Golomb D. et al., 2025: A comparative analysis of surgical trends in upper urinary tract stone management in Ontario, Canada, and Israel.
Dor Golomb 1 2, Orit Raz 1, Amir Cooper 1, J Andrew McClure 3, Blayne Welk 4, Sumit Dave 4, Fernanda Gabrigna Berto 4, Jennifer Bjazevic 4, Hassan Razvi 4
1Department of Urology, Assuta Ashdod University Hospital, Ashdod, Israel.
2Clalit Health Services, Central District, Israel.
3Department of Surgery, London Health Sciences Centre, London, ON, Canada.
4Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Abstract
Objective: To compare trends and incidence of surgical intervention among adults with urolithiasis in Ontario, Canada, and Israel.
Patients and methods: A retrospective analysis was conducted using administrative databases from Clalit Health Service in Israel and IC/ES in Canada. The study included adults who underwent their initial surgical treatment for urolithiasis. Descriptive statistics summarized baseline patient demographics, while comparisons were analyzed with a t-test.
Results: Between 2003 and 2018, 31,034 and 105,013 patients who underwent surgical intervention for upper urinary tract stones for the first time in their clinical history, excluding those with prior surgical treatments for the same condition, in Israel and Ontario, respectively. The number of insured at Clalit Health Services increased by 21.3%, while the population in Ontario grew by 18.5%. The total number of treated cases rose by 82% and 64.4% in Israel and Ontario, respectively. The procedures per 100,000 people increased by 51% in Israel and 34.6% in Ontario. In Israel, the proportion of females undergoing surgery decreased from 33.5% to 32%, while in Ontario, it increased from 36.3% to 49.8%. Ureteroscopy (URS) was more commonly used in Ontario, while shock wave lithotripsy (SWL) was more common in Israel. URS utilization surged by 281% in Israel and 145.5% in Ontario. Percutaneous nephrolithotripsy (PCNL) increased by 52% in Israel and 8.6% in Ontario, while SWL procedures declined by 57% in Israel and 32.5% in Ontario.
Conclusions: A significant rise in the number of patients undergoing their first stone-related procedure in both regions, particularly in Israel. There was a difference in the proportion of female patients requiring surgical intervention, with an increase in Ontario and a decrease in Israel.
Urologia. 2025 Mar 12:3915603251325096. doi: 10.1177/03915603251325096. Online ahead of print. PMID: 40071870
Comments 1
This epidemiological report is a summary of surgical treatment of stones based on observations in Ontario and Israel. For the interested reader many details can be found in the report.
The essential message is summarized in the Table below (period 2003-2018):
It is of note the number of SWL treatments was decreased by 32.5% in Ontario and by 57% in Israel. Moreover, URS increased by 281% in Israel and 146% in Ontario.
It was emphasized that the increase in total number of procedures in the two regions cannot be explained by increased size of populations, or by increased incidence of stone disease. The increased use of URS needs further analysis and so does the decreased application of SWL. Although different explanations are suggested one possibility is that URS is used more than necessary because of technical advances. But the latter assumption is not clearly stated in the report.
Hans-Göran Tiselius