From Shocks to Scopes: National Trends in Stone Surgery in Australia

The surgical management of nephrolithiasis in Australia has changed markedly over the past three decades. Extracorporeal shock wave lithotripsy (SWL), once the dominant modality, has been progressively supplanted by advances in ureteroscopy (URS), flexible pyeloscopy and percutaneous nephrolithotomy (PCNL). This study aimed to characterise Australian trends in stone surgery between 1994 and 2024, examining changes in the relative utilisation of SWL, endoscopic, PCNL and non-endoscopic procedures, contextualised against population growth.

Annual national counts were extracted from the Australian MBS between 1994 and 2024 for SWL, URS, flexible pyeloscopy, PCNL, nephro/pyelolithotomy and ureterolithotomy. Descriptive statistics and temporal trend analyses were performed. Australian Bureau of Statistics data were used for population context. Compound annual growth rates (CAGR) described long-term changes. As publicly available, de-identified data were analysed; ethics approval was not required.

A total of 393 415 procedures were performed between 1994 and 2024. Over this period, the Australian population grew by 53%, while stone surgery rates increased 3.5-fold, from 26 to 89 per 100 000. SWL peaked in 2002 and declined by 48%, accounting for 7.4% of all procedures in 2024. URS volumes rose sevenfold, while pyeloscopy rose rapidly from 2001, surpassing SWL by 2009. PCNL volumes remained stable whilst open/laparoscopic lithotomy procedures declined. Total procedures increased at a CAGR of 5.6%, driven primarily by endoscopic modalities.

Australian stone surgery has transitioned decisively from SWL to endoscopic management over the past 30 years, with intervention rates rising well beyond population growth. These trends reflect technological advances and increasing preference for minimally invasive treatment, with significant implications for future workforce planning and resource allocation.