Comparing Top Two Ways to Eliminate Kidney Stones

Kidney stones can be treated with two main procedures but one may be better than the other

(RxWiki News) Kidney stones are a very painful problem to have, and there are two main procedures doctors use to get rid of them. The question is: Is one way better than the other?

New research showed that ureteroscopy was more successful at completely eliminating the stones than shock wave lithotripsy.

Ureteroscopy is slightly more invasive, but quite a bit cheaper, the researchers noted.

"Ask your surgeon about the best way to get rid of kidney stones."

This research was led by Charles D. Scales Jr., MD, of Duke University Medical Center in Durham, North Carolina.

Dr. Scales and colleagues looked at data for 47,851 insured patients who sought emergency room or urgent care for kidney stones from 2002-2010.

Kidney stones are small, hard deposits made of mineral and acid salts that form inside the kidneys. They usually do not cause permanent damage but can be very painful if they are too large to pass through the ureter (the tube in the body that propels urine to the kidneys).

About one in 11 people have kidney stones.

Two procedures are used about 90 percent of the time to get rid of the stones. Ureteroscopy involves threading a long, thin instrument into the ureter to look at the stones and then collect them in a small basket at the end of the instrument. In some cases, the stones can be fragmented using laser first.

Shock wave lithotripsy is non-invasive and involves sending shock waves to the kidney to crush the stones, which are then passed through the ureter.

Dr. Scales’s group wanted to see if one procedure led to more patients returning for a repeat procedure because they still had kidney stones.

In their retrospective study, 21,937 patients underwent shock wave lithotripsy and 25,914 patients had ureteroscopy. Within three months of the initial procedure, 11 percent of the patients who had shock wave lithotripsy needed a second treatment. Less than 1 percent of patients who had ureteroscopy needed it to be redone.

The researchers noted that patients often like the idea of shock wave lithotripsy better because it is noninvasive. However, this study showed that shock wave lithotripsy required more repeats.

According to a Duke University press release, Medicare pays about $700 for shock wave lithotripsy to treat kidney stones, while it pays just $400 for ureteroscopy.

The study authors noted that new lithotripters used for shock wave lithotripsy seem less effective than the older model, and doctors have become more adept at performing ureteroscopy and have better tools, which may account for some of the differences in patients requiring repeat interventions.

"Many patients believe that because nothing is inserted into the body, shock wave lithotripsy is better, but that may not always be the case," Dr. Scales said in a press release. "There can be important tradeoffs for having the non-invasive 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."

This study appeared May 16 in JAMA Surgery. It was also presented at the American Urological Association's annual meeting.

This research was supported by the Robert Wood Johnson Foundation Clinical Scholars Program and the US Department of Veterans Affairs.

The study authors did not disclose any conflicts of interest.

Review Date: 
May 16, 2014