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Comparative Study
. 2018 Jan:111:72-77.
doi: 10.1016/j.urology.2017.09.002. Epub 2017 Sep 21.

The Comparative Effectiveness of Treatments for Ureteropelvic Junction Obstruction

Bruce L Jacobs  1 , Julie C Lai  2 , Rachana Seelam  2 , Janet M Hanley  2 , J Stuart Wolf Jr  3 , Brent K Hollenbeck  4 , John M Hollingsworth  5 , Andrew W Dick  2 , Claude M Setodji  2 , Christopher S Saigal  6 ; Urologic Diseases in America Project
Affiliations
Comparative Study

The Comparative Effectiveness of Treatments for Ureteropelvic Junction Obstruction

Bruce L Jacobs et al. Urology. 2018 Jan.

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.

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Figures

Figure 1
Figure 1
Adjusted* failure-free probability, according to treatment type * Adjusted for age, gender, comorbidity, benefit plan type, employment classification, employment status, region of residence, patient MSA, provider MSA, and treatment year. Overall, the adjusted failure-free probabilities were high for all three treatments. Endopyelotomy had the lowest failure-free rates (logrank p<0.0001). For all three treatments, the majority of failures occurred within the first two years.
Figure 2
Figure 2
Adjusted* hospital length of stay after minimally invasive and open pyeloplasty *Adjusted for age, gender, comorbidity, benefit plan type, employment classification, employment status, region of residence, patient MSA, provider MSA, and treatment year. The hospital length of stay was significantly shorter for minimally invasive pyeloplasty compared to open pyeloplasty (p<0.001, ANCOVA).
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References

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