You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety II (MP33)1 May 2024MP33-05 SINGLE-USE CYSTOSCOPES OFFERS FASTER TIME-TO-SCOPE WITH EQUIVALENT PERCEIVED FUNCTIONALITY VS REUSABLE SCOPES IN THE INPATIENT SETTING Stephen Hassig, Matthew Steidle, Carl Ceraolo, Jason Fairbourn, Denzel Zhu, Ashley Li, Galen Chen, Kelvin Lim, Christopher Wanderling, Aaron Saxton, Laena Hines, Trevor Hunt, Mark Ninomiya, Austin Lee, Rajat Jain, and Scott O. Quarrier Stephen HassigStephen Hassig , Matthew SteidleMatthew Steidle , Carl CeraoloCarl Ceraolo , Jason FairbournJason Fairbourn , Denzel ZhuDenzel Zhu , Ashley LiAshley Li , Galen ChenGalen Chen , Kelvin LimKelvin Lim , Christopher WanderlingChristopher Wanderling , Aaron SaxtonAaron Saxton , Laena HinesLaena Hines , Trevor HuntTrevor Hunt , Mark NinomiyaMark Ninomiya , Austin LeeAustin Lee , Rajat JainRajat Jain , and Scott O. QuarrierScott O. Quarrier View All Author Informationhttps://doi.org/10.1097/01.JU.0001009520.30626.80.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Single-use (SU) cystoscopes have increased in frequency both in the literature and in urologic practices, but incremental changes in workflow compared to reusable (RU) scopes are understudied. We hypothesized that SU cystoscopes reduce time in supply gathering and scope return for in-hospital consults requiring beside cystoscopy, without decreasing perceived functionality during real cystoscopy. METHODS: Urology residents from a single institution were randomized to a SU or RU cystoscope to complete a sham "difficult catheter placement" in the Emergency Department of the same hospital. Subjects collected equipment, set up and then tore down as if doing a cystoscopy at bedside, and returned equipment. Travel paths were standardized and all sections timed. Residents performing real cystoscopies over a 4-month period were also randomized by month to SU or RU scope, and afterwards filled out a NASA Task Load Index (TLX). T-test was used to compare continuous variables. Linear regression was used to assess difference in overall time. RESULTS: 10 urology residents volunteered and were randomized to SU or RU, with an average of 2.8 years of post-graduate training per group. Neither residency year nor resident height was statistically different between the two groups. At all examined time points aside from "other walking time," the SU times were less compared to RU (Table 1). RU scope acquisition depends on central processing and demonstrated high variability. Overall, SU scope saved 8 min 53 sec (p<0.01). Table 2 shows there were no significant differences across all 6 of the RAW TLX parameters, including "assessment of success." CONCLUSIONS: Single-use cystoscopes reduce time-to-scope for hospital bedside cystoscopy leading to more timely delivery of care and a decrease in non-clinical time burden related to preparing for cystoscopy compared to RU scopes without compromising the actual task, as measured by TLX. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e562 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Stephen Hassig More articles by this author Matthew Steidle More articles by this author Carl Ceraolo More articles by this author Jason Fairbourn More articles by this author Denzel Zhu More articles by this author Ashley Li More articles by this author Galen Chen More articles by this author Kelvin Lim More articles by this author Christopher Wanderling More articles by this author Aaron Saxton More articles by this author Laena Hines More articles by this author Trevor Hunt More articles by this author Mark Ninomiya More articles by this author Austin Lee More articles by this author Rajat Jain More articles by this author Scott O. Quarrier More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE To determine urology applicants' confidence in judging their fit with residency programs during a virtual application and interview cycle. METHODS Applicants to our residency program from the 2023-2024 AUA match cycle were surveyed. Applicants' confidence in judging fit with residency programs virtually was assessed with Likert scale items grouped by time point (pre-interview, day of interview, post-interview). A standard definition of "fit" was provided to reduce interpretation bias. Free-text responses gathered qualitative data for each survey section and regarding use of technology, and were analyzed with a grounded theory approach to identify emergent themes. RESULTS Response rate was 47% (110/233). Applicants completed a median of 2 urology away rotations, applied to 77 programs, and attended 15 virtual interviews. Applicants were confident with determining fit overall and based on the majority of