To examine the effectiveness of the three primary treatments for ureteropelvic junction obstruction (i.e., open pyeloplasty, minimally invasive pyeloplasty, and endopyelotomy) as assessed by failure rates.
Using MarketScan(®) data, we identified adults (ages 18-64) who underwent treatment for ureteropelvic junction obstruction between 2002 and 2010. Our primary outcome was failure (i.e., 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.
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<0.001).
Endopyelotomy has the highest failure rates, yet remains a common treatment for ureteropelvic junction obstruction. Future research should examine to what extent patients and physicians are driving the use of endopyelotomy.
Urology. 2017 Sep 21 [Epub ahead of print]
Bruce L Jacobs, Julie C Lai, Rachana Seelam, Janet M Hanley, J Stuart Wolf, Brent K Hollenbeck, John M Hollingsworth, Andrew W Dick, Claude M Setodji, Christopher S Saigal, Urologic Diseases in America Project
Department of Urology, University of Pittsburgh, Pittsburgh, PA. Electronic address: ., RAND Corporation, Santa Monica, CA.. Electronic address: ., RAND Corporation, Santa Monica, CA.. Electronic address: ., RAND Corporation, Santa Monica, CA.. Electronic address: ., Dell Medical School of the University of Texas, Austin, TX.. Electronic address: ., 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. Electronic address: ., Department of Urology, Divisions of Endourology, University of Michigan, Ann Arbor, MI.; Department of Urology, Division of Health Services Research, University of Michigan, Ann Arbor, MI.. Electronic address: ., RAND Corporation, Santa Monica, CA.. Electronic address: ., RAND Corporation, Santa Monica, CA.. Electronic address: ., Department of Urology, David Geffen School of Medicine, University of California, Los Angeles.; RAND Corporation, Santa Monica, CA.. Electronic address: .