UP-74 Trends in the Surgical Management of Adult Urolithiasis in Ontario, Canada: A Population-Based Retrospective Cohort Study
Thursday June 27, 2019 from

Dor Golomb, Canada



Schulich School of Medicine and Dentistry


Trends in the surgical management of adult urolithiasis in Ontario, Canada: A population-based retrospective cohort study

Dor Golomb1, Andrew McClure2, Sumit Dave1, Jennifer Bjazevic1, Brendan B. Wallace1, Hassan Razvi1.

1Division of Urology, Schulich School of Medicine and Dentistry, London, ON, Canada; 2Epidemiology and Biostatistics, Western University, London, ON, Canada

Introduction: The incidence of urinary stone disease is increasing. The aim of this review was to document the trends and incidence of surgical intervention for adults with upper urinary tract stones in Ontario, Canada.

Methods: We carried out a retrospective, population-based cohort study utilizing administrative databases held at the Institute of Clinical Evaluative Sciences to identify all adults (>18 years) who underwent their first surgical treatment for urolithiasis as recorded in the Canadian Institute for Health Information, Discharge Abstract Database or via physician billing information using the Ontario Health Insurance Plan database from 2002-2018. During this period, we assessed the incidence of surgically treated urolithiasis, age and gender distribution and modality of surgical treatment. Descriptive statistics were used to summarize patient demographics and surgical trends were analyzed using the Cochrane-Armitage test for trend.

Results: Between 2002-2018, 140,263 patients were treated surgically for urolithiasis in Ontario. The median ages were 57(IQR 21), 55(IQR 25) and 52(IQR 20) for percutaneous nephrolithotomy (PCNL), ureteroscopy and shock wave lithotripsies (SWL) respectively. The number of stone-related surgical procedures increased from 5,946 cases in 2002 to 10,732 cases in 2018. By type of procedure, PCNL increased by 35%, ureteroscopy increased by 38.6%, while SWL declined by  68%. While the adult population increased by 24.8%, the increase in procedures exceeded what would be expected based on population growth alone, with 0.07% of patients in 2002 requiring intervention vs 0.1% in 2018.  

Conclusions: The total number of surgical procedures performed for upper urinary tract stones rose significantly and cannot be accounted for by population growth alone. The reasons for the increase in procedures are likely multifactorial and may imply an increasing incidence of stone disease. These findings may have future resource planning implications.


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