Department of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA.
Urology. 2013 Mar;81(3):522-6. doi: 10.1016/j.urology.2012.11.020. Epub 2013 Jan 24.
To study the difference in operative time for endoscopic management of ureteral and renal stones according to the stone location.
We hypothesized that these cases are not equivalent in terms of the surgeon's work as measured by the operating time, and we assessed whether significant variations exist within the umbrella of the Common Procedural Terminology code 52353: "ureterorenoscopic lithotripsy." We retrospectively reviewed the records of all patients undergoing unilateral ureteroscopic laser lithotripsy or retrograde intrarenal surgery under the care of 1 fellowship-trained endourologist from 2008 to 2010. The patients who underwent simultaneous additional endoscopic procedures, including bilateral ureteropyeloscopy, were excluded. The demographics, stone size and location, presence of a previously placed stent, and operative time were assessed and compared. The cohorts were designated according to the stone location--ureteral or renal.
Of the total 213 ureteroscopic laser lithotripsy and retrograde intrarenal surgery cases reviewed, 115 were ureteral stones and 98 were renal stones. The renal stones required a significantly increased mean operative time (112 minutes) than did the ureteral stones (70 minutes; P <.001). The renal stone size was significantly larger (11.3 vs 7.7 mm, P <.001), and these cases had a greater preoperative stent rate (55% vs 37%, P = .014).
Despite bundling within a single Current Procedural Terminology code, endoscopic management of renal stones and ureteral stones were markedly different, with a significant increase in the operative time for renal stones. The renal stone size was significantly larger, as expected. Current Procedural Terminology differentiation should be considered to appreciate the difference between ureteral and renal ureterorenoscopic lithotripsy in terms of resource requirements.
根据结石位置研究输尿管和肾结石内镜治疗的手术时间差异。
我们假设这些病例在手术时间方面，即外科医生的工作量方面并不等同，并评估了通用操作代码 52353“输尿管镜碎石术”伞下是否存在显著差异。我们回顾性分析了 2008 年至 2010 年间由 1 名接受过 fellowship培训的腔内泌尿科医生治疗的所有接受单侧输尿管镜激光碎石术或逆行肾盂手术的患者的记录。排除同时进行双侧输尿管肾盂镜检查等其他内镜手术的患者。评估并比较了患者的人口统计学资料、结石大小和位置、是否有先前放置的支架以及手术时间。根据结石位置（输尿管或肾脏）将队列分组。
在回顾的 213 例输尿管镜激光碎石术和逆行肾盂手术中，115 例为输尿管结石，98 例为肾结石。肾结石所需的平均手术时间明显增加（112 分钟），而输尿管结石为 70 分钟（P<.001）。肾结石的大小明显更大（11.3 毫米对 7.7 毫米，P<.001），且这些病例术前支架率更高（55%对 37%，P=.014）。
尽管捆绑在单个当前操作代码下，但肾结石和输尿管结石的内镜治疗方法明显不同，肾结石的手术时间明显增加。正如预期的那样，肾结石的大小明显更大。应该考虑当前操作代码的分化，以认识到输尿管镜碎石术治疗输尿管和肾脏结石在资源需求方面的差异。
