The following is a summary of “Time Course and Risk Factors for Repeat Procedures After Ureteroscopy or Shockwave Lithotripsy,” published in the APRIL 2023 issue of Urology by Wong, et al.
For a study, researchers sought to identify risk factors and determine the time course for repeat procedures following ureteroscopy (URS) or shockwave lithotripsy (SWL) for treating ureteral or renal stones using a comprehensive employer-based claims database.
Using the IBM MarketScan Commercial Database, we identified all patients who underwent URS or SWL for ureteral or renal stone treatment between January 1, 2007, and December 31, 2014. A 90-day grace period was allowed after the index procedure before evaluating the occurrence of a repeat stone procedure. Patients were followed until December 31, 2017. Cox proportional hazards models were used to perform multivariate analyses and identify independent risk factors for repeat procedures after the initial stone removal.
A total of 189,739 patients who underwent SWL or URS were included in the study. The incidence of repeat procedures per 100 person-years was 6.8, with rates of 4.4 after SWL and 4.4 after URS, respectively. The median time to reoperation was 12.5 months for SWL and 14.6 months for URS. Multivariable analysis revealed that SWL was associated with an increased risk of repeat procedures compared to URS (hazard ratio [HR] = 1.63). Additionally, paralysis, neurogenic bladder, and inflammatory bowel disease were identified as independent risk factors for repeat procedures (HR = 1.66, 1.40, and 1.36, respectively).
Based on a large national cohort, the study demonstrated that patients with paralysis and neurogenic bladder had a significantly higher risk of requiring repeat stone procedures. Furthermore, SWL was associated with a higher risk of repeat procedures than URS. The findings provided valuable insights for urologists to identify and counsel patients who were at a higher risk of requiring recurrent procedures for stone management.
Source: goldjournal.net/article/S0090-4295(22)01081-0/fulltext
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