title: Urolithiasis Treatment in Australia: The Age of Ureteroscopic Intervention.
abstract: BACKGROUND
  The incidence of urolithiasis is increasing in the Western population. Significant advances in ureteroscopy and stone fragmentation energy sources have resulted in a paradigm shift in urolithiasis management. We aimed to assess the current state of urolithiasis management in Australia over the last 15 years using population-based data.
  
  
  METHODS
  Medicare Australia databases were accessed and Medicare rebate codes pertaining to ureteroscopy, extracorporeal shockwave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL) were extracted per state, year, and gender between 2001 and 2015. Population data were extracted from the Australian Bureau of Statistics website and provided the "population at risk" denominator to calculate incidence proportions.
  
  
  RESULTS
  From January 2001 to December 2015, 114,789 ureteroscopy or pyeloscopy procedures for stone extraction in adult patients were performed in Australia. During the same period, 48,209 SWL and 6956 PCNL procedures were performed. Ureteroscopy and pyeloscopy procedures have been increasing by an average of 9.3% year-on-year, population adjusted, while SWL has decreased by 3.5% and PCNL by 6.4% every year over the same period. In absolute terms, scope procedures have increased yearly by an average of 3.9 per 100,000 of population (confidence interval [95% CI]: 3.2, 4.5), while SWL has changed by -0.77 (95% CI: -0.88, -0.65) and PCNL by -0.16 (95% CI: -0.17, -0.14).
  
  
  CONCLUSIONS
  Over the past 15 years in Australia, the total number of stone treatment procedures has increased significantly. Considerable increases in ureteroscopy were observed with relative and absolute reductions in SWL and PCNL. Regional variations in urolithiasis management strategies highlight the need for consensus on stone treatments within Australia.
authors.affiliation: 1 Department of Surgery, Austin Health, University of Melbourne , Melbourne, Australia .
authors.forename: Marlon
authors.initials: M
authors.lastname: Perera
authors.affiliation: 1 Department of Surgery, Austin Health, University of Melbourne , Melbourne, Australia .
authors.forename: Nathan
authors.initials: N
authors.lastname: Papa
authors.affiliation: 1 Department of Surgery, Austin Health, University of Melbourne , Melbourne, Australia .
authors.forename: Ned
authors.initials: N
authors.lastname: Kinnear
authors.affiliation: 1 Department of Surgery, Austin Health, University of Melbourne , Melbourne, Australia .
authors.forename: David
authors.initials: D
authors.lastname: Wetherell
authors.affiliation: 1 Department of Surgery, Austin Health, University of Melbourne , Melbourne, Australia .|2 Olivia Newton-John Cancer Research Institute , Melbourne, Australia .|3 Department of Surgical Oncology, Peter MacCallum Cancer Centre , Melbourne, Australia .
authors.forename: Nathan
authors.initials: N
authors.lastname: Lawrentschuk
authors.affiliation: 1 Department of Surgery, Austin Health, University of Melbourne , Melbourne, Australia .
authors.forename: David
authors.initials: D
authors.lastname: Webb
authors.affiliation: 1 Department of Surgery, Austin Health, University of Melbourne , Melbourne, Australia .|2 Olivia Newton-John Cancer Research Institute , Melbourne, Australia .
authors.forename: Damien
authors.initials: D
authors.lastname: Bolton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008096:Lithotripsy / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000295:instrumentation* / Q000379:methods*; D052878:Urolithiasis / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult
keywords: extracorporeal shock wave lithotripsy; nephrolithiasis; percutaneous nephrolithotomy; renal stone; ureteroscopy