URS shows fewer repeat treatments than SWL

When compared with shock wave lithotripsy (SWL), ureteroscopy is associated with fewer repeat treatments, according to a recent study from Duke University.

The study results coincide with new research showing a dramatic increase in the use of ureteroscopy and a corresponding decline in SWL.

For the Duke study, which was published online in JAMA Surgery (May 16, 2014) and presented at the AUA annual meeting in Orlando, FL, first author Charles D. Scales, Jr., MD, MSHS, and co-authors analyzed data for nearly 48,000 insured U.S. patients who sought emergency department or urgent care treatment for kidney stones from 2002-’10.

About half of the patients underwent SWL, and about half received ureteroscopy, the authors reported.

Within 4 months of the initial procedure, approximately 20% of the patients needed a second treatment. The authors focused their comparison on patients who were equally qualified for either procedure. Among that group, 11% of patients undergoing SWL needed a second procedure, while less than 1% of ureteroscopy patients required an additional treatment.

“Nearly one out of 11 people in the United States has kidney stones, leading to more than $10 billion a year in treatment costs. As we explore ways to improve value in the health care system, we need to look at the kinds of things that drive costs up; reducing the number of repeat procedures is one place to start,” Dr. Scales said in a press release from Duke.

“Many patients believe that because nothing is inserted into the body, shock wave lithotripsy is better, but that may not always be the case. There can be important tradeoffs for having the noninvasive procedure. One question to ask is about the likelihood of a second procedure, and the impact that might have on the cost of care and the time off work,” Dr. Scales added.

The study was conducted for the Urologic Diseases in America Project.

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