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Der Urologe

, Volume 51, Issue 3, pp 372–378 | Cite as

Moderne Steintherapie

Ist die Ära der extrakorporalen Stoßwellenlithotripsie zu Ende?
  • A. Miernik
  • K. Wilhelm
  • P. Ardelt
  • S. Bulla
  • M. Schoenthaler
Originalien

Zusammenfassung

Hintergrund

Die Therapie der Urolithiasis hat mit der Einführung der extrakorporalen Stoßwellenlithotripsie (ESWL) und der perkutanen und ureterorenoskopischen Techniken in den 1980er Jahren grundlegende Veränderungen erfahren. Seither wurden diese minimal-invasiven Techniken kontinuierlich weiterentwickelt.

Ergebnisse

Nachdem über viele Jahre die ESWL eine überragende Rolle in der Steintherapie gespielt hat, zeigt sich in den letzten Jahren ein zunehmender Trend zur endoskopischen Therapie. Dies kann auf die zunehmende operationstechnische Erfahrung, insbesondere aber auch auf die Weiterentwicklung des zur Verfügung stehenden Instrumentariums zurückgeführt werden. Dieser Trend wird durch die vorhandene Datenlage nicht adäquat abgebildet (fehlende aktuelle randomisierte Studien). Neuere Daten der endoskopischen Techniken liegen bislang z. T. als Kohortenstudien, meist aber lediglich als Fallserien vor. Entsprechend fokussieren die Empfehlungen der deutschen und internationalen Leitlinien noch auf die ESWL als Erstlinientherapie für die meisten Steinlokalisationen und -größen.

Schlussfolgerung

Die Analyse der Behandlungsdaten unserer Klinik bestätigt die beschriebenen Trends und zeigt die hohe Behandlungseffizienz der modernen Steintherapie und die damit verbundene Absenkung des sozioklinischen Aufwands.

Schlüsselwörter

Ureterorenoskopie Stoßwellenlithotripsie Perkutane Nephrolithotripsie Steintherapie Behandlungseffizienz 

Modern urinary stone therapy

Is the era of extracorporeal shock wave lithotripsy at an end?

Abstract

Background

Treatment of urolithiasis saw major changes with the introduction of extracorporeal shock wave lithotripsy (ESWL) and percutaneous and ureteroscopic techniques in the 1980s. Since then these minimally invasive treatment modalities have continuously been developed further.

Results

For years ESWL has been the treatment of choice. However, recent years have seen a significant shift towards endoscopic therapies. This can be attributed to the evolving surgical experience in the use of these techniques, but even more to major improvement in the technical equipment. This trend is not backed sufficiently by high-level data (RCTs). Some of the newer data on endoscopic techniques are presented in cohort studies, but most studies are case series. Accordingly, recommendations of the German and international guidelines still focus on ESWL as first-line therapy for most locations and sizes of urinary stones.

Conclusion

The analysis of treatment data of our institution confirms these trends and demonstrates high treatment efficiency in modern stone management and a consecutive significant lowering of socio-clinical expenses.

Keywords

Ureterorenoscopy Shock wave lithotripsy Percutaneous lithotripsy Urinary stone therapy Treatment efficiency 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • A. Miernik
    • 1
  • K. Wilhelm
    • 1
  • P. Ardelt
    • 1
  • S. Bulla
    • 2
  • M. Schoenthaler
    • 1
  1. 1.Abteilung Urologie, Chirurgische UniversitätsklinikUniversitätsklinikum FreiburgFreiburgDeutschland
  2. 2.Radiologische Universitätsklinik FreiburgFreiburgDeutschland

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