Sudarshan Seringapatam et al., 2024: Effect of core preventative screening on kidney stone surgical patterns

Tuesday, 24 September 2024

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Sudarshan Seringapatam 1 , Linda Guan 2 , Caroline Baughn 2 , Hubert S Swana 2 3 , David B Bayne 4
1University of Central Florida, College of Medicine, Orlando, FL, USA.
2University of Central Florida, College of Medicine, Orlando, FL, USA.
3Department of Urology, Orlando Health, Orlando, FL, USA.
4University of California, San Francisco, San Francisco, CA, USA.

Abstract

Purpose: In the surgical treatment of kidney stones, decreased access to healthcare has been shown to exacerbate stone burden, often requiring more invasive and extensive procedures. The objective of this study is to evaluate the effects of preventative health screening on kidney stone surgical treatment patterns.

Methods: We performed a retrospective analysis of data from the Healthcare Cost and Utilization Project (HCUP) Florida state-wide dataset and the PLACES Local Data for Better Health dataset from the Centers of Disease Control and Prevention (CDC). ZIP Code Tabulation Areas (ZCTAs) identified from the PLACES data were merged with the HCUP dataset to create a single dataset of community-level stone outcomes and community health measures. We included adult patients 18 years or older who underwent at least one urologic stone procedure from 2016 to 2020.

Results: 128,038 patients from 885 communities were included in the study. Patients underwent an average of 1.42 surgeries (Median = 1.39, SD = 0.16). Increased core preventative screening was associated with increased surgical frequency (Estimate: 0.51, P < 0.001). The low core preventative screening group had a higher prevalence of PNL than SWL while the high core preventative screening group had a low PNL prevalence compared to SWL.

Conclusion: Increased core preventative screenings are associated with less invasive kidney stone surgeries, suggesting that preventative screenings detect stones at an earlier stage.

Int Urol Nephrol. 2024 Jul;56(7):2131-2139. doi: 10.1007/s11255-023-03930-5. Epub 2024 Feb 3.
PMID: 38308799 DOI: 10.1007/s11255-023-03930-5

Comments 1

Peter Alken on Tuesday, 24 September 2024 11:00

Interesting study. However, I wouldn't trust it. There is one urologist among the five authors. According to his PubMed data, he appears to be a paediatric urologist who has never published anything on stones. That in itself is not a limitation, but the other 4 authors seem to have a very unusual or inexperienced view of the stone problem. They “hypothesize that an increased prevalence of preventative health care in communities leads to increased frequency of minimally invasive interventions (SWL) relative to more invasive kidney stone surgeries (PNL).” They seem to believe in the good in people. Medical therapeutic decisions are influenced by so many factors that it’s hard to believe that a single factor like preventative health screening would have a massive impact. This dose not only apply to urology [See comment to (1)].
The present study is . Some limitations mentioned by the authors are:
• “This study utilized two datasets: Florida state-wide dataset from the HCUP and PLACES dataset from the CDC. As such, the limitation of these datasets is that the factors were at the community level. It is difficult to generalize these conclusions to individual patients, …
• our primary outcome, the number of surgeries over a five-year period, was the average number of surgeries per patient…
• Our study also lacks outpatient clinic data at the individual level making it difficult to analyse the specific effect of urologic specialty care in kidney stone prevention.
• neither the HCUP data nor the PLACES data include imaging data making the interpretation of intent to treatment dependent on record of surgeries.”
If preventive screening had a significant impact on the treatment of stones, I would expect the number of ESWL cases in the so-called civilised countries to increase, not decrease.
1 Bush N, et al. Development of a novel CT-based index for predicting the number of extracorporeal shockwave lithotripsy (ESWL) sessions required for successful fragmentation of obstructing pancreatic duct stones
Pancreatology. 2024 Mar 28:S1424-3903(24)00079-6. doi: 10.1016/j.pan.2024.03.018. Online ahead of print.

Peter Alken

Interesting study. However, I wouldn't trust it. There is one urologist among the five authors. According to his PubMed data, he appears to be a paediatric urologist who has never published anything on stones. That in itself is not a limitation, but the other 4 authors seem to have a very unusual or inexperienced view of the stone problem. They “hypothesize that an increased prevalence of preventative health care in communities leads to increased frequency of minimally invasive interventions (SWL) relative to more invasive kidney stone surgeries (PNL).” They seem to believe in the good in people. Medical therapeutic decisions are influenced by so many factors that it’s hard to believe that a single factor like preventative health screening would have a massive impact. This dose not only apply to urology [See comment to (1)].
The present study is .  Some limitations mentioned by the authors are: 
•	“This study utilized two datasets: Florida state-wide dataset from the HCUP and PLACES dataset from the CDC. As such, the limitation of these datasets is that the factors were at the community level. It is difficult to generalize these conclusions to individual patients, …
•	our primary outcome, the number of surgeries over a five-year period, was the average number of surgeries per patient…
•	Our study also lacks outpatient clinic data at the individual level making it difficult to analyse the specific effect of urologic specialty care in kidney stone prevention. 
•	neither the HCUP data nor the PLACES data include imaging data making the interpretation of intent to treatment dependent on record of surgeries.”
If preventive screening had a significant impact on the treatment of stones, I would expect the number of ESWL cases in the so-called civilised countries to increase, not decrease. 
1 Bush N, et al.  Development of a novel CT-based index for predicting the number of extracorporeal shockwave lithotripsy (ESWL) sessions required for successful fragmentation of obstructing pancreatic duct stones 
Pancreatology. 2024 Mar 28:S1424-3903(24)00079-6. doi: 10.1016/j.pan.2024.03.018. Online ahead of print.

Peter Alken

Interesting study. However, I wouldn't trust it. There is one urologist among the five authors. According to his PubMed data, he appears to be a paediatric urologist who has never published anything on stones. That in itself is not a limitation, but the other 4 authors seem to have a very unusual or inexperienced view of the stone problem. They “hypothesize that an increased prevalence of preventative health care in communities leads to increased frequency of minimally invasive interventions (SWL) relative to more invasive kidney stone surgeries (PNL).” They seem to believe in the good in people. Medical therapeutic decisions are influenced by so many factors that it’s hard to believe that a single factor like preventative health screening would have a massive impact. This dose not only apply to urology [See comment to (1)]. The present study is . Some limitations mentioned by the authors are: • “This study utilized two datasets: Florida state-wide dataset from the HCUP and PLACES dataset from the CDC. As such, the limitation of these datasets is that the factors were at the community level. It is difficult to generalize these conclusions to individual patients, … • our primary outcome, the number of surgeries over a five-year period, was the average number of surgeries per patient… • Our study also lacks outpatient clinic data at the individual level making it difficult to analyse the specific effect of urologic specialty care in kidney stone prevention. • neither the HCUP data nor the PLACES data include imaging data making the interpretation of intent to treatment dependent on record of surgeries.” If preventive screening had a significant impact on the treatment of stones, I would expect the number of ESWL cases in the so-called civilised countries to increase, not decrease. 1 Bush N, et al. Development of a novel CT-based index for predicting the number of extracorporeal shockwave lithotripsy (ESWL) sessions required for successful fragmentation of obstructing pancreatic duct stones Pancreatology. 2024 Mar 28:S1424-3903(24)00079-6. doi: 10.1016/j.pan.2024.03.018. Online ahead of print. Peter Alken

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