|The following article features coverage from the American Urological Association (AUA) 2019 meeting. Click here to read more of Renal & Urology News’ conference coverage.|
CHICAGO—Ureteroscopy (URS) has been on the rise, while extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) have held steady as treatment strategies for ureteral calculi, according to new trend data presented at the 2019 American Urological Association annual meeting.
Of 249,265 urolithiasis patient records in a New York State database during 2004 to 2014, URS accounted for 125,465 cases, ESWL for 89,905, and PCNL for 33,895, Michael A. Palese, MD, of the Icahn School of Medicine at Mount Sinai in New York, and colleagues reported. More urolithiasis cases shifted from the inpatient to the outpatient and ambulatory care settings. From 2004 to 2014, annual cases of URS increased significantly from 9601 to 12,087, notably in the outpatient setting where cases rose from 6551 to 9102. Inpatient ESWL declined significantly from 7116 to 5918 cases, whereas ambulatory ESWL increased significantly from 941 to 2116 cases. Inpatient PCNL did not change over the period.
The vast majority of patients undergoing a single procedure required no further treatment in the ensuing 90 days: 89.6% of URS, 82.1% of ESWL, and 92.3% of PCNL cases. However, URS patients had the highest risk for ureteral injury requiring repair (2.3% inpatient and 1.7% outpatient). PCNL patients had the highest risk for sepsis (4.1% inpatient and 1.9% outpatient) and pyelonephritis (2.3% inpatient and 0.8% outpatient).
“Previously, ESWL was the default treatment of choice for distally located stones, and proximal stones required more invasive management with PCNL,” co-author Khawaja Hasan Bilal told Renal & Urology News. “The development of small caliber flexible ureteroscopes along with improvements in optics, stone-retrieval devices and laser technology, have allowed URS to become an effective treatment for urinary stones in all locations.
“Moreover,” he continued, “our results show that an increasingly greater proportion of urolithiasis cases are now being treated in the outpatient and ambulatory care setting. These trends indicate that URS performed in the outpatient setting is becoming the top choice for management of urolithiasis.”
Read more of Renal & Urology News’ coverage of the AUA 2019 meeting by visiting the conference page.
Bilal K, Tomer N, Kaplan-Marans E, et al. Utilization trends and 90-day treatment-free rates for ESWL, URS, and PCNL Cases in the inpatient and outpatient setting between 2004-2014. Presented at the 2019 American Urological Association annual meeting held May 3-6 in Chicago. MP08-12.