Cost Effectiveness of Extracorporeal Shock Wave Lithotripsy and Percutaneous Nephrolithotomy for Medium-Sized Kidney Stones

Carlsson, Per; Kinn, Anne‐Charlotte; Tiselius, Hans‐Göran; Ohlsèn, Hans; Rahmqvist, Mikael

doi:10.3109/00365599209180879

Cited by 33 publications

(17 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…4) corresponded to a reduction from Aus$ 4748 to Aus$ 2374 per patient, albeit that such values do not consider changes in resource use per inpatient-day. These outcomes are generally consistent with results of other population-based research [16,17] and clinical trials of the cost-effectiveness of the noninvasive and minimally invasive treatment methods [10][11][12][13][14]. The third benefit has been the increased chance of renal preservation.…”

Section: Discussionsupporting

confidence: 84%

“…That ESWL is used to treat most calculi in the upper urinary tract is not surprising, given that it has consistently out-performed even minimally invasive endourological procedures in clinical trials of costeffectiveness [10][11][12][13][14]. Moreover, patients prefer to avoid surgery in the treatment of stone disease, with ESWL being perceived by them as the most desirable treatment option [15].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Changing treatments for primary urolithiasis: impact on services and renal preservation in 16 679 patients in Western Australia

et al. 2002

View full text Add to dashboard Cite

Objectives To examine changing treatments for the primary presentation of urinary lithiasis and their effects on re-admissions, repeat procedures, cumulative hospital use and renal preservation. Patients and methods Linked hospital morbidity records were used to identify first-time admissions for renal and ureteric calculi from 1980 to 1997 in the population of Western Australia. The cases were followed to mid-1999 and actuarial methods used to estimate risks of further hospital admissions and procedures, including the loss of a renal moiety. Results Between 1980 and 1997 the total rate of inpatient procedures for urinary stones more than doubled, at a time when the rate of first-time hospital admissions increased by only 13% and the conservative management of stones remained constant at <59%. The predominant procedure for stone management was initially open lithotomy, replaced in the early 1980s by percutaneous nephrolithotomy and soon supplemented by extracorporeal shock wave lithotripsy (ESWL). The changes in technology led to a four-fold increase in procedural re-admissions within 30 days of primary separation. This was a result of repeated, staged or postponed interventions, often involving the use of stents or a second treatment with ESWL. The risk of surgical intervention decreased from 48% to 32%, whilst the cumulative length of stay over the first year decreased from 7.8 to 3.9 days. The risk of kidney loss declined significantly from 2% to <0.1% during the period. Conclusions The main reason for more interventions were short-term procedural re-admissions. ESWL reduced the need for invasive procedures and decreased cumulative hospital stay, despite more re-admissions. Renal preservation improved by a factor of 10.

show abstract

Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Changing treatments for primary urolithiasis: impact on services and renal preservation in 16 679 patients in Western Australia

et al. 2002

View full text Add to dashboard Cite

show abstract

“…In the study of Carlsson et al [16] the cost-effectiveness of SWL versus PNL in the treatment of LP stones was evaluated. They showed that SWL was less costly.…”

Section: Discussionmentioning

confidence: 99%

Lower Pole Midsize (1–2 cm) Calyceal Stones: Outcome Analysis of 56 Cases

2012

View full text Add to dashboard Cite

Objectives: To compare efficacy of shockwave lithotripsy (SWL) with percutaneous nephrolithotomy (PNL) and retrograde ureterorenoscopy (RUR) in the management of midsize (1–2 cm) lower calyceal stones and the impact of lower pole (LP) anatomy on lithotripsy results. Patients and Methods: Between 2007 and 2011, 56 patients with lower calyceal stones 1–2 cm were indicated for intervention. 24 patients were treated with SWL, 19 with PNL, and 13 with RUR. Results: Mean age at surgery was 53, 45 and 47 years for SWL, PNL and RUR, respectively. Mean stone size was 15.6 ± 4.3, 17.3 ± 3.3 and 14.5 ± 3.2 mm, respectively. The stone-free rate was 62.5, 89.4 and 74.6%, respectively (p > 0.05). The mean time of procedures was 48.3 ± 16 min compared to 63 ± 32 and 76 ± 34 min in PNL and RUR, respectively (p > 0.05). In the SWL group there was a significant difference in LP anatomical measurements between the stone-free group and residual stone group. Conclusion: SWL is an effective treatment modality for patients with favorable LP calyceal anatomy. PNL and RUR with laser lithotripsy are effective therapeutic alternative options in midsize (1–2 cm) lower calyceal stones. This study may be limited by its retrospective nature and modest sample size, but it is enhanced by comparing three different treatment modalities.

show abstract

“…It is not yet possible to look at a film and select the proper treatment for upper-tract calculi, i.e., ESWL or percutaneous nephrolithotomy. This would be the more desirable, since it has been shown that the latter treatment is less expensive under certain circumstances [12].…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Radiological Criteria for Disintegration Rates of Extracorporeal Shock Wave Lithotripsy

et al. 2001

View full text Add to dashboard Cite

Objective: To evaluate routinely applicable criteria to predict fragmentation of renal calculi by extracorporeal shock wave lithotripsy (ESWL). Patients and Methods: Two hundred and two consecutive patients (121 men, 81 women), median age 48 (range 19–81) years, were treated with the original Dornier HM-3 lithotriptor at a single stone center. Inclusion criteria were: solitary stones, 10–30 mm in greatest diameter, located in renal pelvis or calyces. Based on plain radiographs, the calculi were classified according to their size, form, location, density (compared to the 12th rib), structure and surface. Furthermore, age of the patient, gender and body mass index were also considered for evaluation. Disintegration was documented on day 1 after ESWL by plain X-ray. A multivariate regression analysis was applied to all preoperative parameters, based on the dual variable stone free versus residual fragments. Results: The overall disintegration rate was 95.5%; 42 patients (20.8%) were completely stone free, and 151 patients (74.7%) had clinically insignificant residual fragments (5 mm or smaller). 14.9% of men and 29.6% of women were stone free (p = 0.01). All other parameters did not reach statistical significance. Conclusions: The disintegration rate of the HM-3 is excellent for kidney stones; women did significantly better than men. However, because of this high disintegration rate, a much larger series would be necessary to define possible differences between preinterventional parameters, if there were any at all.

show abstract

Cost Effectiveness of Extracorporeal Shock Wave Lithotripsy and Percutaneous Nephrolithotomy for Medium-Sized Kidney Stones

Cited by 33 publications

References 5 publications

Changing treatments for primary urolithiasis: impact on services and renal preservation in 16 679 patients in Western Australia

Changing treatments for primary urolithiasis: impact on services and renal preservation in 16 679 patients in Western Australia

Lower Pole Midsize (1–2 cm) Calyceal Stones: Outcome Analysis of 56 Cases

Predictive Value of Radiological Criteria for Disintegration Rates of Extracorporeal Shock Wave Lithotripsy

Contact Info

Product

Resources

About