Cost Of Shock Wave Lithotripsy Research Articles

Percutaneous nephrolithotomy versus shock wave lithotripsy for high-density moderate-sized renal stones: A prospective randomized study.

Context:The management of renal stones of high density (>1000 Hounsfield units) on non-contrast computed tomography (NCCT), and moderate sized (15-25 mm) is still debatable.Aims:The aim of this study was to compare the outcomes of percutaneous nephrolithotomy (PCNL) and shock wave lithotripsy (SWL) for the high-density and moderate-sized renal stones regarding the stone-free rate (SFR), morbidity, and patients' quality of life.Settings and Design:This is a prospective randomized study.Patients and Methods:Eighty consecutive patients with renal stones, excluding those with lower calyceal stones, were randomized to receive either PCNL or SWL (40 in each arm). Patients were followed up by abdominal ultrasound and plain X-ray (NCCT if indicated) till clearance of stone. Outcomes, complications, costs, and SF-8 Health Survey scoring were recorded for each group.Statistical Analysis:We used Stata software, version 9.2 (Intercooled STATA®; StataCorp LP College Station, Texas, USA). Comparison of the two groups was made with regard to patient and stone criteria and the procedure details. Continuous variables were compared using the Mann–Whitney U-test with values shown as the median and interquartile range. Categorical variables were compared using the Pearson's Chi-square/Fisher's exact test. Multivariate logistic regression analysis was used to identify variables independently associated with the stone clearance after two sessions of SWL. P < 0.05 was considered statistically significant.Results:The basic characteristics of both groups were comparable. After a single treatment session, the SFR was 80% and 27.5% for PCNL and SWL, respectively (P < 0.001). The overall 3-month SFR was 87.5% versus 90%, respectively (P = 0.723). The median number of the required maneuvers was 1 (range: 1–3) for PCNL versus 2 (range: 1–4) for SWL (P < 0.001). The complication rate was 10% and 7.5%, respectively (P = 0.692). The cost of SWL was significantly lower (P < 0.001). On multivariate analysis, a single stone was an independent predictor for stone clearance after two sessions of SWL (odds ratio: 7.26, 95% confidence interval: 1.13–46.62, P = 0.037).Conclusions:PCNL for the dense, and moderate-sized renal stone provides higher initial success and lower re-treatment rates compared with SWL with comparable outcome after 3 months of therapy. However, SWL is an alternative, especially for a single stone.

Comparison of the Efficacy of Ultra-Mini PCNL, Flexible Ureteroscopy, and Shock Wave Lithotripsy on the Treatment of 1–2 cm Lower Pole Renal Calculi

Objective: To compare the efficacy of new percutaneous technique (“ultra-mini PCNL”, UMP), shock wave lithotripsy (SWL) and flexible ureteroscopy (FURS) on the treatment of 1–2 cm lower pole kidney stones, and to determine the advantages and disadvantages of each method. Materials and Methods: This prospective study was based on data collected from the files of patients between March 2015 and March 2017. This study recruited a total of 180 patients with single radio-opaque lower caliceal calculi of 1–2 cm. All patients were randomly divided into 3 groups: group A was treated with UMP, group B was treated with FURS by using holmium laser and group C was treated with SWL by using the electromagnetic lithotripter. The average age, sex, size of the stone, the time of operation, the rate of no stone, the time of hospitalization, the rate of retreatment, the cost and the complications of the 3 groups were compared. The success of the operation was defined as no residual stone or < 0.3 cm on computed tomography at 3 months postoperatively. Results: The stone burdens of the groups were equivalent. The re-treatment rate in group C was significantly higher than that in group A and B (30 vs. 1.6%, 5%). The average operating time in group B (93.35 ± 21.64 min) was statistically significantly longer than that in group A and C (68.58 ± 15.82 min, 46.33 ± 5.81 min). Although the time of hospitalization of group A (5.32 ± 1.20 day) was longer than that of group B (3.22 ± 0.52 day) and C (1.08 ± 0.28 day; p < 0.05). The stone-free rate (SFR) in UMP, FURS, SWL were 98, 92, and 73% respectively; the highest SFR was in the UMP group (p < 0.05). The complication rates were evaluated by using the Clavien grading system, which were determined to be 16.67% in UMP, 6.67% in SWL and 8.33% in FURS. In particular, the complications of GI and GII were more common in group A (p < 0.05). Conclusions: UMP, FURS, and SWL are all safe and effective in the treatment of 1–2 cm lower pole kidney stones. UMP and FURS had a better SFR than SWL, but the time of hospitalization in UMP group was longer and there were more complications in the UMP group. In addition, the operation time of FURS is longer as compared to UMP and SWL, and there is a higher rate of postoperative fever. The invasiveness and cost of SWL were lower than that of UMP and FURS, but the re-treatment rate was higher.

