Lange Jessica, Terlecki Ryan
Department of Urology, Wake Forest Baptist Health , Winston-Salem, North Carolina.
J Endourol. 2017 Nov;31(11):1211-1214. doi: 10.1089/end.2017.0487. Epub 2017 Sep 21.
In the era of minimally invasive surgery, endoscopic and percutaneous interventions for urinary tract stones have become a mainstay, and the need for open stone surgery (OSS) has decreased. We sought to determine the contemporary incidence of OSS among urologists in the United States.
Case logs submitted for certification to the American Board of Urology from 2005 to 2015 were queried for Current Procedural Terminology codes relevant to OSS. Cases were analyzed for the associated practice type, practice area population, geographic region, provider subspecialty, and certifying status of the reporting urologist.
A total of 334 cases of OSS were identified, with 73.4% performed by urologists self-identified as generalists. The most common subspecialists performing OSS were endourologists (12.3%). Most cases were done in the private practice setting (80.4%), and in practice areas with populations exceeding 1,000,000 (43.2%). OSS was more commonly reported by urologists applying for recertification than initial certification. Thirty open stone cases were reported each year on average, and there was no decrease in stone cases over time based on linear regression analysis (R = 0.06). OSS was most commonly performed in the Western Section of the American Urological Association (AUA) (25.1%) and least commonly performed in the Northeastern Section (1.5%). A chi-square analysis was performed, and the Western Section had a significantly higher number of OSSs than expected as its urologists represent only 17% of the total AUA membership (p < 0.01). The Northeastern Section comprises 7% of the AUA membership but only performed 1.5% of OSSs that were significantly lower than expected (p < 0.001).
Domestic performance of OSS remains stable. It is unclear as to whether the majority of these cases could be served by less-invasive technologies or whether the volume represents a true nadir. Future work may be warranted to assess attitudes, training, and feasibility of minimally invasive stone management in areas where OSS is most common.
在微创手术时代，内镜和经皮治疗尿路结石已成为主流，开放性结石手术（OSS）的需求有所减少。我们试图确定美国泌尿外科医生中OSS的当代发病率。
查询2005年至2015年提交给美国泌尿外科委员会认证的病例记录，以获取与OSS相关的现行手术术语代码。分析病例的相关执业类型、执业地区人口、地理区域、医生亚专业以及报告泌尿外科医生的认证状态。
共识别出334例OSS病例，其中73.4%由自称普通外科医生的泌尿外科医生实施。实施OSS最常见的亚专业医生是腔内泌尿外科医生（12.3%）。大多数病例在私人执业环境中进行（80.4%），且在人口超过100万的执业地区（43.2%）。申请重新认证的泌尿外科医生比初次认证的医生更常报告OSS。平均每年报告30例开放性结石病例，根据线性回归分析，结石病例数未随时间减少（R = 0.06）。OSS最常在美国泌尿外科协会（AUA）西区进行（25.1%），在东北区最少（1.5%）。进行了卡方分析，西区的OSS数量明显高于预期，因为其泌尿外科医生仅占AUA总会员的17%（p < 0.01）。东北区占AUA会员的7%，但仅实施了1.5%的OSS，明显低于预期（p < 0.001）。
国内OSS的实施情况保持稳定。目前尚不清楚这些病例中的大多数是否可以通过微创技术治疗，或者该数量是否代表真正的最低点。未来可能有必要开展工作，以评估OSS最常见地区微创结石管理的态度、培训和可行性。
