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Al Darrab R. et al., 2020: Trends of upper urinary tract stone management in a high volume stone center in Saudi Arabia, 12 years analysis

Al Darrab R, Addar AM, Al Shohaib I, Ghazwani Y.
Division of Urology, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Abstract

Introduction: Urolithiasis is a common urological problem globally with tremendous health and economic burden. In Saudi Arabia, an estimation has shown that the risk of developing a stone episode is 50% higher than that in Western countries. About 20% of males would experience at least one episode by 70 years of age. The introduction of minimally invasive and noninvasive methods such as shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotripsy (PCNL) has driven the urologists to more complex decision-making with a noted variance in management options.

Objectives and methods: The objective of the study was to observe the trend of upper urinary tract stone management in our institution in the past 12 years.

Methods: Charts of patients who underwent upper urinary tract lithotripsy procedures of any kind were reviewed. The information obtained included, patient's age, surgeon, surgery type, stone size, stone location, and duration of surgery.

Analysis: The data obtained were from 2006 to 2016. Excel sheets used for the collection of data and SPSS software was used for analysis.

Results: The results showed that the majority of the patients were males accounting for 65%. ESWL was the predominant approach from 2006 to 2010. In 2006, ESWL accounted for 77.7% of the cases, 76% in 2007, 70% in 2008, 64% in 2009, and 62% in 2010. However, in 2011, the rates dropped to almost 18% and URS rates have increased from a few cases per year to 64%. The frequency of URS continued to rise through the years until 2015 where URS rates reached 75%. During the 12-year period, URS is the most common upper tract procedure conducted when compared to ESWL and PCNL, accounting for 63%, 16%, and 20%, respectively.

Conclusion: In our institution, the frequency of URS rose over the years being the most abundant procedure done. ESWL rates have decreased over the years.
Urol Ann. 2020 Apr-Jun;12(2):128-131. doi: 10.4103/UA.UA_49_19. Epub 2020 Apr 14.PMID: 32565649. FREE ARTICLE

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Comments 1

Peter Alken on Friday, August 21 2020 08:30

In publications like this one, you always find a typical sentence on the epidemiology: “Urinary stone disease is increasing globally with growing concern toward prevention, treatment, and cost effectiveness.” Unfortunately, numbers from a single institution do not mirror epidemiology but just the activities of the department. This one had good times and bad times (Fig.1).

https://www.storzmedical.com/images/blog/Aldarrab.JPG

Other publications on the use of ESWL, URS ad PNL frequently show that not only did the use of the procedures change during the years but also the absolute number of cases increased.
This is usually attributed to a change in life style and other causes are not given (1). A remarkable publication from Iceland showed that - at least in this country - the increase is nearly exclusively due increase of asymptomatic stones detected by imaging for other indications (2). These asymptomatic stones are probably of small size and a good target for EWSL (3-6). Consequently the use of ESWL should be rising. Maybe urologist do not specifically report on the treatment of small stones - but I am sure they do it - by URS. Those authors who followed asymptomatic stones showed that ESWL was the most frequently applied treatment technique (3-6).

Peter Alken


1 Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World J Urol. 2017;35:1301–20. [PubMed: 28213860]

2 Edvardsson VO, Indridason OS, Haraldsson G, Kjartansson O, Palsson R. Temporal trends in the incidence of kidney stone disease Kidney Int. 2013;83(1):146-152. doi:10.1038/ki.2012.320

3 Koh LT, Ng FC, Ng KK. Outcomes of long-term follow-up of patients with conservative management of asymptomatic renal calculi. BJU Int. 2012;109(4):622-625. doi:10.1111/j.1464-410X.2011.10329.x

4 Sener NC, Bas O, Sener E, et al. Asymptomatic lower pole small renal stones: shock wave lithotripsy, flexible ureteroscopy, or observation? A prospective randomized trial. Urology. 2015;85(1):33-37. doi:10.1016/j.urology.2014.08.023

5 Darrad MP, Yallappa S, Metcalfe J, Subramonian K. The natural history of asymptomatic calyceal stones. BJU Int. 2018;122(2):263-269. doi:10.1111/bju.14354

6 Li X, Zhu W, Lam W, Yue Y, Duan H, Zeng G. Outcomes of long-term follow-up of asymptomatic renal stones and prediction of stone-related events. BJU Int. 2019;123(3):485-492. doi:10.1111/bju.14565

In publications like this one, you always find a typical sentence on the epidemiology: “Urinary stone disease is increasing globally with growing concern toward prevention, treatment, and cost effectiveness.” Unfortunately, numbers from a single institution do not mirror epidemiology but just the activities of the department. This one had good times and bad times (Fig.1). [img]https://www.storzmedical.com/images/blog/Aldarrab.JPG[/img] Other publications on the use of ESWL, URS ad PNL frequently show that not only did the use of the procedures change during the years but also the absolute number of cases increased. This is usually attributed to a change in life style and other causes are not given (1). A remarkable publication from Iceland showed that - at least in this country - the increase is nearly exclusively due increase of asymptomatic stones detected by imaging for other indications (2). These asymptomatic stones are probably of small size and a good target for EWSL (3-6). Consequently the use of ESWL should be rising. Maybe urologist do not specifically report on the treatment of small stones - but I am sure they do it - by URS. Those authors who followed asymptomatic stones showed that ESWL was the most frequently applied treatment technique (3-6). Peter Alken 1 Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World J Urol. 2017;35:1301–20. [PubMed: 28213860] 2 Edvardsson VO, Indridason OS, Haraldsson G, Kjartansson O, Palsson R. Temporal trends in the incidence of kidney stone disease Kidney Int. 2013;83(1):146-152. doi:10.1038/ki.2012.320 3 Koh LT, Ng FC, Ng KK. Outcomes of long-term follow-up of patients with conservative management of asymptomatic renal calculi. BJU Int. 2012;109(4):622-625. doi:10.1111/j.1464-410X.2011.10329.x 4 Sener NC, Bas O, Sener E, et al. Asymptomatic lower pole small renal stones: shock wave lithotripsy, flexible ureteroscopy, or observation? A prospective randomized trial. Urology. 2015;85(1):33-37. doi:10.1016/j.urology.2014.08.023 5 Darrad MP, Yallappa S, Metcalfe J, Subramonian K. The natural history of asymptomatic calyceal stones. BJU Int. 2018;122(2):263-269. doi:10.1111/bju.14354 6 Li X, Zhu W, Lam W, Yue Y, Duan H, Zeng G. Outcomes of long-term follow-up of asymptomatic renal stones and prediction of stone-related events. BJU Int. 2019;123(3):485-492. doi:10.1111/bju.14565
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