Matlaga Brian R
James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
J Urol. 2009 May;181(5):2152-6. doi: 10.1016/j.juro.2009.01.023. Epub 2009 Mar 17.
Upper urinary tract calculi are treated with multiple technologies including shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy. Our knowledge of surgical practice patterns in the treatment of these calculi is limited. We performed a study of the surgical practice logs submitted to the American Board of Urology by candidates for initial certification and recertification to characterize the manner in which renal and ureteral calculi are treated.
Logs from initial certification, first recertification and second recertification cohorts were reviewed. CPT codes were used as search criteria, and included 50590 (shock wave lithotripsy), 52352 (ureteroscopy, stone removal), 52353 (ureteroscopy, lithotripsy), 50080 (percutaneous nephrolithotomy for stones less than 2 cm) and 50081 (percutaneous nephrolithotomy for stones greater than 2 cm).
For the initial certification cohort surgical logs from 2004 to 2008 were reviewed and 1,065 individuals were identified. For the 2 recertification cohorts logs from 2003 to 2007 were reviewed, with 1,120 individuals identified in the first recertification cohort, and 831 identified in the second recertification cohort. Candidates for initial certification used ureteroscopy in the majority of stone removal procedures (52.0%), and candidates for first and second recertification used shock wave lithotripsy in the majority of their procedures (57.4% and 60.5%, respectively). There was a decreasing use of percutaneous nephrolithotomy across the cohorts with 6.8% in the initial, 4.5% in the first and 2.6% in the second recertification cohort.
Provider specific attributes may affect how upper tract calculi are treated. Urologists in the initial certification cohort claimed the greatest use of endoscopic treatment modalities and most commonly performed ureteroscopy. Shock wave lithotripsy was more commonly used by the 2 recertification cohorts, comprised of more senior urologists.
上尿路结石的治疗采用多种技术，包括冲击波碎石术、输尿管镜检查和经皮肾镜取石术。我们对这些结石治疗的手术实践模式的了解有限。我们对初次认证和再认证候选人提交给美国泌尿外科委员会的手术实践记录进行了研究，以描述肾和输尿管结石的治疗方式。
回顾初次认证、首次再认证和第二次再认证队列的记录。使用CPT编码作为搜索标准，包括50590（冲击波碎石术）、52352（输尿管镜检查，结石清除）、52353（输尿管镜检查，碎石术）、50080（经皮肾镜取石术治疗小于2 cm的结石）和50081（经皮肾镜取石术治疗大于2 cm的结石）。
对于初次认证队列，回顾了2004年至2008年的手术记录，确定了1065人。对于2个再认证队列，回顾了2003年至2007年的记录，首次再认证队列中有1120人，第二次再认证队列中有831人。初次认证候选人在大多数结石清除手术中使用输尿管镜检查（占52 . 0%），首次和第二次再认证候选人在大多数手术中使用冲击波碎石术（分别占57 . 4%和60 . 5%）。各队列中经皮肾镜取石术的使用呈下降趋势，初次认证队列中为6 . 8%，首次再认证队列中为4 . 5%，第二次再认证队列中为2 . 6%。
提供者的特定属性可能影响上尿路结石的治疗方式。初次认证队列中的泌尿外科医生声称内镜治疗方式的使用最多，最常进行输尿管镜检查。由更资深的泌尿外科医生组成的2个再认证队列更常使用冲击波碎石术。
