Non-invasive lithotripsy leads to more treatment for kidney stones

May 16, 2014, Duke University Medical Center

When it comes to treating kidney stones, less invasive may not always be better, according to new research from Duke Medicine.

In a direct comparison of shock wave lithotripsy vs. ureteroscopy – the two predominant methods of removing kidney stones – researchers found that ureteroscopy resulted in fewer repeat treatments.

The findings were published May 16, 2014, in the journal JAMA Surgery, coinciding with presentation at the annual meeting of the American Urological Association.

"Nearly one out of 11 people in the United States has kidney stones, leading to more than $10 billion a year in treatment costs," said lead author Charles D. Scales Jr., M.D., assistant professor of surgery at Duke. "As we explore ways to improve value in the health care system, we need to look at the kinds of things that drive costs up; reducing the number of repeat procedures is one place to start."

Scales and colleagues analyzed data for nearly 48,000 insured patients in the United States who sought emergency room or urgent care treatment for kidney stones from 2002-10.

Roughly half the patients received shock wave lithotripsy, a non-invasive approach that focuses pressure waves on the stones to break them into tiny pieces that can then pass painlessly. The other half of patients underwent ureteroscopy, a minimally invasive procedure that uses a laser to break up the stone, and a thin scope that travels through the urethra to snare the stone in a small basket for removal.

Within 120 days of the initial procedure, approximately one in five of the patients needed a second treatment. The researchers focused their comparison on patients who were equally qualified for either procedure. Among that group, 11 percent of patients undergoing shock wave lithotripsy needed a second procedure, while less than 1 percent of ureteroscopy patients needed an additional treatment.

"Our findings add new insight, since most of published research around the effectiveness of the procedures was conducted years ago, when the technology was new," Scales said. In the past 20 years, he said, many experts believe shock wave lithotripsy has become less effective as the devices underwent design changes to improve safety. At the same time, ureteroscopy improved with better endoscopes and laser technology."

The researchers noted that the findings have important policy implications around Medicare reimbursements. For treating , Medicare currently pays about $700 for a patient to receive lithotripsy, but only about $400 for a patient to receive the endoscopic ureteroscopy treatment, which the study found to be more effective.

The researchers suggested that differences in effectiveness, invasiveness and costs highlight important tradeoffs between the two procedures. In all cases, Scales said, the decision to undergo shock wave lithotripsy or ureteroscopy should be carefully considered by both the doctor and the patient.

"Many believe that because nothing is inserted into the body, shock wave lithotripsy is better, but that may not always be the case," Scales said. "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."

Explore further: Complications from kidney stone treatments are common and costly

Related Stories

Complications from kidney stone treatments are common and costly

April 28, 2014
Despite their overall low risk, procedures to treat kidney stones lead to complications that require hospitalization or emergency care for one in seven patients, according to researchers at Duke Medicine.

Study finds no correlation between primary kidney stone treatment and diabetes

October 21, 2011
A Mayo Clinic study finds no correlation between the use of shock waves to break up kidney stones and the long-term development of diabetes. The study was released Friday during a meeting of the North Central Section of the ...

'Smart stethoscope' advance in monitoring treatment of kidney stones

December 12, 2012
A new listening device, developed by scientists from the University of Southampton, is being used to monitor the effectiveness of the treatment of kidney stones - saving patients unnecessary repeat therapy and x-ray monitoring.

More effective kidney stone treatment, from the macroscopic to the nanoscale

April 17, 2014
Researchers in France have hit on a novel method to help kidney stone sufferers ensure they receive the correct and most effective treatment possible.

Recommended for you

Surprise finding—for very sick elderly, lighter sedation won't drop risk of postoperative delirium, study suggests

August 13, 2018
Johns Hopkins Medicine researchers say a study designed to see if reducing the amount of anesthesia reduces the risk of postoperative delirium in older patients surprisingly found that lighter sedation failed to do so in ...

Kidney transplant chains more effective in saving lives

August 9, 2018
New research from the UBC Sauder School of the Business has found that transplant societies which prioritize kidney transplant chains over kidney exchanges can increase the total number of transplants, thereby saving more ...

Surgical mesh implants may cause autoimmune disorders

July 31, 2018
Surgical mesh implants, often used for hernia or gynecological repair, may be the reason so many patients report symptoms of an autoimmune disorder, according to a University of Alberta rheumatologist.

Surgeons discuss options when the risks of surgery may be too high

July 27, 2018
In an essay published July 26 in the New England Journal of Medicine, Ira Leeds, M.D., research fellow, and David Efron, M.D., professor of surgery, both of the Johns Hopkins University School of Medicine, along with their ...

Blood plasma during emergency air transport saves lives

July 25, 2018
Two units of plasma given in a medical helicopter on the way to the hospital could increase the odds of survival by 10 percent for traumatically injured patients with severe bleeding, according to the results of a national ...

The dark side of antibiotic ciprofloxacin

July 25, 2018
The use of ciprofloxacin and other antibiotics of the class of fluoroquinolones may be associated with disruption of the normal functions of connective tissue, including tendon rupture, tendonitis and retinal detachment. ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.