virtual application cycle factors (12/16, 75%), and 63% preferred a virtual application cycle. However, 65% rated in-person away rotations as the most important factor for determining fit. Qualitative themes identified included: in-person assessment, direct interactions with programs, crowdsourced opinions, insider knowledge and personal advice, strengths and challenges of virtual interviews, and difficulty with judging fit virtually, among others. CONCLUSION Urology applicants remain confident in judging their "fit" with programs throughout a virtual application cycle, and most now prefer a virtual experience. However, nearly two thirds still value in-person away rotations above all else for judging fit. Both quantitative and qualitative data are critical to refining application and interview cycles as programs regain the option of inperson activities. UROLOGY 199: 221-229, 2025. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

OBJECTIVES:Hematological toxicities are a common sequelae of radiation therapy (RT), and pelvic RT is of particular concern as the pelvic marrow contributes nearly 50% of total body hematopoiesis. We evaluated the impact of pelvic RT on hematological toxicities in pediatric patients with pelvic genitourinary rhabdomyosarcoma (GU-RMS). METHODS:A secondary evaluation of 448 pediatric patients (53.8% male) with intermediate-risk RMS in the ARST0531 trial included 65 with pelvic GU-RMS (who received pelvic RT). Multivariable logistic regression was used to compare cytopenias and complications (febrile neutropenia, infectious complications) between GU-RMS and non-GU-RMS. Primary analysis assessed toxicities over the study period (weeks 1-43), with secondary analysis evaluating T1 (weeks 1-15), T2 (weeks 16-30), and T3 (weeks 31-43). RESULTS:GU-RMS patients did not have a significantly higher risk of cytopenias than non-GU RMS patients. Neutropenia was the most common, affecting 79.4% of subjects, with no significant difference between the GU (73.8%) and non-GU (80.4%) groups (OR 0.64, 95% CI 0.34-1.19, p = 0.16). Anemia rates were similar in the GU (36.9%; n = 24) and non-GU (35.2%; n = 135) groups (OR 0.96, 95% CI 0.54-1.70, p = 0.89). Thrombocytopenia occurred slightly more often in the GU group (33.8%) than the non-GU group (28.4%) but was not statistically significant (OR 1.49, 95% CI 0.81-2.73, p = 0.20). Pelvic RT for GU-RMS in T1 was linked to a significantly higher risk of thrombocytopenia compared to non-GU subjects (OR 2.79, 95% CI 1.25-6.23, p = 0.01), which declined over time (T2, T3). Rates of febrile neutropenia (3.1%-9.2%) and infectious complications (4.6%-15.4%) in GU patients did not differ significantly from those in non-GU cohorts (febrile neutropenia: 7.3%-13.05%; infectious complications: 5.5%-9.7%) across T1-T3. CONCLUSIONS:Hematological toxicities were comparable between pediatric GU and non-GU RMS patients. Pelvic RT for GU-RMS increased the risk of early thrombocytopenia, which diminished over time.

BACKGROUND:Multiparametric MRI (mpMRI) and fusion-targeted biopsy (TB) have improved the detection of clinically significant prostate cancer (csPCa); however, it remains unclear whether secondary lesions (SLs) identified on mpMRI must also be biopsied in addition to the index lesion (IL). Currently, American Urological Association and European Association of Urology guidelines suggest biopsying all lesions, but supporting data are sparse. This study examines whether including SL biopsies provides additional value in csPCa detection compared to IL biopsy alone when systematic biopsy (SB) is also performed. METHODS:Men with multiple PI-RADS ≥ 3 lesions on mpMRI who underwent prostate biopsy were retrospectively identified. The primary analysis compared csPCa detection rates from SB and IL TB, with or without SL TB. Secondary analyses assessed the impact of prostate-specific antigen (PSA) density and SL PI-RADS scores on csPCa detection. Sensitivity analyses were performed to investigate the robustness of findings. RESULTS:Among 73 men, csPCa detection rate was 47% with SB and IL biopsy alone and improved to 52% with SL biopsies included (p = 0.62). Secondary analyses showed no significant differences in csPCa detection based on PSA density or SL PI-RADS scores. Two of three sensitivity analyses supported the primary findings. CONCLUSIONS:Biopsying SLs does not significantly increase csPCa detection rates compared to IL biopsy alone when SB is also performed. This supports the notion that SL biopsies can be safely omitted without compromising clinical outcomes, thereby potentially reducing patient discomfort and procedural costs, and may inform future guideline development and revisions.

