Condition

Urolithiasis

Clinical trials and treatment information for Urolithiasis

4M
People Affected
50
Active Trials
322K
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• 52% Safety• 81 trials• 75K participants
HIGH EvidenceGood Value
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Comparative Safety Scale(Higher is safer)

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52
DangerousModerateSafe

Time to Effect

Immediate stone removal, recovery weeks

Duration

Single procedure, hospital stay 1-3 days

Response Rate

95%

Remission Rate

95%

Common Side Effects:

Hemorrhage requiring transfusion: 5%
Infection/Sepsis: 8%
Fever: 15%
Organ injury (e.g., colon, pleura): 1%
Prolonged pain: 10%

Annual Cost of Care

Drug Cost

$0

Monitoring

$1,500

Side Effects

$1,000

Total Annual

$17,500

Cost-Effectiveness

GOOD

QALYs Gained

1.5

Cost per Remission

$18,421

Cost per Responder

$18,421

Treatment Outcomes
Primary Outcomes
Residual Stone Volume2500 mm^3
-90% (-2250 mm^3)
Numeric Rating Scale (NRS) Pain Score7/10
-85.7% (-6 points)
Renal Pelvic Diameter2.8 cm
-71.4% (-2.0 cm)
Estimated Glomerular Filtration Rate (eGFR)58 mL/min/1.73m^2
+17.2% (+10 mL/min/1.73m^2)
Secondary Benefits
SF-36 Physical Component Summary (PCS) Score38 points
+26.3% (+10 points)
Annual Number of Symptomatic UTI Episodes2.5 episodes/year
-80% (-2.0 episodes/year)
Daily Oral Morphine Equivalent (OME)25 mg OME/day
-90% (-22.5 mg OME/day)
Common Side Effects
Hemorrhage requiring transfusion
+5%
Infection/Sepsis
+8%
Fever
+15%

Clinical Trial Phases:

Phase 4
2
Ureteroscopy (URS)
90% Effectiveness• 92% Confidence• 58% Safety• 24 trials• 90K participants
HIGH EvidenceGood Value
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58
DangerousModerateSafe

Time to Effect

Immediate stone removal, recovery days-weeks

Duration

Single procedure, stent 3-14 days

Response Rate

90%

Remission Rate

90%

Common Side Effects:

Stent discomfort/pain: 60%
Hematuria: 40%
Urinary tract infection: 8%
Ureteral injury: 2%
Fever: 5%

Annual Cost of Care

Drug Cost

$0

Monitoring

$800

Side Effects

$300

Total Annual

$8,600

Cost-Effectiveness

GOOD

QALYs Gained

1.2

Cost per Remission

$9,555

Cost per Responder

$9,555

Treatment Outcomes
Primary Outcomes
Stone-free status (post-procedure)0% Stone-free (all patients presenting with stones)
+85% (+85 percentage points)
Renal Colic Pain IntensityVAS score: 7/10
-85.7% (-6 points on VAS (0-10 scale))
Hydronephrosis Resolution0% Resolution (all patients presenting with hydronephrosis)
+75% (+75 percentage points)
Secondary Benefits
Health-Related Quality of Life ScoreQoL score: 45/100 (lower score indicating poorer QoL)
+22.2% (+10 points on QoL scale (0-100, higher is better))
Lower Urinary Tract Symptom (LUTS) SeverityIPSS score: 18/35 (moderate-severe symptoms)
-44.4% (-8 points on IPSS (0-35 scale, lower is better))
Emergency Room Visits for Urolithiasis0.5 visits per patient per year (pre-treatment average)
-80% (-0.4 visits per patient per year)
Common Side Effects
Stent discomfort/pain
+60%
Hematuria
+40%
Urinary tract infection
+8%

Clinical Trial Phases:

Phase 4
3
Extracorporeal Shockwave Lithotripsy (ESWL)
80% Effectiveness• 88% Confidence• 60% Safety• 48 trials• 100K participants
HIGH EvidenceExcellent Value
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60
DangerousModerateSafe

Time to Effect

Immediate stone fragmentation, passage over days-weeks

Duration

Single session, potentially repeated

Response Rate

80%

Remission Rate

80%

Common Side Effects:

Renal colic: 20%
Hematuria: 50%
Skin bruising at treatment site: 30%
Nausea/Vomiting: 10%
Steinstrasse (stone street): 3%

Annual Cost of Care

Drug Cost

$0

Monitoring

$700

Side Effects

$200

Total Annual

$5,400

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.8

Cost per Remission

$6,750

Cost per Responder

$6,750

Treatment Outcomes
Primary Outcomes
Stone Volume500 mm³
-80% (-400 mm³)
Hydronephrosis Grade (based on ultrasound/CT)Grade 2/4
-50% (-1 grade (e.g., from Grade 2 to Grade 1))
Renal Colic Pain Score (VAS)8/10 on VAS
-75% (-6 points on VAS)
Stone-free Rate (at 3 months post-procedure)0% (all patients have stones pre-treatment)
+75% (+75% (achieved stone-free rate))
Secondary Benefits
Urolithiasis-Specific Quality of Life Score50/100 (indicating moderate impact on QoL)
+60% (+30 points)
Duration of Impairment from Stone Episode21 days (if managed conservatively or before effective treatment)
-66.7% (-14 days)
Emergency Department Visits for Renal Colic (per 3 months)2 visits/3 months
-90% (-1.8 visits/3 months)
Common Side Effects
Renal colic
+20%
Hematuria
+50%
Skin bruising at treatment site
+30%

