Surgical management of urolithiasis in france from 2016 to 2022: epidemiological data from the national PMSI database

The incidence of urolithiasis is rising in France, with a prevalence approaching 10% in the general population. Over the past decades, minimally invasive endourological techniques have profoundly transformed surgical management. Although current guidelines recommend extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL) based on stone and patient characteristics, little is known about their nationwide use. This study aimed to describe recent trends in the surgical management of upper urinary tract stones in France.

Data from the French national hospital discharge database (Programme de Médicalisation des Systèmes d'Information, PMSI) were analyzed from 2016 to 2022. The number of ESWL, URS, and PCNL procedures, their distribution by hospital type (public, private, and university hospitals), length of stay, and patient demographics were assessed.

Between 2016 and 2022, the total number of procedures for upper urinary tract stones increased from 105,264 to 118,098 (+ 12%), including a 37% increase in URS. During the same period, ESWL and PCNL procedures decreased by 36% and 5%, respectively. Procedure volumes increased steadily, except in 2020. The male-to-female ratio was approximately 2:1, except for PCNL, where it was close to 1:1. Patients aged 51-60 years represented the largest group across all techniques. Overall, 75% of ESWL and 70% of URS procedures were performed in private hospitals, whereas 60% of PCNL procedures were carried out in public hospitals, nearly half of them in university hospitals. Mean length of stay decreased by 56% for ESWL, 32% for URS, and 22% for PCNL, with the shortest stays observed in private hospitals.

The number of surgical procedures increased from 105,264 to 118,098 between 2016 and 2022, with a progressive replacement of ESWL by URS and shorter hospital stays. Since 2022, the widespread adoption of new endourological technologies is likely to further reinforce these trends. Future studies that integrate clinical outcomes with medico-economic data are needed to guide healthcare planning.