紧急上尿路减压：双 J 支架还是肾造口术？欧洲 YAU/ESUT/EULIS/BSIR 泌尿科医生和放射科医生调查。

Emergency upper urinary tract decompression: double-J stent or nephrostomy? A European YAU/ESUT/EULIS/BSIR survey among urologists and radiologists.

机构信息

Associate Specialist in Urology, University Hospital Southampton, Southampton, UK.

Complexo Hospitalario Universitario de Ourense, Ourense, Spain.

出版信息

World J Urol. 2022 Jul;40(7):1629-1636. doi: 10.1007/s00345-022-03979-4. Epub 2022 Mar 14.

DOI:10.1007/s00345-022-03979-4

PMID:35286423

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8918906/

Abstract

PURPOSE

To evaluate the decompression of the pelvicalyceal system between urologists and radiologists.

METHODS

A survey was distributed to urologists and to radiologists comparing double-J stent (DJS), percutaneous nephrostomy (PN) and primary ureteroscopy (URS) for three clinical scenarios (1-febrile hydronephrosis; 2-obstruction and persistent pain; 3-obstruction and anuria) before and after reading literature The survey included perception on radiation dose, cost and quality of life (QoL).

RESULTS

Response rate was 40% (366/915). 93% of radiologists believe that DJS offers a better QOL compared to 70.6% of urologists (p = 0.006). 28.4% of urologists consider PN to be more expensive compared to 8.9% of radiologists (p = 0.006). 75% of radiologists believe that radiation exposure is higher with DJS as opposed to 33.9% of urologists. There was not a difference in the decompression preference in the first scenario. After reading the literature, 28.6% of radiologists changed their opinion compared to 5.2% of urologists (p < 0.001). The change favored DJS. In the second scenario, responders preferred equally DJS and they did not change their opinion. In the third scenario, 41% of radiologists chose PN as opposed to 12.6% of urologists (p < 0.001). After reading the literature, 17.9% of radiologists changed their opinion compared to 17.9% of urologists (p < 0.001), in favor of DJS. Although the majority of urologists (63.4%) consistently perform primary URS, only 3, 37 and 21% preferred it for the first, second and third scenarios, respectively.

CONCLUSION

The decision on the type of drainage of a stone-obstructing hydronephrosis should be individualized.

摘要

目的

评估泌尿科医生和放射科医生在肾盂系统减压方面的差异。

方法

对泌尿科医生和放射科医生进行了一项调查，比较了双 J 支架（DJS）、经皮肾造瘘术（PN）和原发性输尿管镜检查（URS）在三种临床情况下（1-发热性肾积水；2-梗阻和持续疼痛；3-梗阻和无尿）的应用，分别在阅读文献前后进行。该调查包括对辐射剂量、成本和生活质量（QoL）的感知。

结果

应答率为 40%（366/915）。93%的放射科医生认为 DJS 比 70.6%的泌尿科医生提供更好的 QoL（p=0.006）。28.4%的泌尿科医生认为 PN 更昂贵，而 8.9%的放射科医生认为 PN 更昂贵（p=0.006）。75%的放射科医生认为 DJS 的辐射暴露更高，而 33.9%的泌尿科医生则认为 DJS 的辐射暴露更高。在第一种情况下，没有减压偏好的差异。阅读文献后，28.6%的放射科医生改变了他们的观点，而只有 5.2%的泌尿科医生改变了他们的观点（p<0.001）。改变倾向于 DJS。在第二种情况下，应答者同样更喜欢 DJS，他们没有改变他们的观点。在第三种情况下，41%的放射科医生选择 PN，而只有 12.6%的泌尿科医生选择 PN（p<0.001）。阅读文献后，17.9%的放射科医生改变了他们的观点，而 17.9%的泌尿科医生也改变了他们的观点（p<0.001），倾向于 DJS。尽管大多数泌尿科医生（63.4%）始终进行原发性 URS，但只有 3%、37%和 21%的医生分别在第一种、第二种和第三种情况下首选它。