1
|
Karchin JB, Curry D, Friedman ES, Denburg M, Tasian GE. Effects of Medications on the in vitro Growth of Gut Bacteria Associated With Kidney Stones. Kidney Int Rep 2024; 9:1528-1530. [PMID: 38707803 PMCID: PMC11068949 DOI: 10.1016/j.ekir.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 05/07/2024] Open
Affiliation(s)
- Jing Bi Karchin
- Department of Surgery, Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dylan Curry
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elliot S. Friedman
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle Denburg
- Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory E. Tasian
- Department of Surgery, Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
2
|
Shah N, Tasian GE, Ellison JS. Establishing and Sustaining the Kidney Stone Engagement Core: A Model for Patient Engagement in Benign Urologic Disease. J Urol 2024; 211:614-616. [PMID: 38181390 DOI: 10.1097/ju.0000000000003842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Nayan Shah
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gregory E Tasian
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan S Ellison
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
3
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
4
|
Breeggemann MC, Harris PC, Lieske JC, Tasian GE, Wood KD. How We Treat Primary Hyperoxaluria Type 1. Clin J Am Soc Nephrol 2024:01277230-990000000-00365. [PMID: 38494457 DOI: 10.2215/cjn.0000000000000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/12/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Matthew C Breeggemann
- Division of Nephrology, University of California San Francisco, San Francisco, California
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kyle D Wood
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
5
|
Fernandez N, Ellison JS, Wang Z, Huang J, Chu DI, Sturm R, Stec AA, Hsi RS, Wu W, Nelson C, Ching C, Augelli B, Lorenzo M, Bi-Karchin J, Tasian GE. Surgeon, and Institution Characteristics Associated Surgical Preferences in the Pediatric KIDney Stone Care Improvement Network. Urology 2024:S0090-4295(24)00132-8. [PMID: 38458327 DOI: 10.1016/j.urology.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/26/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To reveal barriers and opportunities to implement evidence for the management of pediatric kidney stone disease, we determined surgeon and institutional factors associated with preferences for the type of surgical intervention for kidney and ureteral stones. METHODS We conducted a cross-sectional study of urologists participating in the Pediatric KIDney Stone Care Improvement Network (PKIDS) trial. Questionnaires ascertained strengths of urologists' preferences for types of surgery as well as characteristics of participating urologists and institutions. The outcome was the strength of preferences for ureteroscopy, shockwave lithotripsy, and percutaneous nephrolithotomy for four scenarios for which two alternative procedures are recommended by the AUA guidelines: (1) 2 cm kidney stone, (2) 9 mm proximal ureteral stone, (3) 1.5 cm lower pole kidney stone, (4) 1 cm nonlower pole kidney stone. Principal component analysis was performed to identify unique clusters of factors that explain surgical preferences. RESULTS One hundred forty-eight urologists at 29 sites completed surveys. Stated preferences were highly skewed except for the choice between ureteroscopy and percutaneous nephrolithotomy for a 1.5 cm kidney stone. Shockwave lithotripsy ownership and local practice patterns most frequently associated with the strength of surgeons' preferences for the type of surgery. Principal component analysis revealed that three clusters of stone, patient, and heterogenous characteristics explained 30% of the variance in preferences. CONCLUSION There is wide variation in the strengths of preferences for surgical interventions supported by current guidelines that are partially explained by surgeon and institutional characteristics. These results reveal opportunities to develop strategies for guidelines that consider real-world drivers of care.
Collapse
Affiliation(s)
- Nicolas Fernandez
- Department of Surgery, Division of Urology, Seattle Children's Hospital, Seattle, WA
| | | | - Zi Wang
- Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jing Huang
- Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - David I Chu
- Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Urology. Chicago, IL
| | - Renea Sturm
- Mattel Children's Hospital, Department of Urology, University of California, Los Angeles, CA
| | - Andrew A Stec
- Division of Urology, Nemours Children's Health, Jacksonville, FL
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Wayland Wu
- Division Pediatric Urology, Cohen Children's Medical Center of New York, Zucker School of Medicine at Hofstra/Northwell, Long Island, NY
| | - Caleb Nelson
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Christina Ching
- Kidney and Urinary Tract Center, Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH
| | - Brian Augelli
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Matt Lorenzo
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jing Bi-Karchin
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Gregory E Tasian
- Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA.
