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"Baground: the optimal management of lower calyceal stones is still controversial, because no single method is suitable for the removal of all lower calyceal stones. Minimally invasive procedures such as extracorporeal shock wave lithotrispy (ESWL), percutaneous nephrolithotomy (PNCL) and flexible ureteroscopy (fURS) are the therapautic methods for lower calyceal stones. the aim of this study was to identify the optimal management of 10-20 mm lower pole stones. Methods : a meta-analysis of cohort studies published before July 2016 was performed from Medline and Cochrane databases. Management of 10-20 mm lower pole stone treated by fURS, ESWL and PCNL with follow-up of residual stones in 1-3 months after procedure were include and urinary stone in other location and size were exclude. A fixed-effects model with Mantzel-Haenzel method was used to calculate the I2 statistic. All analyses were performed with review manager 5.3. Result : we analized 8 cohort studies. The stone free rate from 958 patient (271 PCNL, 174 fURS and 513 ESWL), 3 months after operation, was 90.8% (246/271) after PCNL; 75.3% (131/174) after fURS; and 64.7% (332/513)after ESWL. Base on stone free rate in 10-20 mm lower pole stone following management, PCNL is better than fURS (overall RR was 1.32 (95% CI 1.13-1.55) ; p<0.001 and I2=57%) and ESWL (overall risk ratio 1.42 (95% CI.30-1.55); p=<0.001 and I2=85%). But if we compare between fURS and ESWL, fURS is better than ESWL base on stone free rate in 10-20 mm lower pole stone management with overall RR 1.16 (95% CI 1.04-1.30; p=0.01 and I2=40%). Conclusion: percutaneous nephrolithotomy provided a higher stone free rate than fURS and ESWL. This meta-analysis may help urologist in makin decision of intervention in 10-20mm lower pole stone management."

"Sebelum ditemukannya alat-alat canggih, pengobatan penyakit batu saluran kemih, khususnya batu ureter, adalah dengan cara operasi terbuka (invasif). Namun saat ini pengobatan yang bersifat invasif mulai ditinggalkan, dan beralih ke cara pengobatan yang minimal invasif, bahkan non invasif.Saat ini, di RSUPN-CM Jakarta, telah tersedia alat untuk mengobati penyakit batu saluran kemih, khususnya batu ureter distal, yang bersifat minimal invasif, yaitu Ureterorenoskop, dan yang bersifat non invasif, yaitu Extracorporeal Shock Wave Lithotripsy (ESWL). Cara pengobatan batu ureter dengan menggunakan alat Ureterorenoskop, disebut tindakan Ureteroskopi (URS).Tujuan dari penelitian ini adalah, untuk mengetahui efektivitas biaya dari pengobatan batu ureter distal, antara yang menggunakan cara URS dengan cara ESWL. Penelitian ini bersifat deskriptif, menggunakan data sekunder subbagian urologi swadana RSUPN-CM, tahun 2001 periode Juni s/d Desember. Analisis data biaya investasi menggunakan biaya investasi setahun. Analisis biaya menggunakan metode Activity Based Costing (ABC), karena metode ini yang paling cocok untuk menganalisis biaya dalam mengobati penyakit batu ureter distal yang merupakan salah satu jenis kegiatan yang ada di subbagian urologi yang memiliki berbagai jenis kegiatan.Hasil dari penelitian ini menunjukkan bahwa, pengobatan batu ureter distal yang paling efektif biaya adalah dengan cara ESWL. Bahkan tindakan ESWL kelas super VIP masih lebih efektif biaya dibandingkan dengan tindakan URS dengan ruang perawatan kelas III.

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An Effectiveness Analysis of Distal Urethral Stones Treatment Compared with Ureterorenoskop and Extracorporeal Shock Wave Lithotripsy at RSUPN-CM Jakarta, 2001Before sophisticated-medical equipment was discovered, invasive surgery was used for Urinary Tract Stone treatments; especially urethral stone. Today, invasive surgery has been no longer implemented, and shifting into minimal or non invasive treatment.

RSUPN-CM Jakarta, has two different medical equipments to treat Urinary Tract Stone patient which are Ureterorenoscop for minimal invasive treatment and Extracorporeal Shock Wave Lithotripsy (ESWL) for non invasive treatment. The treatment using Ureterorenoscop is called Ureteroscopy (URS).

The aim of this research is to examine and compare the cost effectiveness of urethral distal stone treatment using both equipments. This research is descriptive, using secondary data from subbagian urologi RSUPN-CM in the period of June-December 2001. Meanwhile, data analysis for investment cost is considered in annual base.

