Korean J Urol.  2002 Jun;43(6):454-458.

Cost and Effectiveness of Different Treatment Options for Renal Calculi Larger than 2cm

• Lim JK
• Hyun JS
• Chung KH

Abstract

PURPOSE
The cost and effectiveness of extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PNL), and combined therapy in the treatment of renal calculi larger than 2cm were examined.
MATERIALS AND METHODS
A total of 122 patients with renal calculi larger than 2cm, including twenty three cases of staghorn calculi, were divided into two groups, the ESWL group (97 cases) and the PNL group (25 cases), according to the first line of treatment modalities. Each group was divided into two sub-groups according to the need for additional procedures. The stone free rate and duration of treatment of each group were examined. The costs were calculated per patient and based on the cumulative charge of the procedures, which included cost for in-patient care, and treatment of additional procedures and treated complications.
RESULTS
In the ESWL group, eighty cases were treated with ESWL only and had a 69% stone free rate. Seventeen cases needed additional procedures including percutaneous nephrostomy, or ureteroscopic procedures, and had a stone free rate of only 41%. In the PNL group, six cases became stone free with PNL only. Nineteen cases required ESWL for residual fragments after PNL, and had a 90% stone free rate. The cumulative average cost per group was as follows: ESWL only, 1,593,260 won; ESWL with additional procedures, 2,130,475 won; PNL only, 1,654,760 won; and PNL with ESWL, 1,973,270 won. The average duration of treatment per group was 47, 112, 5.3 and 8.8 days, respectively.
CONCLUSIONS
PNL followed by ESWL, if necessary, is considered the most cost effective method of treating large renal calculi.

Keyword

Renal calculi; Extracorporeal shock wave lithotripsy; Percutaneous nephrolithotomy

MeSH Terms

Calculi
Humans
Kidney Calculi*
Lithotripsy
Nephrostomy, Percutaneous
Shock