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I (MP40)1 May 2024MP40-19 EVALUATING THE INCIDENCE OF NEPHROLITHIASIS SURGERY BEFORE AND AFTER PARATHYROIDECTOMY: A RETROSPECTIVE OBSERVATIONAL STUDY Ashley Li, Kelvin Lim, David Song, Angela Wang, Jacob Moalem, Jathin Bandari, Rajat Jain, and Scott Quarrier Ashley LiAshley Li , Kelvin LimKelvin Lim , David SongDavid Song , Angela WangAngela Wang , Jacob MoalemJacob Moalem , Jathin BandariJathin Bandari , Rajat JainRajat Jain , and Scott QuarrierScott Quarrier View All Author Informationhttps://doi.org/10.1097/01.JU.0001008788.18007.3f.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Primary hyperparathyroidism carries an increased kidney stone prevalence of 15-30%. Patients who undergo parathyroidectomy have significantly reduced rates of kidney stone events based on imaging and patient reported history. However, there has been limited knowledge on the impact of parathyroidectomy on stone disease requiring surgical intervention. The aim of this study is to compare the incidence of kidney stone surgery before and after parathyroidectomy. METHODS: We retrospectively reviewed patients>18 years old who underwent parathyroidectomy from 2015 to 2023 at our institution. We evaluated the incidence of kidney stone surgery including shockwave lithotripsy (SWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) based on CPT codes in this patient population. We performed univariate analysis (Chi-Square Test) to compare the incidence rate before and after parathyroidectomy. RESULTS: We reviewed 2104 patients who underwent parathyroidectomy and identified 367 kidney stone surgeries. Patients were 75% female, 18% non-white race and had a median age of 60 years (IQR 52-70) at the time of parathyroidectomy. The median follow-up time was 4.75 years before and 3.6 years after parathyroidectomy. The incidence of kidney stone surgery in patients pre- vs post- parathyroidectomy was 181/10553 person years (1.7%) vs 75/8189 person years (0.9%) respectively, (p<0.0001). Thus, the incidence rate of requiring stone surgery decreased by 1.87 times following parathyroidectomy (95% CI 1.42-2.48, p<0.0001). The cases of URS and SWL decreased whereas the cases of PCNL increased (Table 1). CONCLUSIONS: In patients with hyperparathyroidism, the incidence of stone disease requiring surgical intervention significantly decreased following parathyroidectomy. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e671 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ashley Li More articles by this author Kelvin Lim More articles by this author David Song More articles by this author Angela Wang More articles by this author Jacob Moalem More articles by this author Jathin Bandari More articles by this author Rajat Jain More articles by this author Scott Quarrier More articles by this author Expand All Advertisement PDF downloadLoading ...

Purpose: The purpose of this study was to evaluate risk factors associated with positive urine cultures following holmium laser enucleation of the prostate (HoLEP). Materials and Methods: The data from a prospectively maintained database were analyzed to evaluate urine culture results following HoLEP and determine the contribution of predefined variables (age, prostate size, Charlson comorbidity score, surgical time [surrogate for case difficulty], the presence of a catheter preoperatively, postoperative urinary retention, and preoperative positive culture) on urine culture positivity at 60 days postoperatively. Statistical analyses included logistic regression and ANOVA. Results: The data from 136 subjects were included in the database and were evaluated at a median of 13.37 ± 6.72 months after their HoLEP. Postoperative positive cultures were noted in 23 subjects (16.91%). Preoperative positive cultures were found to predict positive postoperative urine cultures (odds ratio: 3.78, confidence interval: 1.18–12.78, P = 0.03). However, the preoperative and postoperative results were discordant in 9 of 14 subjects with both positive preoperative and postoperative cultures. Conclusions: Positive preoperative cultures were predictive of positive postoperative cultures. However, the pre- and postoperative results were often discordant. Host factors increasing susceptibility to bacteriuria may explain these findings.

