Management of ureteral calculi and DRG

Abstract

Extracorporeal shock wave lithotripsy (ESWL) and ureterolithotripsy (ULT) have dramatically changed the management of ureteral calculi. Since the new financial policy of public hospitals is now operative, we tried to evaluate if the management of ureteral calculi is conditioned by technical availability and by the Diagnosis Related Group (DRG) payment system. Open surgery is still first-line treatment for renal calculi over 3 cm in diameter. ESWL is preferentially employed for the treatment of lumbar ureteral calculi, while ULT is preferred in distal ureteral stones. Non-analytical evaluation of costs in our Hospital showed that ESWL and ULT with an average of three days hospital stay were remunerative if DRG standards were applied. This was not the case if the same treatments were applied on a “day-hospital” basis or in one day of hospital stay. As far as therapeutical choice is concerned, in our and other urological divisions it was dictated by clinical and technical more than economic considerations.