Chan Luke H, Good Daniel W, Laing Karina, Phipps Simon, Thomas Ben G, Keanie Julian Y, Tolley David A, Cutress Mark L
Department of Urology, The Scottish Lithotriptor Centre, Western General Hospital , NHS Lothian, Edinburgh, Scotland.
J Endourol. 2017 May;31(5):510-516. doi: 10.1089/end.2016.0825. Epub 2017 Mar 29.
To assess the clinical features, outcomes, complications, and cost-effectiveness of shockwave lithotripsy (SWL), flexible ureterorenoscopy (FURS), and percutaneous nephrolithotomy (PCNL) in the treatment of lower pole (LP) stones (10-20 mm) in a large tertiary referral center.
Consecutive patients treated for solitary LP stones (10-20 mm) between 2008 and 2013 were identified from a prospective database. SWL was used as primary treatment in all cases (following a stone multidisciplinary team assessment), with FURS and PCNL reserved for SWL contraindications, failure, or patient choice. "Success" was defined as stone free and/or clinically insignificant stone fragments (≤3 mm) at 1 and 3 months follow-up. Effect of anatomy on SWL success was determined from using CT images and regression analysis. Average cost per treatment modality (including additional second-line treatments) was calculated for each group using the National Health Service England 2014/15 National Tariff Healthcare Resource Group codes.
Two hundred twenty-five patients were included (mean age 54.9; median stone size 12 mm). One hundred ninety-eight (88%), 21 (9.3%), and 6 (2.7%) patients underwent SWL, FURS, and PCNL as primary treatments, respectively, for median stone sizes of 12, 12, and 20 mm. Overall success rates were 82.8%, 76.1%, and 66.7%, respectively (p < 0.05). Sixty-three percent of patients undergoing primary SWL were effectively treated after one session. Anatomical analysis determined infundibulopelvic angle and infundibular length to be significantly different in patients effectively treated with SWL (p = 0.04). The average cost per treatment modality was also significantly lower for SWL (£750) than for FURS (£1261) or PCNL (£2658) (p < 0.01).
SWL is both an efficacious and cost-effective primary treatment for patients with solitary LP stones (10-20 mm). The majority of patients can be effectively treated with primary SWL in a dedicated stone center, with the benefits of a short length of stay, low complication, and auxiliary treatment rates. The referral of such patients to high-volume lithotripsy centers with demonstrable outcomes should be given due consideration.
在一家大型三级转诊中心评估冲击波碎石术（SWL）、软性输尿管肾镜检查（FURS）和经皮肾镜取石术（PCNL）治疗下极（LP）结石（10 - 20毫米）的临床特征、治疗效果、并发症及成本效益。
从一个前瞻性数据库中识别出2008年至2013年间接受孤立性LP结石（10 - 20毫米）治疗的连续患者。所有病例均将SWL作为初始治疗方法（经过结石多学科团队评估），FURS和PCNL则用于SWL的禁忌证、治疗失败或患者选择的情况。“成功”定义为在1个月和3个月随访时结石清除和/或残留临床意义不大的结石碎片（≤3毫米）。通过使用CT图像和回归分析确定解剖结构对SWL治疗成功的影响。使用英国国家医疗服务体系2014/15年国家收费医疗资源组代码计算每组每种治疗方式的平均成本（包括额外的二线治疗）。
纳入225例患者（平均年龄54.9岁；结石中位大小12毫米）。分别有198例（88%）、21例（9.3%）和6例（2.7%）患者接受SWL、FURS和PCNL作为初始治疗，结石中位大小分别为12毫米、12毫米和20毫米。总体成功率分别为82.8%、76.1%和66.7%（p < 0.05）。接受初始SWL治疗的患者中，63%在一次治疗后得到有效治疗。解剖学分析确定，接受SWL有效治疗的患者肾盂漏斗角和漏斗长度有显著差异（p = 0.04）。SWL的每种治疗方式平均成本（750英镑）也显著低于FURS（1261英镑）或PCNL（2658英镑）（p < 0.01）。
对于孤立性LP结石（10 - 20毫米）患者，SWL是一种有效且具有成本效益的初始治疗方法。大多数患者在专门的结石中心接受初始SWL治疗可获得有效治疗，具有住院时间短、并发症少和辅助治疗率低的优点。应适当考虑将此类患者转诊至具有可证明治疗效果的大容量碎石中心。
