Abstract

Abstract

BACKGROUND:

Treatment of urolithiasis saw major changes with the introduction of extracorporeal shock wave lithotripsy (ESWL) and percutaneous and ureteroscopic techniques in the 1980s. Since then these minimally invasive treatment modalities have continuously been developed further.

RESULTS:

For years ESWL has been the treatment of choice. However, recent years have seen a significant shift towards endoscopic therapies. This can be attributed to the evolving surgical experience in the use of these techniques, but even more to major improvement in the technical equipment. This trend is not backed sufficiently by high-level data (RCTs). Some of the newer data on endoscopic techniques are presented in cohort studies, but most studies are case series. Accordingly, recommendations of the German and international guidelines still focus on ESWL as first-line therapy for most locations and sizes of urinary stones.

CONCLUSION:

The analysis of treatment data of our institution confirms these trends and demonstrates high treatment efficiency in modern stone management and a consecutive significant lowering of socio-clinical expenses.

Urologe A. 2012 Mar;51(3):372-8. doi: 10.1007/s00120-012-2828-3

PMID: 22350018 [PubMed - in process]

Comment

Comment

 The abstract of this German paper does not clearly show the message: the authors observed a profound change in stone therapy in their department:

Even more impressive is a nearly 50 % drop of a so called socioclinical factor the authors introduce: it is a quotient that correlates the reimbursement, the duration of hospital stay the retreatment rate and the number of patients.  The quotient seems to be generated in a publication that the authors quote: Measuring Effectiveness. What to expect without a randomized control group. D'Agostino RB and Kwan H, Medical Care. 33 (4) 1995 AS95-AS105. The reference does not readily display this quotient nor does the publication. Like this it is unfortunately not possible to find out which driving forces are behind the observed changes. The interested reader might have a look at two other publications:

Volkmer BG, Petschl S, Chaussy C, Köhrmann KU, Haupt G, Jocham D. Economic aspects of the treatment of urinary stones. Results of the German Society for Shock Wave Lithotripsy. Urologe A. 2009 Oct;48(10):1214-21. German.

Wang HH, Huang L, Routh JC, Nelson CP. Shock Wave Lithotripsy vs Ureteroscopy:

Variation in Surgical Management of Kidney Stones at Freestanding Children's

Hospitals. J Urol. 2012 Apr;187(4):1402-7