title: Contemporary Trends in the Ambulatory Surgical Treatment of Urolithiasis: Population-Based Analysis.
abstract: OBJECTIVE
  To describe the utilization of shockwave lithotripsy (SWL) and ureteroscopy (URS) in ambulatory surgery centers, as well as to identify patient-specific factors predictive of one procedure over the other.
  
  
  METHODS
  We evaluated the current trends in the use of SWL and URS in the ambulatory settings over a 5-year period in the state of California using the State of California Office of Statewide Health Planning and Development (OSHPD) database.
  
  
  RESULTS
  We identified 113,447 ambulatory kidney stone surgical procedures including 64,632 SWL (57%) and 48,815 URS (43%) treatments in the OSHPD database between 2005 and 2010. The total annual ambulatory stone surgeries increased from 17,831 cases in 2005 to 18,933 cases in 2010 (P<0.001). Between 2005 and 2010, the use of URS increased significantly from 6978 (39%) cases in 2005 to 9259 (49%) cases in 2010 (P<0.0012), whereas the use of SWL decreased from 10,853 (61%) cases in 2005 to 9674 (51%) cases in 2010 (P=0.0012). In multivariate analysis, age ≥ 75 years (P<0.001), hypertension (P=0.025), and obesity (P<0.001) all increased odds of undergoing URS. In addition, men (P=0.013) and non-Medicaid patients (P<0.001) were more likely to undergo URS.
  
  
  CONCLUSIONS
  The use of URS increased significantly in the state of California among patients undergoing urinary stone surgical procedures in the ambulatory setting, while the use of SWL decreased between 2005 and 2010. Possible explanations for these trends include improved URS stone-free rates, improved cost-effectiveness of URS, and enhanced technology leading to increased use of URS over SWL.
authors: Department of Urology, University of California San Diego Health Care System , San Diego, California.
authors: Omer A
authors: OA
authors: Raheem
authors: Department of Urology, University of California San Diego Health Care System , San Diego, California.
authors: Hossein S
authors: HS
authors: Mirheydar
authors: Department of Urology, University of California San Diego Health Care System , San Diego, California.
authors: Daniel L
authors: DL
authors: Miller
authors: Department of Urology, University of California San Diego Health Care System , San Diego, California.
authors: Kerrin L
authors: KL
authors: Palazzi
authors: Department of Urology, University of California San Diego Health Care System , San Diego, California.
authors: David C
authors: DC
authors: Chang
authors: Department of Urology, University of California San Diego Health Care System , San Diego, California.
authors: Roger L
authors: RL
authors: Sur
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000639:trends*; D002140:California; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy; D008096:Lithotripsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D016896:Treatment Outcome; D014481:United States; D018666:Ureteroscopy / Q000379:methods; D052878:Urolithiasis / Q000601:surgery*