Urolithiasis treatment in Australia: the age of ureteroscopic intervention

Abstract

Introduction: The incidence of urolithiasis is increasing in the Western population. Significant advances in ureteroscopy and stone fragmentation energy sources has resulted in a paradigm shift in urolithiasis management. We aimed to assess the current state of urolithiasis management in Australia over the last 15 years using population-based data. Methods: Medicare Australia databases were accessed and Medicare rebate codes pertaining to ureteroscopy, extra-corporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) were extracted per state, year and gender between 2001 and 2015. Population data was extracted from the Australian Bureau of Statistics website and provided the “population at risk” denominator to calculate incidence proportions. Results: From January 2001 to December 2015, 114,789 ureteroscopy or pyeloscopy procedures for stone extraction in adult patients were performed in Australia. During the same period, 48,209 ESWL and 6,956 PCNL procedures were performed. Ureteroscopy and pyeloscopy procedures have been increasing by an average of 9.3% year-on-year, population adjusted, while ESWL has decreased by 3.5% and PCNL by 6.4% every year over the same period. In absolute terms, scope procedures have increased yearly by an average of 3.9 per 100,000 of population (95% CI: 3.2 to 4.5) whilst ESWL has changed by -0.77 (95% CI: -0.88 to -0.65) and PCNL by -0.16 (95% CI: -0.17 to -0.14). Conclusion: Over the past 15 years in Australia, the total number of stone treatment procedures have increased significantly. Considerable increases in ureteroscopy were observed with relative and absolute reductions in ESWL and PCNL. Regional variations in urolithiasis management strategies highlights the need for consensus on stone treatments within Australia.