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Kim J, Stewart V, Talwar G, Uy M, Hoogenes J, Matsumoto ED. A systematic review of postoperative outcomes of kidney stone surgery and meta-analysis of outcomes of percutaneous nephrolithotomy in individuals with spinal cord injury. Spinal Cord 2023; 61:469-476. [PMID: 37596394 DOI: 10.1038/s41393-023-00927-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 07/28/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES To evaluate outcomes of surgical treatment for nephrolithiasis in individuals with spinal cord injury (SCI). METHODS We systematically reviewed the Ovid MEDLINE, Embase, CENTRAL, and Web of Science databases for studies examining outcomes of kidney stone procedures in individuals with SCI. Our primary outcomes were stone-free rate (SFR) and complications as categorized by Clavien-Dindo classification. A meta-analysis of comparative studies was performed to assess differences in SFR and complication rate between individuals with and without SCI following PCNL. RESULTS A total of 27 retrospective and observational articles were included. Interventions for kidney stones included PCNL, shockwave lithotripsy (SWL), and ureteroscopy. Pooled SFR in individuals with SCI was 54%, for SWL, 74% for PCNL, and 36% for ureteroscopy. Meta-analyses found that there was higher rate of grades I (OR 9.54; 95% CI, 3.06 to 29.79), II (OR 3.38; 95% CI, 1.85 to 6.18), and III-V (OR 2.38; 95% CI, 1.35 to 4.19) complications in individuals with SCI compared to non-SCI individuals following PCNL. The rate of infectious complications was also higher in individuals with SCI (OR 6.15; 95% CI, 1.86 to 20.39). However, there was no difference in SFR (OR 0.64; 95% CI, 0.15 to 2.64) between groups. CONCLUSIONS Individuals with SCI are at higher risk of minor, major, and infectious complications following PCNL compared to non-SCI individuals. There was no significant difference between groups in SFR following PCNL, suggesting that PCNL is an effective surgery for kidney stones in individuals with SCI.
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Affiliation(s)
- John Kim
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Veronica Stewart
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Gaurav Talwar
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Michael Uy
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Jen Hoogenes
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
- McMaster Institute of Urology, St. Joseph's Hospital, Hamilton, ON, Canada
| | - Edward D Matsumoto
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
- McMaster Institute of Urology, St. Joseph's Hospital, Hamilton, ON, Canada
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Incidence and safety outcomes associated with active stone removal procedures (ASRP): a comparison between neurological and non-neurological patients using the French National Health Data Base. World J Urol 2022; 40:1821-1827. [PMID: 35665842 DOI: 10.1007/s00345-022-04054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To compare the incidence and the safety outcomes associated with active stone removal procedure (ASRP) between neurological and non-neurological patients. MATERIALS AND METHODS The present study was conducted using the data issued from the French National Health Data Base. All patients that have been hospitalized to undergo an ASRP between January 1 2012 and December 31 2018 were included and allocated to four neurological groups (multiple sclerosis, spinal dysraphism, paraplegia, tetraplegia) and one non-neurological group. The primary outcome was the rate of patients hospitalized at least once to undergo an ASRP over the study period. The secondary outcomes included the type of ASRP performed, the length of hospital stay, the rates of post-operative UTI, of early re-admission and re-treatments. Multivariate logistic regression was used to estimate odd ratios, the four neurological groups being compared to the non-neurological group. RESULTS During the study period, 45,745,055 patients were hospitalised, with 151,850 of them presenting with an underlying neurological disease. Among the non-neurological patients, 0.89% underwent an ASRP, while 1.39% neurological patients did. Neurological patients presented with a lower rate of ESWL associated with a higher rate of PCNL, while the length of hospital stay, the rate of post-operative UTI, of early re-admission and of re-treatment were systematically increased (p < 0.001), when compared to non-neurological patients, regardless of the type of ASRP considered. CONCLUSIONS The results presented here confirm and clarify the incidence and the safety outcomes associated with ASRP within the neurological population and advocate for the emergence of a dedicated research field focusing on neuro-urolithiasis.
