Comparison of treatment of renal calculi by open surgery, percutaneous nephrolithotomy, and extracorporeal shockwave lithotripsy.

Abstract

This study was designed to compare different methods of treating renal calculi in order to establish which was the most cost effective and successful. Of 1052 patients with renal calculi, 350 underwent open surgery, 350 percutaneous nephrolithotomy, 328 extracorporeal shockwave lithotripsy (ESWL), and 24 both percutaneous nephrolithotomy and ESWL. Treatment was defined as successful if stones were eliminated or reduced to less than 2 mm after three months. Success was achieved in 273 (78%) patients after open surgery, 289 (83%) after percutaneous nephrolithotomy, 301 (92%) after ESWL, and 15 (62%) after percutaneous nephrolithotomy and ESWL. Comparative total costs to the NHS were estimated as £3500 for open surgery, £1861 for percutaneous nephrolithotomy, £1789 for ESWL, and £3210 for both ESWL and nephrolithotomy. ESWL caused no blood loss and little morbidity and is the cheapest and quickest way of returning patients to normal life.

Confounding and Simpson's paradox

“…Charig et al undertook a historical comparison of success rates in removing kidney stones 2. Open surgery (1972-80) had a success rate of 78% (273/350) while percutaneous nephrolithotomy (1980-5) had a success rate of 83% (289/350), an improvement over the use of open surgery.…”

Impact of Socioeconomic Status in Etiology and Management of Urinary Stone Disease

“…It is obvious that ESWL is most cost-effective for a stone of <2 cm in size and PCNL for those >2 cm in size. Open surgery is costlier in both settings in the USA and UK [9,32,[44][45][46][47]. However, in developing countries open surgery still appears to be cost-effective.…”

The bends.

“…Also we note that over 80% of stones in both groups were 20 mm diameter or less, and we would have expected a higher proportion of patients in the nephrolithotomy group even if not in the lithotripsy group to be free of stones. 4 The number of shocks given to the patients in the lithotripsy group is not reported, and there may well have been a certain amount of under-treating. This is reflected in the high percentage of patients with obstruction in the upper tract due to fragments that were too large to pass.…”