No abstract

While the overall SFR following RIRS for renal stones up to 2 cm is generally high, the SFR for 15-20 mm stones is significantly lower, with a longer operating time and hospital stay, and a higher complication rate.

Introduction: We aimed to review the trends and incidence of surgical intervention for adults with upper urinary tract stones in Ontario, Canada, and to hypothesize potential causes for the observed changes. Methods: We carried out a retrospective, population-based cohort study using administrative databases held at the Institute of Clinical Evaluative Sciences (IC/ES) to identify all adults (≥18 years) who underwent surgical treatment for urolithiasis, defined by records using a combination of both hospital and physician billing from 2002–2019. Descriptive statistics were used to summarize baseline patient demographics, and surgical trends were analyzed using the Cochrane-Armitage test for trend. Results: From 2002–2019, 140 263 patients were treated surgically for urolithiasis. During this time period, the total number of surgically treated stone disease increased by 80.5%. By type of procedure, percutaneous nephrolithotomy (PCNL) increased by 187% and ureteroscopy (URS) increased by 158%, while the number of shockwave lithotripsy (SWL) declined by 31.4%. The adult population in Ontario in the years evaluated grew by 24.4%. The number of surgical procedures per 100 000 people over this time grew by 45.3%. For every 1% increase in the population, there was a 2.6% rise in stone-related surgical procedures. Conclusions: The number of stone-related surgical procedures performed rose significantly and cannot be accounted for by population growth alone. This rise was proportionally larger in the female population, further supporting a narrowing of the gender gap in urinary stone disease. The reasons for the increase are likely multifactorial and may imply an increasing incidence of surgically treated stone disease. The change in the proportion of URS and SWL performed may demonstrate a continued shift in surgical preference or may be reflective of resource limitations and availability. The increase in PCNL volumes may also suggest a greater complexity of cases. These findings should be considered for future resource planning and require further study.

Purpose: To reduce the high recurrence rate of nephrolithiasis, patients are routinely prescribed secondary chemoprevention therapy with alkali citrate (Alkasolve Ò ; Sam-On Ltd) for uric acid stones and hypocitraturia or hydrochlorthiazide (Disothiazide Ò ; Dexcel Ltd) for hypercalciuria. However, data on adherence to these regimens are limited. The aim of this study was to assess rates of long-term adherence to alkali citrate and hydrochlorothiazide and reasons for nonadherence. Materials and Methods: Patients on follow-up for kidney stone disease at a dedicated tertiary stone clinic, from 2010 to 2016, were asked to complete a telephone survey on adherence to secondary prevention medications and reasons for nonadherence. Compliance was also verified by actual drug distribution as reported through a computerized monitoring system. Results: The cohort included 356 patients with mean age of 58 years, 199 (64% men, 36% women) treated with alkali citrate and 143 (68% men, 32% women) treated with hydrochlorothiazide. Adherence rates were 42% in the alkali citrate group and 52% in the hydrochlorothiazide group (p = 0.05). The main reason for noncompliance in the alkali citrate group (22%) was the number of pills needed to be taken daily. Adverse drug effects were the most common reason for noncompliance in the hydrochlorothiazide group (24%) and in 10% of the alkali citrate group (p < 0.0005). Adherence was poorer in younger patients who did not regularly take other medications than in older patients with other chronic diseases and polypharmacy. Conclusions: About half the patients with clear metabolic abnormalities who were prescribed secondary chemoprevention with hydrochlorothiazide and alkali citrate failed to adhere to the prescribed regimen. Reasons for noncompliance differed between both drugs. The findings of this study may help clinicians to identify patients at risk for nonadherence and suggests potential means to improve compliance rates.