Department of Urology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
J Urol. 2012 Apr;187(4):1402-7. doi: 10.1016/j.juro.2011.12.010. Epub 2012 Feb 16.
Although shock wave lithotripsy has long been considered the gold standard for treatment of kidney stones in children, ureteroscopy has become increasingly common. The factors determining procedure choice at individual centers are unclear. We sought to identify patient and hospital factors associated with the choice between shock wave lithotripsy and ureteroscopy.
We searched the Pediatric Health Information System hospital database to identify patients with renal calculi who underwent inpatient or outpatient shock wave lithotripsy or ureteroscopy between 2000 and 2008. We used multivariate regression to evaluate whether procedure type was associated with hospital level factors, including treating hospital, region, size and teaching status, or patient level factors, including age, race, gender and insurance type.
We identified 3,377 children with renal stones, of whom 538 (16%) underwent surgery (shock wave lithotripsy in 48%, ureteroscopy in 52%). Procedures in 445 patients at hospitals performing both procedures were included. The relative proportion of ureteroscopy increased during the study period (24% from 2000 to 2002 vs 50% from 2006 to 2008, p=0.0001). Procedure choice was not significantly associated with patient age (p=0.2), gender (p=0.1), race (p=0.07), insurance (p=0.9), hospital size (p=0.6) or teaching status (p=0.99). Procedure choice varied significantly by geographical region (p=0.05), regional population (p=0.002) and stone location (p<0.0001). On multivariable analysis controlling for stone location, gender and treatment year the treating hospital was still highly associated with procedure choice.
There is wide variation in procedure choice for children with kidney stones at freestanding children's hospitals in the United States. Treatment choice depends significantly on the hospital at which a patient undergoes treatment.
尽管体外冲击波碎石术长期以来一直被认为是治疗儿童肾结石的金标准，但输尿管镜检查已变得越来越普遍。个别中心选择治疗方法的因素尚不清楚。我们旨在确定与选择体外冲击波碎石术和输尿管镜检查相关的患者和医院因素。
我们在小儿健康信息系统医院数据库中搜索了 2000 年至 2008 年间接受住院或门诊体外冲击波碎石术或输尿管镜检查的肾结石患者。我们使用多变量回归来评估治疗医院、地区、规模和教学状态等医院水平因素以及年龄、种族、性别和保险类型等患者水平因素是否与治疗方法相关。
我们共确定了 3377 例肾结石患儿，其中 538 例（16%）接受了手术（体外冲击波碎石术 48%，输尿管镜检查术 52%）。445 例在开展两种手术的医院接受手术的患者纳入研究。研究期间输尿管镜检查的比例有所增加（2000 年至 2002 年为 24%，2006 年至 2008 年为 50%，p=0.0001）。治疗方法的选择与患者年龄（p=0.2）、性别（p=0.1）、种族（p=0.07）、保险类型（p=0.9）、医院规模（p=0.6）或教学状态（p=0.99）无显著相关性。治疗方法的选择因地理位置（p=0.05）、地区人口（p=0.002）和结石位置（p<0.0001）而异。在控制结石位置、性别和治疗年份的多变量分析中，治疗医院与治疗方法的选择仍高度相关。
美国独立儿童医院的肾结石患儿治疗方法选择存在广泛差异。治疗选择在很大程度上取决于患者接受治疗的医院。
