Condition

Kidney Stones

Hard deposits forming in the kidneys

100M
People Affected
50
Active Trials
106M
New Cases/Year
18K
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Percutaneous Nephrolithotomy (PCNL)
95% Effectiveness• 90% Confidence• 45% Safety• 79 trials• 45K participants
HIGH EvidenceGood Value
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Comparative Safety Scale(Higher is safer)

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Meth💀
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Morphine💊
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45
DangerousModerateSafe

Time to Effect

Immediate stone removal

Duration

Single procedure (hospitalization 2-4 days)

Response Rate

95%

Remission Rate

90%

Common Side Effects:

Pain: 50%
Bleeding requiring transfusion: 7%
Infection/Sepsis: 6%
Organ injury (bowel, pleura): 1%

Annual Cost of Care

Drug Cost

$0

Monitoring

$2,000

Side Effects

$1,500

Total Annual

$15,000

Cost-Effectiveness

GOOD

QALYs Gained

0.9

ICER

$85,000/QALY

Cost per Remission

$16,667

Cost per Responder

$15,789

Treatment Outcomes
Primary Outcomes
Total Stone Volume2500 mm³
-90% (-2250 mm³)
Renal Colic Pain Score (VAS 0-10)7/10
-80% (-5.6 points)
Renal Pelvic Anteroposterior (AP) Diameter25 mm
-60% (-15 mm)
Frequency of Symptomatic Urinary Tract Infections (per year)3.5 episodes/year
-85% (-2.98 episodes/year)
Secondary Benefits
Kidney Stone Quality of Life (KSQOL-18) Survey Score50/100
+25% (+12.5 points)
Hospitalizations for Stone-Related Complications (per year)1.2 admissions/year
-90% (-1.08 admissions/year)
Lost Workdays due to Kidney Stone Episodes (per year)15 days/year
-90% (-13.5 days/year)
Common Side Effects
Pain
+50%
Bleeding requiring transfusion
+7%
Infection/Sepsis
+6%

Clinical Trial Phases:

Phase 4
2
Ureteroscopy (URS)
90% Effectiveness• 90% Confidence• 55% Safety• 18 trials• 60K participants
HIGH EvidenceGood Value
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Comparative Safety Scale(Higher is safer)

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Morphine💊
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55
DangerousModerateSafe

Time to Effect

Immediate stone removal

Duration

Single procedure (stent for 1-2 weeks)

Response Rate

90%

Remission Rate

85%

Common Side Effects:

Post-operative pain: 40%
Hematuria: 30%
Ureteral stent symptoms: 60%
Ureteral injury/perforation: 3%
Infection: 3%

Annual Cost of Care

Drug Cost

$0

Monitoring

$1,500

Side Effects

$800

Total Annual

$7,000

Cost-Effectiveness

GOOD

QALYs Gained

0.6

ICER

$90,000/QALY

Cost per Remission

$8,235

Cost per Responder

$7,778

Treatment Outcomes
Primary Outcomes
Stone Burden VolumeAverage 350 mm^3
-90% (-315 mm^3)
Renal Colic Pain Score (NRS)NRS score: 8/10 (severe pain)
-87.5% (-7 points)
Renal Obstruction Severity Score (SFU Grade)SFU Grade: 3/4 (moderate to severe obstruction)
-66.7% (-2 grades)
Secondary Benefits
Quality of Life (AUA-QOL Score)AUA-QOL score: 4/6 (poor quality of life related to urinary symptoms)
-50% (-2 points)
Hospital Length of Stay3 days
-66.7% (-2 days)
Incidence of Recurrent Renal Colic EpisodesAverage 0.5 episodes/month
-90% (-0.45 episodes/month)
Common Side Effects
Post-operative pain
+40%
Hematuria
+30%
Ureteral stent symptoms
+60%

Clinical Trial Phases:

Phase 4
3
Potassium Citrate
85% Effectiveness• 85% Confidence• 75% Safety• 23 trials• 8K participants
HIGH EvidenceExcellent ValueDose: 10-20 mEq 2-3 times daily (adjust to urine pH)
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Comparative Safety Scale(Higher is safer)

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75
DangerousModerateSafe

Time to Effect

Weeks to months for dissolution/prevention

Duration

Long-term/Lifetime

Response Rate

85%

Remission Rate

70%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

25

Common Side Effects:

GI upset (nausea, diarrhea, abdominal pain): 15%
Hyperkalemia: 1%

Annual Cost of Care

Drug Cost

$300

Monitoring

$200

Side Effects

$50

Total Annual

$550

Cost-Effectiveness

EXCELLENT

QALYs Gained

1

ICER

$30,000/QALY

Cost per Remission

$786

Cost per Responder

$647

Treatment Outcomes
Primary Outcomes
Urinary Citrate Excretion250 mg/day
+120% (+300 mg/day)
Urinary pH5.5
+18.2% (+1.0 pH unit)
Stone Recurrence Rate (Annualized)15% annual recurrence rate
-50% (-7.5 percentage points)
Urinary Supersaturation of Calcium Oxalate3.0 (dimensionless)
-25% (-0.75)
Secondary Benefits
Stone-related Hospitalizations20% patients hospitalized annually
-40% (-8 percentage points)
Urinary Uric Acid Excretion700 mg/day
-10% (-70 mg/day)
Quality of Life (Kidney Stone Questionnaire)50 (0-100 scale, higher is better)
+15% (+7.5 points)
Common Side Effects
GI upset (nausea, diarrhea, abdominal pain)
+15%
Hyperkalemia
+1%

Clinical Trial Phases:

