Ureteroscopy Use Rising, SWL Use Falling in California

SAN DIEGO—Ureteroscopy use has increased and shock wave lithotripsy use has decreased in California such that the two treatments for kidney stones are now being used at nearly equal rates, researchers reported at the American Urological Association annual meeting.

Hossein S. Mirheydar, MD, and colleagues at the University of California San Diego, analyzed data on 113,447 outpatient kidney stone surgeries performed in California from 2005 to 2010. Of these, 48,815 were treated with URS and 64,332 were treated with SWL. The total number of stone surgeries performed in ambulatory settings increased annually from 17,831 in 2005 to 18,933 in 2010. The URS rate increased significantly from 6,978 to 9,259 cases per year, whereas the SWL rate decreased nonsignificantly from 10,853 to 9,674 per year. In 2010, the number of URS procedures approached that of SWL procedures (9,259 and 9,674, respectively).

In multivariate analysis, age 75 years and older and the presence of hypertension or obesity significantly decreased the likelihood of SWL. Women and Medicaid patients were significantly more likely to undergo SWL.

Improved stone-free rates associated with ureteroscopy and the decreased efficacy of second- and third-generation shock wave lithotripters, in part, may explain these trends, Dr. Mirheydar said. If the trends continue, he told Renal & Urology News, ureteroscopy may overtake SWL for the treatment of kidney stones.

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