Raheem OA et al, 2017: Burden of Urolithiasis: Trends in Prevalence, Treatments, and Costs.
Raheem OA, Khandwala YS, Sur RL, Ghani KR, Denstedt JD.
Department of Urology, University of California San Diego Health, San Diego, CA, USA.
University of California San Diego School of Medicine, San Diego, CA, USA.
Department of Urology, University of Michigan, Ann Arbor, MI, USA.
Department of Surgery, Western University, London, ON, Canada.
CONTEXT: The recent evolution of management options for urolithiasis has presented a unique dilemma for the modern urologist. A comprehensive understanding of epidemiological trends along with current provider preferences in treating urinary stones would be beneficial. OBJECTIVE: To review trends in the prevalence, treatments, and costs of urolithiasis worldwide.
EVIDENCE ACQUISITION: A literature review was performed using the MEDLINE database, the Cochrane Library Central search facility, Web of Science, and Google Scholar between 1986 and 2016. Keywords used for the search were "urolithiasis" and "prevalence; treatment; and cost".
EVIDENCE SYNTHESIS: The incidence and prevalence of urinary stones are rising around the world, including regions that have historically had low rates of urolithiasis. Common theories explaining this trend involve climate warming, dietary changes, and obesity. Shockwave lithotripsy (SWL) has been the preferred mode of treatment since its introduction in the 1980s. However, ureteroscopy (URS) has become increasingly popular for small stones regardless of location because of lower recurrence rates and costs. Developing countries have been slower to adopt URS technology and continue to use percutaneous nephrolithotomy at a steady rate.
CONCLUSIONS: URS has recently challenged SWL as the treatment modality preferred for small upper urinary tract stones. In some cases it is less expensive but still highly effective. As the burden of stone disease increases worldwide, appropriate selection of stone removal therapies will continue to play an important role and will thus require further investigation.
PATIENT SUMMARY: Urinary stones are becoming more prevalent. Recent advances in technology have improved the management of this disease and have decreased costs.
Eur Urol Focus. 2017 Feb;3(1):18-26. doi: 10.1016/j.euf.2017.04.001. Epub 2017 Apr 24.
In the section focusing on therapy selection and costs the authors state: “Management trends for urolithiasis in Europe vary because of similar factors to the rest of the world (health care systems, affluence, and physician training), but appear to be heavily dependent on reimbursement value and the availability of technology. In Sweden, for example, the reimbursement for SWL is not as high as in France, where multiple sessions of SWL are funded. Lithotripsy in Italy is also relatively inexpensive because of a high lithotripter/ person ratio. However, endourological procedures have recently become more popular because of increasing reimbursement rates.”
The influence of reimbursement on the choice of therapy is rarely included in all these studies on stone therapy presented continuously. Recently an Italian Urologist told me that his hospital administration would not finance the necessary replacement of the old ESWL-machine with the argument that the hospital would not make enough money with it. The influence of money on the choice of therapy is rarely …