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Simmons KL, Chandrapal JC, Wolf S, Rice HE, Tracy EE, Fitzgerald T, Pomann GM, Routh JC. Open versus minimally-invasive surgical techniques in pediatric renal tumors: A population-level analysis of in-hospital outcomes. J Pediatr Urol 2021; 17:534.e1-534.e7. [PMID: 33849794 PMCID: PMC8449787 DOI: 10.1016/j.jpurol.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/31/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Minimally-invasive surgery (MIS) has been adopted slowly in pediatric oncology. We attempted to describe contemporary national trends in MIS use; we hypothesized that adolescents (who are more likely to have relatively small renal cell carcinomas) would have a higher proportion of MIS than younger children (who are more likely to have relatively large Wilms tumors) and that this relationship would vary by region. OBJECTIVE To explore whether pediatric urologic oncology outcomes vary by patient age or by surgical technique. METHODS We queried the 1998-2014 National Inpatient Sample (NIS) and included encounters in children aged ≤ 18 y, ICD-9 diagnostic code for renal tumor, and procedure code for open or MIS partial or radical nephrectomy. All analyses used weighted descriptive statistics and outcomes are compared based on age group (</>10 y) or surgery type; Wald-Chi square test was used for differences in proportions and unadjusted weighted ANOVA was used to test for differences in means. RESULTS 9259 weighted encounters were included; 91% were <10 years old and 50.7% were female. MIS surgery accounted for 1.8% of encounters; there was a difference in proportions by age group (1% <9 y vs. 9.9% >9 y, p < 0.01). The proportion of surgery type was similar across regions within age groups, however. Complications occurred in 13.3% of encounters; mean inpatient length of stay was 8.9 days (SD: 0.3); mean cost was $ 34,457.68 (SD: $1197.00). There was no evidence of a difference between surgery type and proportion of post-operative complications, mean inpatient length of stay or mean inpatient cost. DISCUSSION The admission-based, retrospective design of NIS left us unable to assess long-term outcomes, repeated admissions, or to track a particular patient across time; this is particularly relevant for oncologic variables on interest such as tumor stage or event-free survival. We were similarly limited in evaluating the effect of pre-surgical referral patterns on patient distributions. CONCLUSION In this preliminary descriptive analysis, MIS techniques were infrequently used in children, but there was a higher proportion of MIS use among adolescents. There were similar proportions of surgery type across geographic regions within the United States. Whether this infrequent usage is appropriate is as yet unclear given the lack of Level I evidence regarding the relative merits of MIS and open surgery for pediatric and adolescent renal tumors.
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Affiliation(s)
- Kirsten L Simmons
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jason C Chandrapal
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Steven Wolf
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Henry E Rice
- Division of Pediatric Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Elisabeth E Tracy
- Division of Pediatric Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Tamara Fitzgerald
- Division of Pediatric Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Gina-Maria Pomann
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Jonathan C Routh
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC, USA; Surgical Center for Outcomes Research, Duke University School of Medicine, Durham, NC, USA.
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Fremion E, Bustillos P, Khavari R. Contemporary management considerations of urinary tract infections for women with spina bifida. Int Urogynecol J 2021; 33:493-505. [PMID: 34081164 DOI: 10.1007/s00192-021-04860-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary tract infections (UTIs) are one of the leading health concerns and causes of hospitalization for adults with spina bifida (SB). The risk factors, evaluation, management, and prevention of UTIs in women with SB must take into consideration their unique pelvic anatomy and function as well as the desire for pregnancy or the occurrence UTI during pregnancy. This article reviews published literature regarding this topic and offers recommendations for UTI evaluation, management, and prevention in the context of the unique pelvic floor health needs of women with SB. METHODS A systematic review was conducted using the following keywords: spinal dysraphism, spina bifida, myelomeningocele, meningocele, urinary tract infections, females, and adults. Articles were included if they were in English, published during or after 2000, peer reviewed, included women with spina bifida aged 18 or greater, and included outcomes related to urinary tract infection. RESULTS No articles met inclusion criteria. CONCLUSION As no articles were found based on the initial search criteria, articles pertaining to neurogenic bladder UTI risks, evaluation, and management were discussed to develop consensus recommendations for the unique care of UTIs in women with SB.
