Category: Clinical Stones: Outcomes

MP13-19 - Trends of upper urinary tract stone management in a high volume stone center in Saudi Arabia A twelve years analysis

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective :

Stone disease is a common urological problem worldwide with a significant health and financial burden It is estimated that in Saudi Arabia, the lifetime risk of developing a stone episode is around 50% more than the west. 20% of men would have developed at least 1 stone episode by the age of 60-70 years treatment of urolithiasis changed dramatically over the last 30 years, with the development of more minimally invasive and noninvasive methods such as shockwave lithotripsy ( ESWL) ureteroscopy ( URS )  and percutaneous nephrolithotripsy ( PCNL ), The variety of modalities has led to complex decision making and variation between urologists as to which management option to choose for each different case. Kerbl et al. showed an increase in URS by 53% from 1990 to 1998, while there was a drop in the use of SWL by 15%. Daniel et al. showed similar findings of increased adoption of URS. This may be attributed to better equipment, superior efficiency, and cost-effectiveness. Most of the studies have shown an increase in the use of URS over the years with a declining use of PCNL and ESWL.

Methods :

We have reviewed the charts of patients who underwent upper urinary tract lithotripsy procedures of any kind from the years 2003 to 2015
The information obtained included Patients age, surgeon, procedure type, stone size, stone location and duration of surgery The majority of procedures traced were ureteroscopic lithotripsy extracorporeal shockwave lithotripsy and percutaneous nephrolithotripsy

Results :

ESWL was the predominant approach from the year of 2006 until 2010  In 2006 ESWL accounted for  77 % of the cases 76 percent  in 2007 However  in 2011 the rates dropped to almost 18 %
URS rates have increased from few cases per year to 64 % later on 
The frequency of URS continued to rise through the years until 2015 where URS rates reached 75%
During the 12 years period, URS is the most common upper tract procedure conducted when compared to ESWL and PCNL accounting for 63 % 16 % percent and 20 % respectively 
Analysis of variance was studied,  ESWL was significantly correlated to a time where P value is 0.01. However, there was no significance in both URS and PCNL  with P values of 0.65 and 0.1 respectively 
There was no correlation between stone size or physician experience with procedure selection 

Conclusions :

 in our centre, the frequency of URS has increased over the years is the most predominant procedure done over the past few years 
ESWL  rates have declined

Y Ghazwani

Head of Urology Devision
King Abdulaziz Medical City
Riyadh, Ar Riyad, Saudi Arabia

Urology consultant , endo-urologist and neuro-urologist.
assisstant professor king saud bin abdulaziz university

Rakan Aldarrab

Urology resident
King abdulaziz medical city - riyadh
Riyadh, Ar Riyad, Saudi Arabia

Ibrahim Alshohayeb

Riyadh, Ar Riyad, Saudi Arabia

Abdulmalik Addar

Riyadh, Ar Riyad, Saudi Arabia