J Korean Med Sci.  2020 Sep;35(38):e315. 10.3346/jkms.2020.35.e315.

Recent Trends in Transurethral Surgeries and Urological Outpatient Procedures: a Nationwide Populationbased Cohort Study

• Kim JK
• Choi C
• Kim US
• Kwon H
• Lee SH
• Lee YG
• Han JH

• KMID: 2507080
• DOI: http://doi.org/10.3346/jkms.2020.35.e315

Abstract

Background
Demographic change and advances in technology affect transurethral surgery and outpatient procedures in the urologic field. There are few population-based studies that accurately assess the trend of transurethral surgery and outpatient procedures including diagnostic tests. We investigated the recent epidemiologic trends in transurethral surgeries and urological outpatient procedures from 2009 to 2016 in Korea using the entire populationbased cohort.
Methods
We analyzed medical service claim data of transurethral surgery, urological outpatient procedures submitted by medical service providers from the Health Insurance Review and Assessment Service from 2009 to 2016.
Results
Transurethral ureter surgery increased by 134.9% from 14,635 in 2009 to 34,382 in 2016 (B = 2,698; R ² = 0.98; P < 0.001). The transurethral bladder surgery increased by 65.5% from 12,482 in 2009 to 20,658 in 2016 (B = 1,149; R ² = 0.97; P < 0.001). Over the 8-years period, there were not significant changes in transurethral prostate (B = 43; R ² = 0.04; P = 0.617) and urethral surgery (B = −12; R ² = 0.18; P = 0.289). The significantly increasing trends in cystoscopy (B = 5,260; R ² = 0.95; P < 0.001) and uroflowmetry (B = 53,942; R² = 0.99; P < 0.001) were observed during the 8-year period. There was no difference in bladder catheterization during the 8-year period. Urodynamic study (UDS: B = −2,156; R ² = 0.77; P = 0.003) and electrical stimulation treatment (EST: B = −1,034; R ²= 0.87; P < 0.001) significantly decreased.
Conclusion
In Korea, transurethral ureter surgery and transurethral bladder surgery have been continuously increasing. Transurethral prostate surgery and transurethral urethral surgery remained constant with no increase or decrease. Cystoscopy and uroflowmetry continue to increase, while UDS and EST continue to decrease.

Keyword

Lower Urinary Tract Symptoms; Urologic Surgical Procedure; Diagnostic Techniques and Procedures; Insurance; Health

Figure

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  Fig. 1 Transurethral surgery from 2009 to 2016 in a Korean population. Transurethral ureter surgery increased by 134.9% from 14,635 in 2009 to 34,382 in 2016 (B = 2,698; R2 = 0.98; P < 0.001). The transurethral bladder surgery increased by 65.5% from 12,482 in 2009 to 20,658 in 2016 (B = 1,149; R2 = 0.97; P < 0.001). Over the 8-year period, there were not significant changes in transurethral prostate (B = 43; R2 = 0.04; P = 0.617) and urethral surgery (B = −12; R2 = 0.18; P = 0.289).

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  Fig. 2 Transurethral ureter surgery from 2009 to 2016 in a Korean population. The increase in ureteral stent insertion (B = 1,225; R2 = 0.97; P < 0.001) and ureteroscopic lithotripsy (B = 870; R2 = 0.99; P < 0.001) was remarkable, and the increase in flexible ureterorenoscopic lithotripsy had been observed since 2015 (B = 425; R2 = 0.76; P = 0.005).

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  Fig. 3 Transurethral bladder surgery from 2009 to 2016 in a Korean population. The number of claims continued to increase in all transurethral bladder surgeries, with transurethral resection of bladder tumor increasing most rapidly over the 8-year period (B = 713; R2 = 0.98; P < 0.001).

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  Fig. 4 Transurethral prostate surgery from 2009 to 2016 in a Korean population. There are significant decreases in thermal therapy (B = −185; R2 = 0.89; P < 0.001), and open prostatectomy (B = −31; R2 = 0.91; P < 0.001) during the 8-year period. Transurethral resection of the prostate was the most commonly performed surgery for transurethral prostate surgery, but there was no significant change during the 8-year period (B = −42; R2 = 0.13; P = 0.384). The number of photoselective vaporization of the prostate showed a significant decrease from 3991 in 2009 to 723 in 2016 (B = −456; R2 = 0.97; P < 0.001). On the other hand, the number of Holmium laser enucleation of the prostate increased, and it had been conducted more than photoselective vaporization of the prostate after 2012 (B = 540; R2 = 0.90; P < 0.001).

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