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Affiliation(s)
- Ellen Fremion
- Baylor College of Medicine, Departments of Internal Medicine and Pediatrics, Section of Transition Medicine, 7200 Cambridge St. Suite 8a, Houston, TX, 70330, USA.
| | - Paola Bustillos
- Houston Methodist Hospital, Department of Urology, Neurourology and Transitional Urology Clinic, Weill Cornell Medical College, Houston, TX, 77030, USA
| | - Rose Khavari
- Houston Methodist Hospital, Department of Urology, Neurourology and Transitional Urology Clinic, Weill Cornell Medical College, Houston, TX, 77030, USA
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Loftus CJ, Ahn J, Hagedorn JC, Cain M, Holt S, Merguerian P, Shnorhavorian M. The impact of the dependent care provision on individuals with spina bifida transitioning to adulthood. J Pediatr Urol 2021; 17:289.e1-289.e9. [PMID: 33563555 DOI: 10.1016/j.jpurol.2021.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Under the Affordable Care Act, the Dependent Care Provision (DCP) was enacted in 2010 and expanded healthcare coverage for millions of young adults ages 19-25 by allowing them to stay on their parents' insurance until age 26. It is unknown whether the DCP has impacted young adults with SB who are at risk for lapses in insurance coverage as they transition into adult care. OBJECTIVE Our aim was to determine the impact of the DCP on access to care (insurance status) and healthcare-quality (hospital admissions for potentially preventable conditions). METHODS Using the National Inpatient Sample (an all-payor national dataset of hospital admissions), we analyzed pre/post DCP changes for admissions of SB patients ages 19-25. Our outcomes of interest were rates of insurance coverage and proportion of admissions due to potentially preventable conditions (UTI, pyelonephritis, skin conditions, osteomyelitis, sepsis, and pneumonia). Analysis included a difference-in-differences logistic regression model which compared the pre/post DCP difference (2006-s quarter of 2010 vs. 2011-2013) in patients ages 19-25 to the difference in patients ages 26-32 who were ineligible for the DCP policy. RESULTS For admissions of SB patients ages 19-25, the DCP was not associated with improved insurance status compared to admissions ages 26-32 (0% vs. -0.4%, p = 0.10) and rates of private insurance decreased in both age groups, but more so in ages 26-32 (-2.0% vs. -3.9%, p < 0.001). Private insurance rates increased for admissions of white patients ages 19-25 but not for black and Hispanic groups. An increase in overall insurance status was also seen in young adults from high-income zip codes. Admissions for potentially preventable conditions increased in both age groups by a similar degree (+2.6% vs. +2.5%, p = 0.82). DISCUSSION Under the Affordable Care Act, the DCP failed to improve rates of private insurance or decrease rates of noninsurance for admissions of young adults with SB. Certain race and socioeconomic groups benefited more from this national healthcare policy. Meanwhile, admissions for potentially preventable conditions are common in spina bifida patients, and increased over the study period, suggesting a need for further investigation into optimizing the delivery of healthcare to this complex patient population. CONCLUSION The DCP did not result in improved overall insurance rates or in improved rates of private insurance for admissions of SB patients 18-25 years old.
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Affiliation(s)
- Christopher J Loftus
- Department of Urology, University of Washington Medical Center, 1959 NE Pacific St, Box 356510, Seattle, WA 98195, USA.
| | - Jennifer Ahn
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Judith C Hagedorn
- Department of Urology, University of Washington Medical Center, 1959 NE Pacific St, Box 356510, Seattle, WA 98195, USA
| | - Mark Cain
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Sarah Holt
- Department of Urology, University of Washington Medical Center, 1959 NE Pacific St, Box 356510, Seattle, WA 98195, USA
| | - Paul Merguerian
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Margarett Shnorhavorian
- Department of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
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Conway JM, Christodoulidou M, Reid S, Patterson JM. Flexible cystoscopy and laser stone fragmentation via Mitrofanoff stoma: A case series. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820987665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This case series aimed to demonstrate that flexible cystoscopy and laser stone fragmentation via a Mitrofanoff stoma is possible and an effective treatment for symptomatic bladder stones in complex patients with inaccessible urethras and challenging anatomy. Patients and methods: We present three cases which were managed in a tertiary centre. The procedure involved using a flexible cystoscope via the Mitrofanoff stoma and laser stone fragmentation without the need for an access sheath. Results: This technique was performed safely and demonstrated successful bladder stone clearance on follow-up, with no postoperative complications. Conclusion: Our case series illustrates a technique that can be performed in this select group of patients in specialist centres with the relevant surgical exposure and expertise. Level of evidence Level 4.