| |
Collapse
|
6
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
7
|
Tasian GE, Dickinson K, Park G, Marchesani N, Mittal A, Cheng N, Ching CB, Chu DI, Walton R, Yonekawa K, Gluck C, Muneeruddin S, Kan KM, DeFoor W, Rove K, Forrest CB. Distinguishing characteristics of pediatric patients with primary hyperoxaluria type 1 in PEDSnet. J Pediatr Urol 2024; 20:88.e1-88.e9. [PMID: 37848358 DOI: 10.1016/j.jpurol.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/04/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Primary hyperoxaluria type 1 (PH1) is an autosomal recessive inborn error of metabolism that causes oxalate deposition, leading to recurrent calcium oxalate kidney stones, chronic kidney disease and systemic oxalosis, which produces a broad range of serious life-threatening complications. Patients with PH1 have delayed diagnosis due to the rarity of the disease and the overlap with early-onset kidney stone disease not due to primary hyperoxaluria. OBJECTIVE The objective of this study was to determine the clinical features of individuals <21 years of age with PH1 that precede its diagnosis. We hypothesized that a parsimonious set of features could be identified that differentiate patients with PH1 from patients with non-primary hyperoxaluria-associated causes of early-onset kidney stone disease. STUDY DESIGN We determined the association between clinical characteristics and PH1 diagnosis in a case-control study conducted between 2009 and 2021 in PEDSnet, a clinical research network of eight US pediatric health systems. Each patient with genetically confirmed PH1 was matched by sex and PEDSnet institution to up to 4 control patients with kidney stones without PH of any type. We obtained patient characteristics and diagnostic test results occurring before to less than 6 months after study entrance from a centralized database query and from manual chart review. Differences were examined using standardized differences and multivariable regression. RESULTS The study sample included 37 patients with PH1 and 147 controls. Patients with PH1 were younger at diagnosis (median age of 3 vs 13.5 years); 75 % of children with PH1 were less than 8 years-old. Patients with PH1 were more likely to have combinations of nephrocalcinosis on ultrasound or CT (43 % vs 3 %), lower eGFR at diagnosis (median = 52 mL/min/1.73 m2 vs 114 mL/min/1.73 m2), and have normal mobility. Patients with PH1 had higher proportion of calcium oxalate monohydrate kidney stones than controls (median = 100 % vs 10 %). There were no differences in diagnosis of failure to thrive, stone size, or echocardiography results. CONCLUSIONS Children with PH1 are characterized by presentation before adolescence, nephrocalcinosis, decreased eGFR at diagnosis, and calcium oxalate monohydrate stone composition. If externally validated, these characteristics could facilitate earlier diagnosis and treatment of children with PH1.
Collapse
Affiliation(s)
- Gregory E Tasian
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Kimberley Dickinson
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Grace Park
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicole Marchesani
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Christina B Ching
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | - David I Chu
- Department of Surgery, Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Ryan Walton
- Department of Surgery, Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Karyn Yonekawa
- Department of Pediatrics, Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - Caroline Gluck
- Department of Pediatrics, Division of Nephrology, Nemours Children's Health, Wilmington, DE, USA
| | - Samina Muneeruddin
- Department of Pediatrics, Division of Nephrology, Nemours Children's Health, Wilmington, DE, USA
| | - Kathleen M Kan
- Department of Surgery, Division of Urology, Stanford University, Palo Alto, CA, USA
| | - William DeFoor
- Department of Surgery, Division of Urology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
| | - Kyle Rove
- Department of Pediatric Urology, Division of Urology, Children's Hospital Colorado, Aurora, CO, USA
| | - Christopher B Forrest
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
8
|
Khondker A, Kwong JCC, Rickard M, Erdman L, Kim JK, Ahmad I, Weaver J, Fernandez N, Tasian GE, Kulkarni GS, Lorenzo AJ. Application of STREAM-URO and APPRAISE-AI reporting standards for artificial intelligence studies in pediatric urology: A case example with pediatric hydronephrosis. J Pediatr Urol 2024:S1477-5131(24)00050-0. [PMID: 38331659 DOI: 10.1016/j.jpurol.