Perera M et al, 2016: Urolithiasis Treatment In Australia: The Age Of Ureteroscopic Intervention.
Perera M, Papa NP, Kinnear N, Wetherell D, Lawrentschuk N, Webb DR, Bolton DM.
Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia.
Cancer Council Victoria and University of Melbourne, Department of Surgery, Austin Health, Melbourne, Victoria, Australia.
Department of Urology, Heidelberg, Victoria, Australia.
INTRODUCTION: The incidence of urolithiasis is increasing in the Western population. Significant advances in ureteroscopy and stone fragmentation energy sources has resulted in a paradigm shift in urolithiasis management. We aimed to assess the current state of urolithiasis management in Australia over the last 15 years using population-based data.
METHODS: Medicare Australia databases were accessed and Medicare rebate codes pertaining to ureteroscopy, extra-corporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) were extracted per state, year and gender between 2001 and 2015. Population data was extracted from the Australian Bureau of Statistics website and provided the "population at risk" denominator to calculate incidence proportions.
RESULTS: From January 2001 to December 2015, 114,789 ureteroscopy or pyeloscopy procedures for stone extraction in adult patients were performed in Australia. During the same period, 48,209 ESWL and 6,956 PCNL procedures were performed. Ureteroscopy and pyeloscopy procedures have been increasing by an average of 9.3% year-on-year, population adjusted, while ESWL has decreased by 3.5% and PCNL by 6.4% every year over the same period. In absolute terms, scope procedures have increased yearly by an average of 3.9 per 100,000 of population (95% CI: 3.2 to 4.5) whilst ESWL has changed by -0.77 (95% CI: -0.88 to -0.65) and PCNL by -0.16 (95% CI: -0.17 to -0.14).
CONCLUSION: Over the past 15 years in Australia, the total number of stone treatment procedures have increased significantly. Considerable increases in ureteroscopy were observed with relative and absolute reductions in ESWL and PCNL. Regional variations in urolithiasis management strategies highlights the need for consensus on stone treatments within Australia.
J Endourol. 2016 Sep 14. [Epub ahead of print]
The complete text offers some interesting but also conflicting additional information:
“The current study identified the considerable uptake in endoscopic urolithiasis management with relative stagnation of ESWL and PCNL. This finding has been previously reported in Australia, New Zealand, Brazil, USA, UK and other nations.”
“The current study emphasises the rapid increase in private-practice operative MBS billings for stone treatments over the last 15 years.”
“MBS billings only reliably capture private-practice data, and thus, the current data is not a reflection of public practice.”
“Data pertaining to calculi size or location, cost, stone-free rates, time-of procedure and associated morbidity were not available for further analysis. Data pertaining to retreatment per patient and per stone were not available for analysis due to deficiencies in the Medicare-based data.”
“Finally, the increased uptake in ureteroscopy and pyleoscopy may also be influenced by financial incentives. However, from the current data, no meaningful conclusions may be drawn regarding the possible impact of remuneration on stone treatment trends.”
The absolute numbers of endoscopic and ESWL procedures increased by 100% from
~ 92/100.000 in 2001 to ~180/100.000 in 2015. Data on the frequency of open operative procedures are not given. Thus it is impossible to even speculate about the various factors that may have led to the 100% increase in stone treatment.