Park J et al, 2016: National Practice Pattern and Time Trends in Treatment of Upper Urinary Tract Calculi in Korea: a Nationwide Population-Based Study.
Park J, Suh B, Lee MS, Woo SH, Shin DW.
Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea. .
Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Microbiology and Immunology, Eulji University School of Medicine, Daejeon, Korea.
Abstract
Despite high prevalence of upper urinary tract calculi (UUTC), there are few studies regarding patterns of care in Asian populations. We investigated treatment patterns and time trends in patients with newly diagnosed UUTC in Korea using the National Health Insurance database that includes de-identified claims from a random 2% sample of the entire population (> 1 million people). A total of 14,282 patients who received active treatments, including shock wave lithotripsy (SWL), ureteroscopic surgery (URS), percutaneous nephrolithotomy (PNL), and uretero/pyelolithotomy (UPL), for newly diagnosed UUTC between 2003 and 2013 were included. The number of primary and all treated cases of UUTC significantly (43% and 103.3%, respectively) increased over the 10-year period. While patients undergoing SWL, URS, PNL, and UPL as primary treatment increased by 43.7%, 31.9%, 87.5%, and 0%, respectively, the relative proportion undergoing each treatment remained constant over the 10 years (SWL > 90%, URS 4.5% to 7.8%, PNL 0.4% to 1.0%, and UPL < 0.4%, respectively). Multinomial logistic regression analysis showed that age > 40 years (compared to age < 30 years) was significantly associated with URS, PNL, and UPL, rather than SWL, while patients living in urban or suburban/rural areas (compared to metropolitan) were significantly less likely to undergo URS and PNL. In summary, the majority of Korean patients underwent SWL as primary treatment for UUTC, and the predominant use of SWL remained steady over a 10-year period in Korea. Our results will be valuable in examining treatment patterns and time trends in Korean UUTC patients.
J Korean Med Sci. 2016 Dec;31(12):1989-1995. doi: 10.3346/jkms.2016.31.12.1989. FREE ARTICLE
Comments 1
This interesting report comes from Korea where, despite increased incidence of urolithiasis, SWL remained the primary treatment modality during the period 2003-2013. The total number of SWL treatments increased parallel to total number of treatments.
The recurrence-free rates reported for follow-up periods of 2, 5 and 10 years were 89%, 78% and 65%, levels that are very close to my own experience in medically untreated patients with calcium stones.