JSUR Journal

Introduction

Urolithiasis affects a substantial proportion of the population (10%) and remains a major cause of emergency urologic admissions (12%). Urinary stone incidence seems to have increased in the last 20 years ; however, 50% of patients with urinary tract stones will have only one episode during their lifetime, and approximately 10% will present frequent recurrences [1-4]. A link between urinary tract stones and chronic kidney disease is becoming increasingly evident [5]. Quality of life is affected by renal colic episodes and other symptoms, but also by the number of interventions, ureteral stenting duration, and visits to the emergency department [6]. Over the last decade, and owing to its stone-free rates reaching up to 90% [7,8], its minimally invasive nature and the thriving technical improvements of endourological instrumentaiton (LASERs, baskets, access sheathes, vision quality, miniaturization, suction, …), Flexible Retrograde Ureteroscopy (FURS) is seeing a steady increase in its clinical indications in the treatment of renal stones to the detriment of other techniques (ESWL, PCNL) [9] and despite a primary higher cost [10,11] that could be nevertheless balanced by its cost effectiveness [12]. France’s national ScanSanté database offers a unique opportunity to assess real-world practice at a population level [13]. This study analyzes 10 years of national data to assess trends in treatment techniques and their potential impact on acute presentations such as nephritic colic.

Materials and Methods

Study Design: This is a retrospective, descriptive study using national Open Data from ScanSanté (Ministry of Health) https://www. scansante.fr/applications/statistiques-par-groupes-diagnostique-actes [13]. The total of interventions for urinary stones performed in France between January 1, 2014, and December 31, 2023, were collected and analyzed, using procedural codes (Classification Commune Des Actes Médicaux (CCAM)) for Ureteroscopy, Extracorporeal Shock Wave Lithotripsy (ESWL), Percutaneous Nephrolithotomy (PCNL), renal colic (Table 1).

Table 1: Codes according to the urologic procedures (“–” indicates data not specified, Imaging modalities are listed where applicable.)

Outcomes

Primary: Evolution in the use of each procedure type from 2014 to 2023 in France.

Secondary: Correlation between annual renal colic admissions and intervention rates.

Statistical Analysis

Descriptive statistics were conducted by a biostatistician, in accordance with the nature of the variables. Quantitative variables were described using frequencies, means, standard deviations, confidence intervals for the means, medians, minimum and maximum values, and interquartile ranges. They may also be presented in categorized formats (e.g., age groups) and described as qualitative variables based on quartiles, medians, or established clinical thresholds. Qualitative variables were described using frequencies, proportions, and, where appropriate, confidence intervals for the proportions calculated using Wilson’s method. The association between renal colic and ureteroscopies was assessed using Spearman’s rank correlation coefficient with a 95% confidence interval, as the rates of ureteroscopies and renal colic do not follow a normal distribution. SAS for Windows has been used for analysis (v 9.4; SAS Institute Inc).

Results

From January 2014 to December 2023, a total of 1,056,030 interventional procedures for urinary stones have been declared with 611,693 renal interventions (FURS 58,96%, ESWL 39,1%, PCNL 1,94%), 444,337 ureteral interventions (ureteroscopy 89,81%, ESWL 10,19%) and 360,406 renal colic that required institutional care (Figure 1).

Figure 1: Distribution of procedures from jan 2014 to dec 2023; A: ureteroscopy and FURS; B: ESWL; C: PCNL.

Renal Stones Procedures Over Time

The total of FURS increased from 21,374 in 2014 to 51,003 in 2023 (+139%), as ESWL declined from 31,325 in 2014 to 17,919 in 2023 (-43%), especially concerning the radioguided technique and PCNL remained stable, representing 1,94% of renal procedures throughout the decade (Table 2, Figures 2,3).

Note: Each column represents procedure counts per year, split by anatomical location and imaging modality where applicable.

Table 2: Annual volumes of renal interventions (jan 2014– dec 2023).

Figure 2: Distribution of renal procedures over time; A: FURS; B: ESWL; C: PCNL.

Figure 3: Distribution of ESWL over time; A: Xray guidance; B: Ultrasound guidance

Ureteral stones procedures over time

The volume of ureteroscopies rose from 36,743 (jan 2014) to 43,328 (dec 2023), and lumbar location was the most common (42–51%) (Table 3).

Note: The table details ureteral stone management by ureteroscopy (categorized by location and antegrade approach) and ESWL (by imaging modality).

Table 3: Annual volumes of ureteral interventions (jan 2014– dec 2023).

Renal Colic Events Over Time (Table 4)

The total of renal colic that required institutional care declined from 38,403 in jan 2014 to 33,647 in dec 2023 (−12.4%) with a strong inverse association with Spearman correlation (colics vs ureteroscopies): ρ = −0.903, 95% CI [−0.975; −0.603].