Change of trends in the treatment modality for pediatric nephrolithiasis: Retrospective analysis of a US-based insurance claims database. Journal of endourology Park, H. K., Kim, J. H., Min, G. E., Choi, W. S., Li, S. n., Chung, K. J., Chung, B. I. 2019


The objective of this study was to show the prevalence and investigate treatment trends of pediatric nephrolithiasis based on a large population of US insurance individual's data.This research involved a retrospective observational cohort study. Administrative claims data were extracted from the IBM® MarketScan Research Database. We included all newly diagnosed patients with nephrolithiasis, aged less than 18 years old at the time of diagnosis from January 1, 2007 to December 31, 2014. The patient cohort with nephrolithiasis was selected using the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) code for nephrolithiasis. Each treatment method was searched by Current Procedural Terminology (CPT) code.A total of 28,014 patients were diagnosed with nephrolithiasis in our cohort. Of nephrolithiasis patients, 701 (2.5%) patients were treated by surgical methods. The mean age of patients at the time of treatment was 13 years old. Shockwave lithotripsy (SWL) was the most used treatment modality during the period. SWL was performed in 66% of patients. The case number of SWL did not tend to change according to year, while Retrograde intrarenal surgery (RIRS) tended to increase from 15% to 31%. Percutaneous nephrolithotripsy (PCNL) decreased from 13% to fewer than 10 cases. The number of open surgeries was very small and did not show any tendency.During the study period, SWL is stable. RIRS has become more popular in treating renal stones while PCNL has decreased. These results suggest that the RIRS has become more popular than PCNL in treating large renal stones.

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