Clinical and economic rationale for the choice of treatment method for patients with kidney stones 10-20 mm

The clinical and economic rationale for choosing a method of treating patients with kidney stones 10-20 mm in size is presented. Remote lithotripsy was found to be effective in 94,2% of patients whose urolitic density is less than 1000HU and in 81.6% of patients who have a stone density of more than 1000 HU. A «stone free state» with standard and mini- percutaneous nephrolitholapaxia was achieved in 93,5 and 94,1% in patients with a stone density of more than 1000 HU. Uroliths with a density of less than 1000 HU were removed in all patients using standard percutaneous nephrolitholapaxia and in 95% of patients using mini percutaneous nephrolitholapaxia. The smallest direct medical costs were observed when performing remote lithotripsy (patients with a density of uroliths less than 1000 HU - 24292,4 rubles, patients with a density of stones more than 1000 HU - 36930 rubles). When performing operations of standard and mini-nephrolitholapaxia, the cost of treatment was 38715,7 and 35900 rubles. for patients with uroliths with a density of less than 1000 HU, 40024 and37312,8 rubles. in patients with uroliths with a density of more than 1000 HU. The cost increment coefficient showed that additional costs of 1% of the treatment efficiency when using the minipercutaneous technique will require 30,6 rubles, with standard nephrolitholapaxy - 260 rubles per person compared with distance lithotripsy. From the standpoint of clinical and economic analysis, the mini-and standard percutaneous nephrolitholapaxia should be considered as reasonable methods for the surgical treatment of patients with high-density stones of 1-2 cm, remote lithotripsy is the first-line method for the treatment of calculi of lower density.

urolithiasis, kidney stones 10-20 mm in size, extracorporeal shock wave lithotripsy, standard percutaneous nephrolitholapaxy, mini-percutaneous nephrolitholapaxy, the effectiveness of treatment, cost of illness, cost-effectiveness