Urolithiasis

Urolithiasis Jamsheer J. Talati • Hans-Göran Tiselius David M. Albala • Zhangqun Ye Editors Farhat Abbas • M. Hammad Ather Syed Raziuddin Biyabani • Mahesh Desai Tyler Luthringer • Amanullah Memon Kemal Sarica • Ahmed A. Shokeir Khurram M. Siddiqui Associate Editors Urolithiasis Basic Science and Clinical Practice Editors Jamsheer J. Talati, MBBS, FRCS Hans-Göran Tiselius, MD, PhD Professor Emeritus Professor Emeritus Aga Khan University Division of Urology Department of Surgery Department of Clinical Science Section of Urology Intervention and Technology Karachi , Pakistan Karolinska Institutet Stockholm , Sweden David M. Albala, MD Associated Medical Professionals Zhangqun Ye, MD, PhD Syracuse Urology Division New York , USA Tongji Hospital Tongji Medical College, Shanghai, China. Huazhong University of Science and Technology Wuhan, Hubei, China ISBN 978-1-4471-4383-3 ISBN 978-1-4471-4387-1 (eBook) DOI 10.1007/978-1-4471-4387-1 Springer London Heidelberg New York Dordrecht Library of Congress Control Number: 2012954241 © Springer-Verlag London 2012 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro fi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) This book is dedicated to our wives and families to whom we are indebted for their understanding during the preparation of the book… And to the urological residents, young consultants, faculty, and stone patients of our entire, rapidly evolving world. Jamsheer Jehangir Talati Hans-Göran Tiselius David Mois Albala Zhangqun Ye Foreword The World Health Report of 2010, the biennial fl agship publication of the World Health Organization, was devoted to the link between the way health systems are fi nanced and their ability to move closer to the goal of universal coverage [1]. Universal coverage requires all people to have access to quality health services (prevention, promotion, treatment and rehabilitation) when they need them without the risk of incurring severe fi nancial problems linked to paying for care [2, 3]. It is an ambitious goal. Three inter-related actions to help countries move closer to this goal can be taken in the area of health fi nancing. Countries could raise additional funds for health. They could reduce fi nancial barriers to accessing health services associated with direct out of pocket payments such as user-fees through forms of prepayment with subsequent pooling of resources to spread the fi nancial risks of ill health. They could use the resources they raise as ef fi ciently and equi- tably as possible. Many countries, rich and poor, have taken steps in one or more of these areas and the World Health Report showed that all countries could take steps to move more rapidly towards the goal of universal coverage. Clearly the pace at which they can do this varies by country and the resource constraints are particularly severe in low-income countries where the health needs are greatest. Recent work suggests that the low income countries would need immediately an average of US $44 per capita to spend on health, rising to just over $60 in 2015, to have any chance of reaching the health millennium development goals by 2015 [4]. Only $35 is available from domestic and donor funding combined despite a rapid scale up in external assistance for health since the Millennium Declaration was signed in 2000 [5, 6]. These estimates were made based on the costs of ensuring access to a limited range of health services aimed largely at communicable diseases and child and maternal health. Little attention was paid to non-communicable diseases, yet the goal of achieving universal coverage must extend to non-communicable diseases as well. This is increasingly important now that the problems associated with an aging population, the epidemiological transition and chronic diseases are increasing to the extent that the burden of disease associated with them outweighs that of non-communicable diseases even in the low-income countries [7, 8]. The goal of universal coverage must extend to preventing and treating stone disease. More money for health in poorer countries is critical to achieving this goal, and the gaps between the fi nancial needs and their domestic capacities to raise funds, even with reasonable levels of economic growth, remain large. Although most low-income countries could take steps to increase the availability of their own domestic resources for health, increased external donor support remains critical, something that may be dif fi cult to maintain in the current economic climate of rich countries trying to reduce their budget de fi cits and their own levels of indebtedness. More money, however, will not be suf fi cient by itself. Many countries also need to reduce the fi nancial barriers facing patients when they contemplate seeking and then continuing care it. For example, almost a third of the countries in sub-Saharan Africa raise more than 50 % of their total health resources through direct charges levied on patients at the time they seek care. In India, it is more than 60 % [5]. These direct payments not only ensure that millions of vii viii Foreword people are not treated, including for stone disease, but they also ensure that millions of those that are treated suffer severe fi nancial problems simply because they became ill and needed to pay for care [9]. Each year, approximately 100 million people are pushed under the poverty line in this way [10]. This can be addressed only by reducing reliance on direct payments levied at the time people obtain care by moving to forms of prepayment and pooling. Various forms of insurance and tax-based funding are the solution and they are being implemented even in lower income countries in the search to reduce the fi nancial barriers to care. Health fi nancing systems are fundamental to attaining universal coverage, helping to ensure that all people who suffer from stone disease can be identi fi ed and treated, and ensuring that appropriate prevention is in place. On the other hand, if there are no health workers with the appropriate training, or no medicines, or no equipment for diagnosis, for example, universal coverage is not possible. That is why this book is so vital. It is about the science of stone disease. It describes the epidemiology, showing how the prevalence, incidence and severity differ substantially across the different parts of the world necessitating different approaches to case fi nding and treatment. It describes the causes and natural history of the disease, and then the latest developments in diagnosis, treatment and rehabilitation. As such it is also a practical guide for urologists treating the disease as well as trying to prevent recurrence and limit the impact of illness on the subsequent lives of patients. It helps us to understand what can be done to prevent the disease in the fi rst place. It also places the science in the context of society and resource constraints. At times it takes the perspective of the health professional, re fl ecting on how to understand the patient’s needs and expectations, and how to practice ethical medicine when the patient or country might not be able to afford the optimal treatment. The clinician’s task is to provide exemplary care to as large a population as possible. If the treatment is too expensive, they have to fi nd alternatives. These hard choices can be made only if the urologist is knowledgeable, technically competent, and professional. The book provides a basis for helping clinicians make rational choices in the deployment of technology, including those which are expensive. There are also chapters taking the broader planning or social perspective on how to best fi nance and manage equipment, including how to reduce costs by sharing equipment. The information provided in this book will interest researchers seeking to understand disease patterns or the way new technologies relating are developed and disseminated. It will be vital to health professionals seeking to prevent or treat the disease. And it will be important to health planners in their deliberations about how to reduce the burden of stone disease for the resources that are available. All these perspectives are important in their own way, but it is only through the combination of these perspectives that it will be possible to move more rapidly to, and eventually attain, universal coverage everywhere.

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