Introduction
Patients and methods
Study population
Assessment
Confounders
Statistical analysis
Results
Patient characteristics
Parameter | Patients treated with UAS (n = 1494) | Patients treated without UAS (n = 745) | Total population (n = 2239) | Group difference statistic |
---|---|---|---|---|
Age (years), mean (SD) | 51.2 (14.98) (n = 1494) | 50.2 (14.95) (n = 745) | 50.9 (14.98) (n = 2239) | NS |
Gender | ||||
Male, n (%) | 901 (60.3) | 462 (62.0) | 1363 (60.9) | |
Female, n (%) | 593 (39.7) (n = 1494) | 283 (38.0) (n = 745) | 876 (39.1) (n = 2239) | NS |
BMI, mean (SD) | 27.8 (7.4) (n = 1398) | 27.4 (5.8) (n = 606) | 27.7 (6.93) (n = 2004) | NS |
Comorbidity, n (%) | ||||
DM | 192 (12.9) (n = 1483) | 100 (13.7) (n = 729) | 292 (13.2) (n = 2212) | NS |
CVD | 503 (34.0) (n = 1479) | 193 (26.5) (n = 729) | 696 (31.5) (n = 2208) | NS |
Prednisone | 28 (1.9) (n = 1479) | 6 (0.8) (n = 730) | 34 (1.5) (n = 2208) | NS |
Crohn’s disease | 15 (1.0) (n = 1479) | 13 (1.8) (n = 731) | 28 (1.3) (n = 2210) | NS |
Anticoagulation | 153 (10.4) (n = 1475) | 57 (7.8) (n = 729) | 210 (9.5) (n = 2204) | NS |
Antibiotics | 1312 (88.8) (n = 1478) | 662 (91.7) (n = 722) | 1974 (89.7) (N = 2200) | NS |
Renal stone location, n (%) | ||||
Upper pole | 115 (7.9) | 63 (8.6) | 178 (8.1) | NS |
Mid pole | 118 (8.1) | 78 (10.6) | 196 (9.0) | |
Lower pole | 505 (34.9) | 271 (36.8) | 776 (35.5) | |
Renal pelvis | 253 (17.5) | 130 (17.7) | 383 (17.5) | |
Multiple | 458 (31.6) (n = 1449) | 194 (26.4) (n = 722) | 652 (29.8) (n = 2082) | |
Stone size, n (%) | ||||
<10 mm | 720 (51.9) | 458 (65.8) | 1178 (56.6) |
P < 0.01 |
≥10 mm | 666 (48.1) (n = 1386) | 238 (34.2) (n = 696) | 904 (43.4) (n = 2082) | |
Stone burden, mean (SD)a
| 108.3 (114.4) (n = 1287) | 99.2 (100.5) (n = 658) | 102.2 (109.6) (n = 1945) | NS |
Previous calculus treatment, n (%) | 765 (51.8) (n = 1476) | 316 (42.8) (n = 739) | 1081 (48.8) (n = 2215) | NS |
PCNL | 206 (14.0) (n = 1476) | 58 (7.8) (n = 738) | 264 (11.9) (n = 2218) | |
SWL | 408 (27.7) (n = 1473) | 163 (22.1) (n = 738) | 571 (25.8) (n = 2211) | |
Ureterolithotomy | 11 (0.7) (n = 1479) | 10 (1.3) (n = 741) | 21 (0.9) (n = 2220) | |
URS | 384 (26.0) (n = 1475) | 168 (22.6) (n = 742) | 552 (24.9) (n = 2217) | |
Pyelolithomy | 25 (1.7) (n = 1484) | 10 (1.3) (n = 742) | 35 (1.6) (n = 2226) | |
UPJ pyeloplasty | 12 (0.8) (n = 1479) | 4 (0.5) (n = 740) | 16 (0.7) (N = 2222) | |
Solitary kidney | 46 (3.1) (n = 1482) | 19 (2.6) (n = 740) | 65 (2.9) (n = 2222) | NS |
Renal congenital abnormality, n (%) | 105 (7.0) | 40 (6.4) | 145 (6.5) | NS |
Horse shoe | 18 (1.2) | 4 (0.5) | 22 (1.0) | |
Ectopic | 4 (0.3) | 4 (0.5) | 8 (0.4) | |
Malrotation | 4 (0.3) (n = 1490) | 3 (0.4) (n = 741) | 7 (0.3) (n = 2231) | |
Preoperative stent, n (%) | 533 (35.8) | 284 (38.4) | 816 (36.7) | NS |
Double J | 511 (95.9) | 278 (98.2) | 789 (96.7) | |
Single J | 8 (1.5) | – | 8 (1.0) | |
Ureteric catheter | 3 (0.6) (n = 1487) | 2 (0.7) (n = 739) | 5 (0.6) (n = 1432) | |