MP54-20 ACCURACY OF ULTRASONOGRAPHY FOR THE EVALUATION OF UROLITHIASIS IN PATIENTS UNDERGOING EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY: COMPARISON WITH NON-CONTRAST COMPUTED TOMOGRAPHY

INTRODUCTION AND OBJECTIVES: percutaneous nephrolithotomy (PNL) is the preferred treatment of high dense renal stones. In this study we tried to compare the outcomes of PNL versus shock wave lithotripsy (SWL) for high density (1000-1500 HU on non-contrast computed tomography [NCCT]) moderate sized (1025mm) renal calculi as regards stone-free rate and procedure morbidity. METHODS: A prospective study was conducted in our department from March 2012 to May 2014. Eighty consecutive patients; excluding lower calyceal stones; were randomized to receive either PNL or SWL (40 in each arm). Patients were followed-up by abdominal ultrasound and plain X-Ray (NCCT if indicated) till clearance of stone. Outcomes, complications (the modified Clavien system), costs, and SF8 Health Survey scoring were recorded for each group. Median followup was 8 months (range 6 to 30). RESULTS: Basic characteristics of both groups were comparable. After single treatment session, 3-week success rates were 80 and 27.5% for PNL and SWL respectively (p < 0.001). Overall 3-month stone free rates after PNL and SWL monotherapy were 87.5 vs. 90%, respectively (p 1⁄4 0.723). Median number of required maneuvers till stone clearance was one (range 1-3) for PNL vs. two (range 1-4) for SWL (p < 0.001). The complication rates for the PNL and SWL were 10 and 7.5%, respectively (p 1⁄4 0.692). SWL was done as outpatient procedure while median hospitalization time per patient was 2 days (range 2-6) in the PNL group. The cost of SWL was significantly lower (p < 0.001). Patient-reported outcomes, including overall physical and mental health status, were comparable for both PNL and SWL. On multivariate analysis, single renal stone was an independent predictor for complete stone clearance after 2 sessions of SWL (OR 7.26, 95% CI 1.1346.62, p1⁄40.037). CONCLUSIONS: For treatment of moderate-sized high density renal stones, PNL provides significantly higher initial success and lower retreatment rates compared with SWL. Although PNL is effective, it has some limitations including invasiveness and cost. SWL is another alternative especially for single moderate-sized high density renal stone.

MP54-19 PERCUTANEOUS NEPHROLITHOTOMY VERSUS SHOCK WAVE LITHOTRIPSY FOR MODERATE-SIZED HIGH DENSITY KIDNEY STONES: A PROSPECTIVE RANDOMIZED TRIAL

