Current ESWL practice and outcomes in the UK: A multicentre snapshot

Doherty, Rebecca; Manley, Kate; Gordon, S.; Irving, Stuart; Kumar, Spv; Masood, Junaid; Philip, Joe; Bultitude, Matthew; Wiseman, Oliver

doi:10.1177/2051415817696438

Cited by 3 publications

(1 citation statement)

References 23 publications

(40 reference statements)

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“…ESWL is not necessarily initial current practice and there is variation in availability. Therefore, effectiveness at the current time in England is variable and can be much lower than identified from the review; e.g., UK audit data showed effectiveness for ureteric stones of ~60% , but the present analysis has shown even assuming lower effectiveness of ESWL, URS is still unlikely to be cost effective.…”

Section: Discussionmentioning

confidence: 54%

Cost analysis of ureteroscopy (URS) vs extracorporeal shockwave lithotripsy (ESWL) in the management of ureteric stones <10 mm in adults: a UK perspective

Constanti¹,

Calvert

Thomas

et al. 2019

BJU International

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Objectives To compare the total cost of a treatment strategy starting with ureteroscopy (URS) vs a strategy starting with extracorporeal shockwave lithotripsy (ESWL). Methods For ureteric stones of <10 mm, URS or ESWL are the main treatment options that are considered. Although the interventions differ, the goal of the interventions is to achieve a stone‐free status. A systematic review and meta‐analysis undertaken as part of the National Institute for Health and Care Excellence (NICE) guideline on ‘Renal and ureteric stones: assessment and management’ identified URS as more effective, in terms of getting people stone free, but has a higher probability of re‐admission and adverse events (AEs) that contributes to downstream resource use. ESWL is initially less costly, but lower effectiveness means a greater need for repeat or ancillary procedures in order to get a patient stone free. Given these trade‐offs between benefits and costs, a cost analysis of URS and ESWL was undertaken as part of the NICE guideline, using evidence from the literature of effectiveness, re‐admission and AEs. The NICE guideline meta‐analysis showed a lot of heterogeneity and differences in how outcomes were reported between studies. The costing analysis, therefore only used studies where: (i) patients were rendered stone free, and (ii) where effectiveness, was based on the first‐line (initial) procedures. Exploratory quality adjusted life year (QALY) work was also undertaken to identify the QALY and quality of life (QoL) differences required for the most expensive intervention to be cost effective, based on the assumption that the difference in effectiveness between the initial procedures would be the main source of the QALY gain between the two strategies. Results The URS strategy was more costly overall than the ESWL strategy (incremental cost of £2387 [pounds sterling]). Sensitivity analysis varying the initial effectiveness of ESWL treatment (between the base case value of 82% and 40%) showed that URS would still be a more costly strategy even if the initial session of ESWL only had a success probability of 40%. A two‐way sensitivity analysis as part of the exploratory QALY work showed that ESWL would have to have very low effectiveness and people would have to wait for further treatment for many weeks (following a failed ESWL treatment) for there to be feasible QoL gains to justify the additional cost of the URS strategy. Conclusions ESWL is less effective at initial stone clearance and therefore requires more ancillary interventions than URS. However, the magnitude of the difference in costs means URS is unlikely to be cost effective intervention at a population level for first‐line treatment, implying ESWL should be the first choice treatment.

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Section: Discussionmentioning

confidence: 54%

Cost analysis of ureteroscopy (URS) vs extracorporeal shockwave lithotripsy (ESWL) in the management of ureteric stones <10 mm in adults: a UK perspective

Constanti¹,

Calvert

Thomas

et al. 2019

BJU International

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Impact of Case Volume on Shock Wave Lithotripsy Outcomes: Data from the National Shock Wave Lithotripsy Database of New Zealand

Alexander

Gowland²,

Cadwallader³

et al. 2019

Journal of Endourology

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Dopplerographic assessment of the ureter elimination ability in patients with non-obstructive nephrolithiasis

Kolupayev,

Lisovyi

2021

ECM

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The work is dedicated to the study of the elimination ability of the ureter in patients with non-obstructive nephrolithiasis, in the aspect of predicting the duration of the period of stone discharge after extracorporeal shock wave lithotripsy (ESWL). The study included 134 patients with non-obstructive renal pelvis stones who underwent ESWL. All studied patients were divided into 2 groups: the 1st group consisted of 105 (78.4%) patients in whom this status was stated within 14 days after ESWL; the 2nd group was represented by 29 (21.6%) patients with longer periods of achieving this condition or the presence of residual stone fragments on the 28th day of observation. The elimination capacity of the urinary tract was determined on the basis of an assessment of the peristaltic activity of the ureter on the side of the lesion, by studying the Doppler parameters of the ureteral jets. The shape of the Doppler spectrum, duration (T), peak (Jetmax) and average (Jetave) velocity of ureteral jets were evaluated. In the studied patients, monophasic, biphasic, triphasic and continuous types of ureteral emissions were found. According to the results of the study, a significantly larger number of patients in the 2nd group of patients had a continuous type of Doppler spectrum and a significantly lower Jetave value. The odds ratio to have a longer period of stone passage in patients with CC<10 cm/sec compared to patients with values of this indicator ≥10 cm/sec was 5.3. The results of the study suggest that the elimination ability of the ureter in patients with nephrolithiasis is determined by its peristaltic activity, a non-invasive method for assessing which is Doppler investigation of ureteral jets. Markers of low elimination ability of the ureter should be considered an continuous type of Doppler spectrum, as well as an average ureteral jet`s velocity of less than 10 cm/sec. Keywords: urolithiasis, ureteric jets, dopplerography, peristaltic activity.

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Current ESWL practice and outcomes in the UK: A multicentre snapshot

Cited by 3 publications

References 23 publications

Cost analysis of ureteroscopy (URS) vs extracorporeal shockwave lithotripsy (ESWL) in the management of ureteric stones <10 mm in adults: a UK perspective

Cost analysis of ureteroscopy (URS) vs extracorporeal shockwave lithotripsy (ESWL) in the management of ureteric stones <10 mm in adults: a UK perspective

Impact of Case Volume on Shock Wave Lithotripsy Outcomes: Data from the National Shock Wave Lithotripsy Database of New Zealand

Dopplerographic assessment of the ureter elimination ability in patients with non-obstructive nephrolithiasis

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