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP56)1 May 2024MP56-03 ONCOLOGICAL OUTCOMES FOR T1 SMALL RENAL CELL CARCINOMA AFTER PARTIAL NEPHRECTOMY IS NOT SIGNIFICANTLY ASSOCIATED WITH HISTOPATHOLOGICAL SUBTYPE: A 20-YEAR RETROSPECTIVE FOLLOW UP FROM ONE SINGLE INSTITUTION Victor Sandoval, E. Lizabeth Ellis, Jesus Cendejas, Ashley Li, Srindhi Venkatesh, Thomas Osinski, Changyong Feng, Guan Wu, and William Tabayoyong Victor SandovalVictor Sandoval , E. Lizabeth EllisE. Lizabeth Ellis , Jesus CendejasJesus Cendejas , Ashley LiAshley Li , Srindhi VenkateshSrindhi Venkatesh , Thomas OsinskiThomas Osinski , Changyong FengChangyong Feng , Guan WuGuan Wu , and William TabayoyongWilliam Tabayoyong View All Author Informationhttps://doi.org/10.1097/01.JU.0001008940.44711.d4.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patial Nephrectomy (PN) is the preferred surgical treatment for localized T1 Renal Cell Carcinoma. We determined oncological outcomes for T1 RCC categorized on histopathology at our institution. METHODS: We performed a retrospective analysis of PNs from 1997 to 2018. Demographic and clinical information was collected. Local recurrence and survival analysis were performed using Kaplan-Meier and Cox regression analyses. Separately, outcomes for those with Clear Cell (ccRCC), Papillary type 1(pRCC1), papillary type (pRCC2) and Chromophobe (chRCC) were analyzed. RESULTS: We identified 850 PNs at our institution with 537 patients having T1 RCC on final pathology. Table 1 contains pertinent demographic and clinical information for our cohort. Significant differences were found in age at surgery, local recurrence rate, mortality rate and cancer specific mortality between RCC subtypes and stage. Positive margin rate was 10.5% (64/572), but was not associated with recurrence or survival. On cox regression analysis age at surgery (HR 1.06, 95% CI 1.01-1.11, p=0.02) and recurrence (HR 4.9, 95% CI 1.9-13.1, p=0.01) was significant for death. Kaplan-Meier curves for recurrence and survival are shown in Figure 1. While there were significant differences in recurrence free survival and overall survival for T1a vs T1b RCCs, these differences were not found between RCC subtypes. CONCLUSIONS: For T1 tumors, RCC histologic subtype is not significantly associated with recurrence free or overall survival. Overall and cancer specific survival is excellent for those presenting for T1 RCC. Most mortality in this population is not caused by RCC. Furthermore, most local recurrences happen over 3 years from surgery and in those with T1b cancers. Thus, it may be beneficial to have less frequent but longer surveillance for those presenting with T1 RCC. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e926 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Victor Sandoval More articles by this author E. Lizabeth Ellis More articles by this author Jesus Cendejas More articles by this author Ashley Li More articles by this author Srindhi Venkatesh More articles by this author Thomas Osinski More articles by this author Changyong Feng More articles by this author Guan Wu More articles by this author William Tabayoyong More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction:Use of placebo in oncology randomized controlled trials (RCT) is ethically controversial. Placebo may introduce bias, as toxicity profiles of treatment arms can inadvertently unblind subjects and investigators. We investigated the use of placebo in urologic oncology RCTs, hypothesizing that most placebo-controlled trials are effectively unblinded, either explicitly with open-label design or implicitly due to large differences in adverse events (AE) or oncologic outcomes.Methods:Urologic oncology RCTs utilizing placebo were identified via ClinicalTrials.gov. Interventional prostate, bladder/urothelial, and renal cancer trials from 2014 to 2024 were included. Subject incompletion, all-cause mortality, AE rates, and serious AE (SAE) rates were identified and compared between placebo and active arms using chi 2 and Fisher's exact tests.Results:Sixty studies met inclusion criteria and included 66 placebo arms with 12,918 subjects and 81 active arms with 16,098 subjects. There was no significant difference in incompletion rates between placebo and active arms. Subjects enrolled in active arms reported statistically significant higher SAE and AE rates compared to those in placebo arms across the majority of physiological domains, including 18/24 domains for SAEs and 13/24 for AEs. This relationship persisted in sensitivity analyses where unblinded trials were excluded.Conclusions:In urologic oncology placebo-controlled RCTs, active arms are associated with significantly higher rates of AEs and SAEs compared with placebo arms. These findings indicate a strong possibility that true blinding is not possible in oncology RCTs, even with optimal study design, and serve to better inform future clinical trial design and implementation challenges in employing placebo control.

