近端輸尿管結石利用多次輸尿管碎石與體外震波治療成效及經費之比較
吳昀叡12、高銘鴻2、王炯珵13
1恩主公醫院 外科部 泌尿科；2台灣大學附設醫院 泌尿部，3中原大學生物醫學工程系
Yun-Rui Wu12, Ming-Hong Kao2, Chun-Cheng Wang13
1Department of Urology, En Chu Kong Hospital, New Taipei city, Taiwan;
2Department of Urology, College of Medicine, National Taiwan University, Taipei, Taiwan
3Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan
Purpose: We investigated the clinical outcome and cost of treating proximal ureteral stones requiring at least two procedures of initial ureteroscopic lithotripsy (URS) or extracorporeal shock wave lithotripsy (SWL).
Materials and Methods: This retrospective study included 213 patients undergoing treatment for proximal ureteral stones. The inclusion criteria were as follows: 1) patients receiving at least two procedures, including SWL and URS, for the same proximal ureteral stone, and 2) a stone-free status at the 3-month follow-up. The medical records, images, and billing statements of all patients at a referred hospital were reviewed. We compared two groups categorized by their initial treatment method. Stone size was categorized as ≥ 1 cm or < 1 cm.
Results: In the URS group of 81 patients, 65 had stones ≥ 1 cm; in the SWL group of 132 patients, 64 had stones ≥ 1 cm. A higher proportion of patients in the URS group had a history of urolithiasis, chronic kidney disease, acute kidney injury, urosepsis, percutaneous nephrostomy implementation, longer ureteral stent placement duration, longer hospital stay, larger stone size (cm) (1.48±0.56 vs. 1.04±0.47, p<0.01), and higher total cost (United State Dollars) (2672±907 vs. 2256±374, p<0.01) than that in the SWL group. Larger stone size increased the total cost of treatment, regardless of whether URS or SWL was initially performed.
Conclusions: URS was the preferred initial procedure in patients with larger proximal ureteral stones and more comorbidities. More complicated clinical conditions resulted in a higher treatment cost.