MP06-16 EFFICIENCY ANALYSIS OF AN INCREASE OF FOCAL SHOCK WAVE ENERGY THROUGH AN EXPANDED NUMBER OF SHOCKWAVES PER SESSION FOR TREATING URINARY STONES UP TO 2 CM WITH EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy I (MP06)1 Sep 2021MP06-16 EFFICIENCY ANALYSIS OF AN INCREASE OF FOCAL SHOCK WAVE ENERGY THROUGH AN EXPANDED NUMBER OF SHOCKWAVES PER SESSION FOR TREATING URINARY STONES UP TO 2 CM WITH EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY Jose Daniel Löpez-Acón, Javier Díaz-Carnicero, Alberto Budía, Domingo Guzman Ordaz, Pilar Bahilo-Mateu, David Vivas-Consuelo, and Francisco Boronat Jose Daniel Löpez-AcónJose Daniel Löpez-Acón More articles by this author , Javier Díaz-CarniceroJavier Díaz-Carnicero More articles by this author , Alberto BudíaAlberto Budía More articles by this author , Domingo Guzman OrdazDomingo Guzman Ordaz More articles by this author , Pilar Bahilo-MateuPilar Bahilo-Mateu More articles by this author , David Vivas-ConsueloDavid Vivas-Consuelo More articles by this author , and Francisco BoronatFrancisco Boronat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001973.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate the efficiency, in terms of cost-effectiveness, and safety of increasing focal shock wave energy through an expanded number of shockwaves per session in treating urinary lithiasis with extracorporeal lithotripsy. METHODS: a randomized, prospective and comparative study was carried out on patients with renal or ureteral lithiasis up to 2 cm and an indication of extracorporeal lithotripsy, between january 2011 and december 2019. Patients were included into two groups: group A (437 patients) was subjected to a standard treatment with 3500 waves per session, and group B (536 patients) was treated to an expanded treatment with 7000 waves per session. A Siemens Lithoskop Litotripter was used in both groups. Stone-free patients were considered after treatment when there was no lithiasis or it was expulsable (≤ 4 mm) on radiography or non-enhanced contrast TC. The study variables were: age, gender and body mass index (BMI) of the patient, side, location, size and Hounsfield Units (HU) of the stone, number of waves per session, total waves applied to resolution, number of sessions required, stone-free rate (SFR), and major and minor complication rate (Clavien-Dindo classification). A decision tree analysis was modelled for each alternative. Using this model, we estimated the incremental cost effectiveness ratio (ICER) and we conducted a Monte Carlo Simulation for a probabilistic sensitivity analysis RESULTS: Both groups were comparable in terms of age, gender and BMI of the patient, side, HU, location and size of lithiasis. The global SFR was 74.5% and 80.01% in groups A and B respectively (p=0.001). There were no differences in the complication rate (31.12% vs 30.04%, p=0.76) and severity between the two groups. The average cost of the SWL in group B was 1172.31 vs 1191.21 euros in group A. The estimated ICER showed that SWL with an extended number of shockwaves (group B) was dominant versus standard SWL treatment (group A), mainly in renal location and urinary stones bigger than 1 cm (ICER—1608 and—778, respectively). After performing the Monte Carlo simulation, the dominance of extended SWL treatment prevailed regardless of the size or location (renal or ureteral) of stone. CONCLUSIONS: The increase of focal shock wave energy through an expanded number of shockwaves per session in treating urinary lithiasis with extracorporeal lithotripsy is more cost-effective than standard treatment with similar safety. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e96-e96 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jose Daniel Löpez-Acón More articles by this author Javier Díaz-Carnicero More articles by this author Alberto Budía More articles by this author Domingo Guzman Ordaz More articles by this author Pilar Bahilo-Mateu More articles by this author David Vivas-Consuelo More articles by this author Francisco Boronat More articles by this author Expand All Advertisement Loading ...