Urologie, Brixsana private clinic, Brixen, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/j.eururo.2014.11.034","article-title":"Lower-pole stones: do we finally have more answers than questions?","volume":"67","author":"JM Patterson","year":"2015","journal-title":"Eur Urol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1016\/j.eururo.2014.09.054","article-title":"Systematic review and meta-analysis of the clinical effectiveness of shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy for lower-pole renal stones","volume":"67","author":"JF Donaldson","year":"2015","journal-title":"Eur 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