فهرست مطالب wei ouyang

To assess the cost-effectiveness of medical expulsive therapy (MET) versus observation for large distal ureteral stones in China and provide preliminary evidence for the determination of the course of MET by mathe- matical estimation.

With linear success rate assumptions, a decision tree was constructed by TreeAge Pro 2011 software. The stones passage rates after observation or receiving 0.4 mg daily tamsulosin were estimated according to a large randomized clinical trial (RCT). The costs of ureteroscopy, drugs and examinations were esti- mated according to related price from pharmacies or hospitals, or the guidance price published by the government. MET was also compared with observation by the sensitivity analysis. The effectiveness of MET or observation was presented by quality-adjusted life-day. Mathematical estimation of stone expulsion time was made by using a decision-analytic Markov model under the assumption that the daily stone expulsion probability is constant.

In China, the MET was associated with a $295.1 cost advantage over observation. The cost of ureterosco- py has to decrease to $77.8 to reach cost equivalence between observation and MET. Observation is cost-effective only if ureteroscopy is very cheap or the difference of stone expulsion rates is insignificant. The estimated expul- sion time was much longer than those reported in above mentioned RCT.

Due to the high cost of ureteroscopy, MET showed a cost advantage over observation in treating distal ureteral stones in China. The daily stone passage rate was inconstant. More studies are needed to find the appropriate duration of MET.

To describe our experience and analyze the outcomes of robot-assisted laparoscopic ureteral reimplan-tation (RALUR) and conventional laparoscopic ureteral reimplantation (LUR) in treating benign distal ureteral stricture (DUS).

Patients who underwent RALUR or LUR for DUS were retrospectively analyzed. All surgeries were performed by transperitoneal approach in a refluxing manner. Baseline characteristics, history of previous abdominal surgery, operative profile and follow-up data were collected and analyzed.

Among 68 patients with DUS, 62 were diagnosed with unilateral DUS, including 28 patients underwent RALUR. The mean operative time of the RALUR group was 2.44 ± .45 hours, while the mean operative time of the LUR group was 3.09 ± .74 hours (P < .001). The average suturing time of LUR (39.59 ± 3.78 min) is about 2 times that of RALUR (20.04 ± 3.5 min) (P < .001). The success rate of the RALUR group and the LUR group were 89.3% and 82.4% respectively (P = .494). In multiple linear regression model, the modality of surgery was the only variable that influences operative time (Beta = -.964, P < .001), suturing time (Beta = -1.899, P < .001) and hemoglobin decline (Beta = -.611, P = .020).

Basically, the postoperative outcomes are similar but robotic surgery offers a quicker surgery and anastomosis.