Ahn JS et al, 2017: National Imaging Trends After Ureteroscopic or Shockwave Lithotripsy For Nephrolithiasis
Ahn JS, Holt S, May P, Harper JD.
Department of Urology, University of Washington, Seattle, Washington.
PURPOSE: The study of diagnostic imaging use after procedural intervention for nephrolithiasis is limited. We sought to characterize actual national imaging patterns and longitudinal trends after ureteroscopic or shockwave lithotripsy.
MATERIALS & METHODS: We analyzed the MarketScan™ database and identified a nationally representative sample of insured employed patients, ages 17-64, who underwent ureteroscopic or shockwave lithotripsy between 2007-2014 for nephrolithiasis. Patients were excluded if they lacked at least 1 year of postoperative database enrollment or had a repeat nephrolithiasis procedure of any type within 90 days after their initial procedure. We identified and tracked post-operative imaging modalities by medical billing codes.
RESULTS: We identified 101,554 ureteroscopy patients of whom 55% and 39% received no post-operative imaging within 3 and 12 months, respectively. Of 101,590 shockwave lithotripsy patients, 23% and 16% had no postoperative imaging within 3 and 12 months, respectively. Abdominal x-ray was the most common imaging modality after either procedure type. Ultrasound use increased over time while CT decreased. Roughly 25% of ureteroscopy and shockwave lithotripsy patients received at least one postoperative CT within a year. Female sex and older age were associated with higher rates of imaging. Ultrasound utilization was higher in the northeast region and more dense population areas.
CONCLUSIONS: A notable portion of ureteroscopy patients and smaller percentage of shockwave lithotripsy patients do not receive any follow-up imaging within 1 year. The majority who do receive imaging undergo abdominal x-ray, precluding the ability to screen for hydronephrosis or silent obstruction in nearly 75% of ureteroscopy patients.
J Urol. 2017 Sep 20. pii: S0022-5347(17)77565-9. doi: 10.1016/j.juro.2017.09.079. [Epub ahead of print]
America runs way behind with the use of sonographic imaging. It’s good to see that this imaging technique, which is urological routine since the 1980s in Germany, was the fastest growing imaging procedure during the years studied. It will continue to grow.