THE CASE FOR PRIMARY ENDOSCOPIC MANAGEMENT OF UPPER URINARY-TRACT CALCULI .2. COST AND OUTCOME ASSESSMENT OF 112 PRIMARY URETERAL CALCULI

Objectives. To compare extracorporeal shock-wave lithotripsy (ESWL) wi th endoscopic lithotripsy to establish the more efficacious and cost-e ffective treatment for ureteral caiculi. Methods. The records of 112 p atients with primary ureteral calculi treated at one center with eithe r ESWL or endoscopic lithotripsy were retrospectively reviewed. Follow up data at 1 and 3 months were obtained in all patients. Success was d efined as complete clearance of a stone burden in the endoscopy group. In the ESWL group patients with a residual, asymptomatic 2-mm fragmen t were also considered successful treatments. The number of auxiliary procedures, retreatments, postoperative office visits, and imaging stu dies required before a patient was considered stone free was defined. The impact of these variables on global costs was carefully reviewed. Results. Patients with ureteral calculi primarily treated with ESWL or ureteroscopic lithotripsy had stone-free rates after a single session of 45% versus 95% at 1-month follow-up, and 62% versus 97% at 3-month follow-up. Retreatment and auxiliary procedure rates were significant ly higher in the ESWL group (31% versus 3%). The mean number of postop erative visits and imaging studies until a patient was stone free was also higher in the ESWL group (2.07 versus 1.13). Operative treatment costs were similar for both modalities, but overall costs weighed heav ily against ESWL. Conclusions. ESWL remains the treatment of choice fo r moderately sized, uncomplicated renal calculi. In skilled hands, ure teroscopic lithotripsy is by far the most expeditious and cost-effecti ve means of clearing a ureteral stone burden.