确定接受上尿路尿石症治疗的普通人群中输尿管镜检查阴性的发生率。
Defining the Rate of Negative Ureteroscopy in the General Population Treated for Upper Tract Urinary Stone Disease.
作者信息
Lamberts Remy W, Conti Simon L, Leppert John T, Elliott Christopher S
机构信息
1 Department of Urology, Stanford University School of Medicine , Stanford, California.
2 Division of Urology, Veterans Affairs Palo Alto Health Care System , Palo Alto, California.
出版信息
J Endourol. 2017 Mar;31(3):266-271. doi: 10.1089/end.2016.0751. Epub 2017 Feb 3.
INTRODUCTION
Ureteroscopy is increasingly used to treat upper tract urinary stone disease. A negative ureteroscopy is a ureteroscopy performed with the intent of removing a kidney or ureteral stone, but in which ultimately no stone is removed. Negative ureteroscopy may occur when the stone is found to have already passed, or the presumed stone is found to be outside of the collecting system. We sought to determine the rate of negative ureteroscopy in a large population-based sample as well as factors associated with its use.
PATIENTS AND METHODS
We examined nonpublic data from the Office of Statewide Health Planning and Development (OSHPD) Database for all patients in California undergoing outpatient surgery from 2010 to 2012. We identified all patients with an International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code for upper tract urinary stone disease, who underwent a ureteroscopic procedure. After excluding patients undergoing second look procedures or who had diagnosis codes for separate urologic pathology, the negative ureteroscopy rate was defined as the proportion of those ureteroscopy cases coded as a diagnostic ureteroscopy. We fit logistic regression models to evaluate patient factors associated with negative ureteroscopy.
RESULTS
During the years 2010 to 2012, 20,236 eligible patients underwent ureteroscopic procedures for upper tract stone disease. Of these, 1287 patients underwent diagnostic ureteroscopy and 19,039 underwent ureteroscopy with stone removal accounting for a negative ureteroscopy rate of 6.3%. The odds of receipt of a negative ureteroscopy rate were higher in females compared to males (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.25, 1.58) and lower in self-pay patients compared with insured patients (OR = 0.55, 95% CI 0.33, 0.91).
CONCLUSIONS
Negative ureteroscopy is common, occurring in nearly 1 in 16 procedures to treat urinary stone disease.
引言
输尿管镜检查越来越多地用于治疗上尿路结石疾病。阴性输尿管镜检查是指旨在取出肾结石或输尿管结石而进行的输尿管镜检查，但最终未取出结石。当发现结石已排出，或推测的结石位于集合系统之外时，可能会出现阴性输尿管镜检查。我们试图确定在一个基于人群的大样本中阴性输尿管镜检查的发生率以及与其使用相关的因素。
患者与方法
我们检查了加利福尼亚州全州卫生规划与发展办公室（OSHPD）数据库中2010年至2012年接受门诊手术的所有患者的非公开数据。我们识别出所有患有国际疾病分类第九版（ICD - 9）上尿路结石疾病诊断编码且接受输尿管镜检查的患者。在排除接受二次探查手术的患者或有其他泌尿系统病理诊断编码的患者后，阴性输尿管镜检查率定义为那些编码为诊断性输尿管镜检查的输尿管镜检查病例的比例。我们拟合逻辑回归模型以评估与阴性输尿管镜检查相关的患者因素。
结果
在2010年至2012年期间，20236名符合条件的患者因上尿路结石疾病接受了输尿管镜检查。其中，1287名患者接受了诊断性输尿管镜检查，19039名患者接受了取石输尿管镜检查，阴性输尿管镜检查率为6.3%。女性接受阴性输尿管镜检查的几率高于男性（优势比[OR] 1.41，95%置信区间[CI] 1.25，1.58），自费患者接受阴性输尿管镜检查的几率低于参保患者（OR = 0.55，95% CI 0.33，0.91）。
结论
阴性输尿管镜检查很常见，在治疗尿路结石疾病的手术中，近十六分之一会出现阴性输尿管镜检查。
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