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

Abstract

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.

Are robots the future? A case for robotic pyeloplasty as the gold standard treatment in ureteropelvic junction obstruction

“…However, that is not the case. LPs are only performed in 13% of all minimally invasive procedures (MIPs) as of 2010 [8]. Autorino's study also addresses the use of MIS over open pyeloplasty.…”

“…fatigue due to their ability to sit, and the absence of a fulcrum effect at the site of port leading to less trauma at the site of the port. Clinically, early studies have shown high success rates, decreased complication rate, decreased length of hospital stay, better cosmetic result [8]. This goal of this article is to argue for the use of robotic pyeloplasty as the gold standard of UPJO treatment through a summary of the results of studies that have compared robotic pyeloplasty the various methods currently offered.…”

Clinical and radiographic outcomes following salvage intervention for ureteropelvic junction obstruction

“…Our series and several other retrospective head-to-head comparisons following failed primary pyeloplasty (6)(7)(8) suggest a similar dichotomy in the secondary setting, with superior outcomes of pyeloplasty (failure 0-17%) compared to endopyelotomy (failure 29-76%). These data in the context of decreased morbidity and increased availability of laparoscopic/robotic approaches (14,15) make secondary pyeloplasty an increasingly attractive approach. Indeed, one study comparing redo laparoscopic pyeloplasty to primary laparoscopic pyeloplasty in a matched fashion found no evident differences in complications or outcomes, with the exception of operative time (16).…”

Robotic versus Open Pyeloplasty: Perioperative and Functional Outcomes

“…Surgical management of UPJO has historically been performed with open dismembered pyeloplasty (OP), according to Anderson-Hynes, which was considered the standard gold treatment of UPJO, yielding a greater than 90% success rate [ 5 ].…”