Presentation Authors: Akinori Takei*, Shinichi Sakamoto, Yasutaka Yamada, Masahiro Sugiura, Yoshiyasu Amiya, Makoto Sasaki, Takayuki Shima, Noriyuki Suzuki, Jun Shimazaki, Tomohiko Ichikawa, Hiroomi Nakatsu, Chiba, Japan
Introduction: In the treatment of urolithiasis, ESWL, URS or PNL were selected based on the location and type of stone. In the Japanese nationwide survey of urolithiasis in 2015, there was a significant increase in the number of URS, while a significant decrease in the number of ESWL. Here we study the 10 years trends of surgical approach in the upper urinary tract stones at a single high volume center. The current result may represent the real world trends of upper urinary tract stones in Japan.
Methods: Total of 4829 patients from 2007 to 2017 received ESWL, URS and PNL were retrospectively analyzed. Treatment selection and surgical outcome were statistically studied.
Results: There was a consistent decrease in the number of operation from 515 cases in 2007 to 229 cases in 2017. The number of ESWL increased up to 410 cases in 2009, however, reduced subsequently to 46 in 2017. In contrary, the number of URS was 111 cases in 2007, however, increased to 269 cases in 2017. The highest number of treatment modality was taken over from ESWL to URS in 2012 and consistent thereafter with the ratio of 1: 5 in 2017. In the case of PNL, there was a decent increase in the number of operation from 10 cases in 2007 to 23 cases in 2017. The mean number of ESWL in each stone significantly decreased from 2.1 in 2009 to 1.1 in 2017, while the mean number of URS slightly increase from 1.1 in 2007 to 1.4 in 2017. The overall number of operation reduced from 515 to 338 between 2007 to 2017. Furthermore, the overall number of outpatients, inpatients, and the number of hospitalization of each patient decreased from 4568 to 3385, 562 to 397, and 1.6 to 1.3, respectively in the last 10 years.
Conclusions: We observed a significant shift from ESWL to URS in the trends of treatment modalities of the upper urinary tract stones in the past 10 years. The remarkable reduction in the number of ESWL, along with the number of inpatients, and outpatients, may represent an optimal adaptation of the treatment modalities of upper urinary tract stones in Japan.