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Current management of urolithiasis: progress or regress?
Kurt Kerbl1, Jamil Rehman, Jaime Landman
1Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Journal of Endourology
|August 20, 2002
Summary
Urologists are increasingly using ureteroscopy over shockwave lithotripsy (SWL) for kidney stones. Advances in ureteroscopy and laser lithotripsy, coupled with stagnant SWL technology, drive this shift toward more invasive procedures.
Area of Science:
- Urology
- Endourology
- Nephrolithiasis Treatment
Background:
- Shockwave lithotripsy (SWL) was a minimally invasive standard for kidney stone treatment.
- Recent advancements in ureteroscopy and laser lithotripsy have emerged.
- The efficacy of second- and third-generation SWL devices is under scrutiny.
Purpose of the Study:
- To evaluate the impact of less powerful SWL devices on surgical stone therapy.
- To identify national and institutional trends in kidney stone treatment.
- To compare current treatment modalities with data from 1990.
Main Methods:
- Retrospective analysis of urolithiasis procedures at a single institution in 1998 vs. 1990.
- Analysis of Medicare data (1988-2000) for national trends in stone treatment.
- Comparison of ureteroscopy, SWL, open surgery, and percutaneous nephrolithotomy utilization.
Main Results:
- Institutional ureteroscopy increased by 53%, while SWL decreased by 15%.
- National Medicare data showed a decrease in open surgery and an increase in ureteroscopy.
- Percutaneous nephrolithotomy rates remained stable; SWL showed a slight increase nationally.
Conclusions:
- Improved ureteroscopes and intracorporeal lithotripters favor ureteroscopy.
- Lack of cost-effective SWL advancements contributes to this trend.
- There is a need for renewed research into SWL technology to maintain noninvasive options.