Department of Urology, Divisions of Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
J Endourol. 2013 Mar;27(3):355-60. doi: 10.1089/end.2012.0017. Epub 2012 Nov 7.
Minimally invasive pyeloplasty is an effective treatment for patients with ureteropelvic junction obstruction that offers quicker convalescence than open pyeloplasty. Technical challenges, however, may have limited its dissemination. We examined population trends and determinants of surgical options for ureteropelvic junction obstruction.
Using the State Inpatient and Ambulatory Surgery Databases for Florida, we identified adults who underwent ureteropelvic junction obstruction repair between 2001 and 2009. After determining the surgical approach (minimally invasive pyeloplasty, open pyeloplasty, or endopyelotomy), we estimated annual utilization rates and the effects of patient, surgeon, and hospital predictors on surgery type, using multilevel multinomial logistic regression.
Rates of minimally invasive pyeloplasty increased 360% (P for monotonic trend < 0.01), while rates of open pyeloplasty decreased 56% (P<0.01). Rates of endopyelotomy were substantially higher and remained relatively stable (P=0.27). Compared with open pyeloplasty, minimally invasive pyeloplasty was used more commonly among patients with private insurance (odds ratio [OR] 1.6; 95% confidence interval [CI], 1.2-2.3), those treated at teaching hospitals (OR 1.6; CI 1.0-2.6), and those treated by high-volume surgeons (OR 2.9; CI 2.0-4.2). Its use was less frequent among patients with multiple comorbidities (OR 0.53; CI 0.37-0.76). Similar associations were observed when comparing receipt of minimally invasive pyeloplasty with endopyelotomy; however, patients who underwent endopyelotomy were older.
The use of minimally invasive pyeloplasty has dramatically increased, largely replacing open pyeloplasty, while the use of endopyelotomy, albeit significantly more common than the other approaches, has remained stable. The surgical approach is influenced by several patient, surgeon, and hospital factors.
微创肾盂成形术是治疗肾盂输尿管连接部梗阻的有效方法，比开放肾盂成形术康复更快。然而，技术挑战可能限制了其传播。我们检查了人口趋势和肾盂输尿管连接部梗阻手术选择的决定因素。
我们使用佛罗里达州的州住院和门诊手术数据库，确定了 2001 年至 2009 年间接受肾盂输尿管连接部梗阻修复的成年人。在确定手术方法（微创肾盂成形术、开放肾盂成形术或内切开术）后，我们使用多水平多项逻辑回归估计了每年的利用率，并评估了患者、外科医生和医院预测因素对手术类型的影响。
微创肾盂成形术的使用率增加了 360%（P<0.01，单调趋势），而开放肾盂成形术的使用率降低了 56%（P<0.01）。内切开术的使用率较高且相对稳定（P=0.27）。与开放肾盂成形术相比，微创肾盂成形术在私人保险患者中更为常见（比值比[OR] 1.6；95%置信区间[CI]，1.2-2.3）、在教学医院治疗的患者（OR 1.6；CI 1.0-2.6）和由高容量外科医生治疗的患者（OR 2.9；CI 2.0-4.2）。在患有多种合并症的患者中，其使用率较低（OR 0.53；CI 0.37-0.76）。当比较接受微创肾盂成形术与内切开术的患者时，观察到了类似的关联；然而，接受内切开术的患者年龄较大。
微创肾盂成形术的使用率大幅增加，在很大程度上取代了开放肾盂成形术，而内切开术的使用率虽然明显高于其他方法，但仍保持稳定。手术方法受多种患者、外科医生和医院因素的影响。
