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Becker REN, DiBianco JM, Higgins AM, Konheim J, Kleer E, Leavitt D, King A, Kachroo N, Majdalany SE, Gandham D, Fernandez Moncaleano G, Conrado B, Shoemaker E, Daignault-Newton S, Dauw CA, Ghani KR. Daily Ecological Momentary Assessments of Pain and Ability to Work After Ureteroscopy and Stenting. J Endourol 2024; 38:545-551. [PMID: 38545762 DOI: 10.1089/end.2023.0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
Introduction: Ureteral stents can cause significant patient discomfort, yet the temporal dynamics and impact on activities remain poorly characterized. We employed an automated tool to collect daily ecological momentary assessments (EMAs) regarding pain and the ability to work following ureteroscopy with stenting. Our aims were to assess feasibility and better characterize the postoperative patient experience. Materials and Methods: As an exploratory endpoint within an ongoing clinical trial, patients undergoing ureteroscopy with stenting were asked to complete daily EMAs for 10 days postoperatively or until the stent was removed. Questionnaires were distributed through text messages and included a pain scale (0-10) and a single item from the validated Patient-Reported Outcomes Measurement Information System Ability to Participate in Social Roles and Activities instrument, as well as days missed from work or school. Results: Among the first 65 trial participants, 59 completed at least 1 EMA (overall response rate 91%). Response rates were >85% for each time point through postoperative day (POD)10. Median respondent age was 58 years (interquartile range [IQR] 50-67), and 56% were female. Stones were 54% renal and 46% ureteral, with a median diameter of 9 mm (IQR 7-10). Median stent dwell time was 7 days (IQR 6-8). Pain scores were highest on POD1 (median score 4) and declined on each subsequent day, reaching a median score of 2 on POD5. Sixty-three percent of patients on POD1 reported that they had trouble performing their usual work at least sometimes, but by POD5, this was <50% of patients. Patients who work or attend school reported a median of 1 day missed (IQR 0-2). Conclusions: An automated daily EMA system for capturing patient-reported outcomes was demonstrated to be feasible with sustained excellent engagement. Patients with stents reported the worst pain and interference with work on POD1, with steady improvements thereafter, and by POD5, the majority of patients had minimal pain or trouble performing their usual work. This work is associated with a registered clinical trial [NCT05026710].
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Affiliation(s)
| | | | - Andrew M Higgins
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeremy Konheim
- Department of Urology, Trinity Health IHA Medical Group, Ypsilanti, Michigan, USA
| | - Eduardo Kleer
- Department of Urology, Trinity Health IHA Medical Group, Ypsilanti, Michigan, USA
| | - David Leavitt
- Department of Urology, Henry Ford Health System, Detroit, Michigan, USA
| | - Andre King
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Naveen Kachroo
- Department of Urology, Henry Ford Health System, Detroit, Michigan, USA
| | - Sami E Majdalany
- Department of Urology, Henry Ford Health System, Detroit, Michigan, USA
| | - David Gandham
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Bronson Conrado
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Elaina Shoemaker
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Casey A Dauw
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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Ziemba JB, Jones A, Lin G, Stambakio H, Tasian GE, Huang J. Postoperative Recovery of Quality-of-Life Following Ureteroscopy for Nephrolithiasis: The Impact on Pain Intensity and Interference and the Ability to Participate in Social Roles. Urology 2024:S0090-4295(24)00167-5. [PMID: 38508532 DOI: 10.1016/j.urology.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/20/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To prospectively capture patient-reported outcomes to assess the recovery profile of ureteroscopy (URS). MATERIALS AND METHODS Adults undergoing URS for renal/ureteral stones were eligible for inclusion (11/2020-8/2022). Patients prospectively completed PROMIS - Pain Intensity, - Pain Interference, and - Ability to participate in social roles and activities in-person preoperatively (POD 0) and via email on POD 1, 7, 14, and 30. Scores are reported as T-scores (normalized to U.S. population, mean=50) with a change of 5 (0.5 SD) considered clinically significant. RESULTS One hundred and seventy-eight participants enrolled at POD 0 (POD 1 =87, POD 7 =83, POD 14 =70, POD30 =67). There was a worsening of quality of life from day 0 to day 1 and day 0 to 7. All dimensions then improved with an increase in scores from day 0 to day 14 and day 0 to day 30. On multivariable analysis, the presence of a preoperative ureteral stent (OR 0.14) and use of semirigid URS (OR 0.33) were associated with a reduced odds for severe pain interference at day 1. The use of semirigid URS (OR 0.20) was associated with a reduced odds for severe worsening in the ability to participate in social roles at day 1. CONCLUSION Ability to participate in social roles declines immediately postoperatively, while pain intensity and interference sharply increase. There is a gradual improvement until POD 30. Findings suggest preoperative stents may influence postoperative recovery. Results offer meaningful insight to assist in counseling and setting expectation for patients postoperatively.
