PURPOSE: Upper tract nephrolithiasis is a common surgical condition and is treated with multiple surgical techniques including shock wave lithotripsy (SWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL).
We analyzed case logs submitted to the American Board of Urology by candidates for initial certification and recertification to help elucidate the trends in management of upper tract urinary calculi.
MATERIALS AND METHODS: Annualized case logs from 2003 to 2012 were analyzed and logistic regression models assessed how surgeon-specific attributes affected how upper tract stones are treated. Cases were identified by CPT code system for corresponding procedure.
RESULTS: A total of 6,620 urologists in three certification groups recorded case logs: initial certification (n=2,275), first recertification (n=2,381) and second recertification (n=1,964). A total of 441,162 total procedures were logged: 54.2% URS, 41.3% SWL, and 4.5% PCNL. From 2003-2013, there was an increase in the use of URS from 40.9% to 59.6% and corresponding drop in use of SWL from 54% to 36.3%. New urologists increased use of URS from 47.6% to 70.9% of all stones cases logged. Senior clinicians displayed an increased use of URS from 40% to 55%. Endourologists performed a significantly higher proportion of PCNL than non-endourologists (10.6% vs. 3.69%, p< 0.0001) and a significantly smaller proportion of SWL (34.2% vs. 42.2%, p=0.001).
CONCLUSIONS: Both junior and senior clinicians exhibited a dramatic adoption of endoscopic techniques. The treatment of upper tract calculi is an evolving field and provider-specific attributes affect how these stones are treated.
Written by:
Oberlin DT, Flum AS, Bachrach L, Matulewicz RS, Flury SC. Are you the author?
Department Of Urology, Northwestern Memorial Hospital, Chicago, IL.
Reference: J Urol. 2014 Sep 11. pii: S0022-5347(14)04393-6.
doi: 10.1016/j.juro.2014.09.006
PubMed Abstract
PMID: 25219700