Pediatric Rhabdomyosarcoma (RMS) is a morbid and often lethal condition characterized by a paucity of clinical data. Beyond a detailed risk categorization system, it is unclear if genitourinary (GU) sites (bladder/prostate, paratesticular, female organs) have outcomes distinct from non-GU sites. This study pools primary data from phase-3 clinical trials involving pediatric RMS to evaluate this question. We obtained primary data from three Children’s Oncology Group pediatric RMS trials (NCT00075582, NCT00354835, NCT00354744) evaluating low- (LR), intermediate- (IMR), and high risk (HR) Pediatric RMS. Survival analysis was conducted using the Kaplan-Meier method, with Event-Free Survival (EFS) defined per protocol specifications. 599 subject records were included in the analysis (111 GU RMS, 488 non-GU RMS). For subjects with GU RMS, overall survival (OS) was superior to non-GU RMS (HRR 0.55 [95

Introduction:This study investigated the effectiveness of buprenorphine as an alternative to the use of conventional opioids perioperatively in an effort to help mitigate the impact of the use of perioperative conventional opioids for patients undergoing robotic-assisted laparoscopic prostatectomy.Methods:Outcomes of patients with localized prostate cancer undergoing robotic-assisted laparoscopic prostatectomy were examined before and after implementation of novel quality improvement study that included receiving buprenorphine compared to conventional opioids for pain control intraoperatively and postoperatively. The primary end point was adequate pain control with secondary end points being analgesic consumption at home, opioid-related side effects, and patient satisfaction.Results:When analyzing the secondary end point of oral morphine milligram equivalents, the buprenorphine group received significantly less morphine milligram equivalent compared to the conventional opioid group (15.19 vs 47.91, P = .006). The buprenorphine group also had lower reported pain scores at discharge (4.3; scale 1-10) compared to the conventional opioid group (5.4), though this did not reach significance (P = .069). In the buprenorphine group, 76.9% strongly agreed that their pain was adequately controlled in the hospital compared to 57.5% of the conventional opioid group (P = .223). There was no difference in overall satisfaction at postoperative day 5 (P = .358).Conclusions:Our study demonstrates buprenorphine's analgesic capabilities to maintain adequate pain control and patient satisfaction compared to conventional opioids during robotic-assisted laparoscopic prostatectomy, while decreasing perioperative opioid use.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety IV (MP83)1 Apr 2020MP83-20 DOES FOOT PEDAL ILLUMINATION IMPROVE SPEED, EFFICIENCY AND ACCURACY DURING UROLOGIC SURGERY? Hyelin You, Jon Maldonado*, Andrew Krause, Ashley Li, Jeremy Brown, Akin S. Amasyali, Mohammad Hajiha, Phillip Stokes, Muhannad Alsyouf, John Smith, Jason Groegler, Daniel Baldwin, and D. Duane Baldwin Hyelin YouHyelin You More articles by this author , Jon Maldonado*Jon Maldonado* More articles by this author , Andrew KrauseAndrew Krause More articles by this author , Ashley LiAshley Li More articles by this author , Jeremy BrownJeremy Brown More articles by this author , Akin S. AmasyaliAkin S. Amasyali More articles by this author , Mohammad HajihaMohammad Hajiha More articles by this author , Phillip StokesPhillip Stokes More articles by this author , Muhannad AlsyoufMuhannad Alsyouf More articles by this author , John SmithJohn Smith More articles by this author , Jason GroeglerJason Groegler More articles by this author , Daniel BaldwinDaniel Baldwin More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000975.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Endourologic procedures frequently use pedal activation in a low-light operating room (OR). Foot pedal activation in low-light conditions risks incorrect pedal activation, which may increase radiation exposure, cause patient burns, or start OR fires. This study compares speed, accuracy, dark adaptation, and surgeon preference for pedal activation in 4 different lighting conditions. METHODS: During a simulated percutaneous nephrolithotomy (PCNL), pedals for fluoroscopy (c-arm), holmium laser, and ultrasonic lithotripter (USL) were randomized to 3 different positions. Twenty participants activated pedals in a randomized order in 4 settings: a dark OR with black light illumination, a dark OR with glow stick illumination, a dark OR with no foot pedal lighting, and a bright OR with overhead lights on (Fig 1). Endpoints included time to pedal activation, number of attempted, incomplete, and incorrect presses, dark adaptation, and surgeon preference. Mann-Whitney U Test was used with p<0.05 considered significant. RESULTS: Compared to no illumination (8.47 s), the