OBJECTIVE: To assess trends in surgical management of ureteral calculi over a ten year period.
MATERIALS AND METHODS: An analysis of the 5% Medicare Public Use Files (years 2001, 2004, 2007 and 2010) was performed to assess the use of URS, SWL and UL in treating ureteral calculi. Patients were identified using ICD-9 (cm) and CPT codes. Statistical analyses, including the Fisher, χ2 tests, and multivariate logistic regression analysis (dependent variables: URS, SWL, UL, treatment, no treatment; independent variables: age, gender, ethnicity, geography and year of treatment) were performed using SAS 9.3 (SAS Institute Inc., Cary, NC) and SPSS v20 (IBM Corp., Armonk, NY).
RESULTS: A total of 299,920 patients were identified with ureteral calculi. Of these, 115,200 underwent surgery. Men (OR=1.15, p< 0.0001) were more, while minorities (OR=0.84, p=0.004) were less likely to be treated. Patients in the West were also less likely to be treated (OR=0.76, p< 0.0001) as were patients aged < 65 or > 84 years old (p=0.29). URS represented the predominant surgical approach (65.2%), followed by SWL (33.6%) and UL (1.2%). The relative usage of URS increased over time, while SWL and UL declined. Women (OR=1.25, p< 0.0001) were more likely to undergo URS. Patients in the South (OR=1.51, p< 0.0001) and minorities were more likely to undergo SWL (OR=1.23, p=0.03).
CONCLUSIONS: The surgical treatment of ureteral calculi changed significantly from 2001-2010. The utilization of URS expanded at the expense of SWL and UL. Multiple inequalities existed in overall surgical treatment rates and in the choice of treatment: Age, gender, ethnicity, and geography influenced both whether patients underwent surgical intervention and the type of surgical approach used.
Written by:
Seklehner S, Laudano MA, Jamzadeh A, Del Pizzo JJ, Chughtai B, Lee RK. Are you the author?
Department of Urology, Weill Medical College of Cornell University, New York, NY, USA; Department of Urology, Landesklinikum Baden-Mödling, Baden, Austria.
Reference: BJU Int. 2013 Jul 22. Epub ahead of print.
doi: 10.1111/bju.12372
PubMed Abstract
PMID: 24053734
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