You have accessJournal of UrologyStone Disease: Shock Wave Lithotripsy1 Apr 2016MP54-19 PERCUTANEOUS NEPHROLITHOTOMY VERSUS SHOCK WAVE LITHOTRIPSY FOR MODERATE-SIZED HIGH DENSITY KIDNEY STONES: A PROSPECTIVE RANDOMIZED TRIAL Ahmad A Elderwy, Mohamed Gadelmoula, Ghaleb Althamthami, and Ahmad Abdulmoneim Ahmad A ElderwyAhmad A Elderwy More articles by this author , Mohamed GadelmoulaMohamed Gadelmoula More articles by this author , Ghaleb AlthamthamiGhaleb Althamthami More articles by this author , and Ahmad AbdulmoneimAhmad Abdulmoneim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.589AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES percutaneous nephrolithotomy (PNL) is the preferred treatment of high dense renal stones. In this study we tried to compare the outcomes of PNL versus shock wave lithotripsy (SWL) for high density (1000-1500 HU on non-contrast computed tomography [NCCT]) moderate sized (10- 25mm) renal calculi as regards stone-free rate and procedure morbidity. METHODS A prospective study was conducted in our department from March 2012 to May 2014. Eighty consecutive patients; excluding lower calyceal stones; were randomized to receive either PNL or SWL (40 in each arm). Patients were followed-up by abdominal ultrasound and plain X-Ray (NCCT if indicated) till clearance of stone. Outcomes, complications (the modified Clavien system), costs, and SF-8 Health Survey scoring were recorded for each group. Median followup was 8 months (range 6 to 30). RESULTS Basic characteristics of both groups were comparable. After single treatment session, 3-week success rates were 80 and 27.5% for PNL and SWL respectively (p < 0.001). Overall 3-month stone free rates after PNL and SWL monotherapy were 87.5 vs. 90%, respectively (p = 0.723). Median number of required maneuvers till stone clearance was one (range 1-3) for PNL vs. two (range 1-4) for SWL (p < 0.001). The complication rates for the PNL and SWL were 10 and 7.5%, respectively (p = 0.692). SWL was done as outpatient procedure while median hospitalization time per patient was 2 days (range 2-6) in the PNL group. The cost of SWL was significantly lower (p < 0.001). Patient-reported outcomes, including overall physical and mental health status, were comparable for both PNL and SWL. On multivariate analysis, single renal stone was an independent predictor for complete stone clearance after 2 sessions of SWL (OR 7.26, 95% CI 1.13- 46.62, p=0.037). CONCLUSIONS For treatment of moderate-sized high density renal stones, PNL provides significantly higher initial success and lower retreatment rates compared with SWL. Although PNL is effective, it has some limitations including invasiveness and cost. SWL is another alternative especially for single moderate-sized high density renal stone. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e734 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ahmad A Elderwy More articles by this author Mohamed Gadelmoula More articles by this author Ghaleb Althamthami More articles by this author Ahmad Abdulmoneim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

S051: Comparison of flexible ureterorenoscopy and mini percutaneous nephrolithotomy in treatment of lower calyceal stones smaller than 2 cm

INTRODUCTION AND OBJECTIVES: Medium-sized renal stones are primarily treated with one of three methods: ureteroscopy (URS), shockwave lithotripsy (SWL), or percutaneous nephrolithotomy (PCNL). Many studies have addressed the efficacy of these procedures, but evaluating the relative costs is rarely done because actual cost data (not charge data) is not readily available. In this study, we used an innovative tool to evaluate the efficacy and cost of treating medium-sized renal stones. METHODS: We retrospectively identified all adult patients treated from January 2012 to December 2013 for unilateral, 10-20 mm renal stones with URS, SWL, or PCNL by a single surgeon. Patient demographics, stone characteristics, procedural data, and complications were obtained from electronic medical records. Efficacy was measured by the stone free rate (SFR). Complications were defined as seeking medical attention for urinary symptoms/complaints within 30 days of treatment, e.g. UTI, hematuria, flank pain. Costs were calculated using a proprietary cost-allocation tool developed at the University of Utah (Value Driven Outcomes, VDO). We used VDO to itemize and assign all costs associated with each patient episode including all postoperative visits, both routine and unexpected. Importantly, the allocated costs are independent of hospital charges. RESULTS: Forty-two patients met inclusion criteria. Demographics and stone characteristics are similar between all three groups. The cost of SWL was set at 1.0; other costs are relative to SWL. PCNL is the most expensive, and PCNL and SWL have similar retreatment and complication rates. URS is more expensive than SWL but has the lowest retreatment and complication rates, as well as the highest SFR (see table). CONCLUSIONS: For medium-sized renal stones, SWL is the least expensive for a single episode of care, but URS offers the best balance between efficacy and cost when compared to SWL and PCNL. In an era of healthcare cost concerns, this study supports VDO as being a valuable tool in evaluating the relative costs of different treatment modalities for the same disease.

SWL is More Cost-Effective than Ureteroscopy and Holmium:YAG Laser Lithotripsy for Ureteric Stones: A Comparative Analysis for a Tertiary Referral Centre

