Ureteroscopy is more cost effective than shock wave lithotripsy for stone treatment: systematic review and meta-analysis

Geraghty, Robert; Jones, Patrick; Herrmann, Thomas; Aboumarzouk, Omar; Somani, Bhaskar K.

doi:10.1007/s00345-018-2320-9

Cited by 72 publications

(60 citation statements)

References 28 publications

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“…Similarly, among four patients from URS group, 75% were successfully treated with second session of URS and 25% case required PCNL because of stone migration. The re-treatment or auxillary treatment rates between ESWL and URS were 20% and 25% with ESWL and URS group which are similar to the study by Geraghty RM et al 13 Both ESWL and URS treatment have been shown to be safe and effective but requires expensive equipments and urological expertise. The complication rate was higher with URS in comparison to ESWL because URS is more invasive, requiring anaesthesia.…”

Section: Discussionsupporting

confidence: 85%

A Prospective Study to Assess the Effectiveness of Extracorporeal Shock Wave Lithotripsy Versus Ureteroscopy for Proximal Ureteral Calculi Between Sizes 5 to 10 mm

Rayamajhi

Khadka

Thapa

2020

Med. J. Shree Birendra Hosp.

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Introduction: There are various international guidelines for the surgical treatment of upper ureteral calculi. For upper ureteral stone of less than 10 mm size, ESWL and URS are regarded as first line treatment. However, there is lack of national guidelines for appropriate surgical options for such stone in our settings. Methods: The study was prospective comparative type involving 100 patients who were divided into ESWL and URS groups comprising 50 patients in each. ESWL and URS were performed after confirmation of stone size with ultrasonography and non-contrast enhanced computed tomography. All patients underwent X-ray KUB at one week and six weeks post procedure for confirmation of stone clearance. Those with residual calculi of size < 5 mm were considered stone free. Statistical analysis was done using Graph pad prism version 6. Results: The mean age of patients in ESWL and URS groups were 41.28 ± 15.3 years and 42.84 ± 16.1 years respectively. The male to female ratio was higher in ESWL group. The mean size of the stone pre ESWL was 8.58 mm and pre URS was 8.44 mm. The percentage of stone clearance at one week and six weeks for ESWL was 56% and 90% respectively whereas for URS, it was more than 90% at both one week and six weeks. The complications were higher with URS (20%) than ESWL (8%). Conclusions: The ESWL and URS are equally effective in stone clearance. The duration is longer with ESWL and the complications were more in URS group.

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Section: Discussionsupporting

confidence: 85%

A Prospective Study to Assess the Effectiveness of Extracorporeal Shock Wave Lithotripsy Versus Ureteroscopy for Proximal Ureteral Calculi Between Sizes 5 to 10 mm

Rayamajhi

Khadka

Thapa

2020

Med. J. Shree Birendra Hosp.

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“…Also, not all were in a ureteric stone population. A recent systematic review on costing studies of URS vs ESWL confirmed a lack of cost‐utility analyses, particularly from a UK relevant perspective, and found studies were conflicting on whether ESWL or URS is more costly, but these are mostly USA or Chinese studies where intervention costs cannot be compared to the UK. There are differing financial incentives even in countries with similar healthcare systems to the UK, e.g., in Germany ESWL always requires an admission, and the length of stay can also vary according to the healthcare system.…”

Section: Discussionmentioning

confidence: 99%

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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“…Rob et al reported that there was no significant difference in the complication rates of URS (both major and minor) between medium and highvolume paediatric centres [24]. A recent meta-analysis by Geraghty et al also found the overall cost of URS procedure to be lower than SWL ($2801) compared to SWL ($3627) ($2801 vs. $3627, p = 0.03) [25].…”

Section: Role Of Swl and Pcnlmentioning

confidence: 99%

Outcomes of ureteroscopy (URS) for stone disease in the paediatric population: results of over 100 URS procedures from a UK tertiary centre

et al. 2019

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Purpose To report the outcomes of paediatric ureteroscopy (URS) for stone disease from a specialist endourology centre in the UK. Ureteroscopy for management of stone disease has increased worldwide and is now being done more commonly in the paediatric age group. Methods Data were analysed retrospectively from a database maintained between April 2010 and May 2018. Consecutive patients ≤ 16 years of age undergoing semi-rigid or flexible URS for stone disease were included. Stone size and stone-free rate (SFR) were routinely assessed using an ultrasound (USS) and/or plain KUB XR. Complications were graded according to the Clavien-Dindo classification and recorded within 30 days post-procedure and readmissions within 90 days after the procedure were also captured. Results Over the 8-year period between April 2010 and April 2018, 81 patients with a mean age of 8.8 years (range 18 months-16 years) and a male to female ratio 1:1.1 underwent 102 procedures (1.28 procedure/patient to be stone free). Of the 81 patients, 29 (35.8%) had comorbidities, with 26 (32%) having multiple comorbidities. The mean (± SEM) single and overall stone size was 9.2 mm (± 0.48, range 3-30 mm) and 11.5 mm (± 0.74, range 4-46 mm) respectively, with 22 (27.1%) having multiple stones. Thirty-five (34.7%) had stent in situ pre-operatively. The stone location was in the ureter (26.6%), lower pole (35.4%), and renal pelvis (16.5%), with 22/81(27%) having multiple stones and 21/102 (20.5%) where a ureteral access sheath (UAS) was used. With a mean hospital stay of 1.2 days, the initial and final SFR was 73% and 99%, respectively, and 61/102 (60%) had ureteric stent placed at the end of the procedure. While there were no intra-operative complications, the readmission rate was less than 1% and there were only three early complications recorded. This included a case each of prolonged admission for pain control (grade I), urinary retention (grade II) and post-operative sepsis requiring a brief ITU admission (grade IV). Conclusion Our study demonstrates that in appropriate setting a high stone-free rate can be achieved with minimal morbidity for paediatric patients. There is potentially a need to factor the increasing role of URS in future paediatric urolithiasis guidelines.

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Ureteroscopy is more cost effective than shock wave lithotripsy for stone treatment: systematic review and meta-analysis

Cited by 72 publications

References 28 publications

A Prospective Study to Assess the Effectiveness of Extracorporeal Shock Wave Lithotripsy Versus Ureteroscopy for Proximal Ureteral Calculi Between Sizes 5 to 10 mm

A Prospective Study to Assess the Effectiveness of Extracorporeal Shock Wave Lithotripsy Versus Ureteroscopy for Proximal Ureteral Calculi Between Sizes 5 to 10 mm

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

Outcomes of ureteroscopy (URS) for stone disease in the paediatric population: results of over 100 URS procedures from a UK tertiary centre

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