Department of Urology, Vedanayagam Hospital and Postgraduate Institute, Tamilnadu, India.
Department of Urology, University Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece.
Eur Urol. 2014 Dec;66(6):1046-51. doi: 10.1016/j.eururo.2014.06.054. Epub 2014 Jul 12.
The Clinical Research Office of the Endourological Society (CROES) undertook the Ureteroscopy Global Study to establish a prospective global database to examine the worldwide use of ureteroscopy (URS) and to determine factors affecting outcome.
To investigate the influence of case volume on the outcomes of URS for ureteral stones.
DESIGN, SETTING, AND PARTICIPANTS: The URS Global Study collected prospective data on consecutive patients with urinary stones treated with URS at 114 centres worldwide for 1 yr. Centres were identified as low or high volume based on the median overall annual case volume.
Pre- and intraoperative characteristics, and postoperative outcomes in patients at low- and high-volume centres were compared. The relationships between case volume and stone-free rate (SFR), stone burden, complications, and hospital stay were explored using multivariate regression analysis.
Across all centres, the median case volume was 67; 58 and 56 centres were designated as low volume and high volume, respectively. URS procedures at high-volume centres took significantly less time to conduct. Mean SFR was 91.9% and 86.3% at high- and low-volume centres, respectively (p<0.001); the adjusted probability of a stone-free outcome increased with increasing case volume (p<0.001). Patients treated at a high-volume centre were less likely to need retreatment, had shorter postoperative hospital stay, were less likely to be readmitted within 3 mo, and had fewer and less severe complications. At case volumes approximately >200, the probability of complications decreased with increasing case volume (p=0.02). The study is limited by the heterogeneity of participating centres and surgeons and the inclusion of patients treated by more than one approach.
In the treatment of ureteral stones with URS, high-volume centres achieve better outcomes than low-volume centres. Several outcome measures for URS improve with an increase in case volume.
Outcomes following treatment of ureteral stones by ureteroscopy (URS) were studied in a large group of patients at centres worldwide. The proportion of successful procedures (ie, those in which patients became stone free) increased as the annual volume of URS at a hospital increased. Hospital stays were shorter and postoperative complications were less likely at high-volume hospitals. We conclude that for URS, the best outcomes are seen in patients treated at high-volume hospitals.
腔内泌尿外科学会临床研究办公室（CROES）开展了输尿管镜全球研究，以建立一个前瞻性的全球数据库，研究全球范围内输尿管镜检查（URS）的使用情况，并确定影响结果的因素。
探讨病例量对输尿管镜治疗输尿管结石结果的影响。
设计、设置和参与者：URS 全球研究收集了全球 114 个中心连续接受 URS 治疗的尿石症患者的前瞻性数据，为期 1 年。根据整体年度病例量中位数，将中心确定为低容量或高容量中心。
比较低、高容量中心患者的术前和术中特征及术后结局。采用多元回归分析探讨病例量与无石率（SFR）、结石负荷、并发症和住院时间的关系。
在所有中心中，中位病例量为 67；58 个和 56 个中心分别被指定为低容量和高容量中心。高容量中心的 URS 手术时间明显更短。高、低容量中心的 SFR 分别为 91.9%和 86.3%（p<0.001）；结石清除率的调整概率随病例量的增加而增加（p<0.001）。在高容量中心治疗的患者需要再次治疗的可能性较低，术后住院时间较短，3 个月内再次入院的可能性较低，并发症较少且较轻微。在病例量约>200 时，并发症的概率随病例量的增加而降低（p=0.02）。该研究的局限性在于参与中心和外科医生的异质性以及纳入了接受多种方法治疗的患者。
在使用输尿管镜治疗输尿管结石方面，高容量中心的治疗效果优于低容量中心。多项 URS 治疗结果随着病例量的增加而改善。
对全球多个中心的大量患者进行了输尿管镜治疗输尿管结石的结局研究。在医院每年 URS 量增加的情况下，手术成功率（即患者无结石）的比例增加。在高容量医院，住院时间更短，术后并发症的可能性更小。我们得出的结论是，对于 URS 治疗，最好的结果出现在高容量医院接受治疗的患者中。
