Cost and efficacy of extracorporeal shock wave lithotripsy versus ureteroscopy in the treatment of lower ureteral calculi.

We retrospectively reviewed the extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy experience relative to cost and efficacy of a group of practitioners skilled in the use of both procedures for the treatment of lower ureteral stones. Although the initial success rate was higher with ureteroscopy, no significant difference could be found in final success or complication rates. The cost of ESWL was approximately 60% higher than that for ureteroscopy (mean $7,320.26 versus $4,568.47, p less than 0.005). Given the current restraints on resources, and the equal efficacy and morbidity of both procedures, ureteroscopy must be considered the procedure of choice in the management of lower ureteral stones.

Psychosocial and physiologic needs of patients with arterial occlusive disease during the preoperative phase of hospitalization.

This study explored the needs experienced by 60 patients with chronic AOD during the period of hospitalization preceding reconstructive surgery. Ten physiological, psychological, and sociocultural need variables were found to relate to two major needs, a need for information and a need for support. The investigator identified a need for information related to preventive health behaviors and a need for support related to four areas. The patients expressed a need for support to overcome difficulties experienced in coping with the ramifications of chronic illness and anxiety regarding future progression of the disease. Significant differences existed between male and female and older and younger patients in several need areas. Influencing factors were primarily associated with perceived changes in self-concept and role relationships. The study indicated that difficulties experienced in adapting to chronic vascular disease exert a major influence on patients' perceptions during the preoperative period. Intervention during this period must thus meet needs related to both the chronic nature and the acute surgical phase of the disease. The study has provided an initial basis for developing interventions to meet these needs. However, further research utilizing a multivariate approach, is necessary before the complex nature of factors influencing patients' needs will be understood totally.