J Korean Med Sci.  2016 Dec;31(12):1989-1995. 10.3346/jkms.2016.31.12.1989.

National Practice Pattern and Time Trends in Treatment of Upper Urinary Tract Calculi in Korea: a Nationwide Population-Based Study

• Park J
• Suh B
• Lee MS
• Woo SH
• Shin DW

• KMID: 2355630
• DOI: http://doi.org/10.3346/jkms.2016.31.12.1989

Abstract

Despite high prevalence of upper urinary tract calculi (UUTC), there are few studies regarding patterns of care in Asian populations. We investigated treatment patterns and time trends in patients with newly diagnosed UUTC in Korea using the National Health Insurance database that includes de-identified claims from a random 2% sample of the entire population (> 1 million people). A total of 14,282 patients who received active treatments, including shock wave lithotripsy (SWL), ureteroscopic surgery (URS), percutaneous nephrolithotomy (PNL), and uretero/pyelolithotomy (UPL), for newly diagnosed UUTC between 2003 and 2013 were included. The number of primary and all treated cases of UUTC significantly (43% and 103.3%, respectively) increased over the 10-year period. While patients undergoing SWL, URS, PNL, and UPL as primary treatment increased by 43.7%, 31.9%, 87.5%, and 0%, respectively, the relative proportion undergoing each treatment remained constant over the 10 years (SWL > 90%, URS 4.5% to 7.8%, PNL 0.4% to 1.0%, and UPL < 0.4%, respectively). Multinomial logistic regression analysis showed that age > 40 years (compared to age < 30 years) was significantly associated with URS, PNL, and UPL, rather than SWL, while patients living in urban or suburban/rural areas (compared to metropolitan) were significantly less likely to undergo URS and PNL. In summary, the majority of Korean patients underwent SWL as primary treatment for UUTC, and the predominant use of SWL remained steady over a 10-year period in Korea. Our results will be valuable in examining treatment patterns and time trends in Korean UUTC patients.

Keyword

Urinary Calculi; Clinical Practice Pattern; Lithotripsy; Ureteroscopic Surgery

MeSH Terms

Asian Continental Ancestry Group
Calculi*
Humans
Korea*
Lithotripsy
Logistic Models
National Health Programs
Nephrostomy, Percutaneous
Practice Patterns, Physicians'
Prevalence
Shock
Ureteroscopy
Urinary Calculi
Urinary Tract*

Figure

• 

  Fig. 1 Time trends of upper urinary tract calculi in Korea’s primary treatment (A) and all treatment cases (B) for Time trends for the relative proportions of primary treatments (C) and all treatment cases (D) are also shown. SWL = shock wave lithotripsy, URS = ureteroscopic surgery, PNL = percutaneous nephrolithotomy, UPL = uretero/pyelolithotomy.

• 

  Fig. 2 Recurrence-free survival curves after primary treatment in entire cohort (A) and according to each treatment modality (B) for upper urinary tract calculi in Korea. SWL = shock wave lithotripsy, URS = ureteroscopic surgery, PNL = percutaneous nephrolithotomy, UPL = uretero/pyelolithotomy.

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