Cost-effectiveness of anti-retropulsive devices varies according to the locations of proximal ureteral stones: a retrospective cohort study

Abstract

Background Anti-retropulsive devices are often used to prevent stone migration in the treatment of proximal ureteral calculi. They are helpful. However, in the meantime, they also add extra expenses. This study was carried out to investigate the best criteria for treating proximal ureteral stones with anti-retropulsive devices. Methods Data from all patients who underwent ureteroscopic holmium: YAG laser lithotripsy for solitary upper ureteral stones in 2018 were collected. Patients who encountered stone retropulsion during the process of inserting the ureteroscope were excluded. Patients were divided into either group URS or group URS + ARD depending on whether the anti-retropulsive device was used. Then, the stone-free rate, expenses and other criteria were compared between groups according to stone location. Stone-free was defined as no stones present. Results For stones located ≤ 30 mm from the ureteropelvic junction (UPJ), the stone-free rates for the URS group were 80% and 80% at one day and one month after the operation, respectively. Those for the URS + ARD group were 71.4% and 78.6% at one day and one month, respectively. For stones located 31–90 mm from the UPJ, the stone-free rates were 84.7% and 84.7% for the URS group and 89.6% and 95.5% for the URS + ARD group at one day and one month, respectively. A statistically significant difference occurred at one month. For stones located > 90 mm from the UPJ, the two groups were both stone free. In the URS + ARD group, expenses were higher. In addition, the mean diameter of residual stones derived from stones located at 31–90 mm from the UPJ was statistically smaller, and 4 of 7 residual stones passed spontaneously within one month, which was obviously more than that in other locations and the URS group. Other outcomes, including operation time and postoperative stay, showed no significant difference between the groups. Conclusion Anti-retropulsive devices are indeed helpful, but they might be cost-effective for stones located solely in the middle part of the upper ureter, not for those too close to or far from the ureteropelvic junction.

Vibration Therapy for Health Promotion

“…This form of mechanotransduction would be responsible for a number of physiological processes in the body, including proprioception, effects on bone (2,6,7), effects on bone mineral density (6) and in the metabolism (3,4), endocrine (2,3,4), and immunity systems (2,7), muscle (6) and vital functions (1,5), balance (2,6,7), and functionality (2,6,7).…”

“…As a consequence, everyone must be prepared to be challenged and use what technological advances have to offer, providing better living conditions for all people who need help to improve their health condition and quality of life. Knowledge about potential benefits and limitations will guide the best way to take advantage of new technologies [1][2][3]. Thus, the establishment of safety-related criteria that must be followed together with the update in the level of evidence of related publications will guide the effectiveness of the procedure with the safe use of the technique without adverse events [4][5][6][7].…”

“…Figure 5.Some targets of the mechanical vibration in the body related to proprioception(2,6,7), effects on bone mineral density(6) and in the metabolism(3,4), endocrine(2,3,4), and immunity systems(2,7), muscle(6) and vital functions(1,5), balance(2,6,7), and functionality(2,6,7).…”