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Torricelli FCM, Vicentini FC, Zanetti L, Perrella R, Marchini GS, Danilovic A, Batagello CA, Murta CB, Claro JFA, Srougi M, Nahas WC, Mazzucchi E. Percutaneous nephrolithotomy in patients with spinal cord injury: should all these patients be automatically assigned a Guy's stone score of 4? World J Urol 2020; 39:2129-2134. [PMID: 32930845 DOI: 10.1007/s00345-020-03443-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/05/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To assess the complication and stone-free rates of PCNL in patients with spinal cord injury (SCI) and to evaluate whether this population should be assigned a Guy's stone score (GSS) of 4. METHODS A case-control study was conducted, and electronic charts were reviewed to search for patients with SCI, bladder dysfunction, and kidney stones who had undergone PCNL. Control cases were randomly selected from among patients with complete staghorn calculus (GSS = 4). RESULTS One hundred and seventeen patients were included. Patients with SCI had a significant shorter operative time (119 vs. 141 min; p = 0.018). There were no significant differences between the groups in terms of the patients' position, number of renal tracts, bleeding or transfusion rate; however, there was a significantly higher complication rate (23.1% vs. 7.8%; p = 0.009) and a longer hospital stay (5.8 vs. 3.1 days; p = 0.002) among patients with SCI. With regards to the stone-free rate in patients with different grades of GSS patients with SCI who had a GSS of 1 had a stone-free rate of 85.7%, while those with a GSS of 2, 3, or 4 had 50%, 50%, and 31.5%, respectively (p = 0.024). Only patients with a GSS of 4 in the SCI group had outcomes that were similar to those of control patients (31.5% vs. 31.6%). CONCLUSION Patients with SCI should not be automatically assigned GSS 4. Stone-free rate is related to stone burden in these patients, although they do show a higher complication rate and a longer hospital stay than non-neurological patients.
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Affiliation(s)
- Fabio C M Torricelli
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil.
| | - Fabio C Vicentini
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil.,Division of Urology, Hospital Brigadeiro, Sao Paulo, SP, Brazil
| | - Lucas Zanetti
- Faculdade das Américas School of Medicine, Sao Paulo, SP, Brazil
| | | | - Giovanni S Marchini
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil
| | - Alexandre Danilovic
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil
| | - Carlos A Batagello
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil
| | - Claudio B Murta
- Division of Urology, Hospital Brigadeiro, Sao Paulo, SP, Brazil
| | | | - Miguel Srougi
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil
| | - William C Nahas
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil
| | - Eduardo Mazzucchi
- Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP, 04604-006, Brazil
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Nettey OS, Bowen DK, Santiago-Lastra Y, Metcalfe P, Kielb SJ. Complications in adulthood for patients with paediatric genitourinary reconstruction. World J Urol 2020; 39:1029-1036. [PMID: 32529452 DOI: 10.1007/s00345-020-03295-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 06/03/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Caring for adults with prior paediatric genitourinary reconstruction remains a challenge for adult providers. Reconstructions typically have occurred decades before; surgical records are not always available and patients and families may be unable to convey procedures performed. Spina bifida (SB) patients are vulnerable to cognitive decline which may compound these challenges. Changes in patient body habitus and loss of function may contribute to problems with previous reconstructions. METHODS This is a non-systematic review of the literature and represents expert opinion where data are non-existent. This review focuses on the evaluation and management of complications arising from genitourinary reconstruction in congenital neurogenic bladder patients. RESULTS Common complications experienced by congenital neurogenic bladder patients include recurrent urinary tract infection, incontinence of catheterizable channel and urinary reservoir as well as malignancy as this population ages. Preservation of renal function and prevention of urinary tract infection while optimizing continence are essential guiding principles in the care of these patients. Many of the recommendations, however, are gleaned from available data in the adult spinal cord patient (a more commonly studied population) or the paediatric urologic literature due to limited studies in adult management of such patients. CONCLUSION Close follow-up and vigilance is warranted to monitor for infectious, mechanical and malignant complications while optimizing preservation of the upper urinary tracts and patient quality of life.
