A success and cost analysis study of the methods of managing impacted lower ureteric calculi

A personal series of 216 non-consecutive patients with renal calculi, measuring up to 0.7 cm in diameter, impacted in the lower third of their ureters were reviewed at least 2 years after either spontaneous expulsion of the calculus or surgical removal had been achieved in an endeavour to compare the natural history and complications of spontaneous expulsion with the results and complications of both attempted endoscopic and open extraction operations and the cost-effectiveness of these different methods of management. Spontaneous expulsion, without detectable complications, occurred within 3 months of presentation in 88% (88 of 100 patients) with calculi measuring 0.5 cm or less but was achieved in only 44% (9 of 16 patients) with calculi measuring between 0.5 and 0.7 cm despite a maximum 12 months period of expectant management. Of 100 attempted endoscopic calculus extractions, the operative success rate averaged 62%, without any significant complication, for those calculi measuring 0.5 cm or less but only 22%, with a significant complication rate of 19%, for calculi measuring between 0.6 and 0.7 cm. The average 1983 costs ranged from +1960 for a non-hospital spontaneous expulsion to +5278 for the failed endoscopic extraction of a larger calculus which subsequently required open surgical removal.