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Keywords:

  • urolithiasis;
  • ureteric calculi;
  • ureteroscopy;
  • lithotripsy;
  • surgical procedures;
  • minimally invasive

Objective

  • To assess trends in the surgical management of ureteric calculi over a 10-year period.

Materials and Methods

  • 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.
  • Patients were identified using International Classification of Diseases 9th edition (Clinical Modification) and Current Procedure Terminology codes.
  • 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.

Results

  • A total of 299 920 patients with ureteric calculi were identified. Of these, 115 200 underwent surgery.
  • Men (odds ratio [OR] = 1.15, P < 0.001) were more likely, while patients from ethnic minorities (OR = 0.84, P = 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, P < 0.001) as were patients aged <65 or >84 years old (P = 0.29).
  • The predominant surgical approach was URS (65.2%), followed by ESWL (33.6%) and UL (1.2%).
  • The use of URS increased over time, while the use of ESWL and UL declined.
  • Women (OR = 1.25, P < 0.001) were more likely to undergo URS. Patients in the South of the USA (OR = 1.51, P < 0.001) and patients from ethnic minorities were more likely to undergo ESWL (OR = 1.23, P = 0.03).

Conclusions

  • The surgical treatment of ureteric calculi changed significantly between 2001 and 2010.
  • The use of URS expanded at the expense of ESWL and UL.
  • 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.