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Affiliation(s)
- Oluwarotimi S Nettey
- Department of Urology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Arkes 23rd floor, Chicago, IL, 60611, USA.
| | - Diana K Bowen
- Department of Adult and Pediatric Urology, Lurie Children's Hospital, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Yahir Santiago-Lastra
- Department of Urology, University of Southern California San Diego, San Diego, CA, USA
| | - Peter Metcalfe
- Department of Surgery, Division of Pediatric Surgery, University of Alberta, Alberta, Canada
| | - Stephanie J Kielb
- Department of Urology, Gynecology, and Medical Education, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Lane GI, Roberts WW, Mann R, O'Dell D, Stoffel JT, Clemens JQ, Cameron AP. Outcomes of renal calculi in patients with spinal cord injury. Neurourol Urodyn 2019; 38:1901-1906. [DOI: 10.1002/nau.24091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/17/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Giulia I. Lane
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
| | | | - Rachel Mann
- Department of UrologyUniversity of Minnesota Minneapolis Minnesota
| | - Diana O'Dell
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
| | - John T. Stoffel
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
| | | | - Anne P. Cameron
- Department of UrologyUniversity of Michigan Ann Arbor Michigan
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Wang S, Zhang X, Xiao B, Hu W, Chen S, Li J. Ultrasound-guided percutaneous nephrolithotomy for upper urinary tract calculi in patients with spinal deformity: a decade's experience. BJU Int 2018; 124:109-115. [PMID: 30358056 DOI: 10.1111/bju.14601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shu Wang
- Department of Urology; Beijing Tsinghua Changgung Hospital; Beijing China
- Division of Urology; University of Maryland School of Medicine; Baltimore MD USA
| | - Xin Zhang
- Department of Urology; Beijing Tsinghua Changgung Hospital; Beijing China
| | - Bo Xiao
- Department of Urology; Beijing Tsinghua Changgung Hospital; Beijing China
| | - Weiguo Hu
- Department of Urology; Beijing Tsinghua Changgung Hospital; Beijing China
| | - Song Chen
- Department of Urology; Beijing Tsinghua Changgung Hospital; Beijing China
| | - Jianxing Li
- Department of Urology; Beijing Tsinghua Changgung Hospital; Beijing China
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Re: Subcapsular Splenic Urinoma and Splenorenal Fistula: A New Complication of Percutaneous Nephrolithotomy. J Urol 2018; 199:1391-1392. [DOI: 10.1016/j.juro.2018.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Affiliation(s)
- Alvaro A Saavedra
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB
| | - Dawn Maclellan
- Department of Urology, Dalhousie University, Halifax, NS; Canada
| | - Gary J Gray
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB
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13
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Mitchell S, Gurung PMS, Choong S, Morris T, Smith D, Woodhouse C, Philp T. Percutaneous Nephrolithotomy and Spina Bifida: Complex Major Stone Surgery? J Endourol 2018; 32:205-212. [PMID: 29343086 DOI: 10.1089/end.2017.0775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The incidence of spina bifida (SB) is ∼1:1000, and risk of stone disease is substantially raised in SB. This is the unique published study of the outcome of patients with SB undergoing percutaneous nephrolithotomy (PCNL) compared to a neurologically intact historically matched control group at the same institution. PATIENTS AND METHOD A series of 96 PCNLs in 13 SB and 50 non-SB patients was analyzed. The following measurements were recorded: (1) Comorbidities; (2) Preoperative: (renal function, American Society of Anesthesiologists [ASA] score); (3) Intraoperative: (anesthesia time, number of tracks, stone-free rate); and (4) Postoperative: (sepsis, intensive therapy unit and total length of stay, transfusion rate, stone composition, rate of stone disease-related nephrectomy). RESULTS Retrograde access to the ureter was impossible in all cases of SB. The median ASA grade (OR 10.5, 95% confidence interval [CI] 2.6-42.7) and operative time (median difference 30 minutes, 95% CI 20-40) were both higher in the SB cohort. Surgeon's estimate of stone-free rate was significantly lower in the SB cohort (46% vs 82%). Intensive care requirement (0.29 days/PCNL vs 0.1 days/PCNL); total hospital stay (7 days vs 4 days); postoperative transfusion rate (11.8% vs 1.6%); and sepsis rate (38% vs 1.6%) were all significantly higher in the SB group. Repeat PCNL and nephrectomy for recurrent stone disease were both significantly increased in SB cohort compared to control group. CONCLUSIONS PCNL in patients with SB is associated with multiple parameters of poor outcome. Patients with SB should be counseled about increased peri-operative risk and likelihood of stone recurrence. In an era where hospitals are judged according to comparative outcomes, a case may be made for comparing PCNL in this cohort of patients separately because of the significantly increased peri- and postoperative morbidity.
