Trends of surgical interventions for nephrolithiasis over the past decade: a population-based analysis

Background: Nephrolithiasis is common and often requires surgical interventions, which include extracorporeal shockwave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and ureteroscopy (URS). As our understanding of nephrolithiasis has evolved, along with technological advances in surgical management, the preferred methods of treatment have evolved. This study aims to describe population-based trends in SWL, PCNL, and URS over the past decade. Methods: Data were collected on patients aged 18-100 years who received SWL, PCNL, or URS between January 2014 and December 2023 using the TriNetX database. Cohorts were classified by year using Current Procedural Terminology and International Classification of Diseases codes. Basic statistics were conducted utilizing R. Results: A total of 268,628 records were identified. URS procedures accounted for the majority of procedures in 2014 (59.27%), followed by SWL (33.61%) and then PCNL (7.11%). URS procedures rose to encompass 75.77% (+16.50%) of all procedures in 2023, while SWL dropped to 17.06% (-16.55%). PCNL remained consistent at 7.16% (+0.05%). Within URS, the observed sex ratio favored men between 2014 and 2019, but favored females consistently between 2020 and 2023. The sex ratio for SWL skewed towards men each year, while PCNL showed a female predominance. Conclusions: URS is even more frequently utilized to surgically manage nephrolithiasis. PCNL and SWL accounted for a smaller proportion of procedures in 2023 compared to 2014, with notable decreases in SWL. In 2020, the proportion of females receiving URS exceeded males, aligning with recent literature suggesting rising stone incidence in females.