Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical School, Boston, MA, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
World J Urol. 2021 Jun;39(6):2177-2182. doi: 10.1007/s00345-020-03430-6. Epub 2020 Sep 9.
To identify clinical and non-clinical predictors of treatment failure and perioperative complications following ureterorenoscopy versus shockwave lithotripsy.
The New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) database was used to identify 226,331 patients who underwent index ureteroscopy or shockwave lithotripsy for renal stones from 2000 to 2016. Propensity-matched generalized linear-mixed modeling was utilized to compare failure and complication rates between the two procedure groups.
219,383 individuals meeting inclusion criteria who underwent either ureterorenoscopy (n = 124,342) or shockwave lithotripsy (n = 95,041) in New York State between 2000 and 2016 were included in our analysis. After propensity score matching, patients undergoing shockwave lithotripsy were found to have decreased odds of experiencing any type of 30-day complication (P < 0.001 for all) but increased odds of treatment failure at both 90 (OR 1.70, 95% CI 1.64-1.77) and 180 (OR 1.83, 95% CI 1.76-1.89) days (P < 0.001 for both).
Patients undergoing shockwave lithotripsy experienced significantly higher odds of treatment failure, although this undesirable outcome appears to be partially offset by lower 30-day complication rates.
确定输尿管镜检查与冲击波碎石术治疗后失败和围手术期并发症的临床和非临床预测因素。
利用纽约州卫生署全州规划和研究合作系统（SPARCS）数据库，对 2000 年至 2016 年间因肾结石接受指数输尿管镜检查或冲击波碎石术的 226331 名患者进行了识别。利用倾向评分匹配广义线性混合模型比较两组手术的失败和并发症发生率。
符合纳入标准的 219383 名个体（n=124342）在纽约州接受输尿管镜检查，或（n=95041）接受冲击波碎石术，包括在我们的分析中。在进行倾向评分匹配后，发现接受冲击波碎石术的患者发生任何类型的 30 天并发症的可能性降低（所有 P<0.001），但在 90 天（OR 1.70，95%CI 1.64-1.77）和 180 天（OR 1.83，95%CI 1.76-1.89）时治疗失败的可能性增加（均 P<0.001）。
接受冲击波碎石术的患者发生治疗失败的可能性明显更高，尽管这种不良后果似乎部分被 30 天并发症率较低所抵消。
