ABSTRACT
PURPOSE: We wanted to evaluate the cost and effectiveness of different medical options for treating lower calyceal stones that measure less than 2cm, and specifically percutaneous nephrolithotomy (PNL) versus extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: A total of 61 patients with lower calyceal stones that measured less than 2cm were divided into two groups according to the first-line of treatment modality: the PNL (group 1) group and the ESWL (group 2) group. Each group was divided into two sub-groups; subgroup A, which included stones less than 1cm (group 1A and 2A) and subgroup B, which included stones that measured 1-2cm (group 1B and 2B). The stone-free rate and many other factors were analyzed. RESULTS: The success rates of treatment for group 1A and 2A were 100% (8/8) and 76.4% (13/17), respectively (p=0.269). However, in groups 1B and 2B, the success rates of treatment were 100% (14/14) and 63.6% (14/22), respectively (p=0.013), with group 1B showing a higher success rate. The total cost of treatment and the average of a patient's expenditure per group were as follows: group 1 with 2,622,501 won and 1,093,508 won, respectively; group 2 with 938,225 won and 447,935 won, respectively (p<0.001). CONCLUSIONS: The results of this study indicate that ESWL can serve as an effective first-line treatment modality for lower calyceal stones that measured less than 2cm. However, when considering other factors, such as the expensive burden of additional treatment and our national health insurance system, PNL may be an acceptable first-line treatment modality for lower calyceal stones that measure 1-2cm.