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• W4293024105 abstract "In the recent article by Jour et al. [1] they perform a comprehensive analysis of Hospital Episode Statistics (HES) data and report on the national trends for the surgical management of urolithiasis in England over the past 5 years. To distil down such a large volume of data is challenging, and we therefore congratulate the authors for providing a clear and easy to understand summary. Not only have they included the results on different patient groups such as children and the elderly, but they have also presented results in the context of changes since the year 2000. This present overview is particularly valuable as it captures changes in the time of the coronavirus disease 2019 (COVID-19) pandemic and the published recommendations from the national Getting It Right First Time (GIRFT) programme. Their findings reveal the annual prevalence of stone disease to have plateaued in recent years (0.12%, estimated lifetime prevalence 12%). While the number of stone episodes has largely remained static, it has risen in those aged >60 years (+9%). The number of ureteroscopy (URS) procedures has risen by 18.9%, which represents >250% rise since the year 2000. In contrast, shockwave lithotripsy (SWL) fell by 4.8% in this final period. Interestingly, this study has captured a key turning point (2017/2018) for SWL, as it had risen by 41% between 2000 and 2015. Percutaneous nephrolithotomy (PCNL) witnessed a fall (−4.8%) in case load too since 2015. Day-case procedures have gone up (+14.7%) and as have emergency procedures (+40%). The results captured provide useful data on where the UK currently stands regarding the endourology landscape. The most pronounced findings are those associated with URS. In this regard, URS seems to have the largest effect of any of the endourological treatments in the provision of day-case surgery, formal stone treatment in the emergency setting and reducing waiting lists. This perhaps comes as no surprise given the constant new advances associated with this particular treatment modality. An inventory check for modern innovations in URS reveals an extensive list. Highlights include thulium fibre laser (TFL), high power holmium systems with pulse modulation and single-use ureteroscopes [2]. Predictive tools and increased awareness surrounding the subjective outcomes for patient care have supported this. All these changes support the goal of a personalised stone approach. Its expansion looks set to continue with many areas under development such as intelligent control systems for intra-renal pressure and temperature regulation, artificial intelligence systems for tracking stone fragments intraoperatively and scopes capable of multi-axis tip deflection [3]. So, while URS is perhaps looking for more space to house this inventory, arguably, its neighbour SWL does not have this same problem. The decline in SWL revealed in this study is mirrored across many nations. Indeed, some have suggested SWL to be facing a future as an ‘endangered species’ [4]. The question remains however, to what lengths are we prepared to go to prevent its possible extinction. For while SWL has not witnessed the technological advances that match those of URS, world literature is not short of studies, which highlight how clinicians can work to maximise the benefits, which can be achieved [5]. We have also been reminded of its benefits during the COVID-19 pandemic [6]. PCNL still remains the reference stone treatment for large stone burdens and miniaturisation among other advances have shown PCNL’s ability to adapt in the modern era [2]. As acknowledged by the authors, there are limitations to be aware of when analysing the HES data. This includes the lack of data capture for procedures performed privately as well as robust clinical coding. However, it is generally accepted that as its primary role was for hospital reimbursement, there has been gradual improvement in engagement and data equality. Endourology is equipped with a range of minimally invasive surgical interventions, which each have their own advantages and disadvantages. At a time of increased financial challenges, an ageing population and pressures related to COVID-19, we are all responsible for reflecting on valuable reports such as this to implement clinical and cost-effective strategies, which take advantage of strengths and provide the best possible care for patients. None declared." @default.
• W4293024105 created "2022-08-25" @default.
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• W4293024105 date "2022-08-23" @default.
• W4293024105 modified "2023-09-26" @default.
• W4293024105 title "Endourology landscape: winners and losers based on a review of <scp>UK</scp> national database" @default.
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• W4293024105 doi "https://doi.org/10.1111/bju.15754" @default.
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