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Affiliation(s)
- Justin B Ziemba
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Amanda Jones
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - George Lin
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hanna Stambakio
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jing Huang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Lai HHH, Yang H, Tasian GE, Harper JD, Desai AC, McCune RD, Kirkali Z, Al-Khalidi HR, Scales CD, Curatolo M. Contribution of Hypersensitivity to Postureteroscopy Ureteral Stent Pain: Findings From Study to Enhance Understanding of Stent-associated Symptoms. Urology 2024; 184:32-39. [PMID: 38070834 DOI: 10.1016/j.urology.2023.10.039] [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: 07/18/2023] [Revised: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To examine the relationships between preoperative hypersensitivity to pain and central sensitization, and postoperative ureteral stent pain after ureteroscopy (URS) for urinary stones. METHODS Adults enrolled in the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS) underwent quantitative sensory testing (QST) prior to URS and stent placement. Hypersensitivity to mechanical pain was assessed using a pressure algometer. Participants rated their pain intensity to pressure applied to the ipsilateral flank area and lower abdominal quadrant on the side of planned stent placement, and the contralateral forearm (control). Pressure pain thresholds were also assessed. Central sensitization was assessed by applying a pointed stimulator (pinprick) and calculating the temporal summation. Postoperative stent pain intensity and interference were assessed using PROMIS questionnaires. Data were analyzed using repeated-measures mixed-effects linear models. RESULTS Among the 412 participants, the median age was 54.0years, and 46% were female. Higher preoperative pain ratings to 2 kg and 4 kg mechanical pressure to the ipsilateral flank and abdominal areas were associated with higher postoperative stent pain intensity with the stent in situ. Greater degree of central sensitization preoperatively, manifesting as higher temporal summation, was associated with higher postoperative pain intensity. Factors associated with preoperative hypersensitivity on QST included female sex, presence of chronic pain conditions, widespread pain, and depression. CONCLUSION Hypersensitivity to pain and central sensitization preoperatively was associated with postoperative ureteral stent pain, suggesting a physiologic basis for stent symptom variation. QST may identify patients more likely to develop stent pain after URS and could inform selection for preventive and interventional strategies.
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Affiliation(s)
- Hing Hung Henry Lai
- Division of Urologic Surgery, Departments of Surgery and Anesthesiology, Washington University School of Medicine, St. Louis, MO.
| | - Hongqui Yang
- Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Gregory E Tasian
- Division of Urology and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | | | - Alana C Desai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Rebecca D McCune
- Division of Urology and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Hussein R Al-Khalidi
- Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Charles D Scales
- Departments of Surgery (Urology) and Population Health Science, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Michele Curatolo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA; Harborview Injury Preventions and Research Center, University of Washington, Seattle, WA; Center for Sensory-Motor Interaction, University of Aalborg, Aalborg, Denmark
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Spencer KA, Wahlstedt ER, Upton KE, Bylund JR, Bell JR. Any Questions? Understanding the Functional Health Literacy in Patients Who Underwent Ureteroscopy. Urology 2024; 183:39-45. [PMID: 37926383 PMCID: PMC11178141 DOI: 10.1016/j.urology.2023.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/22/2023] [Accepted: 09/05/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To correlate health literacy of patients undergoing ureteroscopy and identify gaps within current patient education practices in order to better tailor the preoperative experience. METHODS Eighteen patients were retrospectively recruited to complete an in-depth semistructured interview and the Test of Functional Health Literacy for Adults (TOFHLA). All interviews were recorded, transcribed, and then coded and analyzed using the grounded theory of analysis. RESULTS The average participant age was 56.2 ± 12.8years, and 10 (55.6%) identified as female. Education level ranged from some high school to a professional degree. The average TOFHLA score was 88.1 ± 11.7. Irrespective of score, all participants felt they understood the purpose and basic elements of a ureteroscopy. The use of nontechnical language, repetition, and previous healthcare experiences were identified as positive aspects of the education experience. However, 72.2% (n = 13) identified the primary gap in understanding revolved around the use, purpose, and pain associated with stents. CONCLUSION Functional health literacy is an essential element, but not the only factor informing patient education and comprehension. Current practices are effective in explaining the basics of a ureteroscopy, but even when identified health literacy is higher than expected, a gap remains in stent education. Efforts should be made to better understand how stents can be effectively explained to patients in addition to continuing to refine education practices to elicit true comprehension.
