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    Study: URS found superior to SWL in stones <1.5 cm

    Careful patient selection may improve cost effectiveness of SWL, study finds

    Providence, RI—In renal stones smaller than 1.5 cm diameter, ureteroscopic lithotripsy (URS) is associated with superior stone-free rates compared with shock wave lithotripsy (SWL), according to a recent study.

    RELATED: Flexible URS found safe, effective in stones <2 cm

    In addition, a comparison of cost effectiveness of the procedures suggests that careful patient stratification and selection may increase the cost effectiveness of SWL, researchers found.

    URS vs. SWL for stones <1.5 cm: 1-year comparisons

    The authors reported superior stone-free rates for renal stones <1.5 cm for URS compared with SWL. Using a modeling system, the authors demonstrated that SWL is as cost effective as URS, if SWL success is as high as 65% to 67% for a single session. The study, presented at the 2014 AUA annual meeting in Orlando, FL, suggested that careful stratification and selection of stone patients might be the key to improving the cost effectiveness of SWL. The study has since been published in the Journal of Endourology (2014; 28:639-43).

    Continue to the next page for more.

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    • Dr. Jon Owen Marks
      The most 'efficient' modality is not necessarily what the patient would prefer. For example, a patient with sciatica wouldn't proceed directly to laminectomy without first trying rehab or epidural injection first. A patient with knee pain wouldn't proceed to total knee without trial of physical therapy or arthroscopy. In general, a trial of 'conservative' therapy has always been recommended where possible. ESWL, if readily available, fits this 'conservative' description: it's non-invasive, has a 70% chance of success, does not require a stent, and can be followed by a more invasive procedure such as URS if needed. In a cohort of 100 patients with ureteral stones requiring intervention, 100 ESWLs followed by 30 ureteroscopies IF NEEDED, will save 70 patients from an invasive procedure. Sounds like good odds to me. BTW: post-ureteroscopy stents are no fun. Ask most urologists what they'd prefer for themselves; ESWL wins. One can't use cost alone as the criteria for all clinical decisions. Full disclosure: I'm the CEO of a very large lithotripsy group that also provides facilities for ureteroscopy. In addition, I specialized in endoUrology for over 30 years.

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