Background: To identify the most cost-effective treatment for ureteric stones ≤15 mm in our department, by using an economic model to compare the total cost of shockwave lithotripsy (SWL) versus ureteroscopy with Holmium:YAG laser lithotripsy (URSL). Patients and methods: Data for patients treated with the same lithotriptor were retrospectively analyzed. The financial department provided data about the cost of procedures. This model accepted a 100% stone-free rate for URSL in outpatients, and a 50% rate of insertion of a ureteric stent. The cost for each procedure to render a patient stone-free was estimated by the following equations: costSWL = cost(initial SWL session) + [cost(SWL session) × retreatment rate] + [cost(URSL) × SWL failure rate] + [cost(stent insertion and removal) × rate] + [cost(KUB film) × 4] costURSL = cost(URSL) + [cost(stent removal) × 50%] + [cost(KUB film) × 2] Results: Records of 228 patients with previously untreated solitary radiopaque ureteric stones ≤15 mm were reviewed. The total cost for SWL (cSWL) was £1491/patient, while the total cost for URSL (cURSL) was £2195/patient. The difference was highest in the upper ureter (over £1000), and lowest in the distal part (URSL about 40% more expensive). For lower ureteric stones &gt;10 mm, SWL was over £500 more expensive than URSL. Conclusion: Using data from the department to calculate cost-effectiveness for ureteric stones ≤15 mm a difference in favour of SWL versus URSL was found. Uniform guidelines incorporating cost are impossible considering differences between countries; each centre should probably assess their data individually.

Laparoscopic ureterolithotomy: Its role and some controversial technical considerations

To define the role of laparoscopic ureterolithotomy in the management of urolithiasis and evaluate the controversial techniques of this operation. Between July 1997 and December 2004, retroperitoneoscopic ureterolithotomy was performed as a primary procedure in 30 patients who had either large or impacted stones in the upper ureter. The other indications were stones which could not be fragmented by shock wave lithotripsy or the patients could not afford the cost of shock wave lithotripsy. The mean (range) age of the patients was 44.07 years (17-78) and the mean (range) stone size was 19.03 mm (10-40). The ureter was closed with intracorporeal laparoscopic suture without placing a stent. The stone was removed in all but one case. The mean (range) operative time was 121.38 min (75-270). No intraoperative complications were recorded. The mean (range) postoperative drain removal was 2.86 days (2-10). Postoperative complications included prolonged urinary leakage in one patient. On the sixth month of follow up, all patients were stone free without any evidence of ureteral stricture. Laparoscopic ureterolithotomy is a minimally invasive treatment and may be considered as the useful first-line management for large impacted upper ureteric stones. The technical recommendations were retroperitoneal access and suturing the ureterotomy incision. Ureteral stent should be placed in only cases of severe inflammation of the ureter or inappropriate suturing.

Management Of Ureteral Calculi: A Cost Comparison And Decision Making Analysis

We compared the cost of treatment strategies for ureteral calculi using a decision tree model. A comprehensive literature review was performed to determine the average success rate of each of 3 treatment modalities, namely observation, ureteroscopy and shock wave lithotripsy. Using these success rates decision analysis models were constructed using Data 3.5 software (TreeAge Software, Inc., Williamstown, Massachusetts) to estimate the cost of treatment and followup for each of the 3 treatments. One-way sensitivity analysis was performed to evaluate the effect of varying individual probabilities of success and costs, and 2-way sensitivity analysis was done to evaluate the model for a wide range of potential costs and success rates of ureteroscopy and shock wave lithotripsy. In addition, a table was constructed to enable individual surgeons and institutions to determine the cost impact of ureteroscopy and shock wave lithotripsy in their unique clinical scenarios. Observation was the least costly pathway if no financial cost, such as emergency room visits, was incurred by failed observation. Ureteroscopy was less costly than shock wave lithotripsy for stones at all ureteral locations. A cost difference between the 2 modalities of approximately $1,440, $1,670 and $1,750 was noted for proximal, mid and distal ureteral calculi, respectively. One-way sensitivity analysis showed that the cost of ureteroscopy would have to increase by more than $1,400, $1,700 and $1,850, and the success rate would have to decrease by 28%, 36% and 39% for proximal, mid and distal stones, respectively, before reaching cost equivalence with shock wave lithotripsy. Likewise, the cost of shock wave lithotripsy would have to decrease by more than $1,489 to achieve cost equivalence with ureteroscopy. Overall ureteroscopy was more cost-effective at all stone sites regardless of the success rate of shock wave lithotripsy. Ureteroscopy is the most cost-effective treatment strategy for ureteral stones at all locations after observation fails. The high cost of purchasing and maintaining a lithotriptor is responsible for the high treatment cost associated with shock wave lithotripsy. However, cost is only one of a number of important factors that are considered when determining an appropriate treatment strategy.