[Evolution of urolithiasis treatment over 30 years in a French academic institution]

Abstract

Objective: To assess the evolution of the annual number of surgical procedures and the surgical management for urolithiasis.

Methods: A retrospective monocentric study was conducted between 1985 and 2014 in a French academic institution. The study population was divided into four groups: extracorporeal shock wave lithotripsy (SWL), flexible and rigid ureteroscopy (URS), percutaneous nephrolithotomy (PCNL) and open surgery. The annual number of surgical procedures as well as the distribution of each technique was determinated by using the operating records.

Results: In all, 23,162 procedures were performed during this period. The annual number of procedures rose from 410 in 1985 to 1071 in 2014, representing a rise of 161%. SWL represented 85.6% (351/410) of all surgeries in 1985 then 21.3% in 2014 (228/1071). In contrast, URS accounted for 4.4% (18/410) of all surgeries in 1985 and rose to 76% (814/1071) in 2014. The number of URS has reached the SWL in 2007 and then became the main surgical treatment. The number of PCNL remained stable during the study period but its proportion decreased due to the increased activity, representing 7.1% (29/410) in 1985 and 2.6% (28/1071) in 2014. Open surgery is rarely practiced and represents currently 0.1%.

Conclusion: The number of surgical procedures for urolithiasis has more than doubled in 30years. SWL represented the main treatment until 2007 and its number decreased whereas ureteroscopy represents now the most common stone treatment in our institution, PCNL remaining stable.

Level of evidence: 5.

Keywords: Calculs; Epidemiology; Extracorporeal shockwave lithotripsy; Lithiase urinaire; Lithotripsie extra-corporelle; Management; Néphrolithotomie percutanée; Percutaneous nephrolithtomy; Stones; Traitement chirurgical; Ureteroscopy; Urolithiasis; Urétéroscopie; Épidémiologie.