Tran MA et al, 2016: Geographical variation in the management of urolithiasis in Australia.
Tran MA, Chak-Lee M, Bariol SV.
The University of Sydney, Sydney, New South Wales, Australia.
Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.
BACKGROUND: To examine any geographical variation in the management of urolithiasis amongst the Australian states and territories.
METHODS: Retrospective study with data obtained from the Medicare Australia database, the Royal Australasian College of Surgeons and the Urological Society of Australia and New Zealand.
RESULTS: Minimally invasive stone treatment with shock wave lithotripsy (SWL) and ureteroscopy (URS) accounted for the majority of stone treatments in Australia (98%). Variation of stone treatment modalities exists amongst the Australian states and territories with an inverse relationship between the use of SWL and URS. We compared Western Australia (WA) and Queensland (QLD) which have a comparable geographical area. SWL accounts for 1% and 22% of stone treatments in WA and QLD, respectively. In WA, urologists are concentrated in two cities with no SWL available in the private sector. In QLD, urologists are distributed in 11 cities with SWL available in both the public and private sector. The three largest states or territories by geographical area - the Northern Territory, WA and QLD - have stone treatment rates of 1:1337, 1:1110 and 1:2432 per capita of privately insured patients, respectively. In comparison, smaller Australian states/territories such as Tasmania and Victoria have stone treatment rates of 1:619 and 1:765 per capita of privately insured patients, respectively.
CONCLUSION: The distribution of urologists and treatment modalities available in each state or territory appear to play a contributory role in choice of treatment modality. In addition, inequality to stone treatment access exists in geographically large Australian states/territories.
ANZ J Surg. 2016 Jun 3. doi: 10.1111/ans.13646. [Epub ahead of print]
The bottom-line of this geographical report on procedures for stone removal showed that whereas PNL was used in very low frequency in all parts of Australia, URS and SWL dominated (98%). Overall 73% of the patients were treated with URS and 24% with SWL.
Although the specific geography of Australia might have influenced the choice of treatment and despite a considerable variation, these observations reflect the situation in many other parts of the world.
It should be observed, however, that a major shortcoming of this report is that only private insurance care was accounted for.