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Related Experiment Videos

Does transurethral laser ureterolithotripsy justify its cost?

K Esuvaranathan1, E C Tan, P K Tan

  • 1Department of Surgery, National University Hospital, Singapore.

The Journal of Urology
|September 1, 1992
PubMed
Summary

Transurethral laser ureterolithotripsy offers a higher success rate and lower morbidity compared to ultrasound lithotripsy. Laser treatment demonstrates a superior cost-benefit ratio, especially for upper ureteral calculi.

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Area of Science:

  • Urology
  • Endourology
  • Medical Technology

Background:

  • Transurethral ureterolithotripsy is a common procedure for kidney stone removal.
  • Traditional ultrasound lithotripsy utilizes larger ureteroscopes, potentially limiting access to certain calculi.
  • Advancements in laser technology offer a potential alternative for stone fragmentation.

Purpose of the Study:

  • To compare the efficacy, safety, and cost-benefit of transurethral laser ureterolithotripsy versus ultrasound lithotripsy.
  • To evaluate the impact of ureteroscope size on treatment success rates.
  • To assess the long-term economic advantages of laser lithotripsy.

Main Methods:

  • A prospective comparative study of 64 patients undergoing laser ureterolithotripsy versus 98 patients treated with ultrasound lithotripsy.

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  • Analysis of success rates, fragmentation rates, calculus reachability, and overall morbidity.
  • A 3- and 5-year cost-benefit analysis was performed.

    • Main Results:

    • Laser ureterolithotripsy demonstrated a significantly higher first-attempt success rate (92.2%) compared to ultrasound lithotripsy (71.4%).
    • The primary reason for lower success with ultrasound was the inability to reach upper ureteral calculi due to larger ureteroscope size.
    • Overall morbidity was lower with laser treatment, which also showed a superior 5-year cost-benefit ratio due to higher success and reduced hospital stay.

    Conclusions:

    • Transurethral laser ureterolithotripsy is more effective and safer than ultrasound lithotripsy, particularly for upper ureteral stones.
    • The improved reachability of smaller ureteroscopes in laser lithotripsy is a key factor in its success.
    • Laser ureterolithotripsy presents a favorable cost-benefit profile, making it advantageous for stone management.