Jacobs Bruce L, Lai Julie C, Seelam Rachana, Hanley Janet M, Wolf J Stuart, Hollenbeck Brent K, Hollingsworth John M, Dick Andrew W, Setodji Claude M, Saigal Christopher S
Department of Urology, University of Pittsburgh, Pittsburgh, PA.
University of California, Los Angeles, and RAND Corporation, Santa Monica, CA.
Urology. 2018 Jan;111:72-77. doi: 10.1016/j.urology.2017.09.002. Epub 2017 Sep 21.
To examine the effectiveness of the 3 primary treatments for ureteropelvic junction obstruction (ie, open pyeloplasty, minimally invasive pyeloplasty, and endopyelotomy) as assessed by failure rates.
Using MarketScan data, we identified adults (ages 18-64 years) who underwent treatment for ureteropelvic junction obstruction between 2002 and 2010. Our primary outcome was failure (ie, need for a secondary procedure). We fit a Cox proportional hazards model to examine the effects of different patient, regional, and provider characteristics on treatment failure. We then implemented a survival analysis framework to examine the failure-free probability for each treatment.
We identified 1125 minimally invasive pyeloplasties, 775 open pyeloplasties, and 1315 endopyelotomies with failure rates of 7%, 9%, and 15%, respectively. Compared with endopyelotomy, minimally invasive pyeloplasty was associated with a lower risk of treatment failure (adjusted hazards ratio [aHR] 0.52; 95% confidence interval [CI], 0.39-0.69). Minimally invasive and open pyeloplasties had similar failure rates. Compared with open pyeloplasty, endopyelotomy was associated with a higher risk of treatment failure (aHR 1.78; 95% CI, 1.33-2.37). The average length of stay was 2.7 days for minimally invasive pyeloplasty and 4.2 days for open pyeloplasty (P <.001).
Endopyelotomy has the highest failure rate, yet it remains a common treatment for ureteropelvic junction obstruction. Future research should examine to what extent patients and physicians are driving the use of endopyelotomy.
通过失败率评估输尿管肾盂连接部梗阻的三种主要治疗方法（即开放性肾盂成形术、微创肾盂成形术和肾盂内切开术）的有效性。
利用市场扫描数据，我们确定了2002年至2010年间接受输尿管肾盂连接部梗阻治疗的成年人（年龄18 - 64岁）。我们的主要结局是治疗失败（即需要二次手术）。我们拟合了Cox比例风险模型，以研究不同患者、地区和医疗服务提供者特征对治疗失败的影响。然后我们实施了生存分析框架，以研究每种治疗方法的无失败概率。
我们确定了1125例微创肾盂成形术、775例开放性肾盂成形术和1315例肾盂内切开术，失败率分别为7%、9%和15%。与肾盂内切开术相比，微创肾盂成形术的治疗失败风险较低（调整后风险比[aHR] 0.52；95%置信区间[CI]，0.39 - 0.69）。微创和开放性肾盂成形术的失败率相似。与开放性肾盂成形术相比，肾盂内切开术的治疗失败风险较高（aHR 1.78；95% CI，1.33 - 2.37）。微创肾盂成形术的平均住院时间为2.7天，开放性肾盂成形术为4.2天（P <.001）。
肾盂内切开术的失败率最高，但它仍然是输尿管肾盂连接部梗阻的一种常见治疗方法。未来的研究应探讨患者和医生在多大程度上推动了肾盂内切开术的使用。
