Practice trends in contemporary management of adult ureteropelvic junction obstruction

Marcovich, Robert; Jacobson, Avrum; Aldana, Joel Patrick A.; Lee, Benjamin R.; Smith, Arthur D.

doi:10.1016/s0090-4295(03)00346-7

Cited by 24 publications

(11 citation statements)

References 11 publications

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“…procedures (9). This trend is rapidly changing as more surgeons become familiar with laparoscopic techniques and the rapid advancement of the robotic platform has eased the transition of the open surgeon into the era of minimally invasive surgery.…”

Section: Original Article Introductionmentioning

confidence: 99%

Robot-assisted pyeloplasty: outcomes for primary and secondary repairs, a single institution experience

Thom¹,

Haseebuddin²,

Roytman³

et al. 2012

Int. braz j urol.

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Section: Original Article Introductionmentioning

confidence: 99%

Robot-assisted pyeloplasty: outcomes for primary and secondary repairs, a single institution experience

Thom¹,

Haseebuddin²,

Roytman³

et al. 2012

Int. braz j urol.

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“…16 Although a laparoscopic approach provides these same benefits, 5 it is generally more cumbersome to suture laparoscopically and it is not ergonomic. 17,18 Another reason for the adoption of the minimally invasive approach likely pertains to the transfer of skill obtained from using the robotic platform for other procedures. As an example, during this study period, the use of robotic prostatectomy rapidly increased; by 2013, 85% of prostatectomies were done robotically.…”

Section: Discussionmentioning

confidence: 99%

Variation in the Use of Open Pyeloplasty, Minimally Invasive Pyeloplasty, and Endopyelotomy for the Treatment of Ureteropelvic Junction Obstruction in Adults

Jacobs

Seelam

Hanley

et al. 2017

Journal of Endourology

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Background and Purpose: Ureteropelvic junction obstruction is a common condition that can be treated with open pyeloplasty, minimally invasive pyeloplasty, and endopyelotomy. While all these treatments are effective, the extent to which they are used is unclear. We sought to examine the dissemination of these treatments. Patients and Methods: Using the MarketScan Ò database, we identified adults 18 to 64 years old who underwent treatment for ureteropelvic junction obstruction between 2002 and 2010. Our primary outcome was ureteropelvic junction obstruction treatment (i.e., open pyeloplasty, minimally invasive pyeloplasty, endopyelotomy). We fit a multilevel multinomial logistic regression model accounting for patients nested within providers to examine several factors associated with treatment. Results: Rates of minimally invasive pyeloplasty increased 10-fold, while rates of open pyeloplasty decreased by over 40%, and rates of endopyelotomy were relatively stable. Factors associated with receiving an open vs a minimally invasive pyeloplasty were largely similar. Compared with endopyelotomy, patients receiving minimally invasive pyeloplasty were less likely to be older (odds ratio [OR] 0.96; 95% confidence interval [CI], 0.95, 0.97) and live in the south (OR 0.52; 95% CI, 0.33, 0.81) and west regions (OR 0.57; 95% CI 0.33, 0.98) compared with the northeast and were more likely to live in metropolitan statistical areas (OR 1.52; 95% CI 1.08, 2.13). Conclusions: Over this 9-year period, the landscape of ureteropelvic junction obstruction treatment has changed dramatically. Further research is needed to understand why geographic factors were associated with receiving a minimally invasive pyeloplasty or an endopyelotomy.

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“…Our study supports previous findings that physicians in academic settings are more likely to perform minimally invasive pyeloplasties. [6][7][8] In part, this reflects the higher proportion of surgeons at academic centers who are laparoscopically trained and the types of hospitals investing in new, expensive technologies. 8 The estimated effect of teaching vs a nonteaching hospital does not appear to be explained by differences in surgeon volume.…”

Section: Treatment Of Ureteropelvic Junction Obstructionmentioning

confidence: 99%

“…This finding underscores the technical demands and learning curve associated with minimally invasive pyeloplasty. 5,6 Further, pyeloplasties are not common procedures, and surgeons who do not see a large volume of these patients may be less inclined to learn new and challenging techniques. 26 At the same time, the ability of robotic surgery to reduce the learning curve 9 may help the diffusion of minimally invasive pyeloplasties by attracting lower-volume surgeons.…”

Section: Treatment Of Ureteropelvic Junction Obstructionmentioning

confidence: 99%

“…5,6 Formal laparoscopic training is less prevalent in the urologic community, which manifests as a lower utilization of minimally invasive pyeloplasties in this setting, compared with that in the academic setting. [6][7][8] Although the advent of robotic surgery has mitigated some of these challenges by reducing the learning curve, 5,9 its upfront expense (ie, capital investment of $1 million-$2.25 million 10 ) impedes its widespread adoption. Previous studies demonstrate that minimally invasive techniques for upper urinary tract procedures are influenced not only by patient characteristics, but also by surgeon-and hospital-level factors.…”

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confidence: 99%

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Trends in the Treatment of Adults with Ureteropelvic Junction Obstruction

Jacobs

Kaufman

Morgenstern³

et al. 2013

Journal of Endourology

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Background and Purpose: Minimally invasive pyeloplasty is an effective treatment for patients with ureteropelvic junction obstruction that offers quicker convalescence than open pyeloplasty. Technical challenges, however, may have limited its dissemination. We examined population trends and determinants of surgical options for ureteropelvic junction obstruction. Patients and Methods: Using the State Inpatient and Ambulatory Surgery Databases for Florida, we identified adults who underwent ureteropelvic junction obstruction repair between 2001 and 2009. After determining the surgical approach (minimally invasive pyeloplasty, open pyeloplasty, or endopyelotomy), we estimated annual utilization rates and the effects of patient, surgeon, and hospital predictors on surgery type, using multilevel multinomial logistic regression. Results: Rates of minimally invasive pyeloplasty increased 360% (P for monotonic trend < 0.01), while rates of open pyeloplasty decreased 56% (P < 0.01). Rates of endopyelotomy were substantially higher and remained relatively stable (P = 0.27). Compared with open pyeloplasty, minimally invasive pyeloplasty was used more commonly among patients with private insurance (odds ratio [OR] 1.6; 95% confidence interval [CI], 1.2-2.3), those treated at teaching hospitals (OR 1.6; CI 1.0-2.6), and those treated by high-volume surgeons (OR 2.9; CI 2.0-4.2). Its use was less frequent among patients with multiple comorbidities (OR 0.53; CI 0.37-0.76). Similar associations were observed when comparing receipt of minimally invasive pyeloplasty with endopyelotomy; however, patients who underwent endopyelotomy were older. Conclusions: The use of minimally invasive pyeloplasty has dramatically increased, largely replacing open pyeloplasty, while the use of endopyelotomy, albeit significantly more common than the other approaches, has remained stable. The surgical approach is influenced by several patient, surgeon, and hospital factors.

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Practice trends in contemporary management of adult ureteropelvic junction obstruction

Cited by 24 publications

References 11 publications

Robot-assisted pyeloplasty: outcomes for primary and secondary repairs, a single institution experience

Robot-assisted pyeloplasty: outcomes for primary and secondary repairs, a single institution experience

Variation in the Use of Open Pyeloplasty, Minimally Invasive Pyeloplasty, and Endopyelotomy for the Treatment of Ureteropelvic Junction Obstruction in Adults

Trends in the Treatment of Adults with Ureteropelvic Junction Obstruction

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