Suggested improvements for hiearchy: <<274035004 |Removal of urinary calculus (procedure)

Dear members of CMAG,

In Sweden stakeholders have called for a general quality improvement of the hierarchy <<274035004 |Removal of urinary calculus (procedure)| Urologists points out that they find the hierarchy to be unstructured, with some concepts detailed and some are not. There is a lack of intermediate concepts. Many concepts are primitive.

The suggestion is to better/more clearly divide children concepts after method (open/endoscopic). The endoscopic ones should be modelled with an 312030006 |Urinary endoscope| as the value of Using access device (attribute), not what kind of endoscopic instrument it is (e.g. our urologists point out that cystoscopes are generally too thin, the access device needs to be something larger, but this might arise from Swedish–English that is not compatible). Possibly one can model whether it is rigid or flexible. Furthermore, somehow you need to keep track of whether procedures done in the kidney are performed percutaneously (through the skin straight into the kidney) or transurethrally (via the urethra up to the kidney) – both are endoscopic procedures.
And then maybe there should be descendants representing whether the stone is crushed or not, and if so, with what, eg. laser, litoclast, puncher.

Of course, a balance is needed as to what should be pre-coordinated and not, but the suggestion is that all of the above, maybe except the crushing, would be reasonable to pre-coordinate.

Is there any other country that have input on this matter or are having the same struggles as us?

Best wishes,
National release center of Sweden