Üreter alt uç taşı tedavisinde ESWL veya ureteroskopi seçiminde maliyetin önemi

Ureter alt uç taşı tedavisinde mevcut tedavi seçenekleri Ekstrakorporeal Shockwave Litotripsi (ESWL), üreteroskopik taş ekstraksiyonu (URS) ve üreterolitotomidir. Batı ülkelerinde ureter alt uç taşı tedavisinde URS ve ESWL'nin basan oranlan arasında belirgin fark yok iken tercihte maliyet farklılıkları belirleyici olmaktadır. Kliniğimizde üreter alt uç taşı nedeniyle ESWL ve/veya URS uygulanan hastalan taş boyutlanna göre basan oranlan, komplikasyonlan, kateter kullanımı ve maliyetleri açısından değerlendirerek maliyetin tedavi seçimindeki yerini inceledik Introduction: The treatment options in the treatment of lower ureteral calculi are Extracorporeal Shockwave Lithotripsy (ESWL), ureteroscopy and ureterolitotomy. Although there is no a reliable different success rate between ESWL and ureteroscopy, the costs-of treatment patterns play a major role in the treatment decision in the western countries. We analyzed the patients restrospectjvely for their success and complication rate, the ratio of catheter usage and cost-effectivity. Material and Methods: We retrospectively recorded the age, sex, stone sizes, complications, catheter usage, success rates and costs of treatments for 354 and 109 patients treated with ESWL and URS respectively between 1992 -2000 and 1997 -2001. Costs of treatments were calculated according to the stone sizes $leq$ 1 cm2 and > 1cm2 based on the cumulative sum of costs of our hospital. We exchanged the average cost to USA $. (1 USA $ = 1.400.000 TL) Results: Mean age for ESWL and URS was 44,5 (10-80), 42,2 (6-75) years, respectively and the mean number of shock waves for ESWL was 2,1 (1-13). The success rates of URS and ESWL in the $leq$ lcm2 and >1cm2 subgroups were 85.9%, 80.6% and 94.8%, 89.4% respectively. The average of costs of treatments of URS in the $leq$ 1cm2 and >1cm2 subgroups were 706,4 $ , 738,7 $ and 328,5 $ and 405,7 $ for ESWL, respectively. After performing URS complications were seen in 11 patients including fever in 6, minimal laceration in 2, late ureteral stricture in 2 and only 2 patients had fever after performing ESWL. Conclusions: ESWL does not need surgery practice and has a low complication and high success rate. It is also less invazive and economical than URS. These advantages make ESWL a more preferable option.