Chung KJ. et al., 2019: Changing Trends in the Treatment of Nephrolithiasis in the Real World
Chung KJ, Kim JH, Min GE, Park HK, Li S, Del Giudice F, Han DH, Chung BI.
Department of Urology, Stanford University Medical Center, Stanford, California.
Department of Urology, Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea. Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy. Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
INTRODUCTION: Changes in the surgical treatment of nephrolithiasis, owing to recent technical advances and innovations, have made treatments more effective and less invasive. In this retrospective, observational cohort study, we identified the changing trends in the treatment of nephrolithiasis. MATERIALS AND METHODS: We included patients with newly diagnosed nephrolithiasis who received any treatment in the United States, including extracorporeal shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and open surgery, from January 2007 to December 2014. Demographic factors, such as age, sex, region, surgical treatment type, and cost data, were analyzed. RESULTS: The median age of patients at treatment was 52 years, and the ratio of men and women was similar. There were definite changes in the trends of all treatment modalities (p < 0.01). Both the number and percentage tended to increase for RIRS, whereas for SWL, the number increased, but the percentage showed a steady decrease. In PCNL, both number and percentage increased to a minor degree. The overall cost of nephrolithiasis treatments during the study period nearly doubled (from $30,998,726 to $57,310,956). The number of treatments and average cost per treatment increased annually for each treatment modality. RIRS was the least expensive; the other procedures in decreasing order of their mean costs were as follows: SWL, PCNL, and open surgery. CONCLUSIONS: There was a gradual but constant change in treatment trends of nephrolithiasis, with an increasing trend for RIRS and a decreasing trend for SWL. Although PCNL has relatively invasive characteristics, it is still in steady demand.
J Endourol. 2019 Feb 13. doi: 10.1089/end.2018.0667. [Epub ahead of print]
8 Urologists from Korea, Italy and the USA contributed to this paper and the way they discuss the different procedures and circumstances suggest a little bit that they are not extremely familiar with the topic. These authors combed “the IBM® MarketScan® Research Databases. These databases contain retrospective claims information, including inpatient and outpatient enrollment demographics in the United States.” “Over the 8-year study period, a total of 1,329,311 patients were diagnosed with nephrolithiasis; however, only 67,792 patients (5.25%) received any type of treatment.”
Papers from the USA on health policy and systems research offer the unique advantage to get access to the data of very large number of patients. Most Non-US readers are unfamiliar with the sometimes selective, restricted, or even skewed view these databases offer. Application of the results and conclusions on the situation in other countries may be limited. See also: Kirshenbaum EJ, Doshi C, Dornbier R, Blackwell RH, Bajic P, Gupta GN, Gorbonos A, Turk TMT, Flanigan RC, Baldea KG. Socioeconomic Disparities in the Acute Management of Stone Disease in the United States. J Endourol. 2019 Feb;33(2):167-172. doi: 10.1089/end.2018.0760.