Surgical procedure and recurrence of upper urinary tract stone: a national-wide study based on hospitalized patients
Qin Wang1,2,3, Yu Wang4,5, Chao Yang1,3,6
1Renal Division, Department of Medicine, Institute of Nephrology, Peking University First Hospital, Peking University, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
Insights
Different surgical procedures for upper urinary tract stones carry varying recurrence risks. Extracorporeal shock wave lithotripsy (ESWL) has the lowest medical burden, despite higher recurrence rates than open surgery.
Area of Science:
- Urology
- Health Services Research
- Nephrology
Background:
- Upper urinary tract stones affect a significant patient population.
- Surgical interventions are common for stone removal.
- Understanding recurrence and cost implications is crucial for patient management.
Purpose of the Study:
- To assess the impact of different surgical interventions on the recurrence risk of upper urinary tract stones.
- To compare the medical burden, including cost and hospital stay, of various surgical procedures.
Main Methods:
- Analysis of a national database of hospitalized patients in China (2013-2018).
- Inclusion of 556,217 patients diagnosed with upper urinary tract stones.
- Cox regression analysis to evaluate associations between surgical procedures and surgical recurrence (defined as re-operation >90 days after initial procedure).
Main Results:
- Over 2.7 years median follow-up, 4.1% of patients experienced surgical recurrence.
- Compared to open surgery, extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL) were associated with higher recurrence risks.
- ESWL demonstrated the shortest hospital stay and lowest cost among the procedures.
Conclusions:
- While ESWL, URS, and PCNL increase surgical recurrence risk compared to open surgery, ESWL presents the lowest medical burden.
- Balancing intervention efficacy with medical expenditure is a critical consideration for clinical practice and future research.
Purpose:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
