Stefano DI Bari et al., 2024: Stone centers: a national survey on surgical techniques performed in Italy

Stefano DI Bari, Giuseppe Stella, Mattia Benedetti, Michele Talso, Alberto Saita, Carlo Zaraca, Riccardo Ferrari, Pietro Acquati, Riccardo Lombardo, Stefania Ferretti, Stefano Puliatti, Luigi Cormio, Salvatore Micali 
Società Italiana di Urologia (SIU) PMID: 38742556 DOI: 10.23736/S2724-6051.24.05778-1
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Abstract

Background: Recurrent and complex stone disease may be considered a challenging disease. In 2018, the Calculus group of the SIU (Italian Society of Urology) set itself the goal of establishing the minimum requirements for a center that could continuously manage urolithiasis pathology, named a Stone Center. In this study we present the results of a pilot survey carried out in 2019 with the aim of drawing a map of the situation of Italian urological centers dealing with urinary stones.

Methods: A total of 260 national urology departments dealing with urolithiasis surgery were contacted for this study. A survey was issued to each of the centers to determine the number of patients treated for urinary stones and the amount of procedures performed per year: 1) extracorporeal shock wave lithotripsy ESWL; 2) ureterorenoscopy URS; 3) retrograde intrarenal surgery RIRS; 4) percutaneous nephrolithotomy PCNL.

Results: Out of 260 centers contacted, 188 fulfilled the survey. Outcomes were quite variable, with approximately 37% of the centers lacking a lithotripter, and 46% of those that did have it performing fewer than 100 treatments per year. In terms of endoscopic procedures, more than 80% of the centers contacted performed URS or RIRS; however, when it came to percutaneous lithotripsy, these numbers dropped significantly; 33% of the centers contacted did not perform PCNL, and of those who did, 18% had less than 5 years of experience as a center.

Conclusions: Our survey shows a very heterogeneous national picture about urolithiasis treatments. Our goal is to create national paradigms to be able to define stone centers where the patient suffering from complex urinary stones can find a network of professionals with an adequate armamentarium suitable for the management of their pathology.

Comment Hans-Göran Tiselius

What is a “Stone Center” and what is required for such a center? That issue was addressed in this Italian report, based on reviews on how well-equipped centers dealing with stone patients are and how modern treatment principles are applied. This is an epidemiological report, however, with the shortcoming that information was obtained from only 188 of 300 identified centers.
Methods for stone removal:

The heterogeneous approach was even more apparent in terms of diagnostic evaluation and recurrence treatment. Particularly low was the analysis of the underlying pathology.
Based on the observed shortcomings, the conclusion was that great efforts are needed to get a standard level of qualitative handling of stone patients. It is likely that such a situation exists also in many other countries.

Hans-Göran Tiselius