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Efficiency and cost of treating proximal ureteral stones: shock wave lithotripsy versus ureteroscopy plus holmium:yttrium-aluminum-garnet laser.
Urology. 2004 Dec; 64(6):1102-6; discussion 1106.U

Abstract

OBJECTIVES

To compare the success rates, cost effectiveness, and efficiency of ureteroscopy (URS) and extracorporeal shock wave lithotripsy (ESWL) for proximal ureteral stones.

METHODS

In a retrospective manner, 220 patients who underwent treatment for proximal ureteral stones were included in the study. The patient records, radiographs, and billing statements of all patients treated for upper ureteral stones between January 1997 and June 2001 at Scott and White Memorial Hospital were reviewed. The patients were placed into two treatment groups according to the method of their stone's initial treatment. The stones were categorized as less than 1 cm and 1 cm or greater.

RESULTS

A total of 111 patients were in the ESWL group, 73 of whom had stones less than 1 cm, and 109 patients in the URS group, 81 of whom had stones less than 1 cm. In the URS group, 91% were successfully treated with one treatment intervention, and 55% of the ESWL group were successfully treated with their initial intervention (P <0.0001). Of the patients with URS failure, all but one was treated successfully with a second URS. Of the patients with ESWL failure, 52% were treated successfully by subsequent URS. The remaining patients with ESWL failure were treated with repeat ESWL, with a 62% success rate. The efficiency quotient for stones less than 1 cm for URS and ESWL was 0.79 and 0.51, respectively. For stones 1 cm or greater, URS had an efficiency quotient of 0.72 and ESWL of 0.46. The URS group required fewer days to be stone free (8 versus 25.5 days, P <0.0001). No statistically significant difference was found in the overall complication rates (P = 0.43). URS had significantly lower charges for the initial procedure (7575 dollars versus 9507 dollars, P <0.0001). The total charges were also lower for URS (9378 dollars versus 15,583, dollars P <0.0001). Complications were similar in the two groups. The URS group had two ureteral strictures.

CONCLUSIONS

The results of this study indicate that URS is more efficient and cost-effective for stones up to and larger than 1 cm with similar complication rates compared with ESWL.

Authors+Show Affiliations

Department of Urology, Scott and White Memorial Hospital and Clinic, Scott, Sherwood and Brindley Foundation, and Texas A&M University, Temple, TX 76508, USA. bparker@swmail.sw.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15596177

Citation

Parker, Brian D., et al. "Efficiency and Cost of Treating Proximal Ureteral Stones: Shock Wave Lithotripsy Versus Ureteroscopy Plus Holmium:yttrium-aluminum-garnet Laser." Urology, vol. 64, no. 6, 2004, pp. 1102-6; discussion 1106.
Parker BD, Frederick RW, Reilly TP, et al. Efficiency and cost of treating proximal ureteral stones: shock wave lithotripsy versus ureteroscopy plus holmium:yttrium-aluminum-garnet laser. Urology. 2004;64(6):1102-6; discussion 1106.
Parker, B. D., Frederick, R. W., Reilly, T. P., Lowry, P. S., & Bird, E. T. (2004). Efficiency and cost of treating proximal ureteral stones: shock wave lithotripsy versus ureteroscopy plus holmium:yttrium-aluminum-garnet laser. Urology, 64(6), 1102-6; discussion 1106.
Parker BD, et al. Efficiency and Cost of Treating Proximal Ureteral Stones: Shock Wave Lithotripsy Versus Ureteroscopy Plus Holmium:yttrium-aluminum-garnet Laser. Urology. 2004;64(6):1102-6; discussion 1106. PubMed PMID: 15596177.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficiency and cost of treating proximal ureteral stones: shock wave lithotripsy versus ureteroscopy plus holmium:yttrium-aluminum-garnet laser. AU - Parker,Brian D, AU - Frederick,Robert W, AU - Reilly,T Philip, AU - Lowry,Patrick S, AU - Bird,Erin T, PY - 2004/01/13/received PY - 2004/07/13/accepted PY - 2004/12/15/pubmed PY - 2005/7/30/medline PY - 2004/12/15/entrez SP - 1102-6; discussion 1106 JF - Urology JO - Urology VL - 64 IS - 6 N2 - OBJECTIVES: To compare the success rates, cost effectiveness, and efficiency of ureteroscopy (URS) and extracorporeal shock wave lithotripsy (ESWL) for proximal ureteral stones. METHODS: In a retrospective manner, 220 patients who underwent treatment for proximal ureteral stones were included in the study. The patient records, radiographs, and billing statements of all patients treated for upper ureteral stones between January 1997 and June 2001 at Scott and White Memorial Hospital were reviewed. The patients were placed into two treatment groups according to the method of their stone's initial treatment. The stones were categorized as less than 1 cm and 1 cm or greater. RESULTS: A total of 111 patients were in the ESWL group, 73 of whom had stones less than 1 cm, and 109 patients in the URS group, 81 of whom had stones less than 1 cm. In the URS group, 91% were successfully treated with one treatment intervention, and 55% of the ESWL group were successfully treated with their initial intervention (P <0.0001). Of the patients with URS failure, all but one was treated successfully with a second URS. Of the patients with ESWL failure, 52% were treated successfully by subsequent URS. The remaining patients with ESWL failure were treated with repeat ESWL, with a 62% success rate. The efficiency quotient for stones less than 1 cm for URS and ESWL was 0.79 and 0.51, respectively. For stones 1 cm or greater, URS had an efficiency quotient of 0.72 and ESWL of 0.46. The URS group required fewer days to be stone free (8 versus 25.5 days, P <0.0001). No statistically significant difference was found in the overall complication rates (P = 0.43). URS had significantly lower charges for the initial procedure (7575 dollars versus 9507 dollars, P <0.0001). The total charges were also lower for URS (9378 dollars versus 15,583, dollars P <0.0001). Complications were similar in the two groups. The URS group had two ureteral strictures. CONCLUSIONS: The results of this study indicate that URS is more efficient and cost-effective for stones up to and larger than 1 cm with similar complication rates compared with ESWL. SN - 1527-9995 UR - https://www.unboundmedicine.com/medline/citation/15596177/Efficiency_and_cost_of_treating_proximal_ureteral_stones:_shock_wave_lithotripsy_versus_ureteroscopy_plus_holmium:yttrium_aluminum_garnet_laser_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-4295(04)01069-6 DB - PRIME DP - Unbound Medicine ER -