An Empirical Study on the Operative Treatment of Symptomatic Urolithiasis in Germany

Abstract

<b><i>Purpose:</i></b> The guidelines of the German, European, and American Urological Associations on urolithiasis advise against general ureteral stenting before and after an uncomplicated ureterorenoscopy (URS). However, German and European guidelines state that stenting prior to URS facilitates stone extraction and reduces intraoperative complications. According to the published literature, German practice seems to deviate from recommendations. This nationwide survey aimed to evaluate the treatment modalities of urolithiasis. <b><i>Methods:</i></b> In November 2018 and March 2019, a total of 199 urological hospital departments in Germany were anonymously surveyed about operative care of symptomatic urolithiasis. The response rate was 72.9%. The survey consisted of 25 questions about diagnostics, surgical technique, and aftercare of the URS. This questionnaire is available in the appendix. <b><i>Results:</i></b> A primary URS is performed in ≤10% in 49.6% of the hospitals. In every second urological department (49.7%), the German Diagnosis Related Group (G-DRG) system influences the period of pre-stenting before a secondary URS. After a secondary URS, which is performed in 53.8% of the departments in over 80% of the patients, 14% of the departments omit stenting. The standard for stenting seems to be a 28-cm-long 7 Charrière double-J stent in Germany. <b><i>Conclusion:</i></b> In Germany, the percentage of primary URS is low, and a ureter stenting is performed in most of the urological departments after URS. Delaying therapy due to economic aspects is the standard in almost half of all urological departments.

Contemporary treatment trends for upper urinary tract stones in a total population analysis in Germany from 2006 to 2019: will shock wave lithotripsy become extinct?

“…In summary, 87% of urological departments stated that less than 30% of all urinary stones are treated with SWL. 43% of all departments stated that 51–70% of all stone therapy is done via ureterorenoscopy (URS) and further 43% of all departments stated that more than 70% of all cases are managed via URS [ 7 ].…”

Striking a balance: outcomes of short-term Mono-J placement following ureterorenoscopy

“…American, European and German guidelines state that routine stenting after URS and stone removal is not necessary. Despite the downsides of stenting, data from America and Germany indicate that urologists are reluctant to omit stenting [ 7 , 8 ]. This hesitancy might be based on a higher risk of readmission.…”

“…Our research group’s empirical study showed that after primary URS, German urological departments insert a DJ in 79.6% of cases, a Mono-J (MJ) in 7.3% and only 3.6% prefer tubeless procedure. After secondary URS, departments insert a DJ in 62.2% of procedures, a MJ in 10.5% and omit stenting in 14.0% [ 7 ]. Mittakanti published an observational study including 17,129 patients from North America in 2018.…”

A randomized prospective study: assessment of transient ureteral stenting by mono-J insertion after primary URS and stone extraction (FaST 3)

“…A survey among German urological departments showed that after primary URS, 79.6% of urologists inserted a DJ, 7.3% inserted a MJ, and 3.6% omitted a stent. After secondary URS, urologists inserted a DJ in 62.2% of cases, a MJ in 10.5% and did not insert a stent in 14.0% [ 16 ].…”

“…Remarkably, treatment modalities (high rate of pre-stenting) deviate in a highly developed country with a well-equipped health system like Germany, and this could be due to financial incentives and a missing endourological department system [ 16 ].…”