Renal Division, Department of Medicine, Institute of Nephrology, Peking University First Hospital, Peking University, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
World J Urol. 2024 Mar 13;42(1):132. doi: 10.1007/s00345-024-04831-7.
This study aimed to investigate the influence of surgical intervention on recurrence risk of upper urinary tract stone and compare the medical burden of various surgical procedures.
This study analyzed data from patients with upper urinary tract stone extracted from a national database of hospitalized patients in China, from January 2013 to December 2018. Surgical recurrence was defined as patients experience surgical procedures for upper urinary tract stone again with a time interval over 90 days. Associations of surgical procedures with surgical recurrence were evaluated by Cox regression.
In total, 556,217 patients with upper urinary tract stone were included in the present analysis. The mean age of the population was 49.9 ± 13.1 years and 64.1% were men. During a median follow-up of 2.7 years (IQR 1.5-4.0 years), 23,012 patients (4.1%) had surgical recurrence with an incidence rate of 14.9 per 1000 person-years. Compared to patients receiving open surgery, ESWL (HR, 1.59; 95% CI 1.49-1.70), URS (HR, 1.38; 95% CI 1.31-1.45), and PCNL (HR, 1.11; 95% CI 1.06-1.18) showed a greater risk for surgical recurrence. Patients receiving ESWL had the shortest hospital stay length and the lowest cost among the 4 procedures.
Compared with open surgery, ESWL, URS, and PCNL are associated with higher risks of surgical recurrence for upper urinary tract stone, while ESWL showed the least medical burden including both expenditure and hospital stay length. How to keep balance of intervention efficacy and medical expenditure is an important issue to be weighed cautiously in clinic practice and studied more in the future.
本研究旨在探讨手术干预对上尿路结石复发风险的影响，并比较各种手术方式的医疗负担。
本研究分析了来自中国国家住院患者数据库中 2013 年 1 月至 2018 年 12 月期间上尿路结石患者的数据。手术复发定义为患者再次接受上尿路结石手术治疗，时间间隔超过 90 天。采用 Cox 回归评估手术方式与手术复发的关系。
本研究共纳入 556217 例上尿路结石患者。患者的平均年龄为 49.9±13.1 岁，64.1%为男性。在中位随访 2.7 年（IQR 1.5-4.0 年）期间，23012 例（4.1%）患者发生手术复发，复发率为 14.9/1000 人年。与开放手术相比，ESWL（HR，1.59；95%CI 1.49-1.70）、URS（HR，1.38；95%CI 1.31-1.45）和 PCNL（HR，1.11；95%CI 1.06-1.18）的手术复发风险更高。在这 4 种手术方式中，接受 ESWL 治疗的患者住院时间最短，费用最低。
与开放手术相比，ESWL、URS 和 PCNL 与上尿路结石手术复发风险增加相关，而 ESWL 在费用和住院时间方面显示出最小的医疗负担。在临床实践中，如何在干预效果和医疗支出之间取得平衡是一个需要谨慎权衡的重要问题，未来还需要进一步研究。
