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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Dr. Thomas Knoll
Urologische Universitätsklinik · Klinikum Mannheim
Theodor-Kutzer-Ufer 1 - 3
68135 Mannheim
Phone: 0621/383-3349
Fax: 0621/383-734080
Email: t.knoll@uro.ma.uni-heidelberg.de
