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2008 Annual Meeting Abstracts
Practice Patterns in the Management of Stone Disease
Ashley E. Ross1, Michael Lipkin*2, Ojas Shah*2, Brian R Matlaga1
1Johns Hopkins University School of Medicine, Baltimore, MD;2New York University School of Medicine, New York, NY
Introduction: In recent years, the field of endourology has witnessed great progression in endoscopic technology and surgical technique. We performed a study to define the type of procedures performed for stone removal over a one year period in two academic, tertiary referral practices focused on the treatment of stone disease.
Methods: A multi-center, retrospective evaluation of all patients undergoing procedures for stone removal over a one year period was performed. Procedures were categorized as shock wave lithotripsy (SWL), ureteroscopy, (URS), or percutaneous nephrolithotomy (PNL). All procedures at each institution were performed by a single surgeon with a practice focused on the treatment of stone disease.
Results: From August 2006 to July 2007, a total of 369 procedures were performed for the purpose of stone removal. The procedure distribution was 28 SWL (7.5%), 256 URS (69.3%), 85 PNL (23.0%). Stone-free rates were comparable among the endoscopic interventions (78.5% for URS and 91.7% for PNL) and superior to SWL (42.8%). Complications were comparable among all groups.
Conclusions: In these two tertiary referral practices focused on the treatment of stone disease, there is an increasing reliance on endourologic interventions; indeed, it is the minority of patients in these practices that undergo SWL. These data are hypothesis-generating, and it remains to be seen whether other urologic surgery practices are experiencing, or will experience, a similar paradigm shift towards a greater utilization of endourology and a more restricted utilization of SWL in the treatment of patients suffering from stone disease.
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