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Affiliation(s)
- Stephen Mitchell
- 1 Department of Urology, Barnsley and Mid Yorkshire NHS Foundation Hospital Trusts , London, United Kingdom
| | | | - Simon Choong
- 3 Department of Urology, University College London Hospital NHS Foundation Trust , London, United Kingdom
| | - Timothy Morris
- 4 Department of Medical Statistics, MRC Clinical Trials Unit , London, United Kingdom
| | - Daron Smith
- 3 Department of Urology, University College London Hospital NHS Foundation Trust , London, United Kingdom
| | - Christopher Woodhouse
- 3 Department of Urology, University College London Hospital NHS Foundation Trust , London, United Kingdom
| | - Timothy Philp
- 3 Department of Urology, University College London Hospital NHS Foundation Trust , London, United Kingdom
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Stauffer CE, Snyder E, Ngo TC, Elliott CS. Is Neurogenic Bladder a Risk Factor for Febrile Urinary Tract Infection After Ureteroscopy and, if so, Why? Urology 2017; 112:33-37. [PMID: 29056577 DOI: 10.1016/j.urology.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/03/2017] [Accepted: 10/05/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To characterize the rate of febrile urinary tract infections (UTIs) after ureteroscopy in patients with neurogenic bladder compared with those with physiologically normal bladders. Although generally considered safe and effective, there is a growing body of evidence suggesting that patients with neurogenic bladder are at an increased risk of infectious complications following ureteroscopy. METHODS We performed a retrospective chart review of those undergoing ureteroscopy in a single academically affiliated hospital system between June 2013 and May 2016. Information regarding neurogenic bladder status, culture results, bladder management, and the presence of upper tract decompression was collected. Postoperative febrile UTI was defined as a hospital admission within 1 week of surgery because of fever not attributable to another source. RESULTS Of 467 ureteroscopies, 44 (9.5%) were performed in the setting of neurogenic bladder. Febrile UTI rates were higher in patients with neurogenic bladder compared with control patients (9% vs 1.4%, P = .01) with significantly higher rates in those dependent on bladder catheterization. Interestingly, the presence of a nephrostomy tube in patients with physiologically normal bladders increased the risk of postoperative febrile UTI to levels comparable with patients with neurogenic bladder who were catheter dependent (10.5% vs 12.5%, respectively). CONCLUSION Although infectious complications in the neurogenic population are likely multifactorial, the reliance on catheterization and thus colonization appears to be a significant factor and extends to non-neurogenic patients. These data suggest that bacterial colonization may be the significant underlying risk factor for febrile UTI after ureteroscopy.
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Affiliation(s)
| | | | - Tin C Ngo
- Department of Urology, Stanford University, Palo Alto, CA
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Loftus CJ, Moore DC, Cohn JA, Milam DF, Dmochowski RR, Wood D, Kaufman MR, Wood HM. Postoperative Complications of Patients With Spina Bifida Undergoing Urologic Laparotomy: A Multi-institutional Analysis. Urology 2017. [DOI: 10.1016/j.urology.2017.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Abstract
BACKGROUND Urolithiasis is rare in pediatric patients. All patients with inflammatory bowel disease (IBD) have an increased risk of urolithiasis, but this risk is poorly quantified in children. The objective of this study is to evaluate the association of IBD with urolithiasis, assess surgical outcomes, and analyze the financial burden for children hospitalized with urolithiasis and comorbid IBD. METHODS The triennial Healthcare Cost and Utilization Project Kids' Inpatient Database for years 1997 to 2012 was used to evaluate the association between urolithiasis and IBD in hospitalized, nonpregnant children ages 5 to 20 years old. Billing codes were used to define conditions. Logistic regression analysis quantified the association between IBD types and urolithiasis. Length of hospital stay, costs, procedures, and complications were compared between urolithiasis patients with and without IBD. RESULTS Among 8,828,522 hospital admissions, we identified 36,771 admissions with a primary diagnosis of urolithiasis. Of these cases, 230 were associated with Crohn's disease (odds ratios, 1.99; 95% confidence interval, 1.74-2.27) and 102 with ulcerative colitis (odds ratio, 1.63; 95% confidence interval, 1.34-1.99). Urolithiasis patients with ulcerative colitis, but not Crohn's disease, had significantly increased length of stay and costs. Patients with either IBD had a decreased number of urologic procedures. CONCLUSIONS The diagnosis of urolithiasis in pediatric patients is associated with IBD, and those with ulcerative colitis have longer hospital stays and greater costs. Patients with IBD have fewer urologic procedures associated with their urolithiasis diagnosis.