ASA score, n (%) | ||||
I | 512 (36.4) | 267 (41.4) | 779 (38.0) |
P ≤ 0.01 |
II | 649 (46.2) | 266 (41.2) | 915 (44.6) | |
III | 228 (16.2) | 105 (16.3) | 333 (16.2) | |
IV | 16 (1.1) (n = 1405) | 7 (1.1) (n = 645) | 23 (1.1) (n = 2050) | |
Case volume, n (%) | ||||
Low-volume center | 314 (21.0) | 149 (20.0) | 463 (20.7) | NS |
High-volume center | 1180 (79.0) (n = 1487) | 596 (80.0) (n = 745) | 1776 (79.3) (n = 2082) |
Operating parameters
Parameter | Patients treated with UAS (n = 1494) | Patients treated without UAS (n = 745) | Total population (n = 2239) | Group difference statistic |
---|---|---|---|---|
Type of URS, n (%) |
P < 0.01 | |||
Flexible | 973 (65.1) | 416 (55.8) | 1389 (62.0) | |
Flexible + semirigid | 521 (34.9) (n = 1494) | 329 (44.2) (n = 745) | 552 (38.0) (n = 2239) | |
Fragmentation device, n (%) | ||||
Laser | 1304 (87.9) | 609 (82.2) | 1913 (86.0) | NS |
Other | 13 (0.8) | 16 (2.1) | 29 (1.3) | |
None | 167 (11.3) (n = 1484) | 116 (15.7) (n = 741) | 283 (12.7) (n = 2225) | |
Operating time (mins, mean [SD]) | 80.0 (44.2) (n = 1414) | 64.7 (37.3) (n = 722) | 74.8 (42.6) (n = 2136) |
P ≤ 0.01 |
Stone size sub-categories, n (%) |
P ≤ 0.01 | |||
<10 mm | 720 (51.9) | 458 (65.8) | 1178 (56.6) | |
≥10 mm | 666 (48.1) (n = 1386) | 238 (34.2) (n = 696) | 904 (43.4) (n = 2082) | |
Intra-operative complication, n (%) | NS | |||
Uneventful | 1402 (94.1) | 706 (94.9) | 2108 (94.4) | |
Failed | 12 (0.8) | 13 (1.7) | 25 (1.1) | |
Bleeding | 31 (2.1) | 9 (1.2) | 40 (1.8) | |
Perforation | 17 (1.1) | 9 (1.2) | 26 (1.2) | |
Other | 5 (1.0) | 10 (1.3) | 30 (1.3) | |
Converted | 3 (0.2) | 1 (0.1) | 4 (1.2) | |
Avulsion | – (n = 1490) | − (n = 744) | – (n = 2234) | |
Postoperative stent, n (%) | 1352 (90.6) (n = 1493) | 611 (82.0) (n = 745) | 1963 (87.7) (n = 2238) | NS |
Postoperative outcome and complications are shown in Table 3
Parameter | Patients treated with access sheath (n = 1494) | Patients treated without access sheath (n = 745) | Total population (n = 2239) | |
---|---|---|---|---|
Stone-free rate, n (%) | 1051 (73.9) (n = 1422) | 602 (82.8) (n = 727) | 1653 (78.0) (n = 2149) |
P < 0.01 |
SFR by location sub-categories, n (%): | ||||
Upper pole | 84 (76.4) | 52 (83.9) | 136 (79.0) | NS |
Mid pole | 97 (84.3) | 69 (89.6) | 166 (86.5) | NS |
Lower pole | 386 (79.8) | 222 (82.8) | 608 (80.9) | NS |
Renal pelvis | 188 (78.3) | 102 (82.9) | 290 (79.9) | NS |
Multiple | 263 (61.3) (n = 1018) | 148 (79.0) (n = 593) | 411 (66.7) (n = 1611) |
P < 0.01 |
SFR by stone size sub-categories, n (%) | ||||
<10 mm | 118(73.3) | 269 (59.3) | 387 (62.9) | NS |
≥10 mm | 712 (81.5) (n = 830) | 444 (84.9) (n = 713) | 1156 (82.7) (n = 1543) |
P ≤ 0.01 |
Method of evaluation, n (%) | NS | |||
Ultrasound | 572 (38.8) | 331 (44.7) | 903 (40.7) | |
X-ray/KUB | 724 (49.1) | 285 (38.5) | 1009 (45.5) | |
CT | 292 (19.8) | 83 (11.2) | 375 (16.9) | |
IVU | 81 (5.5) | 20 (2.7) | 101 (4.6) | |
