Data reveal big changes in PCNL use in U.S.

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Trends in percutaneous nephrolithotomy may reflect other stone treatment trends, study authors say.

New research shows that percutaneous nephrolithotomy procedures in the United States skyrocketed from 1998 to 2011.

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The rapid change “is likely reflective of a changing paradigm in the surgical management of nephrolithiasis and increased stone prevalence, and it possibly represents an increase in the complexity of stone disease,” urologist Mitchell Humphreys, MD, of Mayo Clinic in Phoenix, told Urology Times.

In a study presented at the AUA annual meeting in San Diego, Dr. Humphreys and colleagues sought to understand how surgical advances have affected percutaneous nephrolithotomy. They turned to the Nationwide Inpatient Sample, which tracks about 20% of hospital stays, in search of statistics about the procedure. The sample, however, only includes inpatient visits of 2 or more consecutive nights.

The overall annual rate of percutaneous nephrolithotomy increased from 17 to 31 per million U.S. adults (p<.001), with significant increases among Caucasian (p<.001) and Hispanic patients (p=.03) but not in African-American patients. Both sexes had significant increases in procedure rates: males increased from 17 to 30 per million adults (p<.001), and females increased from 17 to 32 (p<.001).

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Percutaneous nephrolithotomy among patients younger than 18 years was relatively stable (p=.59). “Kids with stones large enough to need percutaneous nephrolithotomy tend to go to specialty pediatric centers, which are probably not captured in the database,” Dr. Humphreys said.

Next: Among patients aged 18 to 64 years, the procedure rate increased from 39 to 70 per million adults

Among patients aged 18 to 64 years, the procedure rate increased from 39 to 70 per million adults (p<.001) and patients older than 65 years had an even larger increase, from 52 to 113 per million (p<.001).

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What is spurring the trend? The increase in percutaneous nephrolithotomy procedures may reflect other trends in treatment. “The number of shock wave lithotripsy procedures has decreased by 4% to 6% per year, and the rate of both ureteroscopy and percutaneous procedures has grown,” Dr. Humphreys said.

These trends may reflect “that the complexity of stone disease being treated requires more definitive treatment,” he said, “and both urologists and patients may be seeking out a higher stone-free rate.”

Another factor appears to be at play, he says: the age of urologists. According to Dr. Humphreys, previous research has suggested that younger urologists who trained recently prefer procedures like ureteroscopy, while older urologists often favor shock wave lithotripsy.

How can these findings be useful? Since stone disease is on the rise and will burden the health system, Dr. Humphreys says, “it is crucial to better understand how stone disease is treated and managed.”

Dr. Humphreys has no disclosures regarding the work in this study. He consults for Auris LLC, Olympus America, and Boston Scientific.