Bruce L Jacobs1, Julie C Lai2, Rachana Seelam2, Janet M Hanley2, J Stuart Wolf3, Brent K Hollenbeck4, John M Hollingsworth5, Andrew W Dick2, Claude M Setodji2, Christopher S Saigal6. 1. Department of Urology, University of Pittsburgh, Pittsburgh, PA. Electronic address: jacobsbl2@upmc.edu. 2. University of California, Los Angeles, and RAND Corporation, Santa Monica, CA. 3. Dell Medical School of the University of Texas, Austin, TX. 4. Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, MI; Department of Urology, Division of Oncology, University of Michigan, Ann Arbor, MI. 5. Department of Urology, Division of Endourology, University of Michigan, Ann Arbor, MI; Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, MI. 6. Department of Urology, David Geffen School of Medicine, Los Angeles, CA; University of California, Los Angeles, and RAND Corporation, Santa Monica, CA.
Abstract
OBJECTIVE: To examine the effectiveness of the 3 primary treatments for ureteropelvic junction obstruction (ie, open pyeloplasty, minimally invasive pyeloplasty, and endopyelotomy) as assessed by failure rates. MATERIALS AND METHODS: Using MarketScan data, we identified adults (ages 18-64 years) who underwent treatment for ureteropelvic junction obstruction between 2002 and 2010. Our primary outcome was failure (ie, need for a secondary procedure). We fit a Cox proportional hazards model to examine the effects of different patient, regional, and provider characteristics on treatment failure. We then implemented a survival analysis framework to examine the failure-free probability for each treatment. RESULTS: We identified 1125 minimally invasive pyeloplasties, 775 open pyeloplasties, and 1315 endopyelotomies with failure rates of 7%, 9%, and 15%, respectively. Compared with endopyelotomy, minimally invasive pyeloplasty was associated with a lower risk of treatment failure (adjusted hazards ratio [aHR] 0.52; 95% confidence interval [CI], 0.39-0.69). Minimally invasive and open pyeloplasties had similar failure rates. Compared with open pyeloplasty, endopyelotomy was associated with a higher risk of treatment failure (aHR 1.78; 95% CI, 1.33-2.37). The average length of stay was 2.7 days for minimally invasive pyeloplasty and 4.2 days for open pyeloplasty (P <.001). CONCLUSION: Endopyelotomy has the highest failure rate, yet it remains a common treatment for ureteropelvic junction obstruction. Future research should examine to what extent patients and physicians are driving the use of endopyelotomy.
OBJECTIVE: To examine the effectiveness of the 3 primary treatments for ureteropelvic junction obstruction (ie, open pyeloplasty, minimally invasive pyeloplasty, and endopyelotomy) as assessed by failure rates. MATERIALS AND METHODS: Using MarketScan data, we identified adults (ages 18-64 years) who underwent treatment for ureteropelvic junction obstruction between 2002 and 2010. Our primary outcome was failure (ie, need for a secondary procedure). We fit a Cox proportional hazards model to examine the effects of different patient, regional, and provider characteristics on treatment failure. We then implemented a survival analysis framework to examine the failure-free probability for each treatment. RESULTS: We identified 1125 minimally invasive pyeloplasties, 775 open pyeloplasties, and 1315 endopyelotomies with failure rates of 7%, 9%, and 15%, respectively. Compared with endopyelotomy, minimally invasive pyeloplasty was associated with a lower risk of treatment failure (adjusted hazards ratio [aHR] 0.52; 95% confidence interval [CI], 0.39-0.69). Minimally invasive and open pyeloplasties had similar failure rates. Compared with open pyeloplasty, endopyelotomy was associated with a higher risk of treatment failure (aHR 1.78; 95% CI, 1.33-2.37). The average length of stay was 2.7 days for minimally invasive pyeloplasty and 4.2 days for open pyeloplasty (P <.001). CONCLUSION: Endopyelotomy has the highest failure rate, yet it remains a common treatment for ureteropelvic junction obstruction. Future research should examine to what extent patients and physicians are driving the use of endopyelotomy.
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