Evaluating and optimizing endourological care

This thesis evaluates current endourological care for patients with urolithiasis and upper tract urothelial carcinoma (UTUC) and contributes to its further optimisation, with particular attention to clinical effectiveness, patient-reported outcomes, costs, follow-up and variation in practice.
For acute obstructive urolithiasis, the STONE (Stent Or Nephrostomy) trial showed that percutaneous nephrostomy and double-J ureteral stenting are both effective methods of decompression. Although clinical recovery was comparable, the techniques differed in technical success, patient experience and costs. Patient satisfaction decreased and costs increased during the waiting period before definitive stone treatment, demonstrating the burden of temporary drainage and emphasizing the need for timely stone removal.
For stone removal, endoscopic combined intrarenal surgery was shown to be effective and safe in patients with complex renal stones. Stone cultures provided additional microbiological information beyond preoperative urine testing and were associated with postoperative systemic inflammatory response syndrome. A national study of bladder stone surgery demonstrated substantial variation in treatment and follow-up and supported endoscopic treatment for larger stones.
For UTUC, kidney-sparing surgery can provide oncological outcomes comparable to radical nephroureterectomy in selected patients while preserving renal function, but requires intensive surveillance. Current follow-up strategies vary considerably. An international Delphi consensus project identified agreement on several key components of follow-up.
Overall, further improvement of endourological care requires attention to patient-reported outcomes, cost-effectiveness and the reduction of unwarranted practice variation through national and international collaboration.