Modern stone management: Prevalence and practice patterns for treatment of upper tract calculi

Upper tract nephrolithiasis is a common surgical condition and is treated with multiple surgical techniques including shock wave lithotripsy (SWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL). As more treatment modalities become available for treatment of upper tract calculi, there is a corollary increase in the complexity of decision-making in the management of these stones. Urologists are often faced with surgical scenarios in which several different treatment modalities may be acceptable and several studies have confirmed there is considerable variation in the practice patterns of urologists today. In the following chapter we describe the current literature and focus in detail on contemporary studies utilizing various study databases including the Medicare claims database, American Board of Urology case logs, and various administrative and surgical outcomes databases to provide a better understanding of current practice patterns of urologist globally. Overall, in the last decade, clinicians have exhibited a dramatic adoption of endoscopic techniques with a significant rise in the use of ureteroscopy and decline in the use of SWL. The treatment of upper tract calculi remains an evolving field and provider-specific attributes continue to affect how these stones are treated.