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/20/2023] [Accepted: 01/20/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Artificial intelligence (AI) and machine learning (ML) in pediatric urology is gaining increased popularity and credibility. However, the literature lacks standardization in reporting and there are areas for methodological improvement, which incurs difficulty in comparison between studies and may ultimately hurt clinical implementation of these models. The "STandardized REporting of Applications of Machine learning in UROlogy" (STREAM-URO) framework provides methodological instructions to improve transparent reporting in urology and APPRAISE-AI in a critical appraisal tool which provides quantitative measures for the quality of AI studies. The adoption of these will allow urologists and developers to ensure consistency in reporting, improve comparison, develop better models, and hopefully inspire clinical translation. METHODS In this article, we have applied STREAM-URO framework and APPRAISE-AI tool to the pediatric hydronephrosis literature. By doing this, we aim to describe best practices on ML reporting in urology with STREAM-URO and provide readers with a critical appraisal tool for ML quality with APPRAISE-AI. By applying these to the pediatric hydronephrosis literature, we provide some tutorial for other readers to employ these in developing and appraising ML models. We also present itemized recommendations for adequate reporting, and critically appraise the quality of ML in pediatric hydronephrosis insofar. We provide examples of strong reporting and highlight areas for improvement. RESULTS There were 8 ML models applied to pediatric hydronephrosis. The 26-item STREAM-URO framework is provided in Appendix A and 24-item APPRAISE-AI tool is provided in Appendix B. Across the 8 studies, the median compliance with STREAM-URO was 67 % and overall study quality was moderate. The highest scoring APPRAISE-AI domains in pediatric hydronephrosis were clinical relevance and reporting quality, while the worst were methodological conduct, robustness of results, and reproducibility. CONCLUSIONS If properly conducted and reported, ML has the potential to impact the care we provide to patients in pediatric urology. While AI is exciting, the paucity of strong evidence limits our ability to translate models to practice. The first step toward this goal is adequate reporting and ensuring high quality models, and STREAM-URO and APPRAISE-AI can facilitate better reporting and critical appraisal, respectively.
Collapse
Affiliation(s)
- Adree Khondker
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Temerty Center for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada
| | - Jethro C C Kwong
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Temerty Center for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada
| | - Mandy Rickard
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lauren Erdman
- Temerty Center for AI Research and Education in Medicine, University of Toronto, Toronto, ON, Canada; Center for Computational Medicine, Hospital for Sick Children, Toronto, ON, Canada; Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Jin K Kim
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ihtisham Ahmad
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - John Weaver
- Division of Urology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Nicolas Fernandez
- Division of Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Gregory E Tasian
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
9
|
Dangle P, Tasian GE, Chu DI, Shannon R, Spiardi R, Xiang AH, Jadcherla A, Arenas J, Ellison JS. A Systematic Scoping Review of Comparative Effectiveness Studies in Kidney Stone Disease. Urology 2024; 183:3-10. [PMID: 37806455 PMCID: PMC10841623 DOI: 10.1016/j.urology.2023.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/10/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To review the status of comparative effectiveness studies for kidney stone disease with focus on study outcome, type, population, time trends, and patient-centered approaches. METHODS A systematic scoping review was performed for articles published between January 1, 2005, and March 30, 2021, using keywords relevant to kidney stone disease. Studies published in English that compared two or more alternative methods for prevention, diagnosis, treatment, monitoring, or care delivery were included. Two reviewers independently reviewed abstracts and an arbitrator resolved discrepancies. Nine reviewers abstracted information from full-length studies. Descriptive statistics were summarized, and linear regression was performed to evaluate temporal trends of study characteristics. RESULTS We reviewed 1773 abstracts and 707 full-length manuscripts focused on surgical intervention (440); medical expulsive therapy (MET) (152); analgesic control (80); and homeopathic, diagnostics, and/or prophylaxis (84). Randomized controlled trials were common across all outcome categories, including surgery (41.6%), MET (60.2%), analgesic control (81.3%), homeopathic (41.2%), diagnostic (47.6%), and prophylaxis (49.1%). Patient-reported outcomes were utilized in 71.7% and 95% of MET and analgesic control studies, respectively, but in the minority of all other study themes. Over time, meta-analyses and multicenter studies increased [P < .001]. CONCLUSION Surgical and MET themes dominate published comparative literature in kidney stone disease. There is substantial variation in use of patient-reported outcomes across surgical themes. Multicentered studies and those generating higher level evidence have increased over time but opportunities exist to improve collaborative, high-quality, and patient-centered research in kidney stone disease.
