Dataset Information

Re-Treatment after Ureteroscopy and Shock Wave Lithotripsy: A Population Based Comparative Effectiveness Study.

ABSTRACT:

Purpose

Shock wave lithotripsy and ureteroscopy are the most commonly performed surgeries for kidney and ureteral stones, but the comparative effectiveness of these interventions at the population level is unclear. We compared re-treatment for shock wave lithotripsy and ureteroscopy.

Materials and methods

A retrospective cohort study using all-payer claims data for all patients who underwent shock wave lithotripsy or ureteroscopy from 1997 to 2016 at 74 hospitals in South Carolina was performed. The primary outcome measure was subsequent shock wave lithotripsy or ureteroscopy within 6 months of initial surgery. Pseudorandomized trials of ureteroscopy vs shock wave lithotripsy were performed for each year, applying propensity scores to balance hospital and patient characteristics. Discrete time failure models were fit using propensity score weighted logistic regression.

Results

Overall 136,152 ureteroscopy and shock wave lithotripsy surgeries were performed in 95,227 unique patients with re-treatment representing 9% of all surgeries. A total of 74,251 index surgeries were shock wave lithotripsy (59.9%) and 49,743 were ureteroscopy (40.1%). Shock wave lithotripsy was associated with a 20% increased odds of re-treatment (OR 1.20; 95% CI 1.13-1.26). The probability of re-treatment was 7.5% for ureteroscopy and 10.4% for shock wave lithotripsy. Shock wave lithotripsy had the greatest risk of re-treatment at months 2 (OR 1.85; 95% CI 1.64-2.10) and 3 (OR 1.76; 95% CI 1.50-2.06). Patients with initial shock wave lithotripsy were more likely to have shock wave lithotripsy for re-treatment (84.6%) than those patients who had initial ureteroscopy were to have ureteroscopy (29.3%).

Conclusions

Compared to ureteroscopy, shock wave lithotripsy was associated with increased odds of re-treatment. These results have implications for shared decision making and value based surgical treatment of nephrolithiasis.

SUBMITTER: Bowen DK

PROVIDER: S-EPMC7211122 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:ObjectiveThis study aims to compare the safety and efficacy of extracorporeal shock wave lithotripsy (SWL) and flexible ureteroscopy lithotripsy (f-URS) in treating urinary tract stones.MethodsWe systematically searched PubMed, Embase, and Cochrane for literature comparing SWL with f-URS. The primary outcomes we focused on were stone-free rate (SFR) and complications; the secondary outcomes were operation time, hospital stay, retreatment rate, number of sessions, and auxiliary procedures rate. We used ReviewManager version 5.4.1 and STATA version 14.2 for meta-analysis.ResultsSeventeen studies with a total of 2,265 patients were included in the meta-analysis, including 1,038 patients in the SWL group and 1,227 patients in the f-URS group. The meta-analysis indicated that patients in the f-URS group had higher SFR than those in the SWL group [odds ratio (OR): 2.00, 95% confidence interval (CI): 1.29-3.12, p = 0.002]. In addition, we found no significant difference in complications (OR: 1.08, 95% CI: 0.85-1.37) between the two treatments. Also, we found that the retreatment rate and the auxiliary procedure rate in the f-URS group were significantly lower than those in the SWL group (OR: 0.08, 95% CI: 0.02-0.24, p < 0.00001; OR: 0.30, 95% CI: 0.11-0.83, p = 0.02). Moreover, the number of sessions in the f-URS group was significantly lower than that in the SWL group [mean difference (MD): -1.96, 95% CI: -1.55 to -0.33, p = 0.003]. However, the operation time and hospital stay in the f-URS group were significantly longer than those in the SWL group (MD: 11.24, 95% CI: 3.51-18.56, p = 0.004; MD: 1.14, 95% CI: 0.85-1.42, p < 0.00001).ConclusionFor 1-2-cm urinary stones, f-URS can achieve a higher SFR than SWL while having a lower retreatment rate, number of sessions, and auxiliary procedure rate. For urinary stones <1 cm, there was no significant difference in SFR between SWL and f-URS groups. The SWL group has a shorter operative time and hospital stay than the f-URS group.