MP51-11 RATE OF URETERAL STRICTURE FOLLOWING URETEROSCOPY FOR NEPHROLITHIASIS USING A NATIONAL DATABASE OF INSURED PATIENTS

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2016MP51-11 RATE OF URETERAL STRICTURE FOLLOWING URETEROSCOPY FOR NEPHROLITHIASIS USING A NATIONAL DATABASE OF INSURED PATIENTS Philip May, Sarah Holt, Joshua Calvert, and Jonathan Harper Philip MayPhilip May More articles by this author , Sarah HoltSarah Holt More articles by this author , Joshua CalvertJoshua Calvert More articles by this author , and Jonathan HarperJonathan Harper More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.466AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteroscopy (URS) has become the most commonly utilized intervention in the United States for the surgical management of nephrolithiasis, a trend that may be related to the superior stone free rate in comparison to shockwave lithotripsy (SWL) in many series. Ureteral stricture is believed to occur following <1% of URS, but the precise rate is unknown. Our objective is to describe the rate and risk factors for ureteral stricture following URS using a national database of insured patients. METHODS The MarketScan Database contains insurance claims data from U.S. employer-based commercial health plans, and includes outpatient and hospital admission data for more than 170 million patients. Patients aged 17-65 undergoing URS or SWL for urolithiasis with a diagnosis of renal or ureteral stone between 2007 and 2013 were assessed for ureteral stricture formation. Analysis was restricted to patients with 6 months of continuous enrollment before and after intervention. RESULTS A total of 270,008 patients who received URS or SWL for treatment of upper tract urolithiasis were identified. In patients receiving URS, 57.4% were male and the mean age was 50.8 years; in patients receiving SWL alone, 57.9% were male and the mean age was 51.1 years. The rate of ureteral stricture in patients undergoing URS in comparison to those receiving SWL alone was 3.0% versus 2.0% (p<0.001). In URS patients, the rate of stricture was higher in females (3.35% versus 2.75% in males), those with preoperative hydronephrosis (4.1% v 2.9%), those with renal stones (3.71% v 2.71%), those with prior URS in the 6 month preceding the study URS (3.79% v 2.59%), and those with ureteral stent placement within 30 days of URS (3.56% v 2.82%). All associations were statistically significant on logistic regression analysis (p < 0.001). Risk factors for ureteral stricture were similar in patients receiving SWL, with the exception of stone location, which had no association with stricture risk. CONCLUSIONS Based on a national database of insured patients, the rate of ureteral stricture following URS for renal stone disease is 3.0%, which is approximately three times the rate generally quoted in the literature. This rate is also higher than the rate of 2.0% associated with SWL, which has not been previously reported and is likely related to a combination of stone disease alone and true iatrogenic ureteral injury. Future goals include quantifying the procedural and cost burden of managing ureteral strictures following URS, as well as identifying strategies for ureteral stricture prevention. © 2016FiguresReferencesRelatedDetailsCited byAhn J, Holt S, May P and Harper J (2017) National Imaging Trends after Ureteroscopic or Shock Wave Lithotripsy for NephrolithiasisJournal of Urology, VOL. 199, NO. 2, (500-507), Online publication date: 1-Feb-2018. Volume 195Issue 4SApril 2016Page: e684-e685 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Philip May More articles by this author Sarah Holt More articles by this author Joshua Calvert More articles by this author Jonathan Harper More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...