glow stick (6.77s; p < 0.001) and black light fluorescent illumination (5.34s; p < 0.001) were both associated with decreased combined and individual pedal activation times (p<0.05 for c-arm, laser, and USL). The black light resulted in a significant decrease in attempted (0.30 vs 3.45, p<0.001), incomplete (1.25 vs 7.75, p<0.001), and incorrect presses (0.35 vs 1.25, p=0.035) compared to the dark setting, while demonstrating no difference compared to having room lights on. Dark adaptation was significantly improved with black light illumination compared to having the room lights on (134.5 vs 140.5 luminance units, p<0.001). Subjectively, 100% of participants preferred illuminated pedals compared to the dark OR, with 90% preferring the black light. CONCLUSIONS: During a simulated PCNL, black light foot pedal illumination significantly improved accuracy and efficiency of instrument activation compared to the conventional dark OR, while also maintaining the surgeon’s dark adaptation compared to having the overhead lights on. This study demonstrates that the use of black light foot pedal illumination may reduce errors in the operating room due to inadvertent foot pedal activation while preserving the ability to operate in a low light environment. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1263-e1263 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hyelin You More articles by this author Jon Maldonado* More articles by this author Andrew Krause More articles by this author Ashley Li More articles by this author Jeremy Brown More articles by this author Akin S. Amasyali More articles by this author Mohammad Hajiha More articles by this author Phillip Stokes More articles by this author Muhannad Alsyouf More articles by this author John Smith More articles by this author Jason Groegler More articles by this author Daniel Baldwin More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: The purpose of this study was to evaluate factors during ureteroscopy that can potentially impact procedure cost. Materials and Methods: A retrospective review of 129 consecutive elective ureteroscopy cases was performed to determine direct procedure cost. Direct cost was defined as cost incurred because of operating room expenses, including operating room time, staffing expenses, equipment, and supply costs. Data regarding patient, procedural, and operating room staffing characteristics were compared between the most and least expensive cases. Univariate and logistic regression analysis were performed to identify factors predictive of higher costs. Results: The average direct ureteroscopy cost was $3298/case. On univariate analysis, ureteroscopies in the highest 50th cost percentile had larger stone burden (170.1 vs 146 mm2; p = 0.03) and longer operative times (95.3 vs 49.9 minutes; p < 0.01), were more likely performed for non-stone indications (21.4% vs 7.2%; p = 0.03), more likely to include a resident (65.5% vs 43.6%; p = 0.02), and less likely to have a dedicated urology scrub technician (38.2% vs 61.8%; p = 0.01) compared to cases in the lowest 50th percentile. The presence of a resident, larger stone burden, absence of a dedicated scrub technician, and longer operative time were associated with an average cost increase of $516, $700, $1122, and $1401, respectively. Logistic regression analysis showed that operating room time was the only factor predicting higher cost (OR [odds ratio] 12.8, 95% confidence interval [CI] 2.0-84.0). A post-hoc logistic regression analysis demonstrated that the presence of a resident during ureteroscopy (OR 2.9, 95% CI 1.1-8.0) and larger stone burden (OR 1.01, 95% CI 1.0-1.013) were significantly associated with longer operative times. Conclusion: Operating room time is the primary determinant of ureteroscopy case cost. All efforts should be made to decrease operative time, although balancing patient safety and maintaining a quality training environment.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety II (MP15)1 Apr 2019MP15-06 THE EFFECT OF A TWO-WAY RADIO SYSTEM UPON CLINICAL COMMUNICATION Jeremy Brown, Zahabiya Campwala, Akin Amasyali, Mohammad Hajiha, Muhannad Alsyouf, Phillip Stokes, Ashley Li, Hyelin You, Milan Shah*, Samuel Abourbih, and D. Duane Baldwin Jeremy BrownJeremy Brown More articles by this author , Zahabiya CampwalaZahabiya Campwala More articles by this author , Akin AmasyaliAkin Amasyali More articles by this author , Mohammad HajihaMohammad Hajiha More articles by this author , Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Phillip StokesPhillip Stokes More articles by this author , Ashley LiAshley Li More articles by this author , Hyelin YouHyelin You More articles by this author , Milan Shah*Milan Shah* More articles by this author , Samuel AbourbihSamuel Abourbih More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555322.90041.