Comparison of Extracorporeal and Percutaneous Lithotripsy. Executive Summary and Final Report

摘要

The purpose of this research program was to determine the safety, efficacy, and cost-effectiveness of extracorporeal shock-wave lithotripsy (ESWL) as compared with percutaneous nephrostolithotomy (PNL) for treatment of upper tract kidney stones. The study included a retrospective cohort study to assess the immediate effectiveness of treatment with ESWL and PNL, a prospective followup study to assess stone recurrence and hypertension during the years following treatment, and a cost-effectiveness analysis incorporating clinical and cost data obtained from the cohort studies. Outcomes of treatment were measured in one thousand patients treated with either ESWL or PNL at two academic medical centers. ESWL was shown to have greater effectiveness relative to PNL for removal and fragmentation of stones in the upper urinary tract, particularly for multiple stones, stone burdens > 20 mm, and stones located in the renal pelvis. For most stones, ESWL was the preferred treatment as it was associated with a modest decrease in the amount of morbidity experienced by the patient beginning from the time of treatment and for five years thereafter, compared to PNL. ESWL was also associated with lower economic costs averaged over five years from the initiation of treatment.