Comparison of Percutaneous Nephrolithotomy and Ureteroscopic Lithotripsy for Upper Ureteral Calculi
1Department of Urology, Beijing ChuiYangLiu Hospital, Beijing, P. R. China
2Department of Urology, ChuiYangLiu Hospital aﬃliated to Tsinghua University, Beijing, P. R. China
3Department of Urology, Cancer Hospital Chinese Academy of Medical Science, Beijing, P. R. China
†These authors contributed equally
Online publish date: 15 September 2020
† These authors contributed equally.
This study aimed to investigate the efficacy, safety and cost of ureteroscopic lithotripsy (URSL) and percutaneous nephrolithotomy (PCNL) for large proximal ureteral calculi. We retrospectively reviewed the outcomes of 205 subjects with ureteral stones size ≥ 1 cm from January 2011 to December 2017. We divided URSL into two groups including URSL + S with Stone Cone and URSL without Stone Cone. Ninety subjects were treated with URSL, fifty subjects were treated with URSL + S and sixty-five subjects were treated with PCNL. The success rate was 73.3%, 96.0% and 96.6% in URSL, URSL+ S and PCNL groups, respectively. The treatment time in PCNL group (77.3 ± 19.1 minutes) was longer than URSL group (42.0 ± 16.6 minutes) and URSL+S group (55.6± 20.3 minutes), and the hospital stay was longer in PCNL (9.5 ± 1.6 days) group than in URSL group (2.4 ± 4.8 days) and URSL + S group (2.0 ± 2.4 days). The cost-effectiveness ratio was 124.6, 159.1 and 135.3 in URSL, URSL + S and PCNL groups, respectively. In conclusion, Stone Cone could increase treatment success rate but incur higher cost. URSL is considered as the best cost-effective option, and the patients without medical insurance tend to choose PCNL because of high success rate of treatment.
Lithotripsy, Ureteral calculi, Cost-benefit analysis
Jiyu Zhao,Sheng Yang,Zejun Xiao,Jun Zhang,Jia Liu,Ying Qi,Xianen Gu. Comparison of Percutaneous Nephrolithotomy and Ureteroscopic Lithotripsy for Upper Ureteral Calculi. Signa Vitae. 2020.doi:10.22514/sv.2020.16.0054.
 Wang Q, Guo J, Hu H, et al. Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis. PLoS One. 2017;12:1-16.
 Turk C, Neisius A, Petrik A, et al. Urolithiasis. EAU (European Association of Urology) Guidelines. 2018.
 Türk C, Petřík A, Sarica K, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69:475-482.
 Elashry OM, Tawfik AM. Preventing stone retropulsion during intracor-poreal lithotripsy. Nat Rev Urol. 2012;9:691-698.
 De S, Autorino R, Kim FJ, et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: A systematic review and meta-analysis. Eur Urol. 2015;67:125-137.
 Nguyen DP, Hnilicka S, Kiss B, et al. Optimization of Extracorporeal Shock Wave Lithotripsy Delivery Rates Achieves Excellent Outcomes for Ureteral Stones: Results of a Prospective Randomized Trial. J Urol. 2015;194:418-423.
 Lee JW o., Park J, Lee SB a., et al. Mini-percutaneous Nephrolithotomy vs Retrograde Intrarenal Surgery for Renal Stones Larger Than 10 mm: A Prospective Randomized Controlled Trial. Urology. 2015;86:873-877.
 Reis Santos JM. Ureteroscopy from the recent past to the near future. Urolithiasis. 2018;46:31-37.
 Wang Y, Zhong B, Yang X, et al. Comparison of the efficacy and safety of URSL, RPLU, and MPCNL for treatment of large upper impacted ureteral stones: A randomized controlled trial. BMC Urol. 2017;17:1-7.
 Sozen S, Kupeli B, Tunc L, et al. Management of ureteral stones with pneumatic lithotripsy: report of 500 patients. J Endourol. 2003;17:721-724.
 Shabana W, Teleb M, Dawod T. Safety and efficacy of using the stone cone and an entrapment and extraction device in ureteroscopic lithotripsy for ureteric stones. Arab J Urol. 2015;13:75-79.
 Phan YC, Segaran S, Chew BH, et al. Devices to help combat stone retropulsion during ureteroscopic lithotripsy in 2016. J Clin Urol. 2017;10:87-92.
 Sen H, Bayrak O, Erturhan S, et al. Comparing of different methods for prevention stone migration during ureteroscopic lithotripsy. Urol Int. 2014;92:334-338.
 Qi S, Li Y, Liu X, et al. Clinical Efficacy, Safety, and Costs of Percutaneous Occlusive Balloon Catheter-Assisted Ureteroscopic Lithotripsy for Large Impacted Proximal Ureteral Calculi: A Prospective, Randomized Study. J Endourol. 2014;28:1064-1070.
 Ceylan K, Sünbül O, Şahin A, et al. Ureteroscopic treatment of ureteral lithiasis with pneumatic lithotripsy: Analysis of 287 procedures in a public hospital. Urol Res. 2005;33:422-425.
 Long Q, Guo J, Xu Z, et al. Experience of mini-percutaneous nephrolithotomy in the treatment of large impacted proximal ureteral stones. Urol Int. 2013;90:384-388.
 Basiri A, Simforoosh N, Ziaee A, et al. Retrograde, antegrade, and laparoscopic approaches for the management of large, proximal ureteral stones: A randomized clinical trial. Int Braz J Urol. 2009;35:97.
 YungShun J, ChingChia L, JungTsung S, et al. Percutaneous nephrostomy for removal of large impacted upper ureteral stones. Kaohsiung J Med Sci. 2007;23:412-416.
 Cutler DM. Rising medical costs mean more rough times ahead. JAMA -J Am Med Assoc. 2017;318:508-509.
 Iacobucci G. UK spent 9.9% of GDP on healthcare last year, official figures show. BMJ. 2017;357:j2080.
 Limb M. A fifth of healthcare spending is wasted, says OECD report. BMJ. 2017;356:j215.
 Saleem F, Hassali MA, Iqbal Q, et al. Uncontrollable medicine prices in Pakistan. Lancet. 2016;388:2602.
 Wang W, Fan J, Huang G, et al. Prevalence of kidney stones in mainland China: A systematic review. Sci Rep. 2017;7;41630.
 Ursiny M, Eisner BH. Cost-effectiveness of anti-retropulsion devices for ureteroscopic lithotripsy. J Urol. 2013;189:1762-1766.
 Li H, Dong S, Liu T. Relative efficiency and productivity: A preliminary exploration of public hospitals in Beijing, China. BMC Health Serv Res. 2014;14;158.
 Goel R, Aron M, Kesarwani PK, et al. Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries. J Endourol. 2005;19:54-57.
Science Citation Index Expanded (SciSearch) The Science Citation Index (SCI) is a citation index originally produced by the Institute for Scientific Information (ISI) and created by Eugene Garfield. It (Science Citation Index Expanded) covers more than 8,500 notable and significant journals, across 150 disciplines in science and technology, from 1900 to the present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.