Abstract
Purpose
Latest publications state equal efficacy of a recently introduced new percutaneous technique (“ultra-mini PCNL”, UMP) and flexible ureteroscopy (fURS) in the treatment of medium-size urinary stones. Today we face challenges concerning cost-effectiveness and reduction of in-hospital length of stay. In this retrospective study, we compare clinical outcome parameters and costs of treatment (endoscopes and disposables) of both techniques.
Methods
Thirty patients treated by UMP at two tertiary university centres were matched to 30 fURS patients from previously recorded databases. Data analysis included operating time, length of stay, stone-free rates (SFR), complications (>Clavien II), ancillary procedures (presurgical ureteral stenting, secondary ureteral stenting or placement of a nephrostomy tube, secondary procedures) and costs for disposable materials and instruments (endoscopes, as calculated per procedure).
Results
We found no significant differences in operating times (UMP vs. fURS: 121/102 min), hospital length of stay (2.3/2.0 days), SFR (84/87 %) and complications (7/7 %). Costs for disposable materials and endoscopes were 656 euro (UMP) and 1,160 euro (fURS) per procedure.
Conclusions
UMP and fURS are both safe and effective in the treatment of medium-size urinary stones. Costs for endoscopes and disposable materials are significantly lower in UMP.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- fURS:
-
Flexible ureteroscopy
- PCNL:
-
Percutaneous nephrolithotomy
- SFR:
-
Stone-free rate(s)
- SWL:
-
Shock wave lithotripsy
- UMP:
-
Ultra-mini PCNL
- URS:
-
Ureteroscopy
References
Tuerk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al (2014) EAU guidelines on urolithiasis [Internet]. Available from: http://www.uroweb.org/gls/pdf/22%20Urolithiasis_LR.pdf
De la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R et al (2011) The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol Soc 25(1):11–17
Miernik A, Wilhelm K, Ardelt PU, Adams F, Kuehhas FE, Schoenthaler M (2012) Standardized flexible ureteroscopic technique to improve stone-free rates. Urology 80(6):1198–1202
Hussain M, Acher P, Penev B, Cynk M (2011) Redefining the limits of flexible ureterorenoscopy. J Endourol Soc 25(1):45–49
Desai J, Solanki R (2013) Ultra-mini percutaneous nephrolithotomy (UMP): one more armamentarium. BJU Int. 112(7):1046–1049
Sabnis RB, Ganesamoni R, Doshi A, Ganpule AP, Jagtap J, Desai MR (2013) Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial. BJU Int 112(3):355–361
Schoenthaler M, Wilhelm K, Kuehhas FE, Farin E, Bach C, Buchholz N et al (2012) Postureteroscopic lesion scale: a new management modified organ injury scale–evaluation in 435 ureteroscopic patients. J Endourol Soc 26(11):1425–1430
Skolarikos A, Alivizatos G, de la Rosette J (2006) Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention. Eur Urol 50(5):981–990 discussion 990
Sayed MA, el-Taher AM, Aboul-Ella HA, Shaker SE (2001) Steinstrasse after extracorporeal shockwave lithotripsy: aetiology, prevention and management. BJU Int 88(7):675–678
Deem S, Defade B, Modak A, Emmett M, Martinez F, Davalos J (2011) Percutaneous nephrolithotomy versus extracorporeal shock wave lithotripsy for moderate sized kidney stones. Urology 78(4):739–743
Johnson GB, Portela D, Grasso M (2006) Advanced ureteroscopy: wireless and sheathless. J Endourol Soc 20(8):552–555
Yamaguchi A, Skolarikos A, Buchholz N-PN, Chomón GB, Grasso M, Saba P et al (2011) Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol Soc 25(6):933–939
Miernik A, Wilhelm K, Ardelt P, Bulla S, Schoenthaler M (2012) Modern urinary stone therapy: is the era of extracorporeal shock wave lithotripsy at an end? Urol Ausg 51(3):372–378
Conflict of interest
Martin Schoenthaler Consultant contract with Schoelly GmbH, Denzlingen, Germany and NeoTract Inc., Pleasanton, USA; Ulrich Wetterauer Advisory board, DR. KADE Pharmazeutische Fabrik GmbH, Berlin; Janak Desai Royalty payments form LUT GmbH, Dezlingen, Germany and Arkadiusz Miernik Consultant contract with Schoelly GmbH, Denzlingen, Germany. The study received no external funding.
Ethical standard
The study has been approved by the local ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.
Author information
Authors and Affiliations
Corresponding author
Additional information
German Clinical Trial Register ID DRKS00006957.
Rights and permissions
About this article
Cite this article
Schoenthaler, M., Wilhelm, K., Hein, S. et al. Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of treatment costs (endoscopes and disposables) in patients with renal stones 10–20 mm. World J Urol 33, 1601–1605 (2015). https://doi.org/10.1007/s00345-015-1489-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-015-1489-4