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Improving communication between doctors and nurses in an outpatient clinical setting has the potential to improve efficiency, quality and patient satisfaction while decreasing costs. The purpose of this study is to evaluate the impact of a two-way radio communication system in the urology outpatient clinic setting, and its effect upon efficiency and patient satisfaction. METHODS: All members of the urologic clinical team including attending physicians, fellows, clinic nurses and clinic medical assistants (MA) wore two-way radio headsets during typical outpatient clinics. In half of the clinic visits the nurse's and MA's radios were not turned on (controls), while in half the visits all radios were on (experimental setting). Patients and reviewers were blinded to whether the radios were operational. Clinical efficiency was compared during 8 different clinic days over an 8-week period. Primary endpoints included the time from physician completing discharge documents to the patient receiving the discharge paperwork, and the time from physician completing discharge documents to clinic discharge. Secondary outcomes included a subjective questionnaire for patient and staff members regarding the satisfaction with the two-radio system. Statistical analysis was performed using a Mann-Whitney U test, with p<0.05 considered significant. RESULTS: Visit times for 110 patient visits during 8 different urology clinics were compared including 55 with the two-radios on, and 55 visits where the nurse and MA radios were turned off. Use of the two-way radio communication decreased the time between the printing of discharge documents and the patients receiving the documents by 65% (2.3 minutes versus 6.75 minutes respectively; p<0.001). In addition, two-way radio communication resulted in a 57% decrease in total discharge time (3.3 minutes versus 7.8 minutes respectively; p<0.001). 92% of patients felt the doctor′s use of the radio did not impact patient communication with the doctor. During the period of radio use, the physician′s overall satisfaction ranking rose from 13/15 to 5/15 compared to other physicians in the group. 83% of staff agreed or strongly agreed that two-way radio use improved clinic efficiency. CONCLUSIONS: Implementation of two-way radio communication in an outpatient clinic setting showed a significant decrease in both patient wait times and total discharge time. This improved clinic efficiency improved patient and staff satisfaction and has the potential to improve quality and reduce costs. Source of Funding: None Loma Linda, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e198-e198 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeremy Brown More articles by this author Zahabiya Campwala More articles by this author Akin Amasyali More articles by this author Mohammad Hajiha More articles by this author Muhannad Alsyouf More articles by this author Phillip Stokes More articles by this author Ashley Li More articles by this author Hyelin You More articles by this author Milan Shah* More articles by this author Samuel Abourbih More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction and Objectives: Fluoroscopy units are routinely operated in the automatic brightness control (ABC) mode to optimize image quality. During ureteroscopy, objects may be placed within the fluoroscopy beam and the effect upon radiation exposure is unknown. The purpose of this study is to investigate the effects of equipment within the fluoroscopy beam during simulated ureteroscopy. Methods: ABC fluoroscopy of a cadaver was performed in eight clinical scenarios, including a control (no equipment), and seven groups with different equipment within the fluoroscopy beam. Equipment tested included electrocardiogram (EKG) leads, a Kelly clamp, camera and light cords (straight and coiled configurations), flexible ureteroscope, rigid cystoscope, and the lateral table support beam. Ten 145-second fluoroscopy trials were performed for each arm. The primary outcome was radiation dose (mGy) compared using the Mann-Whitney test with p < 0.05 considered significant. Results: Compared with control (18.5 mGy), radiation exposure was significantly increased with the presence of a straight camera and light cords (19.3 mGy), Kelly clamp (19.4 mGy), coiled camera and light cords (20.2 mGy), a flexible ureteroscope (21.0 mGy), a rigid cystoscope (21.2 mGy), and when the lateral table support beam was in the path of the X-ray (25.0 mGy; a 35% increase; p < 0.007 for all). The EKG leads did not affect the radiation dose. Conclusions: Avoiding equipment within the fluoroscopy beam using ABC mode can reduce radiation exposure. Adjusting the table and patient position to exclude the lateral table support beam will reduce radiation exposure by 35%.

