Login to Access Video or Poster Abstract: MP95-20
Sources of Funding: none

Introduction

In the era of minimally-invasive surgery, endoscopic and percutaneous interventions for urinary tract stones have become a mainstay. As such, the need for open stone removing procedures has decreased. We sought to determine the contemporary incidence of open stone surgery among urologists in the United States.

Methods

Case logs submitted for certification and recertification to the American Board of Urology from 2005-2015 were queried for Current Procedural Terminology codes relevant to open stone-related procedures (50060, 50065, 50070, 50075). Cases were then analyzed for the associated practice type, practice area population, geographic region, provider subspecialty, and certifying or recertifying status of the reporting urologist.

Results

334 cases of open stone surgery were identified with the majority (245/334; 73.4%) performed by urologists self-identified as generalists. The most common subspecialtists performing open stone surgery were endourologists (41/334; 12.3%). Most cases were done in the private practice setting (255/317; 80.4%) and in practice areas with populations exceeding 1,000,000 people (126/292; 43.2%). Open stone removal was more commonly reported by urologists applying for recertification (55%) than initial certification (45%). On average, 30 open stone cases were reported each year during the study period. Open stone removal was most commonly performed in the Western Section of the American Urological Association (AUA) (84/334; 25.1%) and least commonly performed in the Northeastern Section (5/334; 1.5%). A Chi-square analysis was performed comparing the number of open stone surgeries performed in each AUA section versus the number expected based on current AUA sectional membership data. The Western Section not only had the highest number of open stone cases reported, but it had a significantly higher number than expected as its urologists represent only 17% of the total AUA membership (p<0.01). The Northeastern section comprises 7% of the total AUA membership but only performed 1.5% of open stone cases which was significantly lower than anticipated (p<0.001).

Conclusions

Open stone surgery is still performed in the United States, typically by private practice general urologists. Open stone removal is more likely to be reported from the Western Section and in practice areas of the highest population density. This data may prove useful in determining the need and optimal location for future courses highlighting minimally-invasive stone removing strategies.

Funding

none