Oberlin Daniel T, Flum Andrew S, Bachrach Laurie, Matulewicz Richard S, Flury Sarah C
Department of Urology, Northwestern Memorial Hospital, Chicago, Illinois.
Department of Urology, Northwestern Memorial Hospital, Chicago, Illinois.
J Urol. 2015 Mar;193(3):880-4. doi: 10.1016/j.juro.2014.09.006. Epub 2014 Sep 16.
Upper tract nephrolithiasis is a common surgical condition that is treated with multiple surgical techniques, including shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy. We analyzed case logs submitted to the ABU by candidates for initial certification and recertification to help elucidate the trends in management of upper tract urinary calculi.
Annualized case logs from 2003 to 2012 were analyzed. We used logistic regression models to assess how surgeon specific attributes affected the way that upper tract stones were treated. Cases were identified by the CPT code of the corresponding procedure.
A total of 6,620 urologists in 3 certification groups recorded case logs, including 2,275 for initial certification, 2,381 for first recertification and 1,964 for second recertification. A total of 441,162 procedures were logged, of which 54.2% were ureteroscopy, 41.3% were shock wave lithotripsy and 4.5% were percutaneous nephrolithotomy. From 2003 to 2013 there was an increase in ureteroscopy from 40.9% to 59.6% and a corresponding decrease in shock wave lithotripsy from 54% to 36.3%. For new urologists ureteroscopy increased from 47.6% to 70.9% of all stones cases logged and for senior clinicians ureteroscopy increased from 40% to 55%. Endourologists performed a significantly higher proportion of percutaneous nephrolithotomies than nonendourologists (10.6% vs 3.69%, p <0.0001) and a significantly smaller proportion of shock wave lithotripsies (34.2% vs 42.2%, p = 0.001).
Junior and senior clinicians showed a dramatic adoption of endoscopic techniques. Treatment of upper tract calculi is an evolving field and provider specific attributes affect how these stones are treated.
上尿路肾结石是一种常见的外科疾病，可采用多种外科技术进行治疗，包括冲击波碎石术、输尿管镜检查和经皮肾镜取石术。我们分析了初次认证和再次认证候选人提交给美国泌尿外科委员会（ABU）的病例记录，以帮助阐明上尿路尿石症的治疗趋势。
分析了2003年至2012年的年度病例记录。我们使用逻辑回归模型来评估外科医生的特定属性如何影响上尿路结石的治疗方式。通过相应手术的CPT代码识别病例。
3个认证组的6620名泌尿科医生记录了病例，其中初次认证2275例，首次再次认证2381例，第二次再次认证1964例。共记录了441162例手术，其中输尿管镜检查占54.2%，冲击波碎石术占41.3%，经皮肾镜取石术占4.5%。从2003年到2013年，输尿管镜检查的比例从40.9%增加到59.6%，冲击波碎石术相应地从54%下降到36.3%。对于新的泌尿科医生，输尿管镜检查在所有记录的结石病例中从47.6%增加到70.9%，对于资深临床医生，输尿管镜检查从40%增加到55%。腔内泌尿外科医生进行经皮肾镜取石术的比例显著高于非腔内泌尿外科医生（10.6%对3.69%，p<0.0001），而冲击波碎石术的比例显著低于非腔内泌尿外科医生（34.2%对42.2%，p = 0.001）。
初级和高级临床医生都显著采用了内镜技术。上尿路结石的治疗是一个不断发展的领域，医生的特定属性会影响这些结石的治疗方式。
