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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (4): 692-698. doi: 10.19723/j.issn.1671-167X.2022.04.018

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Trends in upper urinary tract reconstruction surgery over a decade based on a multi-center database

Wei ZUO1,Fei GAO1,Chang-wei YUAN1,Sheng-wei XIONG1,Zhi-hua LI1,Lei ZHANG1,Kun-lin YANG1,Xin-fei LI1,Liang LIU2,Lai WEI2,Peng ZHANG3,Bing WANG4,Ya-ming GU4,Hong-jian ZHU2,Zheng ZHAO1,*(),Xue-song LI1,*()   

  1. 1. Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
    2. Department of Urology, Beijing Jiangong Hospital, Beijing 100054, China
    3. Department of Urology, Emergency General Hospital, Beijing 100028, China
    4. Department of Urology, Miyun District Hospital (Miyun Hospital, Peking University First Hospital), Beijing 101599, China
  • Received:2022-03-29 Online:2022-08-18 Published:2022-08-11
  • Contact: Zheng ZHAO,Xue-song LI E-mail:zz_185429@sina.com;pineneedle@sina.com

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Abstract:

Objective: To study the trend of surgical type, surgical procedure and etiological distribution of upper urinary tract repair in recent 10 years. Methods: The preoperative and perioperative variables and follow-up data of upper urinary tract reconstruction surgery in RECUTTER (Reconstruction of Urinary Tract: Technology, Epidemiology and Result) database from 2010 to 2021 were searched, collected and analyzed. The surgical type, surgical procedure, duration of hospitalization, time of operation, incidence of short-term complications, and proportion of the patients undergoing reoperations were compared between the two groups of 2010-2017 period and 2018-2021 period. Results: A total of 1 072 patients were included in the RECUTTER database. Congenital factors and iatrogenic injuries were the main causes of upper urinary tract repair. Among them, 129 (12.0%) patients had open operation, 403 (37.6%) patients had laparoscopic surgery, 322 (30.0%) patients had robot-assisted laparoscopic surgery and 218 (20.3%) patients had endourological procedure. In the last decade, the total number of surgeries showed a noticeable increasing annual trend and the proportion of robot-assisted laparoscopic surgery in 2018-2021 was significantly higher than that in 2010-2017 (P < 0.001). The 1 072 patients included 124 (11.6%) cases of ileal ureter replacements, 440 (41.1%) cases of pyeloplasty, 229 (21.4%) cases of balloon dilation, 109 (10.2%) cases of ureteral reimplantation, 49 (4.6%) cases of boari flap-Psoas hitch surgery, 60 (5.6%) cases of uretero-ureteral anastomosis, 61 (5.7%) cases of lingual mucosal onlay graft ureteroplasty or appendiceal onlay flap ureteroplasty. Pyeloplasty and balloon dilatation had been the main types of surgery, while the proportion of lingual mucosal onlay graft ureteroplasty plus appendiceal onlay flap ureteroplasty had increased significantly in recent years (P < 0.05). In addition, the time of operation was significantly increased (P < 0.05) after 2018, which was considered to be related to the sharp increase in the proportion of robot-assisted laparoscopic surgery. We found that minimally invasive surgery (endourological procedure and robot-assisted laparoscopic surgery) as an independent risk factor (P=0.050, OR=0.472) could reduce the incidence of short-term post-operative complications. Conclusion: We have justified the value of the RECUTTER database, created by the Institute of Urology, Peking University in data support for clinical research work, and provided valuable experience for the construction of other multi-center databases at home and abroad. In recent 10 years, we have observed that, in upper urinary tract reconstruction surgery, the surgery type tends to be minimally invasive and the surgery procedure tends to be complicated, suggesting the superiority of robot-assisted laparoscopic surgery.

Key words: Upper urinary tract, Reconstructive surgical procedures, Robotic surgical procedures, Database

CLC Number: 

  • R691.6

Figure 1

The RECUTTER database start interface The starting interface consists of three parts. Left vertical function directory window, can switch to clinical data search, retrieval and statistics functions; The upper center of the page shows the data input in the last 4 weeks and the overall data input of each standard template (including outpatient template, urinary tract repair inpatient template and follow-up template). At the bottom of the center of the page is a quick entry window that displays recently entered patient data. In the upper right corner, you can switch to data in different institutions through "switch institution"."