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Affiliation(s)
| | | | | | - Jason R Bylund
- University of Kentucky, Department of Urology, Lexington, KY
| | - John Roger Bell
- University of Kentucky, Department of Urology, Lexington, KY
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Juliebø-Jones P, Emiliani E, Sierra A, Esperto F, Ventimiglia E, Pietropaolo A, Tzelves L, Beisland C, Somani BK. Patient Perspectives on Kidney Stone Surgery: A Content Analysis of Instagram Posts by Patients Versus Surgeons. EUR UROL SUPPL 2023; 58:82-86. [PMID: 38152483 PMCID: PMC10751542 DOI: 10.1016/j.euros.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/29/2023] Open
Abstract
Background Both clinicians and patients use social media to post about health care issues such as kidney stone disease, but their perspectives may differ. Objective To evaluate content and themes regarding kidney stone surgery shared by patients and urologists on Instagram. Design setting and participants A search was performed on Instagram using the term "kidney stone surgery". The first 100 posts from individuals who were clearly identified as a patient were assessed. We also assessed 100 posts from self-identified urologists. Outcome measurements and statistical analysis A previously published system was applied as a framework for categorizing the information collected. Outcomes of interested included pain, recovery, and costs. Results and limitations Some 71% of the patients were female and most of their posts (52%) were shared postoperatively. The most common themes covered in patient posts were the need for multiple operative sessions (45%), pain (43%), and recovery (42%). Other themes included activities of daily life (18%), return to work (11%), nervousness (16%), stent issues (31%), stent on a string (5%), diet and prevention (9%), gratitude for health care services (10%), disease recurrence (18%), and costs (10%). Some 94% of the urologists were male and their posts covered the following domains: recovery (11%), stent issues (3%), pain (1%), stent on a string (1%), gratitude for health care services (1%), and recurrence 1%. Among the posts from urologists, 79% included self-promotion and 52% covered new technology. Overall, 10% contained false information. The majority of the posts with surgical images had no clear statement regarding patient consent (97%). Conclusions Kidney stone surgery can affect many areas of a patient's quality of life. Most of the posts shared by patients were negative. Posts shared by urologists do not reflect the same themes. Moreover, there appears to be poor adherence to European Association of Urology recommendations regarding online professional conduct. Patient summary Many patients use social media to share their experiences of kidney stone surgery. Posts are largely related to quality-of-life issues and are mostly negative. While urologists also use social media, the content they post on professional accounts is mostly focused on new technology and career promotion.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- European Association of Urology Young Academic Urologists Urolithiasis Group, Arnhem, The Netherlands
| | - Esteban Emiliani
- European Association of Urology Young Academic Urologists Urolithiasis Group, Arnhem, The Netherlands
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Alba Sierra
- European Association of Urology Young Academic Urologists Urolithiasis Group, Arnhem, The Netherlands
- Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francesco Esperto
- European Association of Urology Young Academic Urologists Urolithiasis Group, Arnhem, The Netherlands
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Eugenio Ventimiglia
- European Association of Urology Young Academic Urologists Urolithiasis Group, Arnhem, The Netherlands
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Amelia Pietropaolo
- European Association of Urology Young Academic Urologists Urolithiasis Group, Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton, Southampton, UK
| | - Lazaros Tzelves
- European Association of Urology Young Academic Urologists Urolithiasis Group, Arnhem, The Netherlands
- Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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Dombeck C, Scales CD, McKenna K, Swezey T, Harper JD, Antonelli JA, Desai AC, Lai HH, McCune R, Curatolo M, Al-Khalidi HR, Maalouf NM, Reese PP, Wessells H, Kirkali Z, Corneli A. Patients' Experiences With the Removal of a Ureteral Stent: Insights From In-depth Interviews With Participants in the USDRN STENTS Qualitative Cohort Study. Urology 2023; 178:26-36. [PMID: 37149059 PMCID: PMC10530092 DOI: 10.1016/j.urology.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/04/2023] [Accepted: 04/18/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To describe the experiences of patients undergoing stent removal in the USDRN Study to Enhance Understanding of Stent-Associated Symptoms (STENTS), a prospective, observational cohort study of patients with short-term ureteral stent placement post-ureteroscopy. METHODS We conducted a qualitative descriptive study using in-depth interviews. Participants reflected on (1) painful or bothersome aspects of stent removal, (2) symptoms immediately after removal, and (3) symptoms in the days following removal. Interviews were audio-recorded, transcribed, and analyzed using applied thematic analysis. RESULTS The 38 participants interviewed were aged 13-77 years, 55% female, and 95% White. Interviews were conducted 7-30 days after stent removal. Almost all participants (n = 31) described that they experienced either pain or discomfort during stent removal, but for most (n = 25) pain was of short duration. Many participants (n = 21) described anticipatory anxiety related to the procedure, and several (n = 11) discussed discomfort arising from lack of privacy or feeling exposed. Interactions with medical providers often helped put participants at ease, but also increased discomfort for some. Following stent removal, several participants described lingering pain and/or urinary symptoms, but these largely resolved within 24 hours. A few participants described symptoms persisting for more than a day post stent removal. CONCLUSION These findings on patients' experiences during and shortly after ureteral stent removal, particularly the psychological distress they experienced, identify opportunities for improvement in patient care. Clear communication from providers about what to expect with the removal procedure, and the possibility of delayed pain, may help patients adapt to discomfort.
