The case for primary endoscopic management of upper urinary tract calculi: II. Cost and outcome assessment of 112 primary ureteral calculi.

OBJECTIVES: To compare extracorporeal shock-wave lithotripsy (ESWL) with endoscopic lithotripsy to establish the more efficacious and cost-effective treatment for ureteral calculi.

METHODS: The records of 112 patients with primary ureteral calculi treated at one center with either ESWL or endoscopic lithotripsy were retrospectively reviewed. Follow-up data at 1 and 3 months were obtained in all patients. Success was defined as complete clearance of a stone burden in the endoscopy group. In the ESWL group patients with a residual, asymptomatic 2-mm fragment were also considered successful treatments. The number of auxiliary procedures, retreatments, postoperative office visits, and imaging studies 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 significantly higher in the ESWL group (31% versus 3%). The mean number of postoperative 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 heavily against ESWL.

CONCLUSIONS: ESWL remains the treatment of choice for moderately sized, uncomplicated renal calculi. In skilled hands, ureteroscopic lithotripsy is by far the most expeditious and cost-effective means of clearing a ureteral stone burden.