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    • Although most people with urolithiasis are

    2018-10-29

    Although most people with urolithiasis are treated effectively, approximately 40% experience recurrence, with some experiencing relapse up to five times. In Taiwan, the stone recurrence rate is 6.12% for the 1st year, but this rate increases to 34.71% within the first 5 years. Our data show that patients admitted for stone treatment had an average age of 52.1 years and that >70% were men. In addition, peak admission times were in spring and summer, as confirmed by a previous report, and this is presumably due to the rapid loss of body fluid in a hot climate when reduced urine output results in a high urine concentration and easy crystal aggregation. Eisner et al reported that high temperatures increase urinary promethazine hydrochloride of calcium, resulting in calcium oxalate and calcium phosphate supersaturation, thereby increasing the risk of stone formation. More than 70% of the patients studied lived in midnorthern Taiwan; this number is considered to be attributed to multiple factors such as the higher population density, differing Medicare approaches, and the availability of Medicare resources within the various regions. The prevalence of pediatric urolithiasis in Taiwan was 0.047% in 2005, which was much lower than that of adults; the peak age of pediatric stone occurrence was 15–18 years and was most commonly associated with urinary tract infection. However, similar to the occurrence rate of adult urolithiasis, that of pediatric urolithiasis correlates significantly with the urbanization level and geographic area. High stone recurrence rates combined with expensive treatment costs place a similarly significant burden on the health-care system in the United Kingdom, and the management of stone diseases comprises a significant and increasing proportion of urological practice, with implications for workforce planning, training, service delivery, and research in this field. Turney et al reported that the number of hospitalizations related to upper urinary tract stone episodes increased from 63% to 83% in the 10-year period from 2000 to 2010, and that the use of ESWL for upper tract stones increased from 14,491 cases to 22,402 cases (a 55% increase), with a 69% increase in lithotripsy for renal stones in the United Kingdom. However, the use of ESWL is four times higher in Taiwan than in the United Kingdom in 2010, which may be a result of the differing treatment guidelines between these two countries. In the United States in the year 2000, urolithiasis was the cause of nearly 2 million office visits, 600,000 emergency room visits, and >177,000 hospitalizations, totaling more than US $2 billion in annual expenditures. The cost appears to be increasing despite a shift from inpatient to outpatient treatment and the emergence of minimally invasive treatment methods, and this increase is considered to be related to an increase in the prevalence of stone disease. Between 1994 and 2000, the rate of hospitalization for urolithiasis decreased by 15%, the length of stay decreased from 2.6 days to 2.2 days, and outpatient visits increased by 40%; in addition, between 1992 and 2000, physician office visits increased by 43%. However, in 2010 in Taiwan, 40,027 patients were admitted for urolithiasis treatment out of a total population of 23 million, which is proportionately higher than the rate in the United States; this difference may be attributed to either the complexity of the disease or the difference in health-care systems. By 2010 in Taiwan, diagnosis-related group items had not yet included inpatient urolithiasis treatment, and therefore, this would have had no direct effect on the inpatient and outpatient ratio. Nevertheless, since its inclusion, a certain percentage of complex patients may have received inpatient treatment and this would thus have had a direct influence on the ratio of inpatients and outpatients. In 2010, the National Health Insurance coverage rate rose to 99.51%, and the case study of urolithiasis inpatients presented here may reflect the state of the Taiwanese health-care system as a whole. However, limitations still exist as only 1 year of data have been available from our database in Taiwan and a serial comparison is lacking.