Retrograde pyelogram | 20 (1.4) | 66 (8.9) | 86 (3.9) | |
Intra-operative confirmation | 246 (16.7) | 99 (13.4) | 345 (15.6) | |
Other | 16 (1.1) | 4 (0.5) | 20 (0.9) | |
None | 142 (9.6) (n = 1476) | 29 (3.9) (n = 741) | 171 (7.7) (n = 2217) | |
Hospital stay (d), mean (SD) | 1.47 (2.24) (n = 1481) | 1.69 (2.92) (n = 738) | 1.55 (2.48) (n = 2219) |
P = 0.025 |
Retreatment, n (%) | 142 (9.5) (n = 1494) | 60 (8.1) (n = 743) | 202 (9.0) (n = 2237) | NS |
Postoperative complication, n (%) | 102 (6.8) (n = 1494) | 40 (5.4) (n = 745) | 142 (6.8) (n = 2239) | NS |
Complication according to stone location sub-categories, n (%): | NS | |||
Upper pole | 8 (7.1) | 5 (12.5) | 13 (8.6) | |
Mid pole | 12 (10.7) | 4 (10.0) | 16 (10.5) | |
Lower pole | 32 (28.6) | 12 (30.0) | 44 (28.9) | |
Renal pelvis | 22 (19.6) | 10 (25.0) | 32 (21.1) | |
Multiple | 38 (33.9) (n = 112) | 9 (22.5) (n = 40) | 47 (30.9) (n = 152) | |
Complication according to stone size sub-categories: | NS | |||
<10 mm | 52 (48.6) | 24 (60.0) | 76 (51.7) | |
≥10 mm | 55 (51.4) (n = 107) | 16 (40.0) (n = 40) | 71 (48.3) (n = 147) | |
Total postoperative complications, n (%) | 115 (7.7) | 40 (5.4) | 155 (6.9) |
P = 0.041 |
Bleeding | 9 (5.6) | 4 (8.7) | 13 (5.9) | |
Fever | 46 (28.6) | 18 (39.1) | 64 (29.4) | |
UTI | 30 (18.6) | 11 (23.9) | 41 (18.8) | |
Bladder cramps | 13 (8.1) | 5 (10.9) | 18 (16.2) | |
Lung embolism | 1 (0.6) | – | 1 (0.5) | |
CVA | – | 1 (2.2) | 1 (0.5) | |
Sepsis | 7 (4.3) | 7 (15.2) | 14 (6.4) | |
Acute abdomen | 2 (1.2) | – | 2 (0.9) | |
Other | 53 (32.9) (n = 1491) | 11 (23.9) (n = 743) | 64 (29.4) (n = 2234) | |
Readmission <3 months
n (%) | 180 (13.1) (n = 1372) | 63 (9.1) (n = 693) | 243 (11.8) (n = 2065) | NS |
Regression analysis
Stone-free status | Coefficient | SE |
P value | 95 % CI |
---|---|---|---|---|
Potential outcome means (POM) | ||||
AccSh | ||||
No (0) A
| 0.504 | 0.478 | 0.291 | −0.432, 1.441 |
Yes (0) B
| 0.753 | 0.012 | 0.000 | 0.730, 0.776 |
Outcome model (0) for the non-treated | ||||
Operating time | 0.000 | 0.000 | 0.620 | 0.000, 0.000 |
Intra-operative complications | −0.306 | 2.468 | 0.901 | −5.143, 4.530 |
Postoperative complications | 0.845 | 1.483 | 0.569 | −2.062, 3.751 |
Constant | −0.035 | 2.088 | 0.986 | −4.127, 4.056 |
Outcome model (1) for the treated | ||||
Operating time | 0.000 | 0.000 | 0.119 | 0.000, 0.000 |
Intra-operative complications | −0.237 | 0.842 | 0.779 | −1.887, 1.414 |
Postoperative complications | −0.957 | 0.867 | 0.270 | −2.656, 0.742 |
Constant | 1.194 | 0.069 | 0.000 | 1.058, 1.329 |
Treatment model | ||||
Stone burden | 0.000 | 0.001 | 0.999 | −0.002, 0.002 |
Stone location | 0.099 | 0.039 | 0.012 | 0.022, 0.176 |
Stone size | 0.054 | 0.028 | 0.059 | −0.002, 0.110 |
Previous treatment | 0.201 | 0.112 | 0.074 | −0.019, 0.420 |
Academic center | −0.252 | 0.112 | 0.024 | −0.472, −0.033 |
Case volume | −0.002 | 0.000 | 0.000 | −0.002, −0.001 |
Constant | 0.370 | 0.227 | 0.103 | −0.075, 0.815 |