title: Variation in the Use of Open Pyeloplasty, Minimally Invasive Pyeloplasty, and Endopyelotomy for the Treatment of Ureteropelvic Junction Obstruction in Adults.
abstract: 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.
  
  
  
  Using the MarketScan®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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: 1 Department of Urology, University of Pittsburgh , Pittsburgh, Pennsylvania.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
authors.affiliation: 2 RAND Corporation , Santa Monica, California.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Lai
authors.affiliation: 2 RAND Corporation , Santa Monica, California.
authors.forename: Rachana
authors.initials: R
authors.lastname: Seelam
authors.affiliation: 2 RAND Corporation , Santa Monica, California.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Hanley
authors.affiliation: 3 Dell Medical School of the University of Texas , Austin, Texas.
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
authors.affiliation: 4 Department of Urology, Division of Health Services Research, University of Michigan , Ann Arbor, Michigan.|5 Department of Urology, Division of Oncology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.affiliation: 4 Department of Urology, Division of Health Services Research, University of Michigan , Ann Arbor, Michigan.|6 Department of Urology, Division of Endourology, University of Michigan , Ann Arbor, Michigan.
authors.forename: John M
authors.initials: JM
authors.lastname: Hollingsworth
authors.affiliation: 2 RAND Corporation , Santa Monica, California.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
authors.affiliation: 2 RAND Corporation , Santa Monica, California.
authors.forename: Claude M
authors.initials: CM
authors.lastname: Setodji
authors.affiliation: 2 RAND Corporation , Santa Monica, California.|7 Department of Urology, David Geffen School of Medicine, University of California , Los Angeles, California.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Saigal
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D016017:Odds Ratio; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends
keywords: MarketScan; endopyelotomy; minimally invasive pyeloplasty; open pyeloplasty; ureteropelvic junction obstruction