Upper urinary tract stones: Evolution of surgical management trends in Germany, France and England over the past decade

ABSTRACT

Introduction & Objective: Global Upper Urinary Tract (UUT) stone prevalence is rising. As a consequence, the increased service demand on hospitals may be difficult to manage, increasing the burden on healthcare providers (HCPs) as well as on patients. In this European analysis we explore the evolution of stone diagnoses and surgical procedures in Germany (DE), France (FR), and England (EN) over the past ten years. Methods: We identified the codes related to UUT stones diagnoses using the International Classification of Diseases (ICD-10) and extracted procedure counts for Extracorporeal Shock Wave Lithotripsy (ESWL), Ureteroscopy (URS), Percutaneous Nephrolithotomy (PCNL) and Open Surgery (OS). We used procedure codes from the National databases in DE, FR and EN, and analyzed the hospital diagnosis counts versus surgical procedure counts related to UUT stones from 2010 to 2019. Results: Between 2010-2019, the ICD-10 N20 codes for calculus of kidney and ureter increased by 8%;26% and 15% in DE, FR, EN respectively, whereas stone procedures increased by 3%;38% and 18%. Over time the dominant surgical UUT stone procedure shifted from ESWL (49-60% of all procedures in 2010) to URS (51-75% of all procedures in 2019). PCNL and OS represent <5% of UUT stones procedures in FR and EN. The highest use of PCNL is observed in DE (increase from 7% in 2010 to 11% in 2019). Over the past decade, the overall length of stay (LoS) decreased for all procedures across the three countries. The URS average LoS decreased by 21% in DE;37% in FR and 6% in EN. Daycase stone procedures volume increased in FR by 68% and in EN by 23%. In DE most cases involve at least one overnight stay. Conclusions: This analysis confirms the rise in stone prevalence globally, including an increase in UUT stones diagnoses and surgical procedures in DE, FR, EN over the past decade. The dominant surgical procedure to treat UUT stone has shifted from ESWL to URS, and the average LoS has decreased. These observed trends may be due to clinical advantages, technological advancement as well as, other factors such as HCP preference or costs. The continued rise of UUT stone prevalence has implications for patients, HCPs and hospitals. If we add to that the COVID19 repercussions, solutions to optimize workforce planning, service delivery and length of stay could help to address the situation.