Dor Golomb et al., 2024: The gender gap in stone-related surgery: A comprehensive analysis from an Israeli perspective
Dor Golomb, Amir Cooper, Orit Raz
Department of Urology, Assuta Ashdod University Hospital, Ashdod, Israel.
Central District, Clalit Health Services, Tel-Aviv, Israel.
Abstract
Objective: To investigate the gender gap in the context of stone-related surgery within an Israeli population.
Methods: We conducted a retrospective cohort study using administrative databases from Clalit Health Services to identify adults aged 18 and above who had their initial surgical treatment for upper tract urolithiasis. We employed descriptive statistics to outline the baseline patient characteristics, and the Cochran-Armitage test for trend was utilized to analyze surgical trends.
Results: Between 2003 and 2020, a total of 36,624 adult patients underwent surgical treatment for upper tract urinary stones. The mean age of patients was 55.01 years (standard deviation (SD) 16.6) for ureteroscopy (URS), 55.05 years (SD 15.1) for percutaneous nephrolithotripsy (PCNL), and 51.07 years (SD 15.1) for shockwave lithotripsy (SWL). When considering the distribution of procedures by gender, males accounted for 69.5% of URS cases, 58.3% of PCNL cases, and 70.6% of SWL cases, whereas females represented 30.5%, 41.7%, and 29.4% of URS, PCNL, and SWL cases, respectively. Across all surgical modalities, the male-to-female ratio exhibited fluctuations without a consistent trend, with both increases and decreases observed. In URS, the ratio saw a modest increase from 1.967 in 2003 to 2.173 in 2020. For PCNL, the ratio initially increased from 2.361 in 2003 to 2.549 in 2014, followed by subsequent fluctuations, but an overarching trend was not apparent. In contrast, for SWL, the ratio decreased from 2.15 in 2003 to 1.32 in 2020, with varying changes in between.
Conclusion: This study highlights the dynamic nature of gender gap in stone-related surgery outcomes. While the male-to-female ratio exhibited fluctuations over a 17-year period, no consistent trend emerged. The absence of a clear trend underscores the complex and multifaceted factors influencing the gender gap in urolithiasis.
Urologia. 2024 Apr 18:3915603241248013. doi: 10.1177/03915603241248013. Online ahead of print.
Comments 1
The article does not keep the promise that the title seems to make. It is based on the number of procedures and I expected to learn why women would get a different surgical treatment than men. However, the discussion centres on the disadvantage that the source used does not allow to determine the actual difference between the stone incidence rates of women and men
What Christian Chaussy probably does not like to read is that the number of ESWL procedures fell below that of PNL:
“PCNL procedures increased … going from 111 to 181 cases per year. SWL exhibited a declining trend … steadily dropping from 746 to 156 cases per year.”
Peter Alken