Ansari M S, Gupta N P
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Urol Int. 2003;70(4):255-61. doi: 10.1159/000070130.
The diverse manifestations of urolithiasis provide a very interesting epidemiological study from the standpoints of geography, socioeconomic status, nutrition and culture. Stone disease not only affects the patient, but also the national economy, as the disease is prevalent in the productive age group. There has been a continuous search for the cost-effectiveness of different treatment modalities not only to treat the patient but also to prevent its recurrence.
The various socioeconomic and dietary factors playing roles in the etiology of urinary calculi in the stone-prevalent areas of the world were analyzed. The impact of urinary tract stone disease on the socioeconomic infrastructure of the patient and national economy was studied. A cost-effectiveness analysis vis-à-vis the safety and efficacy of various treatment modalities in both developed and developing countries was done.
The standard of living and level of nutrition have directly influenced the process of urolithiasis amongst the communities of the world. A low socioeconomic status has been linked to endemic bladder calculi seen in many poor countries with people subsisting on a deficient diet. The incidence of upper urinary tract calculi increases with prosperity and more nutritious diets. Replacement of open surgery with minimally invasive techniques (ESWL, PCNL, URS) for treating stones in the urinary tract has greatly reduced the patients' morbidity and mortality and the period of hospitalization and convalescence. This change in treatment has also led to less days of absence from work and could minimize the loss to national economy. Minimally invasive surgery is more cost effective in developed countries because of the short hospital stay. However, in developing countries open surgery still appears to be cost-effective in certain subset of the patients.
There is a need for proper health care and a medical insurance system to take care of the financial burden, especially in developing countries, of a disease with a high magnitude of recurrence and morbidity. The need and type of medical treatment should be appraised continually to accommodate advances in techniques of stone removal. Lastly, the quest for etiology, cost-effective treatment and prevention still continues and even today we cannot stay better than Frère Jacques, 'I have removed the stone, it is up to God to cure the patient'.
从地理、社会经济地位、营养和文化的角度来看，尿石症的多样表现提供了一项非常有趣的流行病学研究。结石病不仅影响患者，还影响国民经济，因为该疾病在生产年龄组中普遍存在。人们一直在不断探索不同治疗方式的成本效益，不仅是为了治疗患者，也是为了预防其复发。
分析了世界上结石高发地区中在尿路结石病因中起作用的各种社会经济和饮食因素。研究了尿路结石病对患者社会经济基础设施和国民经济的影响。针对发达国家和发展中国家各种治疗方式的安全性和有效性进行了成本效益分析。
生活水平和营养水平直接影响了世界各社区的尿石症发病过程。社会经济地位低下与许多贫困国家中流行的地方性膀胱结石有关，这些国家的人们靠缺乏营养的饮食为生。上尿路结石的发病率随着繁荣和更营养的饮食而增加。用微创技术（体外冲击波碎石术、经皮肾镜取石术、输尿管镜检查）取代开放手术治疗尿路结石，大大降低了患者的发病率和死亡率以及住院和康复时间。治疗方式的这种改变还减少了误工天数，并可将对国民经济的损失降至最低。由于住院时间短，微创手术在发达国家更具成本效益。然而，在发展中国家，开放手术在某些患者亚组中似乎仍然具有成本效益。
需要适当的医疗保健和医疗保险系统来承担这种复发率和发病率都很高的疾病的经济负担，特别是在发展中国家。应不断评估医疗需求和类型，以适应结石清除技术的进步。最后，对病因、成本效益高的治疗方法和预防措施的探索仍在继续，即使在今天，我们也不比弗雷尔·雅克（Frère Jacques）做得更好，“我已取出结石，治愈患者就取决于上帝了”。
