SWL literature
SWL Literature
Reviewer's Choice

Herout R. et al., 2021: Contemporary treatment trends for upper urinary tract stones in a total population analysis in Germany from 2006 to 2019: will shock wave lithotripsy become extinct?

Herout R, Baunacke M, Groeben C, Aksoy C, Volkmer B, Schmidt M, Eisenmenger N, Koch R, Oehlschläger S, Thomas C, Huber J.
Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
Department of Urology, Klinikum Kassel, Kassel, Germany.
Coloplast GmbH, Hamburg, Germany.
Reimbursement Institute, Hürth, Germany.

Abstract

Purpose: To describe the change in upper urinary tract stone management in Germany over a 14-year period.

Methods: Using remote data processing we analyzed the nationwide German billing data from 2006 to 2019. To analyze the clinics' case numbers and regional trends, we used the reimbursement.INFO tool based on standardized quality reports of all German hospitals. To also cover shock wave lithotripsy (SWL) as an outpatient procedure, we analyzed the research database of the Institute for Applied Health Research with a representative anonymous sample of 4 million insured persons.

Results: The number of inpatient interventional therapies for upper tract urolithiasis in Germany increased from 70,099 cases in 2006 to 94,815 cases in 2019 (trend p < 0.0001). In-hospital SWL declined from 41,687 cases in 2006 to 10,724 cases in 2019 (decline of 74%; trend p < 0.0001). The percentage of SWL as an outpatient procedure increased between 2013 and 2018 from 36 to 46% of all performed SWL, while total SWL case numbers declined. Contrarily, the number of ureteroscopies increased from 32,203 cases in 2006 to 78,125 cases in 2019 (increase of 143%; trend p < 0.0001). The number of percutaneous nephrolithotomy also increased from 1673 cases in 2006 to 8937 in 2019 (increase of 434%; trend p < 0.0001).

Conclusion: We observed an increase in interventional therapy for upper tract urolithiasis in Germany with a dramatic shift from SWL to endoscopic/percutaneous treatment. These changes may be attributed to enormous technological advances of the endoscopic armamentarium and to reimbursement issues.
World J Urol. 2021 Aug 28. doi: 10.1007/s00345-021-03818-y. Online ahead of print. PMID: 34453580

1
 

Commentaires 1

Peter Alken le mercredi 12 janvier 2022 08:30

This paper offers quite interesting information:
The absolute number of cases treated in Germany increased by 35% from 2006 to 2019. This is definitely much higher than the steadily but slowly increasing urolithiasis incidence rate. Similar non-proportional increases were recorded in other countries (1). The present authors speculate on the cause. I do not agree to their first argument that the increase is “most likely attributed to an increased life-time prevalence of urinary tract stones due to a higher prevalence of metabolic disorders” The second argument is more attractive: “due to fact that with the widespread use of computed tomography (CT) more asymptomatic upper tract urinary calculi are being diagnosed” But why are so many asymptomatic stones treated? An answer could be hidden in a reference: Patients decision on what to do with a stone heavily depends on the doctors advice (2). So, what’s the doctors advice? In England URS and PNL numbers increased, but ESWL remained stable in a comparable time period between 2006 and 2014 (3) in contrast to the present data. Doctors in England seem to give advices different from those in Germany. Costs, billing, reimbursement for a certain procedure differ from country to country depending on the health system.
A final clue might be:” Procedural coding is linked to reimbursement and, therefore, it is possible that specific codes with higher reimbursement rates are used more frequently, where applicable.” And one conclusion is “The fate of SWL in upper urinary tract stone management will depend on the implementation of recent technological developements and on finding a suitable framework for remuneration within the German health care system.”