You have accessJournal of UrologyStone Disease: Surgical Therapy II (MP17)1 Apr 2019MP17-18 STRUCTURAL AND MECHANICAL CHANGES OF SOFT AND FIRM POLYURETHANE STENTS: A BENCHTOP STUDY Ashley Li, Jeremy Brown, John Smith, Hyelin You, Andrew Krause, Williamson Le, Muhannad Alsyouf, Phillip Stokes*, Mohammad Hajiha, Akin Amasyali, and D. Duane Baldwin Ashley LiAshley Li More articles by this author , Jeremy BrownJeremy Brown More articles by this author , John SmithJohn Smith More articles by this author , Hyelin YouHyelin You More articles by this author , Andrew KrauseAndrew Krause More articles by this author , Williamson LeWilliamson Le More articles by this author , Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Phillip Stokes*Phillip Stokes* More articles by this author , Mohammad HajihaMohammad Hajiha More articles by this author , Akin AmasyaliAkin Amasyali More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555443.60593.5eAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Ureteral stents relieve obstruction and maintain renal drainage. However, chronic indwelling stents carry complications including fragmentation, migration, and encrustation. Other than indwelling time, factors contributing to stent encrustation are unknown. A donor urine bath model for studying stent encrustation has previously been presented. The purpose of this study is to compare the risk for encrustation and force required for removal in soft, firm, multi-length, and fixed length stents in a controlled artificial urine bath. METHODS: Twenty-four double pigtail stent coils (6 firm multi-length, 6 soft multi-length soft, 6 firm fixed length, 6 soft fixed length stent coils) were bathed in an in vitro artificial urine solution to simulate a rapid encrustation model. The stents were bathed for 15 days in an incubator at human body temperature. The urine bath was exchanged every 3 days and the length and diameter of the stent coils were measured. The force required for stent extraction from a ureteral benchtop model was measured in newtons (N) using a force gauge before and after the urine bath. Mann-Whitney U test was used for statistical analysis with p<0.05 considered significant. RESULTS: After 15 days, all stents showed evidence of encrustation on gross evaluation and scanning electron microscopy. The mean force required for stent removal after the urine bath was 0.664 N (firm fixed), 0.549N (firm multi), 0.502N (soft fixed), 0.475N (soft multi). Firm stents required significantly more force for removal than soft stents prior to the urine bath (0.290N vs 0.162N respectively; p<0.001) and after the urine bath (0.606N vs 0.488N respectively; p=0.01) regardless of whether these stents were fixed or multi-length. Soft stents increased in both length (9.5 to 12.7 cm; p<0.001) and diameter (1.4 to 3.3 mm; p<0.001) while firm stents only increased in diameter (1.4 to 2.3 mm; p<0.001). CONCLUSIONS: This benchtop study validates an artificial urine bath as a model for studying stent encrustation. Signs of stent encrustation occurred as early as 15 days. While firm stents required more force for removal, soft stents demonstrated significant spatial changes in vitro. These should be considered at the time of stent selection to optimize patient comfort and quality of life. Source of Funding: None Loma Linda, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e262-e262 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ashley Li More articles by this author Jeremy Brown More articles by this author John Smith More articles by this author Hyelin You More articles by this author Andrew Krause More articles by this author Williamson Le More articles by this author Muhannad Alsyouf More articles by this author Phillip Stokes* More articles by this author Mohammad Hajiha More articles by this author Akin Amasyali More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement PDF downloadLoading ...

Perinephric urinomas commonly arise following traumatic injury or high-grade obstruction from kidney stones or lower urinary tract disorders. Not only are spontaneous urinomas rare in the pediatric population, but malignancy presenting with perinephric urinomas have only been described in the adult population. In this case report, we report flank pain from a spontaneous perinephric urinoma as the presenting symptom of lymphoma in a pediatric patient. (C) 2018 Elsevier Inc.