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Alevizopoulos A, Zosimas D, Piha L, et al. Managing Small Ureteral Stones: A Retrospective Study on Follow-Up, Clinical Outcomes and Cost-Effectiveness of Conservative Management vs. Early Surgery. Curr Urol. 2016;9(1):36-43doi: 10.1159/000442849.
Alevizopoulos, A., Zosimas, D., Piha, L., Hanna, M., & Charitopoulos, K. (2016). Managing Small Ureteral Stones: A Retrospective Study on Follow-Up, Clinical Outcomes and Cost-Effectiveness of Conservative Management vs. Early Surgery. Current urology, 9(1), 36-43. https://doi.org/10.1159/000442849
Alevizopoulos, Aristeidis, et al. "Managing Small Ureteral Stones: A Retrospective Study on Follow-Up, Clinical Outcomes and Cost-Effectiveness of Conservative Management vs. Early Surgery." Current urology vol. 9,1 (2016): 36-43. doi: https://doi.org/10.1159/000442849
Alevizopoulos A, Zosimas D, Piha L, Hanna M, Charitopoulos K. Managing Small Ureteral Stones: A Retrospective Study on Follow-Up, Clinical Outcomes and Cost-Effectiveness of Conservative Management vs. Early Surgery. Curr Urol. 2016 Feb;9(1):36-43. doi: 10.1159/000442849. Epub 2016 Feb 10. PMID: 26989370; PMCID: PMC4789946.
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Curr Urol. 2016 Feb;9(1):36-43. doi: 10.1159/000442849. Epub 2016 Feb 10.

Managing Small Ureteral Stones: A Retrospective Study on Follow-Up, Clinical Outcomes and Cost-Effectiveness of Conservative Management vs. Early Surgery.

Current urology

Aristeidis Alevizopoulos, Dimitrios Zosimas, Lamprini Piha, Milad Hanna, Konstantinos Charitopoulos

Affiliations

  1. Department of Urology, Colchester Hospital University Foundation Trust, Colchester, London, UK.
  2. Department of General Surgery, West Midlesex University Hospital of London, London, UK.
  3. Athens University of Economics and Business, Athens, Greece.
  4. Department of Urology, West Midlesex University Hospital of London, London, UK.

PMID: 26989370 PMCID: PMC4789946 DOI: 10.1159/000442849

Abstract

INTRODUCTION: The management of ureteral calculi has evolved over the past decades with the advent of new surgical and medical treatments. The current guidelines support conservative management as a possible approach for ureteral stones sized = 10 mm.

OBJECTIVES: We purport to follow the natural history of ureteral stones managed conservatively in this retrospective study, and attempt to ascribe an estimated health-care and cost-effectiveness, from presentation to time of being stone-free.

MATERIALS AND METHODS: 192 male and female patients with a single ureteral stone sized = 10 mm were included in this study. The clinical and cost-related outcome was analyzed for different stone sizes (0-4, 4-6 and 6-10 mm). The effectiveness of selected follow-up (FU) scans was also analyzed.

RESULTS: Stone size was found to be related to the degree of hydronephrosis and to the likelihood of need for a surgical management. Conservative management was found to be clinically effective, as 88% of the patients did not require surgery for their stone. 96.1% of the patients with a stone 0-4mm managed to expel their ureteral stone. Bigger ureteral stones were found to be more costly. The cost-effectiveness of the single FU scans was found to be related to their efficiency, while the global cost-effectiveness of conservative management vs. early surgery was higher for smaller stones (26.8 vs. 17.32% for stones 0-4 vs. 6-10 mm).

CONCLUSION: Conservative management is clinically effective with a significant cost-benefit, particularly for the subgroup of stones sized 0-4 mm, where a need for FU scans is in dispute.

Keywords: Conservative management; Cost-effective; Tamsulosin; Ureteral calculus; Urolithiasis

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