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Golomb D. et al., 2023: A retrospective cohort study, analyzing trends in management of upper urinary tract stones in the adult Israeli population.

Golomb D, Cooper A, Raz O.
Department of Urology, Assuta Ashdod University Hospital, Ashdod, Israel.
Clalit Health Services, Central District, Israel.

Abstract

Objective: To assess trends of surgical intervention in adults with upper urinary tract stones in Israel.

Methods: A retrospective cohort study utilizing administrative databases held at Clalit Health Services, to identify all adults (⩾18 years) who underwent their first surgical treatment for upper tract urolithiasis. Descriptive statistics were employed to summarize baseline patient demographics and surgical trends were analyzed using the Cochrane-Armitage test for trend.

Results: Between 2003 and 2020, 36,624 adult patients were treated surgically for upper tract urinary stones. Mean age was 53.6 years (SD16.1). During the period investigated, the number of insured by Clalit Health Services increased by 25% and the total number of surgically treated stones increased by 98.7%. By type of procedure: Ureteroscopy (URS) increased by 351%, percutaneous nephrolithotripsy (PCNL) increased by 67%, shockwave lithotripsy (SWL) declined by 79%. The number of procedures per 100,000 population grew from to 37.5 in 2003 to 58.05 in 2022. The percentage increase in total number of surgical procedures was 103% and 90% in males and females, respectively.

Conclusions: Our findings reveal significant increases in the total number of surgically treated stones over the investigated period. Notably, this increase far outpaced the growth in the number of individuals insured by Clalit Health Services. Further research and interventions are warranted to explore the underlying factors driving these trends and to develop targeted approaches for prevention, early detection, and minimally invasive treatment of upper urinary tract stones in Israel.

Urologia. 2023 Sep 30:3915603231203430. doi: 10.1177/03915603231203430. Online ahead of print. PMID: 37776156

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Comments 1

Hans-Göran Tiselius on Tuesday, 14 May 2024 11:00

This report summarizes the trends in stone removal in Israel between 2003 and 2020.

One interesting observation was that the number of surgical procedures during this period increased by 98.7% and that a major part of this increase was explained by increased number of URS procedures (increment 351%). SWL declined from 746 to 146 procedures. It is difficult to understand why URS increased by 1900 while SWL decreased by 590? Overtreatment?

Although the prevalence of stone disease has increased during the studied period, the number of URS treatments is surprisingly high, and it should be noted that the number of patients with surgical intervention increased from 38 to 58 per 100 000.

It seems as if urologists’ enthusiasm for endoscopic surgery has played a role together with a real increase in stone incidence. Moreover, the switch from SWL to endoscopy is also strongly explained by how modern guidelines are formulated.

Hans-Göran Tiselius

This report summarizes the trends in stone removal in Israel between 2003 and 2020. One interesting observation was that the number of surgical procedures during this period increased by 98.7% and that a major part of this increase was explained by increased number of URS procedures (increment 351%). SWL declined from 746 to 146 procedures. It is difficult to understand why URS increased by 1900 while SWL decreased by 590? Overtreatment? Although the prevalence of stone disease has increased during the studied period, the number of URS treatments is surprisingly high, and it should be noted that the number of patients with surgical intervention increased from 38 to 58 per 100 000. It seems as if urologists’ enthusiasm for endoscopic surgery has played a role together with a real increase in stone incidence. Moreover, the switch from SWL to endoscopy is also strongly explained by how modern guidelines are formulated. Hans-Göran Tiselius
Saturday, 13 July 2024