Jour I. et al., 2022: Urological stone disease: A Five-year update of stone management using hospital episode statistics.
Jour I, Lam A, Turney B.
Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
PGMC, Epsom and Saint Helier University Hospitals NHS Trust, St Helier Hospital, Carshalton, UK.
Nuffield Department of Surgical Sciences, Department of Urology, University of Oxford, Oxford, UK.
Objective: To reassess the trends in upper urinary tract (UUT) stone disease burden and management in the UK during the last 5 years.
Methods: The present paper is our third quinquennial analysis of trends in the management of renal stones in England. Data were collected using the Hospital Episode Statistics database for the years 2015-2020 inclusive. These were then analysed, summarized and presented.
Results: The number of UUT stone episodes increased by 2.2% from 86 742 in 2014-2015 to 88 632 in 2019-2020 but annual prevalence remained static at 0.14%. The number of UUT stone episodes in those of working age has remained static but increased by 9% for patients aged > 60 years (from 27 329 to 29 842). The number of shockwave lithotripsy (SWL) treatments decreased by 6.8%. There was a further increase in the use of ureteroscopy (URS) between 2015 and 2020 of 18.9%. Within this subgroup, flexible URS had the most rapid increase in use, with a rise of 20.4% from 7108 to 8558 recorded cases. Over the 20-year period from 2000 to 2020 there was a remarkable 257% increase in URS cases. There was a further decline in open surgery for UUT stone disease by 40%. Stone surgery day-case numbers have increased by 14.7% (from 31 014 to 35 566), with a corresponding decline in the number of bed days of 14.3%. Emergency cases increased by 40%, while elective cases saw a slight increase of 1.9%.
Conclusion: The present study shows a plateauing in the prevalence of UUT stone disease in England in the last 5 years, with a move towards day-case procedures and an increase in the proportion of emergency work. For the first time in England, URS has overtaken SWL as the most common procedure for treating UUT stone disease, which might reflect patients' or physicians' preference for a more effective definitive treatment.
BJU Int. 2022 Mar 20. doi: 10.1111/bju.15728. Online ahead of print. PMID: 35306719
In this epidemiological report the authors reviewed how different stone treatment regimens were applied and changed in UK during 2015 - 2020. Some of the most interesting observations are extracted and presented below:
Most interesting is it that between 2000 and 2020 there was a 257 % (!) increase in URS procedures. The reason for the latter shift is continuously under debate and not always possible to explain, particularly not when ureteral stones are considered. The authors mention patient’s and surgeon’s preference for one-stage procedures. But the pros and cons are seldom discussed, and it is obvious that in most cases is the patient’s preference identical to that of the surgeon. The final decision depends on how the procedure is described