Evolution of approaches in the treatment of urolithiasis. Multicenter analysis of the work of 5 urological departments of multidisciplinary hospitals in Moscow
Authors:   Pirogov Russian National Research Medical University, Kotov S.V. ,   Moscow, Russia, Belomyttsev S.V. ,   Pirogov Russian National Research Medical University; Moscow, Russia, Mamaev I.E. ,   V.M. Buyanov State Clinical Hospital; Moscow, Russia, Perov R.A. ,   S.S. Yudin State Clinical Hospital; Moscow, Russia, Pulbere S.A. ,   N.I. Pirogov City Clinical Hospital № 1; Moscow, Russia, Surenkov D.N. ,   N.E. Bauman City Clinical Hospital; Moscow, Russia
Published: February 2021

Introduction. The history of treatment of urolithiasis has more than three hundred years and all this time represents a dynamic evolution of approaches and methods. Even today, the treatment of urolithiasis is not «static» and is evolving in step with medical technologies. Materials and methods. Retrospectively analyzed 43818 cases of hospitalization of patients with urolithiasis in urological departments of the following city hospitals: City Clinical Hospital No. 1 named after N.I. Pirogov, City Clinical Hospital Named after V.V. Vinogradov, State Clinical Hospital named after V.M. Buyanov, City Clinical Hospital Named after N.E. Bauman, State Clinical Hospital named after S.S. Yudin between January 2012 and December 2019. Results. During the study period, 17,586 (40.2%) patients were hospitalized for planned surgical treatment, and 26,232 (59.8%) were hospitalized in an emergency. There is an increase in the number of patients with urolithiasis. 33272 (76%) patients were treated with ureteral stone and 10546 (24%) with kidney stone. In the planned treatment of patients, the stone was in the kidney in 57.6% of cases and in the ureter in 42.4%. For emergency hospitalization, patients with ureteral stone accounted for 80.5% and only 19.5% of the stone was localized in the kidney. 19568 surgical interventions were performed: ureterolithotripsy (9688 operations), percutaneous nephrolithotomy (3670 operations) and remote shock wave lithotripsy (6210 patients). It should be noted that the ratio of surgical techniques has changed over time in favor of endoscopic methods. There was a decrease in the lenght of stay from 9.1 to 4.9 days. The effectiveness of endoscopic treatment of urolithiasis was 83%. Discussion. During this period, we noted a progressive increase in the number of patients with urolithiasis who applied for inpatient care, the increase was 58%. In 2019, a 28.7% decrease in the number of patients hospitalized with urolithiasis was recorded, which is due to the introduction of more stringent indications for hospitalization of patients. There was an increase in minimally invasive endoscopic methods in the treatment of patients with urolithiasis and a decrease in the number of ESWL, which reflects international trends. The results of the work are comparable with the data of the majority of Russian and foreign authors, which demonstrates a worldwide trend towards an increase in the incidence of urolithiasis and a growing adherence to endoscopic methods of treatment. The overall effectiveness of endoscopic treatment of ICD was 83%. Conclusion. The evolution in approaches to the treatment of urolithiasis today is a reflection of technological progress in the development of endourological tools and is on the way to minimize access and surgical trauma. Routing patients and including surgical methods in the list of high-tech care is also important in treatment approaches. The increase in surgical activity in relation to urolithiasis, combined with a decrease in bed days and postoperative morbidity, makes it justified to take a more aggressive approach to the treatment of patients of this nosological group.