Table 1

The basic characteristics of patients who underwent upper urinary tract repair surgery"

Items Year
2010 2011 2012 2013 2014 2015 2016
Number 11 18 10 17 42 59 27
Age/years, median (range) 26.0
(15-68)		 26.0
(14-71)		 36.0
(17-51)		 35.0
(15-60)		 28.0
(11-75)		 35.0
(15-63)		 34.0
(17-60)
Gender (male), n 8 10 6 9 20 35 15
Surgical side, n
Left 8 12 5 9 24 20 15
Right 1 4 5 5 17 29 7
Bilateral 2 2 0 3 1 10 5
Preoperative eGFR/(mL/min), median (range) 87.0
(65-103)		 81.0
(41-140)		 77.0
(51-168)		 85.4
(53-128)		 88.8
(59-129)		 92.5
(18-150)		 78.9
(42-98)
Operative time/min, median (range) 202.0
(112-344)		 157.5
(97-394)		 173.0
(67-363)		 162.0
(72-372)		 108.0
(49-276)		 114.0
(40-530)		 99.0
(49-332)
Hospital stay/d, median (range) 5.5
(3-14)		 5.5
(3-36)		 4.5
(1-7)		 4.0
(1-13)		 3.0
(1-32)		 4.0
(1-2)		 3.0
(1-33)
Surgical history of urinary tract repair, n(%) 0 6
(33.3)		 2
(20.0)		 3
(17.6)		 14
(33.3)		 12
(20.3)		 6
(22.2)
Overall success ratea 100.0%
(1/1)		 100.0%
(2/2)		 100.0%
(2/2)		 100.0%
(6/6)		 80.0%
(4/5)		 100.0%
(3/3)
Follow-up time/months, median (range) 8
(8-8)		 8
(7-9)		 17
(4-31)		 6
(2-86)		 13
(11-66)		 46
(12-64)
Complication, n(%) 1
(9.1)		 0 1
(10.0)		 3
(18.8)		 4
(9.5)		 4
(7.3)		 2
(7.4)
Items Year Overall P
2017 2018 2019 2020 2021
Number 79 148 215 195 251 1 072
Age/years, median (range) 32.0
(15-76)		 33.0
(8-77)		 34.0
(14-74)		 35.5
(13-80)		 34.0
(12-68)		 34.0
(8-80)		 0.990
Gender (male), n 32 71 103 103 129 541 0.564
Surgical side, n 0.040
Left 48 71 105 100 148 565
Right 24 61 92 70 82 397
Bilateral 7 16 18 25 21 110
Preoperative eGFR/(mL/min), median (range) 85.2
(43-119)		 79.7
(29-191)		 77.7
(45-129)		 83.4
(32-154)		 78.0
(25-203)		 81.0
(18-203)		 0.841
Operative time/min, median (range) 132.5
(42-487)		 147.0
(40-385)		 155.0
(40-450)		 153.0
(40-425)		 150.0
(40-560)		 148.0
(40-560)		 < 0.001
Hospital stay/d, median (range) 4.0
(0-93)		 5.0
(1-57)		 6.0
(1-68)		 6.0
(2-67)		 5.0
(1-64)		 5.0
(0-93)		 < 0.001
Surgical history of urinary tract repair, n(%) 30
(38.0)		 59
(39.9)		 75
(34.9)		 76
(39.0)		 86
(34.3)		 369
(34.4)		 0.045
Overall success ratea 100.0%
(14/14)		 100.0%
(26/26)		 91.5%
(43/43)		 99.3%
(136/137)		 98.6%
(139/141)		 97.9%
(376/384)		 0.029
Follow-up time/months, median (range) 42
(2-54)		 28
(3-42)		 18
(3-33)		 9
(2-38)		 6
(1-80)		 7
(1-86)		 < 0.001
Complication, n(%) 3
(4.1)		 5
(5.8)		 7
(7.6)		 6
(6.4)		 16
(7.7)		 52
(7.1)		 0.825

Figure 2

Etiological distribution of patients undergoing upper urinary tract repair surgery from 2010 to 2021"

Figure 3

Surgical volume and changes in surgical method of upper urinary tract repair surgery from 2010 to 2021 IUR, ileal ureter replacements; LMU, lingual mucosal onlay graft ureteroplasties; AU, appendiceal onlay flap ureteroplasties; UR, ureteral reimplantations; BPS, boari flap-psoas hitch surgeries; UA, uretero-ureteral anastomosis."

Figure 4

Changes in the surgical procedure of the upper urinary tract repair surgery from 2010 to 2021"

Figure 5

The proportion of upper urinary tract repair surgical procedures performed between 2010-2017 and 2018-2021 Abbreviations as in Figure 4. We compared the surgical procedure composition ratio between 2010-2017 and 2018-2021, and found that the proportion of LMU+AU increased significantly after 2018 (P < 0.05)."

Figure 6

Hospital stay in different upper urinary tract repair surgical procedures performed between 2010-2017 and 2018-2021 Abbreviations as in Figure 4. *P < 0.001."

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