title: Contemporary Trends of Inpatient Surgical Management of Stone Disease: National Analysis in an Economic Growth Scenario.
abstract: OBJECTIVE
  To assess trends in urologic surgical management of upper tract urolithiasis in Brazil over the past 15 years.
  
  
  METHODS
  The Public Health System of Brazil (SUS) provides health coverage to 47% to 74% of the population. SUS has a longitudinal hospital inpatient database (SIH/SUS). Hospital discharges between January 1,1998 and December 31, 2012 were abstracted from the SIH/SUS. All inpatient hospitalizations for patients of any age with a primary/secondary diagnosis code of N20.x (calculus of kidney or ureter) were abstracted (ICD-9/10). All urolithiasis-related procedure codes were analyzed. The absolute number of procedures/year and the proportion among all techniques were analyzed for Brazil and also separately for the five distinguished regions of the country. Prevalence trends over the studied period were quantified by the estimated annual percent change (EAPC) using the least squares linear regression methodology. Significance was set at P<0.05.
  
  
  RESULTS
  The number of surgical interventions for stone disease increased significantly from 10080 to 24713 (+145%; EAPC=1008.1; P<0.001). The most common surgical modalities in 1998 were nephrectomy (n=2918; 29%), ureterolithotomy (n=2361; 23%), and pyelolithotomy (n=1771; 18%). In 2012, ureteroscopy (URS) was the most commonly performed procedure (n=8725; 35%), followed by ureterolithotomy (n=5822; 24%), and nephrectomy (n=3466; 14%). Between 1998 and 2012, percutaneous nephrolithotomy had the highest significant relative increase (+791.8%; EAPC=0.6%; P<0.001), followed by URS (+607%; EAPC=1.78%; P<0.001). Pyelolithotomy showed the most significant decrease (-47.5%; EAPC = -0.91%; P<0.001). All five regions presented a significant positive increase in the EAPC (P<0.001).
  
  
  CONCLUSIONS
  Trends of stone disease surgical management in the public health system of Brazil follow worldwide tendencies toward less invasive treatment modalities.
authors.affiliation: 1 Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School , Sao Paulo, Brazil .
authors.forename: Giovanni Scala
authors.initials: GS
authors.lastname: Marchini
authors.affiliation: 1 Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School , Sao Paulo, Brazil .
authors.forename: Marcos F
authors.initials: MF
authors.lastname: Mello
authors.affiliation: 2 Department of Preventive Medicine, University of Sao Paulo Medical School , Sao Paulo, Brazil .
authors.forename: Renata
authors.initials: R
authors.lastname: Levy
authors.affiliation: 1 Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School , Sao Paulo, Brazil .
authors.forename: Fábio Carvalho
authors.initials: FC
authors.lastname: Vicentini
authors.affiliation: 1 Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School , Sao Paulo, Brazil .
authors.forename: Fábio César Miranda
authors.initials: FC
authors.lastname: Torricelli
authors.affiliation: 2 Department of Preventive Medicine, University of Sao Paulo Medical School , Sao Paulo, Brazil .
authors.forename: José
authors.initials: J
authors.lastname: Eluf-Neto
authors.affiliation: 1 Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School , Sao Paulo, Brazil .
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mazzucchi
authors.affiliation: 1 Section of Endourology, Division of Urology, Hospital das Clínicas, University of Sao Paulo Medical School , Sao Paulo, Brazil .
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D001938:Brazil; D057217:Economic Development; D006801:Humans; D008096:Lithotripsy / Q000639:trends; D009392:Nephrectomy / Q000639:trends; D009403:Nephrostomy, Percutaneous / Q000639:trends; D012044:Regression Analysis; D014513:Ureter / Q000601:surgery; D018666:Ureteroscopy / Q000639:trends; D052878:Urolithiasis / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods / Q000639:trends*