怀孕期间尿病管理的成本效益
Emily K Clennon1, Brian D Duty1, Aaron B Caughey1
1Departments of Obstetrics and Gynecology and Urology, Oregon Health and Science University, Portland, Oregon.
Urology practice
|June 15, 2023
概括
尿路透镜是孕妇患有结石 (尿路结石) 的最有效和最具成本效益的治疗方法. 这种方法提供了更好的结果和显著的成本节省,与尿路支架或皮肤通术相比,无论怀孕阶段如何.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 产科 产科 产科 产科 产科
- 卫生经济学 卫生经济学
背景情况:
- 怀孕期间的尿病给医疗保健团队带来了重大挑战.
- 管理选项,如尿路支架,穿皮瘤和尿路透镜,具有不同的疗效,并发症率,生活质量影响和成本.
研究的目的:
- 为了比较尿路支架的疗效,并发症,生活质量和成本,穿皮瘤切除术和尿路镜检查用于怀孕期间控制尿.
- 根据妊娠年龄来确定最佳的管理策略.
主要方法:
- 开发了一种决策分析模型,比较尿路支架,皮革瘤切除和尿路透镜.
- 结果包括治疗失败,重复治疗率和并发症严重程度,概率和效用来自文献,成本来自机构数据.
- 采用多变量灵敏度分析和蒙特卡洛模拟来评估模型在一年时间的稳定性.
主要成果:
- 尿路透镜检查给出了960年的质量调整寿命,优于支架 (870) 和皮革瘤切除 (880).
- 支架或皮肤穿术的失败率是尿道镜检查失败率的两倍多,超过一半的患者需要进一步治疗.
- 尿路透镜检查显示了显著的成本节约,与支架相比估计为3880万美元,与模拟队列中的皮肤瘤切除相比估计为1760万美元.
结论:
- 尿路透镜是管理所有妊娠年龄的怀孕相关尿路结石病的主要和具有成本效益的策略.
- 即使在模型参数发生了重大变化之后,研究结果仍然稳健,证实了尿路透镜的优越性.
更多相关视频
06:39Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma
Published on: November 22, 2019
7.8K
03:19Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
Published on: June 21, 2024
1.2K
相关概念视频
01:30Urinary Tract Calculi III: Medical Management
9
The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
9
01:28Urinary Tract Calculi V: Nursing Management
14
AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
14
01:25Urinary Tract Calculi VI: Surgical Management
11
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
11
01:27Urinary Tract Calculi IV: Nutrition Therapy and Prevention
11
Management of renal calculi focuses on effective strategies like tailored nutrition and hydration therapy. Adjusting diet and fluid intake reduces stone formation and recurrence, making these interventions simple yet powerful in kidney stone prevention and management.Understanding Kidney StonesKidney stones form when calcium, oxalate, uric acid, and cystine concentrate and crystallize in urine. Factors contributing to their formation include genetic predisposition, certain medical conditions,...
11
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
16
Renal calculi, commonly termed kidney stones, are crystalline solid masses that form in the kidneys but can occur at any point within the urinary system, encompassing the kidneys, ureters, bladder, and urethra.The pathophysiology of renal stones involves several key factors: supersaturation of the urine with stone-forming constituents, changes in urine pH, a decrease in urine volume, and the presence of substances that promote or inhibit stone formation.Supersaturation of Urine: This is the...
16
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
78
IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
78