Acland G et al, 2015: Contemporary trends in urinary tract stone surgery, a regional perspective: Auckland, New Zealand.
Acland G, Zargar-Shoshtari K, Rice M.
Department of Urology, Auckland City Hospital, Auckland, New Zealand.
BACKGROUND: The aim of the study is to assess the contemporary patterns of utilization of various therapeutic options for the management of nephrolithiasis in our tertiary referral institution in Auckland, New Zealand.
METHODS: A retrospective audit was conducted for all urinary stone procedures between January 2007 and December 2013. Procedure-related information was collected for each year. All elective and emergency procedures were included. Data were collected on the elective waiting lists for each procedure.
RESULTS: A total of 5512 stone-related cases were performed during the study period. Six hundred and fifty-three cases were performed in 2007 compared with 945 in 2013. Total number of percutaneous nephrolithotomy (PCNLs) performed, as well as the proportion of PCNL cases, demonstrated a significant decline from 84 (12.9%) in 2007 to 67 (7.1%) in 2013. While the annual numbers of extracorporeal shock wave lithotripsy (ESWLs) have increased, the percentage of ESWLs performed relative to total stone procedures has declined from 33% to 23% over the last 4 years of this audit. There has been a significant rise in the numbers of rigid and flexible ureteroscopies, with these now being the most utilized procedure. The number of patients awaiting elective procedures declined over the duration of this audit, with an associated improvement in meeting annual demand for treatment of nephrolithiasis from 78% in 2007 to 91% in 2013.
CONCLUSIONS: A proportional decline in PCNL and ESWL utilization with a significant increase in flexible and rigid ureteroscopic procedures has been observed over this time and this pattern has been associated with improved adherence to surgical targets despite an increasing number of cases.
ANZ J Surg. 2015 Jul 3. doi: 10.1111/ans.13205. [Epub ahead of print]
An interesting paper. It shows similar population based trends in the use of stone therapy modalities like in Canada (Ordon M et al The surgical management of kidney stone disease: a population based time series analysis. J Urol. 2014 Nov;192(5):1450-6.)
In 2013 the most frequent (43%) of all procedures for stone treatment was eENDO (Emergency endoscopy). It “includes URS and stone clearance, incomplete URS, as well as cystoscopy and stent insertion.” “…emergency URS was undertaken with the aim of complete stone clearance for all patients who had failed medical management of acute ureteric colic during their initial presentation.” The authors have separately published their series of emergency URS (eURS)(Zargar-Shoshtari K et al. Role of emergency ureteroscopy in the management of ureteric stones: analysis of 394 cases. BJU Int. 115 (2015) (6):946-50.). Between January 2010 and December 2011 394 patients had an emergency URS under general or spinal anesthesia with an immediate success in 285 (72 %).
In the failed group 91 % got a temporary double-J-stent. No follow-up seemed to be available in the failed group in ~25 %. Of those 81 patients treated further 40 had a successful ESWL and 41 an elective URS.
eURS competes with eESWL which the authors have not applied in their series. In the most recent publication on eESWL by Panah A et al. (Panah et al. Factors predicting success of emergency extracorporeal shockwave lithotripsy (eESWL) in ureteric calculi - a single centre experience from the United Kingdom (UK). Urolithiasis. 2013 Oct;41(5):437-41) eESWL was successful with a mean of 1,64 sessions in 73 % of 97 cases. ESWL failed in 26 (27 %) patients with 1,88 ESWL session and they underwent ureteroscopy
The New Zealand and UK series are not comparable but eESWL seems to be compatible. Quality of life and cost would be important factors to control in future studies.