比較多次手術處理大型近端輸尿管結石先使用輸尿管鏡碎石或先使用體外震波碎石兩組臨床與經濟上的差異
高銘鴻1,2, 王炯珵1,3
恩主公醫院泌尿科1; 台大醫院泌尿部2; 中原大學醫學工程系3
The comparison of economical and clinical outcome in dealing with large proximal ureteral stone requiring multiple procedures between initial ureteroscopic lithotripsy or extracorporeal shock wave lithotripsy
Ming-Hong Kao1,2, Cheng-Chung Wang1,3
Department of Urology, En Chu Kong Hospital, New Taipei City, Taiwan1 ;
Department of Urology, College of Medicine, National Taiwan University, Taipei, Taiwan 2 ; Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan 3
<Abstract>
Purpose: To investigate the clinical and economical features of dealing with difficult larger proximal ureteral stones (> 1cm ), we compared the total cost and clinical outcome in treating proximal ureteral stones requiring multiple procedures with initial ureteroscopic lithotripsy(URS-L) or extracorporeal shock wave lithotripsy(ESWL)
Materials and Methods: 129 patients undergoing both URS-L and ESWL for the same large proximal ureteral stone(>1 cm ) were included. The medical records, images, and billing statements of all patients for proximal ureteral stones between January 2011 and September 2015 at a regional hospital were reviewed. These patients had at least one episode of URS-L and ESWL during the whole course of managing the same proximal ureteral stone. Two groups were compared according to the initial URS-L or ESWL.
Results: 65 patients were in the URSL first group and 64 patients in the ESWL first group. The URSL first group had higher total cost (83809+28995 versus 71674+12374 TWD, p= 0.001, Taiwanese dollar(TWD)), longer hospital days (3.97+3.31 versus 2.86+0.71 days, p=0.01 ) , larger stone (1.66+0.47 versus 1.43+0.38 cm, p =0.002), more pre-operative urosepsis(12.6 % versus 0%,p=0.006), chronic kidney disease (CKD)(12.6% versus 0%,p=0.006), and pre-OP acute kidney injury(AKI) (20.0% versus 0%,p<0.001) .
Conclusion: The urologists tended to use URS-L first to manage large proximal ureteral stone and more complicated patients. The total costs of URSL first group were higher than the cost of ESWL first group.
Key word: ureteroscopic lithotripsy(URS-L), extracorporeal shock wave lithotripsy(ESWL), economical, clinical outcome