Peter Alken

1 Geraghty RM, Jones P, Somani BK. Worldwide Trends of Urinary Stone Disease Treatment Over the Last Two Decades: A Systematic Review. J Endourol. 2017 Jun;31(6):547-556. doi: 10.1089/end.2016.0895. PMID: 28095709.
2 Omar M, Tarplin S, Brown R, Sivalingam S, Monga M. Shared decision making: why do patients choose ureteroscopy? Urolithiasis. 2016 Apr;44(2):167-72. doi: 10.1007/s00240-015-0806-0. Epub 2015 Jul 25. PMID: 26209009.
3 Rukin NJ, Siddiqui ZA, Chedgy ECP, Somani BK. Trends in Upper Tract Stone Disease in England: Evidence from the Hospital Episodes Statistics Database. Urol Int. 2017;98(4):391-396. doi: 10.1159/000449510. Epub 2016 Oct 1. PMID: 27694759. Free access

See also: Wymer KM, Sharma V, Juvet T, Klett DE, Borah BJ, Koo K, Rivera M, Agarwal D, Humphreys MR, Potretzke AM.
Cost-effectiveness of Retrograde Intrarenal Surgery, Standard and Mini Percutaneous Nephrolithotomy, and Shock Wave Lithotripsy for the Management of 1-2cm Renal Stones.
Urology. 2021 Jul 15:S0090-4295(21)00640-3. doi: 10.1016/j.urology.2021.06.030.

This paper offers quite interesting information: The absolute number of cases treated in Germany increased by 35% from 2006 to 2019. This is definitely much higher than the steadily but slowly increasing urolithiasis incidence rate. Similar non-proportional increases were recorded in other countries (1). The present authors speculate on the cause. I do not agree to their first argument that the increase is “most likely attributed to an increased life-time prevalence of urinary tract stones due to a higher prevalence of metabolic disorders” The second argument is more attractive: “due to fact that with the widespread use of computed tomography (CT) more asymptomatic upper tract urinary calculi are being diagnosed” But why are so many asymptomatic stones treated? An answer could be hidden in a reference: Patients decision on what to do with a stone heavily depends on the doctors advice (2). So, what’s the doctors advice? In England URS and PNL numbers increased, but ESWL remained stable in a comparable time period between 2006 and 2014 (3) in contrast to the present data. Doctors in England seem to give advices different from those in Germany. Costs, billing, reimbursement for a certain procedure differ from country to country depending on the health system. A final clue might be:” Procedural coding is linked to reimbursement and, therefore, it is possible that specific codes with higher reimbursement rates are used more frequently, where applicable.” And one conclusion is “The fate of SWL in upper urinary tract stone management will depend on the implementation of recent technological developements and on finding a suitable framework for remuneration within the German health care system.” Peter Alken 1 Geraghty RM, Jones P, Somani BK. Worldwide Trends of Urinary Stone Disease Treatment Over the Last Two Decades: A Systematic Review. J Endourol. 2017 Jun;31(6):547-556. doi: 10.1089/end.2016.0895. PMID: 28095709. 2 Omar M, Tarplin S, Brown R, Sivalingam S, Monga M. Shared decision making: why do patients choose ureteroscopy? Urolithiasis. 2016 Apr;44(2):167-72. doi: 10.1007/s00240-015-0806-0. Epub 2015 Jul 25. PMID: 26209009. 3 Rukin NJ, Siddiqui ZA, Chedgy ECP, Somani BK. Trends in Upper Tract Stone Disease in England: Evidence from the Hospital Episodes Statistics Database. Urol Int. 2017;98(4):391-396. doi: 10.1159/000449510. Epub 2016 Oct 1. PMID: 27694759. Free access See also: Wymer KM, Sharma V, Juvet T, Klett DE, Borah BJ, Koo K, Rivera M, Agarwal D, Humphreys MR, Potretzke AM. Cost-effectiveness of Retrograde Intrarenal Surgery, Standard and Mini Percutaneous Nephrolithotomy, and Shock Wave Lithotripsy for the Management of 1-2cm Renal Stones. Urology. 2021 Jul 15:S0090-4295(21)00640-3. doi: 10.1016/j.urology.2021.06.030.
Invité
dimanche 26 juin 2022
Linkedin Channel Facebook Channel Instagram Channel Twitter Youtube Channel