Department of Urology, University of Washington, Seattle, Washington.
Department of Urology, University of Washington, Seattle, Washington.
J Urol. 2018 Jul;200(1):147-153. doi: 10.1016/j.juro.2018.01.078. Epub 2018 Feb 1.
Followup imaging after percutaneous nephrolithotomy serves to detect postoperative complications, residual fragments and silent hydronephrosis. However, the timing and optimal imaging modality remain poorly defined. We describe imaging use patterns after percutaneous nephrolithotomy.
In the MarketScan® database we identified patients 17 to 64 years old who underwent percutaneous nephrolithotomy between 2007 and 2014. Imaging modalities were identified by CPT, and ICD-9 and 10 codes, and tracked for 1 year after percutaneous nephrolithotomy. The modalities included computerized tomography, renal ultrasound, abdominal x-ray and intravenous pyelogram. Cumulative longitudinal use patterns were characterized and the association with demographic factors was assessed by the chi-square test.
Of the 6,495 patients included in analysis 29% and 15% had undergone no postoperative imaging by 3 and 12 months, respectively. While abdominal x-ray was the most common modality at 3, 6 and 12 months, performed in 46%, 53% and 62% patients, respectively, nearly 50% underwent computerized tomography by 1 year. Of these patients 34% underwent computerized tomography within 3 months, which was done within the first 3 days in 69%. During the study period renal ultrasound use increased by 13% while computerized tomography and abdominal x-ray use remained relatively stable. Female gender, residence in the Northeast, no health maintenance organization status and treatment in a metropolitan statistical area were independently associated with higher rates of renal ultrasound on multivariate analyses (p <0.05).
Among insured adults national imaging patterns vary following percutaneous nephrolithotomy. Many patients do not receive any followup imaging while approximately half undergo computerized tomography within a year. Imaging patterns may be evolving with the increased use of ultrasound.
经皮肾镜取石术后的随访影像学检查用于检测术后并发症、残留结石和无症状性肾积水。然而，术后随访的时间和最佳影像学检查方式仍未明确。本研究描述了经皮肾镜取石术后的影像学检查应用模式。
我们在 MarketScan®数据库中确定了 2007 年至 2014 年期间接受经皮肾镜取石术的 17-64 岁患者。通过 CPT、ICD-9 和 10 编码确定影像学检查方式，并在经皮肾镜取石术后 1 年内进行追踪。检查方式包括计算机断层扫描、肾脏超声、腹部 X 线和静脉肾盂造影。通过卡方检验评估这些检查方式的累积纵向使用模式，并评估其与人口统计学因素的相关性。
在纳入分析的 6495 例患者中，分别有 29%和 15%的患者在术后 3 个月和 12 个月时未进行任何术后影像学检查。尽管腹部 X 线在术后 3 个月、6 个月和 12 个月时是最常用的检查方式，分别在 46%、53%和 62%的患者中使用，但接近 50%的患者在 1 年内接受了计算机断层扫描。在这些患者中，34%的患者在术后 3 个月内接受了计算机断层扫描，其中 69%的患者在术后 3 天内接受了该检查。在研究期间，肾脏超声的使用率增加了 13%，而计算机断层扫描和腹部 X 线的使用率保持相对稳定。多变量分析显示，女性、居住在东北部、没有健康维护组织状态和在大都市统计区接受治疗与肾脏超声使用率较高独立相关（p<0.05）。
在有保险的成年人中，经皮肾镜取石术后的全国影像学检查模式存在差异。许多患者未接受任何随访影像学检查，而大约一半的患者在 1 年内接受了计算机断层扫描。随着超声的广泛应用，影像学检查模式可能正在发生变化。
