The Comparative Effectiveness of Treatments for Ureteropelvic Junction Obstruction

• Published in: Urology (Ridgewood, N.J.) N.J.), 2018-01, Vol.111, p.72-77
• Main Authors: Jacobs, Bruce L., Lai, Julie C., Seelam, Rachana, Hanley, Janet M., Wolf, J. Stuart, Hollenbeck, Brent K., Hollingsworth, John M., Dick, Andrew W., Setodji, Claude M., Saigal, Christopher S.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Female; Humans; Kidney Pelvis - surgery; Male; Middle Aged; Treatment Outcome; Ureteral Obstruction - surgery; Urologic Surgical Procedures - methods; Young Adult
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2017.09.002

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. 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. 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