Columbia University Division of Urology, Mount Sinai Medical Center, 4302 Alton Road, Suite 540, Miami Beach, FL, 33140, USA.
Warren Alpert Medical School of Brown University, Providence, RI, USA.
World J Urol. 2019 Nov;37(11):2501-2508. doi: 10.1007/s00345-019-02660-7. Epub 2019 Feb 11.
Stent omission after routine ureteroscopy (rtURS) is accepted by current guidelines and may result in decreased patient morbidity and treatment costs. In a value-based healthcare model, the added morbidity and cost of routine stent placement may be scrutinized. Furthermore, data are limited on urologist cost knowledge and it is effect on ureteral stent placement. As such, we seek to describe ureteral stenting practices and urologist cost knowledge amongst US and non-US-based urologists.
The ureteroscopic practice patterns and cost awareness of members of the Endourological Society were surveyed using an international email listserv. Respondents were grouped by practice location (US vs non-US). Logistic regression was used to evaluate the associations of surgeon practice location with stenting practices.
233 completed responses were received with a response rate of 13.5%. Results revealed that 55% and 71% of respondents reported ureteral stent insertion after rtURS more than 75% of the time for ureteral and renal stones, respectively. Reporting stent insertion following more than 75% of rtURS was more common among US participants for both ureteral and renal stones. Overall, reported cost knowledge was high, but lower among US participants. On multivariable analysis, US respondents were more likely to place ureteral stents after rtURS for ureteral stones more than 75% of the time when compared to those abroad (OR 3.43 p < 0.01).
Ureteral stenting after rtURS is over utilized in the US compared to other countries. While this phenomenon is multifactorial in nature, cost knowledge may be under recognized as a determinant of ureteral stent placement following rtURS.
目前的指南接受了常规输尿管镜检查（rtURS）后支架的省略，这可能会降低患者的发病率和治疗成本。在基于价值的医疗保健模式下，常规支架放置的额外发病率和成本可能会受到审查。此外，关于泌尿科医生的成本知识及其对输尿管支架放置的影响的数据有限。因此，我们试图描述美国和非美国泌尿科医生的输尿管支架放置实践和泌尿科医生的成本知识。
使用国际电子邮件列表服务对 Endourological Society 成员的输尿管镜检查实践模式和成本意识进行了调查。根据实践地点（美国与非美国）对受访者进行分组。使用逻辑回归评估外科医生实践地点与支架放置实践的关联。
共收到 233 份完整回复，回复率为 13.5%。结果表明，分别有 55%和 71%的受访者报告在 rtURS 后超过 75%的时间内插入输尿管和肾结石的输尿管支架。美国参与者报告在 rtURS 后超过 75%的时间内插入输尿管支架的情况更为常见，无论是对于输尿管结石还是肾结石。总体而言，报告的成本知识水平较高，但美国参与者的水平较低。在多变量分析中，与国外相比，美国参与者更有可能在 rtURS 后超过 75%的时间内放置输尿管支架治疗输尿管结石（OR 3.43，p<0.01）。
与其他国家相比，美国在 rtURS 后过度使用输尿管支架。虽然这种现象是多因素的，但成本知识可能被低估为 rtURS 后放置输尿管支架的决定因素。
