LAUSR

Introduction and Objective Both ureteroscopy (URS) and shock wave lithotripsy (SWL) are cornerstones in the surgical management of urolithiasis in the United States. We hypothesized that URS utilization outpaced SWL utilization in recent years and quantified the magnitude of change over time for caseloads of URS and SWL amongst urologists from a national Medicare database. Methods Using the public "Medicare Physician & Other Practitioners" database (https://data.cms.gov), we determined case numbers of SWL (CPT 50590) and URS (CPT 52356 or 52353) from 2012-2019. In a sub-analysis, we identified "high-volume stone urologists" as those in the upper quartile of case numbers for both SWL and URS in baseline years of either 2012 or 2013 and trended their caseload from 2012-2019. Linear estimation models assessed annual rates of change and their statistical significance. Results In 2012 urologists performed 41,135 SWL procedures vs. 21,184 URS. URS overtook SWL in 2017 and by 2019 was the dominant modality (60,063 URS vs 43,635 SWL). Between 2012 - 2019, total URS cases annually increased by 5,700 (15%/year, p <0.001) while the number of SWL cases peaked in 2015 and has since declined on average -1.6%/year (p = 0.020). The number of urologists performing URS steadily rose from 1,147 in 2012 to 2,809 in 2019, reflecting an additional 246 urologists (21%/year) performing URS annually. The caseload of high-volume stone urologists showed similar trends with average URS cases increasing by 2.9/year/urologist (9.8%/year, p <0.001) and average SWL cases declining by 0.9/year/urologist (-1.7%/year, p = 0.023). Conclusions URS utilization has increased dramatically and outpaced SWL utilization from 2012-2019 within the Medicare population. URS was increasingly used by both the general urologist population and high-volume stone urologists while SWL utilization has begun to decline.