Skip to main content

Hospital volume in ureterorenoscopic stone treatment: 99 operations per year could increase the chance of a better outcome—results of the German prospective multicentre BUSTER project

Summary

Background

Despite the high utilisation of ureterorenoscopy (URS) in interventional stone treatment, there is little evidence of any link between annual hospital volume and outcome.

Methods

From January to April 2015, data from 307 URS patients were prospectively recorded in the multicentre observational BUSTER-Trial (Benchmarks of ureterorenoscopic stone treatment-results in terms of complications, quality of life, and stone-free rates). The best threshold value for annual hospital volume with an independent effect on the outcome (measured on stone-free and complication rates) of our study group was established with logistic regression.

Results

In 38.4% of cases of renal and 61.6% of ureteral stones, median stone size was 6 mm with an interquartile range (IQR) of 4–8 mm. The annual URS rate in the 14 participating hospitals ranged from 77 to 333 (median 144; IQR 109–208). The binary endpoint as a combination of completely stone-free or residual fragments small enough to pass spontaneously and a maximum complication severity of Clavien–Dindo grade 1 was attained in 234/252 (92.9%) cases with a hospital volume of ≥ 99 URS compared with 43/55 (78.2%) in < 99 URS (p = 0.002). Adjusted for patient-, stone- and physician-related factors, an annual hospital URS volume of ≥ 99 increases the chance of an optimum outcome (OR = 3.92; 95% CI 1.46–10.51; p = 0.007).

Conclusions

An independent effect of URS hospital volume on outcome quality in the 14 participating hospitals was demonstrated. Threshold values for annual case numbers should be scientifically established irrespective of the considered procedure.

This is a preview of subscription content, access via your institution.

References

  1. Osther PJS (2012) Epidemiology of kidney stones in the European Union. In: Talati JJ, Tiselius H-G, Albala DM, Ye Z (eds) Urolithiasis: basic science and clinical practice. Springer, London, pp 3–12. https://doi.org/10.1007/978-1-4471-4387-1_1

    Chapter  Google Scholar 

  2. Raheem OA, Khandwala YS, Sur RL, Ghani KR, Denstedt JD (2017) Burden of urolithiasis: trends in prevalence, treatments, and costs. Eur Urol Focus 3(1):18–26. https://doi.org/10.1016/j.euf.2017.04.001

    Article  PubMed  Google Scholar 

  3. Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y (2017) Epidemiology of stone disease across the world. World J Urol 35(9):1301–1320. https://doi.org/10.1007/s00345-017-2008-6

    Article  PubMed  Google Scholar 

  4. Geraghty RM, Jones P, Somani BK (2017) Worldwide trends of urinary stone disease treatment over the last two decades: a systematic review. J Endourol 31(6):547–556. https://doi.org/10.1089/end.2016.0895

    Article  PubMed  Google Scholar 

  5. Couapel JP, Bensalah K, Bernhard JC, Pignot G, Zini L, Lang H, Rigaud J, Salomon L, Bellec L, Soulie M, Vaessen C, Roupret M, Jung JL, Mourey E, Bigot P, Bruyere F, Berger J, Ansieau JP, Gimel P, Salome F, Hubert J, Pfister C, Baumert H, Timsit MO, Mejean A, Patard JJ (2014) Is there a volume-outcome relationship for partial nephrectomy? World J Urol 32(5):1323–1329. https://doi.org/10.1007/s00345-013-1213-1

    Article  PubMed  Google Scholar 

  6. Groeben C, Koch R, Baunacke M, Wirth MP, Huber J (2017) High volume is the key for improving in-hospital outcomes after radical prostatectomy: a total population analysis in Germany from 2006 to 2013. World J Urol 35(7):1045–1053. https://doi.org/10.1007/s00345-016-1982-4

    Article  PubMed  Google Scholar 

  7. Porter MP, Gore JL, Wright JL (2011) Hospital volume and 90-day mortality risk after radical cystectomy: a population-based cohort study. World J Urol 29(1):73–77. https://doi.org/10.1007/s00345-010-0626-3

    Article  PubMed  Google Scholar 

  8. NCBI_NLM_NIH Pubmed_1. https://www.ncbi.nlm.nih.gov/pubmed/?term=(((((caseload%5BTitle%2FAbstract%5D)+OR+case+volume%5BTitle%2FAbstract%5D)+OR+hospital+volume%5BTitle%2FAbstract%5D)+OR+surgeons+volume%5BTitle%2FAbstract%5D))+AND+(((urs%5BTitle%2FAbstract%5D)+OR+rirs%5BTitle%2FAbstract%5D)+OR+ureteroscopy%5BTitle%2FAbstract%5D). Accessed 07 Jan 2018

  9. NCBI_NLM_NIH Pubmed_2. https://www.ncbi.nlm.nih.gov/pubmed/?term=(((low-volume%5BTitle%2FAbstract%5D)+OR+high-volume%5BTitle%2FAbstract%5D))+AND+(((ureteroscopy%5BTitle%2FAbstract%5D)+OR+urs%5BTitle%2FAbstract%5D)+OR+rirs%5BTitle%2FAbstract%5D). Accessed 07 Jan 2018

