DiBianco John Michael, Daignault-Newton Stephanie, Fernandez Moncaleano Golena, Stockall Eric, Hiller Spencer, Kim Hyung Joon, Pimentel Hector, Wenzler David, Seifman Brian, Kachroo Naveen, Dauw Casey A, Ghani Khurshid R
Department of Urology, University of Florida, Gainesville, Florida.
Department of Urology, University of Michigan, Ann Arbor, Michigan.
J Urol. 2025 Oct;214(4):415-425. doi: 10.1097/JU.0000000000004628. Epub 2025 Jun 9.
AUA guidelines recommend ureteroscopy (URS) or shock wave lithotripsy (SWL) for lower pole (LP) stones ≤ 1 cm, while SWL is second line for stones > 1 to 2 cm. In the era of increasing URS, there are limited data on the modality used and outcomes. We assessed treatment distribution, stone-free rates (SFRs), and unplanned health care.
Using the Michigan Urological Surgery Improvement Collaborative registry, we identified URS and SWL cases for LP stones ≤ 2 cm (2016-2021). We assessed the frequency of patients receiving URS or SWL as a proportion of their LP treatment. A logistic model determined predictive probability of treatment modality. Differences in complete SFRs, postoperative emergency department visits, and hospitalizations were assessed by size (≤1 cm, >1-2 cm), adjusted for patient factors and correlation within practice/provider.
There were 3645 procedures from 35 practices (209 surgeons); 2287 (62.7%) had SWL. Of the stones 80.2% were ≤ 1 cm. There was variation in modality based on practice ( < .001) and surgeon ( < .001). For stones ≤ 1 cm, the SFR was higher for URS (56% vs 39%; < .001). There were no significant differences in SFRs for > 1 to 2 cm stones. Emergency department visits were higher after URS for stones ≤ 1 cm (odds ratio [OR]: 2.95, 95% CI: 1.7-5.0) but not for > 1 to 2 cm stones (OR: 0.97, 95% CI: 0.4-2.2). URS for stones ≤ 1 cm was associated with increased hospitalizations (OR: 4.67, 95% CI: 1.7-12.9) but not for stones > 1 to 2 cm (OR: 0.96, 95% CI: 0.4-2.2).
In Michigan, SWL is the chosen modality for LP stones ≤ 2 cm. For smaller stones, URS was more effective but had greater morbidity. For larger stones, both modalities demonstrated suboptimal efficacy. Our work demonstrates the need for interventions to improve outcomes.
美国泌尿外科学会（AUA）指南推荐，对于直径≤1 cm的下极（LP）结石采用输尿管镜检查（URS）或冲击波碎石术（SWL），而对于直径>1至2 cm的结石，SWL为二线治疗方法。在URS应用日益广泛的时代，关于所采用的治疗方式及其疗效的数据有限。我们评估了治疗分布、无结石率（SFRs）和非计划医疗保健情况。
利用密歇根泌尿外科手术改善协作登记系统，我们确定了2016 - 2021年间直径≤2 cm的LP结石的URS和SWL病例。我们评估了接受URS或SWL治疗的患者频率占其LP结石治疗的比例。采用逻辑模型确定治疗方式的预测概率。根据结石大小（≤1 cm，>1至2 cm）评估完全无结石率、术后急诊就诊次数和住院情况的差异，并对患者因素及医疗机构/医生内部的相关性进行了校正。
来自35家医疗机构（209名外科医生）的3645例手术；其中2287例（62.7%）采用SWL。80.2%的结石直径≤1 cm。治疗方式因医疗机构（<0.001）和外科医生（<0.001）而异。对于直径≤1 cm的结石，URS的无结石率更高（56%对39%；<0.001）。对于直径>1至2 cm的结石，无结石率无显著差异。对于直径≤1 cm的结石，URS术后急诊就诊次数更高（优势比[OR]：2.95，95%置信区间：1.7 - 5.0），但对于直径>1至2 cm的结石则不然（OR：0.97，95%置信区间：0.4 - 2.2）。直径≤1 cm的结石采用URS与住院次数增加相关（OR：4.67，95%置信区间：1.7 - 12.9），但对于直径>1至2 cm的结石则不然（OR：0.96，95%置信区间：0.4 - 2.2）。
在密歇根州，SWL是直径≤2 cm的LP结石的首选治疗方式。对于较小的结石，URS更有效，但发病率更高。对于较大的结石，两种治疗方式的疗效均欠佳。我们的研究表明需要采取干预措施来改善治疗效果。
