Trends and inequalities in the surgical management of ureteric calculi in the USA. (21st November 2013)

• Record Type: Journal Article
• Authors: Seklehner, Stephan; Laudano, Melissa A.; Jamzadeh, Asha; Del Pizzo, Joseph J.; Chughtai, Bilal; Lee, Richard K.
• Is Part Of: BJU international. Volume 113:Number 3(2014:Mar.)
• Page Start: 476
• Page End: 483
• Publication Date: 2013-11-21
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12372
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12372-sec-0001" sec-type="section"> <title>Objective</title> <p> <list id="bju12372-list-0001" list-type="bullet"> <list-item> <p>To assess trends in the surgical management of ureteric calculi over a 10‐year period.</p> </list-item> </list> </p> </sec> <sec id="bju12372-sec-0002" sec-type="section"> <title>Materials and Methods</title> <p> <list id="bju12372-list-0002" list-type="bullet"> <list-item> <p>An analysis of the 5% Medicare Public Use Files, from 2001, 2004, 2007 and 2010, was performed to assess the use of ureteroscopy (URS), extracorporal shockwave lithotripsy (ESWL) and ureterolithotomy (UL) in treating ureteric calculi.</p> </list-item> <list-item> <p>Patients were identified using International Classification of Diseases 9th edition (Clinical Modification) and Current Procedure Terminology codes.</p> </list-item> <list-item> <p>Statistical analyses using the Fisher and chi‐squared tests, and multivariate logistic regression analysis (dependent variables: URS, ESWL, UL, treatment, no treatment; independent variables: age, gender, ethnicity, geography and year of treatment) were performed.</p> </list-item> </list> </p> </sec> <sec id="bju12372-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12372-list-0003" list-type="bullet"> <list-item> <p>A total of 299 920 patients with ureteric calculi were identified. Of these, 115 200 underwent surgery.</p> </list-item> <list-item> <p>Men (odds ratio [OR] = 1.15, <italic>P</italic> < 0.001) were more likely, while patients from ethnic minorities (OR = 0.84, <italic>P</italic> = 0.004) were less likely to be treated. Patients in the West of the USA were also less likely to be treated (OR = 0.76, <italic>P</italic> < 0.001) as were patients aged <65 or >84 years old (<italic>P</italic> = 0.29).</p> </list-item> <list-item> <p>The predominant surgical approach was URS (65.2%), followed by ESWL (33.6%) and UL (1.2%).</p> </list-item> <list-item> <p>The use of URS increased over time, while the use of ESWL and UL declined.</p> </list-item> <list-item> <p>Women (OR = 1.25, <italic>P</italic> < 0.001) were more likely to undergo URS. Patients in the South of the USA (OR = 1.51, <italic>P</italic> < 0.001) and patients from ethnic minorities were more likely to undergo ESWL (OR = 1.23, <italic>P</italic> = 0.03).</p> </list-item> </list> </p> </sec> <sec id="bju12372-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12372-list-0004" list-type="bullet"> <list-item> <p>The surgical treatment of ureteric calculi changed significantly between 2001 and 2010.</p> </list-item> <list-item> <p>The use of URS expanded at the expense of ESWL and UL.</p> </list-item> <list-item> <p>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.</p> </list-item> </list> </p> </sec> </abstract>