The analysis of this study is using Activity Based Costing (ABC) method. This method is the most appropriate method for urethral distal stone treatment since subbagian urologi comprises a broad range of interrelated activities. ABC method, therefore, will evaluate the cost of effectiveness for both URS and ESWL.

The study shows that ESWL is the most effective cost compared to URS. Even, Super VIP using ESWL is more effective than class III URS."

"ABSTRAKLatar Belakang: Tatalaksana bukan pembedahan pada batu sulit duktus biliaris komunis, tidak dapat dilakukan dengan ERCP saja, namun memerlukan modalitas terapi lain seperti pemasangan sten bilier, litotripsi mekanik, Extracorporeal Shock Wave Lithotripsy. Pemasangan sten bilier, Extracorporeal Shock Wave Lithotripsy, memiliki tingkat efektivitas dalam mencapai bersihan total bervariasi 70-80%. Di Indonesia sendiri, belum ada data mengenai efektivitas ESWL sebagai terapi tambahan pasca pemasangan sten dibandingkan dengan pemasangan sten bilier saja sebagai tatalaksana ekstraksi batu sulit.Tujuan: Mengetahui efektivitas ESWL dalam mencapai bersihan total pasca pemasangan sten bilier dibandingkan dengan pemasangan sten bilier saja Metode: Penelitian ini menggunakan metode kohort retrospektif dengan menggunakan data sekunder dari registri Pusat Endoskopi Saluran Cerna Rumah Sakit Umum Pemerintah Cipto Mangunkusumo yang melibatkan 126 subjek batu sulit. Dilakukan analisis dengan membagi menjadi dua kelompok yaitu subjek yang dilakukan pemasangan sten bilier saja, dan subjek yang dilakukan ESWL pasca pemasangan sten bilier dengan keluaran akhir efektivitas berupa bersihan total menggunakan uji Chi Square. Hasil: Sampel berjumlah 126 subjek yang terdiri dari 72 subjek yang dilakukan ESWL pasca pemasangan sten bilier dan 54 subjek yang menjalani pemasangan sten bilier saja. Efektivitas ESWL pasca pemasangan sten bilier dalam mencapai bersihan total yaitu 69,1% dan efektivitas sten bilier dalam mencapai bersihan total yaitu 64,8%. ESWL sebagai terapi tambahan pasca pemasangan sten bilier tidak memberikan perbedaan bermakna secara statistik dengan nilai p 0,703 dengan resiko relatif (RR= 1,050; IK95% 0,816-1,351). Terdapat 26 subjek yang tidak menyelesaikan pengobatan. Simpulan: Subjek dengan batu sulit duktus biliaris yang dilakukan ESWL sebagai terapi tambahan pasca pemasangan sten bilier memiliki efek terapi yang sama dengan subjek yang dilakukan pemasangan sten bilier saja dalam mencapai bersihan total.

Background: Management non-surgical therapy of difficult stones, cannot be removed by ERCP only. There are modalities procedure like biliary stenting, mechanical

lithotripsy, and Extracorporeal Shock Wave Lithotripsy (ESWL) are important in the therapy of difficult stones of the common bile duct. Efficacy of ESWL for achieve ductal clearence aprroxymately 70-80%. However, in Indonesia, there is no data about the theraupetic effect of ESWL for ductal clearance of difficult bile duct stones after biliary stenting compared to insertion of the biliary stent alone. Objective: To determine theraupetic effect of ESWL after biliary stenting compared to biliary stent placement alone Methods: This study is a retrospective cohort study using secondary data from the Gastrointestinal Endoscopy Center registry of the Cipto Mangunkusumo Government General Hospital which involved 126 subjects with difficult stones. The analysis was

done by dividing the subjects into two groups, those who were subjected to biliary stent placement only, and subjects that had ESWL procedure after biliary stent were inserted. The final outcome is total ductal clearance using the Chi Square analysis. Results: The sample consisted of 126 subjects. Seventy-two subjects were subjected to ESWL after insertion of biliary stents and 54 subjects were subjected to biliary stent placement only. The effectiveness of ESWL procedure after biliary stents insertion in achieving total clearance was 69.1% and the effectiveness of biliary stents alone in achieving total clearance was 64.8%. ESWL as an adjunctive therapy after biliary stent placement did not provide statistically significant difference with a p value of 0.703 with a relative risk (RR = 1.050; 95% C0.816-1.351). There were 26 subjects who did not complete treatment.

Conclusion: The therapeutic effects of ESWL after biliary stenting did not result in statistical differences of succesfull total ductal clearance for difficult bile duct stones."