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Martinez LM, Slobodov G, Lewis J, Haddad E, Frimberger D. Transition of Care for Adults with Congenital Urological Conditions. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s40746-016-0040-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Svider PF, Raikundalia MD, Pines MJ, Baredes S, Folbe AJ, Liu JK, Eloy JA. Inpatient Complications After Transsphenoidal Surgery in Cushing’s Versus Non-Cushing’s Disease Patients. Ann Otol Rhinol Laryngol 2015; 125:5-11. [DOI: 10.1177/0003489415595424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: Transsphenoidal surgery (TSS) harbors a potential for hypopituitarism, cerebrospinal fluid (CSF) leaks, and other complications. We utilized the Nationwide Inpatient Sample Database (NIS) to compare inpatient complication rates between Cushing’s disease (CD) and non-Cushing’s disease (NCD) patients undergoing TSS. Methods: Inpatient hospitalization data for 960 CD and 12 110 NCD patients who underwent TSS between 2002 and 2010 were accessed. Demographic information, outcomes, and complication rates were evaluated. Results: Patients with CD had a female predilection (81.7%) and were younger (40.5 ± 14.4 years) than NCD patients (47.8% female; 52.1 ± 16.3 years) ( P < .001). Length of stay and total charges did not differ between groups. Patients with CD had significantly greater postoperative diabetes insipidus rates (14.0% vs 9.6%, P < .001) and urinary/renal complications (1.7% vs 0.9%, P = .027). After adjusting for possible confounders, the relationship between urinary/renal complications and CD status strengthened. There was no difference in rates of CSF leak and iatrogenic pituitary disorders overall. Conclusion: No differences were noted in the rate of early CSF leaks between postoperative TSS CD and NCD patients. Postoperative diabetes insipidus did not significantly differ between groups after adjusting for confounders. Only odds of urinary/renal complications in CD patients was significant after adjustment.
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Affiliation(s)
- Peter F. Svider
- Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Milap D. Raikundalia
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Morgan J. Pines
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Adam J. Folbe
- Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - James K. Liu
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Veenboer PW, de Kort LMO, Chrzan RJ, de Jong TPVM. Urinary considerations for adult patients with spinal dysraphism. Nat Rev Urol 2015; 12:331-9. [DOI: 10.1038/nrurol.2015.99] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Pines MJ, Raikundalia MD, Svider PF, Baredes S, Liu JK, Eloy JA. Transsphenoidal surgery and diabetes mellitus: An analysis of inpatient data and complications. Laryngoscope 2015; 125:2273-9. [PMID: 25646595 DOI: 10.1002/lary.25162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/01/2014] [Accepted: 12/18/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES/HYPOTHESIS Transsphenoidal surgery (TSS) has emerged as the standard approach for pituitary resection due to its minimally invasive nature. There has been little analysis examining the impact of diabetes mellitus (DM) on patients undergoing TSS. In this study, we characterize DM's association with postoperative TSS complications. In addition to analysis of associated charges and patient demographics, we performed comparison of complication rates between DM and non-DM patients who have undergone TSS in recent years. METHODS The Nationwide Inpatient Sample, a database encompassing nearly 8 million inpatient hospitalizations, was evaluated for patients undergoing TSS from 2002 to 2010. RESULTS Of 12,938 TSS patients, 2,173 (16.8%) had a DM diagnosis. The non-DM cohort was younger (50.1 y ± 16.6SD vs. 56.8 y ± 14.1; P < 0.001) and had shorter hospitalizations and lesser charges. DM patients had a greater incidence of pulmonary, cardiac, urinary/renal, and fluid/electrolyte complications, and had a lesser incidence of diabetes insipidus (P < 0.05). Upon controlling for age, the greater incidence of pulmonary and fluid/electrolyte complications was present only among patients < 60 years of age. Higher occurrence of cerebrospinal fluid rhinorrhea was noted among black diabetics when compared to non-DM blacks. CONCLUSIONS DM is associated with greater length of stay and hospital charges among TSS patients. DM patients undergoing TSS have a significantly greater incidence of pulmonary and fluid/electrolyte complications among patients under the age of 60, and greater risk for urinary/renal complications across all ages. Despite a theoretical concern due to an impaired wound-healing in DM patients, association with cerebrospinal fluid rhinorrhea was only noted among black diabetics. LEVEL OF EVIDENCE 2C.
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Affiliation(s)
- Morgan J Pines
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Milap D Raikundalia
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - James K Liu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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