Clinical Trial Phases:

Phase 4
4
Tamsulosin (Medical Expulsive Therapy)
75% Effectiveness• 95% Confidence• 65% Safety• 5 trials• 45K participants
HIGH EvidenceExcellent ValueDose: 0.4mg daily
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65
DangerousModerateSafe

Time to Effect

Days for symptom relief, 2-4 weeks for stone passage

Duration

2-4 weeks

Response Rate

70%

Remission Rate

70%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

15

Common Side Effects:

Retrograde ejaculation: 8%
Orthostatic hypotension: 4%
Dizziness: 3%
Headache: 2%

Annual Cost of Care

Drug Cost

$50

Monitoring

$300

Side Effects

$0

Total Annual

$350

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.3

Cost per Remission

$500

Cost per Responder

$500

Treatment Outcomes
Primary Outcomes
Stone Expulsion Rate (distal ureteral stones < 10mm)50% (spontaneous/placebo rate)
+40% (+20 percentage points)
Mean Time to Stone Expulsion12 days
-41.7% (-5 days)
Visual Analog Scale (VAS) Pain Score7/10 on VAS (acute renal colic)
-42.8% (-3 points on VAS)
Need for Invasive Ureteroscopic Intervention30% of patients
-50% (-15 percentage points)
Secondary Benefits
Resolution of Hydronephrosis70% presence at baseline
+21.4% (+15 percentage points)
Daily Analgesic Doses3 doses/day
-33.3% (-1 dose/day)
Emergency Department Visits for Stone-Related Symptoms15% of patients
-66.7% (-10 percentage points)
Common Side Effects
Retrograde ejaculation
+8%
Orthostatic hypotension
+4%
Dizziness
+3%

Clinical Trial Phases:

Phase 4
5
Potassium Citrate (Prevention)
70% Effectiveness• 90% Confidence• 68% Safety• 3 trials• 8K participants
HIGH EvidenceExcellent ValueDose: 20-60 mEq daily in divided doses
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68
DangerousModerateSafe

Time to Effect

Weeks to months for optimal urinary parameters, long-term for prevention

Duration

Lifetime

Response Rate

60%

Remission Rate

%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

100

Common Side Effects:

Gastrointestinal upset (nausea, diarrhea): 15%
Hyperkalemia (with renal impairment): 1%
Stomach discomfort: 10%

Annual Cost of Care

Drug Cost

$350

Monitoring

$300

Side Effects

$50

Total Annual

$700

Cost-Effectiveness

EXCELLENT

QALYs Gained

1.5

ICER

$-25,000/QALY

Cost per Responder

$1,167

Treatment Outcomes
Primary Outcomes
24-hour Urinary Citrate Excretion250 mg/24 hours
+150% (+375 mg/24 hours)
24-hour Urinary pH5.7
+14% (+0.8 units)
Number of New Stone Events per Year0.7 events/year
-80% (-0.56 events/year)
Stone Growth Rate (for existing stones)0.5 mm/year
-50% (-0.25 mm/year)
Secondary Benefits
Urinary Calcium Oxalate Supersaturation Index3.5
-30% (-1.0 units)
Kidney Stone Quality of Life (KSQOL) Score60/100
+15% (+9 points)
Emergency Department Visits for Stone-Related Pain per Year0.5 visits/year
-70% (-0.35 visits/year)
Common Side Effects
Gastrointestinal upset (nausea, diarrhea)
+15%
Hyperkalemia (with renal impairment)
+1%
Stomach discomfort
+10%

Clinical Trial Phases:

Phase 4
6
Thiazide Diuretics (e.g., Hydrochlorothiazide for Prevention)
70% Effectiveness• 92% Confidence• 68% Safety• 60 trials• 10K participants
HIGH EvidenceExcellent ValueDose: 12.5-50mg daily
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68
DangerousModerateSafe

Time to Effect

Weeks to months for optimal urinary parameters, long-term for prevention

Duration

Lifetime

Response Rate

60%

Remission Rate

%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

8

Common Side Effects:

Hypokalemia: 25%
Hyperuricemia: 15%
Hyperglycemia: 10%
Dizziness/Orthostatic hypotension: 8%
Fatigue: 5%

Annual Cost of Care

Drug Cost

$30

Monitoring

$300

Side Effects

$70

Total Annual

$400

Cost-Effectiveness

EXCELLENT

QALYs Gained

1.5

ICER

$-30,000/QALY

Cost per Responder

$667

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+70%
Response Rate
+60%
Common Side Effects
Hypokalemia
+25%
Hyperuricemia
+15%
Hyperglycemia
+10%

Clinical Trial Phases:

Phase 4