Ergin G et al, 2018: Shock wave lithotripsy or retrograde intrarenal surgery: which one is more effective for 10-20-mm renal stones in children.
Ergin G, Kirac M, Kopru B, Ebiloglu T, Kibar Y, Biri H.
Department of Urology, Koru Ankara Hospital, Ankara, Turkey.
Department of Urology, Gulhane Training and Research Hospital, Ankara, Turkey.
OBJECTIVES: To compare shock wave lithotripsy and flexible ureteroscopy in children with renal stone's diameter of 10 to 20 mm.
MATERIALS AND METHODS: This is a retrospective study including 79 children, who had renal stone and underwent either shock wave lithotripsy or flexible ureteroscopy between January 2007 and June 2017. Of those, 38 patients underwent shock wave lithotripsy assigned as group 1 and 41 patients underwent flexible ureteroscopy assigned as group 2. Stone-free rate, fluoroscopy time, procedure time, complication rates, hospitalization time, and cost-effectiveness were monitored and included in the analyses.
RESULTS: The mean patient age was 4.4 ± 3.5 in group 1 and 4.9 ± 4.1 in group 2. Stone-free rate was not different in both groups in the first and third months of follow-up. The mean fluoroscopy time was statistically significantly longer in group 1 compared to group 2. Procedure and hospitalization times were longer in group 2 compared to group 1. No complications were seen in either groups. The expenditure was calculated as 135.23 and 869.41 Euro per patient for groups 1 and 2, respectively, which shows significant higher cost in group 2.
CONCLUSIONS: In this present study, we have shown that shock wave lithotripsy is cheaper, has short hospitalization time and long fluoroscopy time and similar stone-free rate, and has the same efficiency compared to flexible ureteroscopy regarding pediatric renal stones with the diameter between 10 and 20 mm.
Ir J Med Sci. 2018 Mar 3. doi: 10.1007/s11845-018-1776-3. [Epub ahead of print]
A retrospective study on 79 children treated in 10 years by ESWL or URS; that might be 8 children per year. There is no information why one or the other treatment was selected. Cost calculation is not an easy task (The economics of stone disease. Canvasser NE, Alken P, Lipkin M, Nakada SY, Sodha HS, Tepeler A, Lotan Y. World J Urol. 2017 Sep; 35(9):1321-1329) and can definitively not be done in the way the authors did it: “The cost of SWL for a single person was defined as the price of machine/total number of patients in which SWL was applied + JJ stent if used + antibiotics + the doctor for a single patient + the technician for a single patient + the nurse for a single patient + the doctor for anesthesia per patient + the technician for anesthesia per patient + hospitalization time (hour) hospitalizations price per hour. The cost of RIRS for a single person was defined as the price of flexible ureterorenoscope/ total number of patients in which RIRS was applied + ureteric guide + access sheath/total number of patients in which it was used + laser machine/total number of patients in which it was used + laser fiber/total number of patients in which it was used + JJ stent if used + antibiotics + anesthesia + irrigation solution + contrast agent + the doctor for anesthesia per patient + the technician for anesthesia per patient + the doctor for operation per patient + the technician for operation per patient + the nurse for operation per patient + hospitalization time (hour) hospitalizations price per hour.”
Sometimes I wonder why and how manuscripts travel to get into a journal - like in this case from Turkey into the Irish Journal of Medical Science.