University of Michigan, Ann Arbor, MI.
University of Michigan, Ann Arbor, MI.
Urology. 2020 Mar;137:38-44. doi: 10.1016/j.urology.2019.11.037. Epub 2019 Dec 13.
To understand how treatment of patients with urinary stones by shockwave lithotripsy (SWL) aligns with current published practice guidelines.
We used the Michigan Urologic Surgery Improvement Collaborative Reducing Operative Complications for Kidney Stones registry to understand SWL use in the state of Michigan. This prospectively maintained clinical registry includes data from community and academic urology practices and contains clinical and operative data for patients undergoing SWL and ureteroscopy (URS). We identified patients undergoing SWL from 2016 to 2019. In accordance with AUA guidelines, we evaluated practice patterns in relation to recommendations for treatment selection for SWL as well as clinical implications of guideline nonadherence.
Four thousand, two hundred and nine SWL procedures performed across 34 practices were analyzed. Perioperative antibiotics were administered to 61.3% of patients undergoing SWL. A ureteral stent was placed at the time of SWL in 2.7% of patients. For lower pole renal stones >1 cm or large (>2 cm) renal stones in the registry, 32.2% and 58.9% of patients, respectively, underwent SWL, while the remainder were treated with URS. In these instances, SWL was associated with inferior stone-free rate (SFR) relative to URS. In patients with residual stones after SWL, 34.6% were treated with repeat SWL with lower SFR than those treated with subsequent URS. Postoperatively, 42.1% of patients were prescribed alpha-blockers with no benefit seen in terms of SFR.
Substantial variation exists among urology practices with regard to SWL use. These data serve to inform quality improvement efforts regarding appropriateness criteria for SWL in Michigan.
了解体外冲击波碎石术（SWL）治疗尿路结石的方法是否符合当前发布的实践指南。
我们使用密歇根州泌尿外科手术改进合作组织减少肾结石手术并发症登记处来了解密歇根州 SWL 的使用情况。这个前瞻性维护的临床登记处包括来自社区和学术泌尿科实践的数据，包含接受 SWL 和输尿管镜检查（URS）的患者的临床和手术数据。我们从 2016 年至 2019 年确定了接受 SWL 的患者。根据 AUA 指南，我们评估了治疗选择方面的实践模式以及指南不遵守的临床意义。
在 34 家诊所进行了 4209 次 SWL 手术。接受 SWL 的患者中有 61.3%接受了围手术期抗生素治疗。在 2.7%的患者中，SWL 时放置了输尿管支架。在登记处中，对于下极肾结石>1cm 或大（>2cm）肾结石，分别有 32.2%和 58.9%的患者接受 SWL 治疗，而其余患者则接受 URS 治疗。在这些情况下，SWL 与 URS 相比，结石清除率（SFR）较低。在接受 SWL 治疗后仍有残余结石的患者中，有 34.6%的患者接受了重复 SWL 治疗，其 SFR 低于接受后续 URS 治疗的患者。术后，有 42.1%的患者接受了α受体阻滞剂治疗，但 SFR 方面没有获益。
在 SWL 的使用方面，泌尿科实践之间存在很大差异。这些数据有助于为密歇根州 SWL 的适宜性标准提供质量改进工作的信息。