  10. Kandasami SV, Mamoulakis C, El-Nahas AR, Averch T, Tuncay OL, Rawandale-Patil A, Cormio L, de la Rosette JJ (2014) Impact of case volume on outcomes of ureteroscopy for ureteral stones: the clinical research office of the endourological society ureteroscopy global study. Eur Urol 66(6):1046–1051. https://doi.org/10.1016/j.eururo.2014.06.054

    Article  PubMed  Google Scholar 

  11. Rob S, Jones P, Pietropaolo A, Griffin S, Somani BK (2017) Ureteroscopy for stone disease in paediatric population is safe and effective in medium-volume and high-volume centres: evidence from a systematic review. Curr Urol Rep 18(12):92. https://doi.org/10.1007/s11934-017-0742-3

    Article  PubMed  PubMed Central  Google Scholar 

  12. Scales CD Jr, Saigal CS, Hanley JM, Dick AW, Setodji CM, Litwin MS (2014) The impact of unplanned postprocedure visits in the management of patients with urinary stones. Surgery 155(5):769–775. https://doi.org/10.1016/j.surg.2013.12.013

    Article  PubMed  Google Scholar 

  13. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  14. DRKS. http://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00007668. Accessed 19 Mar 2018

  15. ICTRP. http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00007668. Accessed 19 Mar 2018

  16. Knoll T, Bach T, Humke U, Neisius A, Stein R, Schonthaler M, Wendt-Nordahl G (2016) S2 k guidelines on diagnostics, therapy and metaphylaxis of urolithiasis (AWMF 043/025): compendium. Urologe A 55(7):904–922. https://doi.org/10.1007/s00120-016-0133-2

    Article  CAS  PubMed  Google Scholar 

  17. Canvasser N, Lay A, Kolitz E, Antonelli J, Pearle M (2017) MP75-12 prospective evaluation of stone free rate by computed tomography after aggressive ureteroscopy. J Urol 197(4):e1007–e1008. https://doi.org/10.1016/j.juro.2017.02.2160

    Article  Google Scholar 

  18. Sinha RK, Mukherjee S, Jindal T, Sharma PK, Saha B, Mitra N, Kumar J, Mukhopadhyay C, Ghosh N, Kamal MR, Mandal SN, Karmakar D (2015) Evaluation of stone-free rate using Guy’s Stone Score and assessment of complications using modified Clavien grading system for percutaneous nephro-lithotomy. Urolithiasis 43(4):349–353. https://doi.org/10.1007/s00240-015-0769-1

    Article  PubMed  Google Scholar 

  19. Lebentrau S, May M, Ziegler H, Werthemann P, Enzmann T, Schostak M, Porsch M, Studiengruppe B (2018) The recommendations of the S2 k guideline for the diagnosis, therapy and metaphylaxis of urolithiasis provide a safe course of action for ureterorenoscopic stone treatment—results of the BUSTER study. Aktuelle Urol 49(2):164–170. https://doi.org/10.1055/s-0043-116859

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Our special thanks to Anne Pohrt and Pablo Pirnay-Dummer for the patient discussion of statistical questions.

Members of the BUSTER study group, Andreas Baars, Ulf Balsmeyer, Maximilian Burger, Matthias Claas de Boer, Gerhard Danzer, Thorsten Ecke, Thomas Enzmann, Dirk Fahlenkamp, Sebastian Filter, Hans Martin Fritsche, Christian Gilfrich, Steffen Hallmann, Joachim Hebert, Bernd Hoschke, Toni Huber, Steffen Lebentrau, Mike Lehsnau, Matthias May, Arkadiusz Miernik, Philippe Fabian Müller, Julia Peter, Markus Porsch, Soeren Promnitz, Markus Rodat, Wolfgang Schmidt, Frank Schoeneich, Martin Schoenthaler, Martin Schostak, Steffen Weikert, Peter Werthemann, Ingmar Wolff, Heiko Ziegler.

Author information

Authors and Affiliations

Authors

Consortia

Contributions

SL protocol/project development, data management, data analysis, manuscript writing. TE protocol/project development and data collection. ML data collection and manuscript editing. FC data management and manuscript writing. MS protocol/project development and manuscript editing. MM Data analysis and manuscript writing

Corresponding author

Correspondence to Steffen Lebentrau.

Ethics declarations

Conflicts of interest

None of the contributing authors have any conflict of interest, including specific financial interests or relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.

Ethical standards

We affirm that all authors have complied with the principles of the World Journal of Urology regarding ethical responsibilities of authors and compliance with ethical standards.

Additional information

The members of the BUSTER study group are listed in acknowledgements section.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lebentrau, S., Enzmann, T., Lehsnau, M. et al. Hospital volume in ureterorenoscopic stone treatment: 99 operations per year could increase the chance of a better outcome—results of the German prospective multicentre BUSTER project. World J Urol 37, 743–749 (2019). https://doi.org/10.1007/s00345-018-2431-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-018-2431-3

Keywords

  • Urolithiasis
  • Ureterorenoscopy
  • Hospital volume
  • Annual caseload
  • Cut-off
  • Threshold