A population-based, retrospective cohort study analyzing contemporary trends in the surgical management of urinary stone disease in adults

Authors

  • Dor Golomb Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  • Sumit Dave Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  • Fernanda Gabrigna Berto Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  • J. Andrew McClure 2. Department of Surgery, Schulich School of Medicine and Dentistry London Health Sciences Centre, London, Ontario, Canada
  • Blayne Welk Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  • Peter Wang Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  • Jennifer Bjazevic Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  • Hassan Razvi Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada

DOI:

https://doi.org/10.5489/cuaj.7474

Keywords:

Urolithiasis, PCNL, Ureteroscopy, Shock Wave Lithotripsy, Surgical Trends

Abstract

Introduction: We aimed to review the trends and incidence of surgical intervention for adults with upper urinary tract stones in Ontario, Canada, and to hypothesize potential causes for the observed changes.

Methods: We carried out a retrospective, population-based cohort study using administrative databases held at the Institute of Clinical Evaluative Sciences (ICES) to identify all adults (≥18 years) who underwent surgical treatment for urolithiasis, defined by records using a combination of both hospital and physician billing from 2002–2019. Descriptive statistics were used to summarize baseline patient demographics, and surgical trends were analyzed using the Cochrane-Armitage test for trend.

Results: From 2002–2019, 140 263 patients were treated surgically for urolithiasis. During this time period, the total number of surgically treated stone disease increased by 80.5%. By type of procedure, percutaneous nephrolithotomy (PCNL) increased by 187% and ureteroscopy (URS) increased by 158%, while the number of shockwave lithotripsy (SWL) declined by 31.4%. The adult population in Ontario in the years evaluated grew by 24.4%. The number of surgical procedures per 100 000 people over this time grew by 45.3%. For every 1% increase in the population, there was a 2.6% rise in stone-related surgical procedures.

Conclusions: The number of stone-related surgical procedures performed rose significantly and cannot be accounted for by population growth alone. This rise was proportionally larger in the female population, further supporting a narrowing of the gender gap in urinary stone disease. The reasons for the increase are likely multifactorial and may imply an increasing incidence of surgically treated stone disease. The change in the proportion of URS and SWL performed may demonstrate a continued shift in surgical preference or may be reflective of resource limitations and availability. The increase in PCNL volumes may also suggest a greater complexity of cases. These findings should be considered for future resource planning and require further study.

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Published

2021-11-18

How to Cite

Golomb, D., Dave, S., Gabrigna Berto, F., McClure, J. A., Welk, B., Wang, P., Bjazevic, J., & Razvi, H. (2021). A population-based, retrospective cohort study analyzing contemporary trends in the surgical management of urinary stone disease in adults. Canadian Urological Association Journal, 16(4), 112–8. https://doi.org/10.5489/cuaj.7474

Issue

Vol. 16 No. 4 (2022): CUAJ April

Section

Original Research

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