Pyeloplasty and Ureteral Reconstruction Surgery Trends: A Total Population Analysis in Germany from 2006 to 2022.

BACKGROUND AND OBJECTIVE

With advancement in technology, it has been possible to use minimally invasive surgical approaches for performing pyeloplasty for the treatment of ureteral strictures. This study aims to investigate the current trends of pyeloplasty and reconstructive ureteral procedures.

METHODS

We analyzed the nationwide German hospital billing database (Destatis) from 2006 to 2022. Linear regression models were utilized for the identification of trends over time.

KEY FINDINGS AND LIMITATIONS

A total of 34 975 pyeloplasties and 37 470 cases with ureteral reconstruction procedures were analyzed. The total number of pyeloplasties increased from 1990 procedures in 2006 to 2251 in 2019, before declining again down to 1916 procedures in 2022 ( = 0.783). Open pyeloplasty cases decreased from 79.5% in 2006 to 17.6% in 2022, while those using the robotic approach increased from 0.3% in 2006 to 35.9% in 2022 ( < 0.001). The median length of stay (LOS) for open pyeloplasty decreased from 13 d in 2006 to 8 d in 2022 ( < 0.001). The median LOS for robotic pyeloplasty decreased from 8 d in 2008 to 5 d in 2022 ( < 0.001). In-hospital mortality was 0.15% after open pyeloplasty versus 0.07% for robotic-assisted pyeloplasty versus 0.03 for laparoscopic pyeloplasty ( = 0.009 for comparison of open vs robotic). Reconstructive ureteral surgical cases per year appeared relatively stable, with 1929 cases in 2006 and 2014 cases in 2022 ( = 0.713). A surgical robot was used in 4.5% of all cases with a ureter reconstruction, with inclining shares per year from 0.2% in 2009 and 18.3% in 2022 ( < 0.001).

CONCLUSIONS AND CLINICAL IMPLICATIONS

This study showed an increasing trend toward minimally invasive pyeloplasty in recent years. For reconstructive procedures, the share of robotics was less pronounced. LOS decreased for all procedures and was shortest for the robotic approach.

PATIENT SUMMARY

In this study, current trends of pyeloplasty and reconstructive ureteral procedures in Germany between 2006 and 2022 were investigated. In recent years, minimally invasive pyeloplasty is increasingly being used and length of hospital stay has also decreased.