New-age surgery still out of reach of common man

NEW DELHI, JUNE 1. Surgical removal of kidney stones might have come of age with the advent of ultra-modern advances in medical science, but the benefits still elude the common man who is unable to pay the exhorbitant price tag it comes with.

The Per Cutaneous Nephro Lithotomy (PCNL) is the latest in the `minimally invasive' kidney stone removal surgery techniques, which has cut down drastically the trauma of patients who shy away from open surgery, but for the average middle-class patients without proper health insurance, it's an expensive option.

In a country like India, where doctors say, males have eight to ten per cent chance and females four per cent chance of developing kidney stones, the PCNL is the best treatment available. It uses a key-hole technique for removing mainly large-sized stones from the kidney.

``A telescope is inserted into the kidney via a tiny hole 8-10 mm in diameter and the stone is seen on a TV as well as on a X-ray monitor,'' says Dr S K Pal, a senior Urologist at a private hospital here.

``This surgery has come up in the last two decades in a big way, although very few urologists have the expertise in it, it minimises the recovery time of a patient to a great extent,'' he says.

While the surgery has its advantages, it costs between Rs 25,000 - 55,000 at a private nursing home, a `small price' to pay, doctors claim, for immediate relief.

``The pain that kidney stones generate is only second to that of labour pain, it's that intense,'' says Dr Arthur Pinto of the Holy Family Hospital.

However doctors don't agree that the surgery is `expensive'.

``Even if you consider the economic aspect, the price is not too much, compared to the global standards,'' says Dr N Subramanyam, a Urosurgeon at the Apollo Hospital. ``In comparison to the Western countries, Indian health care cost is cheaper,'' he says.

The problem with the Indian health care system is that there are no adequate health insurance policies, he says.

As far as this surgery is concerned, doctors claim that its benefits totally out-shadow the cost as the patient's stay time at hospital is cut down from over two weeks to just a single day or two.

``The patient returns to normal life within a week. When you compare it to mainstream open surgery, it is more cost-effective since the latter also involves several days of bed rest at the hospital and a month of work-day loss. PCNL ensures instant mobility,'' he says.

Apart from the cost incurred due to post operative care, the patient ends up paying more in open surgery, doctors say due to the fact that duration of hospitlization is longer in the latter case, which also escalates the costs.

PCNL is successfully performed at some of the government hospitals also and the operative costs are less as compared to the private hospitals.

``We provide the latest Extra corporeal shock wave lithotripsy (ESWL), PCNL, Uretroscopy, at our hospital, and PCNL is especially done free of cost for all patients,'' says Dr N P Gupta, Head of Department, Urology, All India Institute of Medical Sciences.

AIIMS, which treats almost 100 cases of kidney stones every year, charges Rs 7000 only for the ESWL method.

While the doctors from private hospitals allege that most often the government hospitals do not have the highly sophisticated equipment required for the operation, Gupta brushes off such suggestions with ``most big hospitals have all the necessary equipment, and a surgery of this kind is always cost effective from a government hopsital.'' - PTI