Aktuelle Aspekte der Steintherapie

Abstract

More than 30 % of all admissions to an urologic clinic are for the treatment of urinary stones. In almost all cases, the treatment is minimally invasive employing extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS) or percutaneous nephrolithotomy (PCNL). Technical advances in endourology and a growing expertise in ESWL led to a decline in ESWL and an increase in endoscopic techniques. In comparison with ESWL, the endoscopic techniques are more invasive but in most cases achieve a stone free state faster. With the introduction of diagnosis related groups (DRG), the economic aspect of stone therapy is gaining in importance. Stone prevention leads to a cost reduction in the health care system, justifying the use of an appropriate stone metaphylaxis. This review article presents the current recommendations for interventional urinary stone therapy and lists the options of conducting both medical and economically rational therapy.

Extracorporeal shockwave lithotripsy vs. percutaneous nephrolithotomy vs. flexible ureterorenoscopy for lower-pole stones

“…Technological advances have been responsible for the development of fURS, especially for improved deflection mechanisms that facilitate intrarenal manoeuvrability [30] . Modern endoscopes with outer diameters of <9 F allow direct access to the upper urinary tract without dilatation of the ureteric orifice in almost all cases [5,6,31–33] . The use of access sheaths further facilitates the procedure and seems to improve the outcome [34,35] .…”

Rezidivprävention der Urolithiasis unter Berücksichtigung ökonomischer Aspekte

“…1) [13]. Bei hohen Blutoder Urinspiegeln der Harnsäure wird zusätzlich Allopurinol (100-300 mg/Tag je nach Nierenfunktion) gegeben [8,11].…”

“…Dabei muss auch während der Nacht getrunken werden. Eine Harnalkalisierung mit Alkalicitratpräparaten ist zwingend erforderlich (Urin-pH konstant ad 7, [5][6][7][8]5 …”