Phase 4
4
Tamsulosin
75% Effectiveness• 85% Confidence• 70% Safety• 23 trials• 25K participants
HIGH EvidenceExcellent ValueDose: 0.4mg daily
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Comparative Safety Scale(Higher is safer)

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Meth💀
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70
DangerousModerateSafe

Time to Effect

1-2 days (expulsion within 2-4 weeks)

Duration

2-4 weeks

Response Rate

75%

Remission Rate

75%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

15

Common Side Effects:

Dizziness/Orthostatic Hypotension: 15%
Ejaculatory dysfunction: 10%
Headache: 7%

Annual Cost of Care

Drug Cost

$100

Monitoring

$300

Side Effects

$50

Total Annual

$450

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.15

Cost per Remission

$600

Cost per Responder

$600

Treatment Outcomes
Primary Outcomes
Stone Expulsion Rate (5-10mm distal ureteral stones)55% (spontaneous passage rate without Tamsulosin)
+36.4% (+20 percentage points (from 55% to 75%))
Stone Expulsion Time15 days
-33.3% (-5 days (reduction from 15 to 10 days))
Need for Urological Intervention (e.g., ESWL, Ureteroscopy)45% (patients requiring intervention after initial observation)
-44.4% (-20 percentage points (from 45% to 25%))
Analgesic Consumption3.5 doses/day (mean number of analgesic doses)
-37.1% (-1.3 doses/day (reduction to 2.2 doses/day))
Secondary Benefits
Mean Pain Score7/10 (Visual Analog Scale during renal colic)
-42.8% (-3 points (reduction from 7 to 4 on VAS))
Health-Related Quality of Life Score50/100 (hypothetical QoL scale, higher is better)
+16% (+8 points (improvement from 50 to 58))
Rate of Hospitalization/Emergency Room Visits20% (patients requiring hospitalization or ER visit due to renal colic)
-60% (-12 percentage points (reduction from 20% to 8%))
Common Side Effects
Dizziness/Orthostatic Hypotension
+15%
Ejaculatory dysfunction
+10%
Headache
+7%

Clinical Trial Phases:

Phase 4
5
Hydrochlorothiazide (HCTZ)
75% Effectiveness• 85% Confidence• 65% Safety• 7 trials• 7K participants
HIGH EvidenceExcellent ValueDose: 12.5-50mg daily
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Comparative Safety Scale(Higher is safer)

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65
DangerousModerateSafe

Time to Effect

Weeks to months

Duration

Long-term/Lifetime

Response Rate

75%

Remission Rate

60%

Number Needed to Treat (NNT)

5

Number Needed to Harm (NNH)

20

Common Side Effects:

Hypokalemia (low potassium): 15%
Hypotension/Dizziness: 7%
Hyperglycemia, Hyperuricemia: 7%

Annual Cost of Care

Drug Cost

$50

Monitoring

$200

Side Effects

$100

Total Annual

$350

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.9

ICER

$25,000/QALY

Cost per Remission

$583

Cost per Responder

$467

Treatment Outcomes
Primary Outcomes
24-hour Urinary Calcium Excretion320 mg/24h
-30% (-96 mg/24h)
Kidney Stone Recurrence Rate0.8 events/patient-year
-60% (-0.48 events/patient-year)
Urinary Saturation of Calcium Oxalate (RSS)3.0
-35% (-1.05)
Secondary Benefits
Episodes of Renal Colic2.5 episodes/year
-50% (-1.25 episodes/year)
Stone-related Hospitalizations0.7 admissions/year
-40% (-0.28 admissions/year)
Kidney Stone Disease-Specific Quality of Life Score (KSD-QOL, 0-100 where higher is better)65/100 points
+10% (+6.5 points)
Common Side Effects
Hypokalemia (low potassium)
+15%
Hypotension/Dizziness
+7%
Hyperglycemia, Hyperuricemia
+7%

Clinical Trial Phases:

Phase 4
6
Extracorporeal Shock Wave Lithotripsy (ESWL)
70% Effectiveness• 80% Confidence• 60% Safety• 43 trials• 30K participants
MODERATE EvidenceGood Value
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Comparative Safety Scale(Higher is safer)

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60
DangerousModerateSafe

Time to Effect

Immediate stone fragmentation, clearance can take weeks

Duration

Single session

Response Rate

70%

Remission Rate

55%

Common Side Effects:

Pain/Discomfort: 30%
Hematuria (blood in urine): 25%
Stone fragments requiring repeat procedure/intervention: 20%
Skin bruising: 15%

Annual Cost of Care

Drug Cost

$0

Monitoring

$1,000

Side Effects

$500

Total Annual

$5,000

Cost-Effectiveness

GOOD

QALYs Gained

0.4

ICER

$70,000/QALY

Cost per Remission

$9,091

Cost per Responder

$7,143

Treatment Outcomes
Primary Outcomes
Largest Stone Dimension10 mm
-70% (-7 mm)
VAS Pain Score (0-10 scale)7 points
-71.4% (-5 points)
Hospitalization Days for Renal Colic3 days/year
-80% (-2.4 days/year)
Episodes of Stone-related UTI2 episodes/year
-75% (-1.5 episodes/year)
Secondary Benefits
SF-36 Physical Component Summary Score40 points
+12.5% (+5 points)
Days Lost from Work/Activities due to Stones14 days/year
-80% (-11.2 days/year)
Daily Oral Analgesic Dose (Morphine Equivalents)30 mg/day
-60% (-18 mg/day)
Common Side Effects
Pain/Discomfort
+30%
Hematuria (blood in urine)
+25%
Stone fragments requiring repeat procedure/intervention
+20%

Clinical Trial Phases:

Phase 4