Parker Brian D, Frederick Robert W, Reilly T Philip, Lowry Patrick S, Bird Erin T
Department of Urology, Scott and White Memorial Hospital and Clinic, Scott, Sherwood and Brindley Foundation, and Texas A&M University, Temple, TX 76508, USA.
Urology. 2004 Dec;64(6):1102-6; discussion 1106. doi: 10.1016/j.urology.2004.07.040.
To compare the success rates, cost effectiveness, and efficiency of ureteroscopy (URS) and extracorporeal shock wave lithotripsy (ESWL) for proximal ureteral stones.
In a retrospective manner, 220 patients who underwent treatment for proximal ureteral stones were included in the study. The patient records, radiographs, and billing statements of all patients treated for upper ureteral stones between January 1997 and June 2001 at Scott and White Memorial Hospital were reviewed. The patients were placed into two treatment groups according to the method of their stone's initial treatment. The stones were categorized as less than 1 cm and 1 cm or greater.
A total of 111 patients were in the ESWL group, 73 of whom had stones less than 1 cm, and 109 patients in the URS group, 81 of whom had stones less than 1 cm. In the URS group, 91% were successfully treated with one treatment intervention, and 55% of the ESWL group were successfully treated with their initial intervention (P <0.0001). Of the patients with URS failure, all but one was treated successfully with a second URS. Of the patients with ESWL failure, 52% were treated successfully by subsequent URS. The remaining patients with ESWL failure were treated with repeat ESWL, with a 62% success rate. The efficiency quotient for stones less than 1 cm for URS and ESWL was 0.79 and 0.51, respectively. For stones 1 cm or greater, URS had an efficiency quotient of 0.72 and ESWL of 0.46. The URS group required fewer days to be stone free (8 versus 25.5 days, P <0.0001). No statistically significant difference was found in the overall complication rates (P = 0.43). URS had significantly lower charges for the initial procedure (7575 dollars versus 9507 dollars, P <0.0001). The total charges were also lower for URS (9378 dollars versus 15,583, dollars P <0.0001). Complications were similar in the two groups. The URS group had two ureteral strictures.
The results of this study indicate that URS is more efficient and cost-effective for stones up to and larger than 1 cm with similar complication rates compared with ESWL.
比较输尿管镜检查术（URS）和体外冲击波碎石术（ESWL）治疗近端输尿管结石的成功率、成本效益和效率。
本研究采用回顾性研究方法，纳入220例接受近端输尿管结石治疗的患者。回顾了1997年1月至2001年6月期间在斯科特和怀特纪念医院接受上输尿管结石治疗的所有患者的病历、X光片和账单记录。根据结石初始治疗方法将患者分为两个治疗组。结石分为小于1 cm和1 cm及以上两类。
ESWL组共有111例患者，其中73例结石小于1 cm；URS组有109例患者，其中81例结石小于1 cm。在URS组中，91%的患者经一次治疗干预成功治愈，而ESWL组中55%的患者经初始干预成功治愈（P<0.0001）。在URS治疗失败的患者中，除1例之外，其余均经第二次URS治疗成功。在ESWL治疗失败的患者中，52%经后续URS治疗成功。其余ESWL治疗失败的患者接受了重复ESWL治疗，成功率为62%。URS和ESWL治疗小于1 cm结石的效率商分别为0.79和0.51。对于1 cm及以上的结石，URS的效率商为0.72，ESWL为0.46。URS组达到无结石状态所需天数更少（8天对25.5天，P<0.0001）。总体并发症发生率无统计学显著差异（P = 0.43）。URS初始手术费用显著更低（7575美元对9507美元，P<0.0001）。URS的总费用也更低（9378美元对15583美元，P<0.0001）。两组并发症情况相似。URS组有2例输尿管狭窄。
本研究结果表明，与ESWL相比，URS治疗1 cm及以上结石的效率更高且更具成本效益，并发症发生率相似。
