Aktuelle Aspekte der Steintherapie

Zusammenfassung

Mehr als 30 % aller stationären Aufnahmen in einer urologischen Klinik erfolgen zur Behandlung von Harnsteinen. Die Therapie erfolgt heute in fast allen Fällen minimalinvasiv durch extrakorporale Stoßwellenlithotripsie (ESWL), Ureterorenoskopie (URS) oder perkutane Nephrolithotomie (PCNL). Technische Weiterentwicklungen in der Endourologie und gewachsene Erfahrung mit der ESWL haben in den letzten Jahren zu einem Rückgang der ESWL-Behandlungen und einem häufigeren Einsatz endoskopischer Techniken geführt. Diese sind zwar im Vergleich zur ESWL invasiver, führen jedoch in den meisten Fällen zu einer rascheren Steinfreiheit. Durch die Einführung des Fallpauschalensystems (DRGs) wird auch die ökonomische Seite der Steintherapie immer wichtiger werden. Steinprävention führt zu einer Kostenreduktion im Gesundheitswesen, weshalb eine geeignete Steinmetaphylaxe durchgeführt werden sollte. Die vorliegende Übersichtsarbeit stellt daher die aktuellen Therapieempfehlungen der interventionellen Harnsteintherapie und Steinmetaphylaxe dar und zeigt Möglichkeiten auf, eine sowohl medizinisch als auch ökonomisch rationale Therapie durchzuführen.

Abstract

More than 30 % of all admissions to an urologic clinic are for the treatment of urinary stones. In almost all cases, the treatment is minimally invasive employing extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS) or percutaneous nephrolithotomy (PCNL). Technical advances in endourology and a growing expertise in ESWL led to a decline in ESWL and an increase in endoscopic techniques. In comparison with ESWL, the endoscopic techniques are more invasive but in most cases achieve a stone free state faster. With the introduction of diagnosis related groups (DRG), the economic aspect of stone therapy is gaining in importance. Stone prevention leads to a cost reduction in the health care system, justifying the use of an appropriate stone metaphylaxis. This review article presents the current recommendations for interventional urinary stone therapy and lists the options of conducting both medical and economically rational therapy.

Schlüsselwörter

Harnsteine - extrakorporale Stoßwellenlithotripsie (ESWL) - Ureterorenoskopie (URS) - perkutane Nephrolithotomie (PCNL) - Fallpauschalensystem (DRG) - Kostenreduktion

Key words

Urinary stones - extracorporeal shock wave lithotripsy (ESWL) - ureterorenoscopy (URS) - percutaneous nephrolithotomy (PCNL) - diagnosis related groups (DRG) - cost reduction

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