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Affiliation(s)
- Carrie Dombeck
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Charles D Scales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Surgery (Urology), Duke Surgical Center for Outcomes Research & Equity in Surgery, Duke University School of Medicine, Durham, NC.
| | - Kevin McKenna
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Teresa Swezey
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | | | - Jodi A Antonelli
- Department of Surgery (Urology), Duke Surgical Center for Outcomes Research & Equity in Surgery, Duke University School of Medicine, Durham, NC
| | - Alana C Desai
- Department of Surgery (Urologic Surgery), Washington University in St. Louis, St. Louis, MO
| | - H Henry Lai
- Department of Surgery (Urologic Surgery), Washington University in St. Louis, St. Louis, MO; Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO
| | | | - Michele Curatolo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Hussein R Al-Khalidi
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Naim M Maalouf
- Department of Internal Medicine and Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX
| | - Peter P Reese
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hunter Wessells
- Department of Urology, University of Washington, Seattle, WA
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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7
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Harper JD, Desai AC, Maalouf NM, Yang H, Antonelli JA, Tasian GE, Lai HH, Reese PP, Curatolo M, Kirkali Z, Al-Khalidi HR, Wessells H, Scales CD. Risk Factors for Increased Stent-associated Symptoms Following Ureteroscopy for Urinary Stones: Results From STENTS. J Urol 2023; 209:971-980. [PMID: 36648152 PMCID: PMC10336697 DOI: 10.1097/ju.0000000000003183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/10/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE The STudy to Enhance uNderstanding of sTent-associated Symptoms sought to identify risk factors for pain and urinary symptoms, as well as how these symptoms interfere with daily activities after ureteroscopy for stone treatment. MATERIALS AND METHODS This prospective observational cohort study enrolled patients aged ≥12 years undergoing ureteroscopy with ureteral stent for stone treatment at 4 clinical centers. Participants reported symptoms at baseline; on postoperative days 1, 3, 5; at stent removal; and day 30 post-stent removal. Outcomes of pain intensity, pain interference, urinary symptoms, and bother were captured with multiple instruments. Multivariable analyses using mixed-effects linear regression models were identified characteristics associated with increased stent-associated symptoms. RESULTS A total of 424 participants were enrolled. Mean age was 49 years (SD 17); 47% were female. Participants experienced a marked increase in stent-associated symptoms on postoperative day 1. While pain intensity decreased ∼50% from postoperative day 1 to postoperative day 5, interference due to pain remained persistently elevated. In multivariable analysis, older age was associated with lower pain intensity (P = .004). Having chronic pain conditions (P < .001), prior severe stent pain (P = .021), and depressive symptoms at baseline (P < .001) were each associated with higher pain intensity. Neither sex, stone location, ureteral access sheath use, nor stent characteristics were drivers of stent-associated symptoms. CONCLUSIONS In this multicenter cohort, interference persisted even as pain intensity decreased. Patient factors (eg, age, depression) rather than surgical factors were associated with symptom intensity. These findings provide a foundation for patient-centered care and highlight potential targets for efforts to mitigate the burden of stent-associated symptoms.
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Affiliation(s)
- Jonathan D Harper
- Department of Urology, University of Washington, Seattle, Washington
| | - Alana C Desai
- Department of Surgery (Urologic Surgery), Washington University in St Louis, St Louis, Missouri
| | - Naim M Maalouf
- Department of Internal Medicine and Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hongqiu Yang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Jodi A Antonelli
- Department of Surgery (Urology), Duke Surgical Center for Outcomes Research & Equity in Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Gregory E Tasian
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - H Henry Lai
- Department of Surgery (Urologic Surgery), Washington University in St Louis, St Louis, Missouri
- Department of Anesthesiology, Washington University in St Louis, St Louis, Missouri
| | - Peter P Reese
- Department of Medicine, Renal Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michele Curatolo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Hussein R Al-Khalidi
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Hunter Wessells
- Department of Urology, University of Washington, Seattle, Washington
| | - Charles D Scales
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Surgery (Urology), Duke Surgical Center for Outcomes Research & Equity in Surgery, Duke University School of Medicine, Durham, North Carolina
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
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