Supplementary Material for: Focus on the Blind Spot of Stone Disease: Analysis of Lower Urinary Tract Stone Interventions from 2006 to 2020 using German nationwide inpatient data.

Introduction To analyze contemporary treatment trends in bladder stone management in Germany over a 15-year period. Methods We analyzed data from the nationwide German hospital billing database from 2006 to 2020. The significance of changes over time was evaluated via linear regression analysis. Results Total case numbers of therapeutic interventions for lower urinary tract calculi increased from 6,770 in 2006 to 9,037 in 2020 (p<0.001). Transurethral cystolithotripsy (TUCL) was the predominant procedure with increasing case numbers from 5,552 in 2006 to 7,699 in 2020 (p<0.001). Also, the share of TUCL increased by 4 % during the study period. TUCL with laser fragmentation was coded in 82 cases in 2006 and in 1,527 cases in 2020 (p<0.001). Case numbers of percutaneous cystolithotripsy (PCCL) also increased over time from 406 to 430 cases (p=0.005), but the share decreased by 20 %. Inpatient shock wave lithotripsy (SWL) is very rarely performed for bladder calculi with an average of 22 cases per year in all hospitals in Germany. Case numbers of open cystolithotomy (OCL) also increased from 614 cases in 2006 to 692 cases in 2020 (p=0.006), but the share decreased by 15.5 %. On average 164 cases of stone removal from neobladders per year were performed, mainly transurethrally (47 %) or via an open approach (21 %). Case numbers of TUCL combined with transurethral resection of the prostate (TUR-P) declined from 1,712 in 2006 to 1,450 in 2020 (p=0.014). However, this might be attributed to the concomitant rise of laser enucleation of the prostate with steadily increasing case numbers in Germany. Conclusion We present contemporary population-based data on bladder stone treatment in Germany. TUCL is the predominant therapeutic modality with increasing case numbers, but open cystolithotomy is still performed frequently. TUR-P is the procedure that is most often combined with TUCL.