Urolithiasis: Basic Science and Clinical Practice

955 Pages·2012·34.094 MB·English

by  Palle J. S. Osther M.D., Ph.D. (auth.), Jamsheer J. Talati, Hans-Goran Tiselius, David M. Albala, ZHANGQUN YE (eds.)

Urolithiasis

Jamsheer J. Talati (cid:129) Hans-Göran Tiselius
David M. Albala (cid:129) Zhangqun Ye
Editors
Farhat Abbas (cid:129) M. Hammad Ather
Syed Raziuddin Biyabani (cid:129) Mahesh Desai
Tyler Luthringer (cid:129) Amanullah Memon
Kemal Sarica (cid:129) 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
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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 rehabili-
tation) 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 uni-
versal 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 eco-
nomic 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 dis-
ease. 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 dis-
ease 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.
Geneva, Switzerland David B. Evans
Director
Department of Health Systems Financing (HSF)
World Health Organization
Bibliography
1. World Health Organization. WHO|The world health report – health systems fi nancing: the path to universal
coverage. 2010. Retrieved from h ttp://www.who.int/whr/2010/en/index.html .
2. World Health Organization. WHA resolution 58.33: sustainable health fi nancing, universal coverage and
social health insurance. Fifty-Seventh World Health Assembly. Geneva: World Health Organization; 2005.
Retrieved from h ttp://apps.who.int/gb/ebwha/pdf_ fi les/WHA58/WHA58_33-en.pdf .
Foreword ix
3. Carrin G, Mathauer I, Evans DB. Universal coverage of health services: tailoring its implementation. Bull
World Health Organ. 2008;86(11):857–63.
4. World Health Organization. Constraints to scaling up the health millennium development goals: costing
and fi nancial gap analysis. Background document for the taskforce on innovative international fi nancing for
health systems, working group 1: constraints to scaling up and costs. 2009. Retrieved from h ttp://www.
who.int/choice/publications/d_ScalingUp_MDGs_WHO_ fi nalreport.pdf .
5. World Health Organization. WHO|National Health Accounts. WHO. 2009. Retrieved 1 Nov 2011 from
http://www.who.int/nha/en/ .
6. Ravishankar N, Gubbins P, Cooley RJ, Leach-Kemon K, Michaud CM, Jamison DT, Murray CJ. Financing
of global health: tracking development assistance for health from 1990 to 2007. Lancet. 2009;373:2113–24.
doi: 1 0.1016/S0140-6736(09)60881-3 .
7. Boutayeb A, Boutayeb S. The burden of non-communicable diseases in developing countries. Int J Equity
Health. 2005;4(1):2.
8. World Health Organization. WHO|The global burden of disease: 2004 update. Geneva: World Health
Organization; 2008. Retrieved from h ttp://www.who.int/healthinfo/global_burden_disease/2004_report_
update/en/ .
9. Wagstaff A. The economic consequences of health shocks: evidence from Vietnam. J Health Econ.
2007;26(1):82–100. doi: 10.1016/j.jhealeco.2006.07.001 .
10. Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from cata-
strophic health spending. Health Affairs. 2007;26(4):972–83. doi: 1 0.1377/hlthaff.26.4.972 .