Collapse
Affiliation(s)
- Pankaj Dangle
- Division of Pediatric Urology, Riley Hopsital for Children at IU Health, Indianapolis, IN
| | - Gregory E Tasian
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - David I Chu
- Division of Urology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Rachel Shannon
- Division of Urology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ryan Spiardi
- Renal-Electrolyte & Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alice H Xiang
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Aditya Jadcherla
- Division of Pediatric Urology & Department of Urology, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, WI
| | | | - Jonathan S Ellison
- Division of Pediatric Urology & Department of Urology, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, WI.
| |
Collapse
|
10
|
Spiardi R, Goldfarb DS, Tasian GE. Role of Climate Change in Urologic Health: Kidney Stone Disease. Eur Urol Focus 2023; 9:866-868. [PMID: 37839975 DOI: 10.1016/j.euf.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
Kidney stones are rising in incidence and prevalence worldwide. Given the temperature dependence of kidney stone presentations, climate change is projected to further increase the burden of disease for individuals and society. PATIENT SUMMARY: This mini-review reports current knowledge on climate change in relation to kidney stone disease. Kidney stones are more common in patients living in parts of the world that are hotter and more humid. Kidney stone problems are also more common after periods of high heat, which have a greater impact on men than on women. As temperatures rise with climate change, it is likely that the occurrence of kidney stones and the costs associated with their diagnosis and treatment will increase as well.
Collapse
Affiliation(s)
- Ryan Spiardi
- Renal-Electrolyte and Hypertension Division, Penn Presbyterian Medical Center, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Goldfarb
- Nephrology Division, NYU Langone Health and NYU Grossman School of Medicine, New York, NY, USA; Nephrology Section, NY Harbor VA Healthcare System, New York, NY, USA
| | - Gregory E Tasian
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| |
Collapse
|
11
|
Weaver JK, Logan J, Broms R, Antony M, Rickard M, Erdman L, Edwins R, Pominville R, Hannick J, Woo L, Viteri B, D'Souza N, Viswanath SE, Flask C, Lorenzo A, Fan Y, Tasian GE. Deep learning of renal scans in children with antenatal hydronephrosis. J Pediatr Urol 2023; 19:514.e1-514.e7. [PMID: 36775719 DOI: 10.1016/j.jpurol.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Antenatal hydronephrosis (ANH) is one of the most common anomalies identified on prenatal ultrasound, found in up to 4.5% of all pregnancies. Children with ANH are surveilled with repeated renal ultrasound and when there is high suspicion for a ureteropelvic junction obstruction on renal ultrasound, a mercaptuacetyltriglycerine (MAG3) Lasix renal scan is performed to evaluate for obstruction. However, the challenging interpretation of MAG3 renal scans places patients at risk of misdiagnosis. OBJECTIVE Our objective was to analyze MAG3 renal scans using machine learning to predict renal complications. We hypothesized that our deep learning model would extract features from MAG3 renal scans that can predict renal complications in children with ANH. STUDY DESIGN We performed a case-control study of MAG3 studies drawn from a population of children with ANH concerning for ureteropelvic junction obstruction evaluated at our institution from January 2009 until June of 2021. The outcome was renal complications that occur ≥6 months after an equivocal MAG-3 renal scan. We created two machine learning models: a deep learning model using the radiotracer concentration versus time data from the kidney of interest and a random forest model created using clinical data. The performance of the models was assessed using measures of diagnostic accuracy. RESULTS We identified 152 eligible patients with available images of which 62 were cases and 90 were controls. The deep learning model predicted future renal complications with an overall accuracy of 73% (95% confidence inteveral [CI] 68-76%) and an AUC of 0.78 (95% CI 0.7, 0.84). The random forest model had an accuracy of 62% (95% CI 60-66%) and an AUC of 0.67 (95% CI. 0 64, 0.72) DISCUSSION: Our deep learning model predicted patients at high risk of developing renal complications following an equivocal renal scan and discriminate those at low risk with moderately high accuracy (73%). The deep learning model outperformed the clinical model built from clinical features classically used by urologists for surgical decision making. CONCLUSION Our models have the potential to influence clinical decision making by providing supplemental analytical data from MAG3 scans that would not otherwise be available to urologists. Future multi-institutional retrospective and prospective trials are needed to validate our model.
Collapse
Affiliation(s)
- J K Weaver
- Division of Urology Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - J Logan
- Division of Urology, Children's Hospital of Philadelphia, PA, USA; Department of Biostatistics, Epidemiology and Informatics and Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - R Broms
- Division of Urology, Children's Hospital of Philadelphia, PA, USA
| | - M Antony
- Division of Urology, Children's Hospital of Philadelphia, PA, USA
| | - M Rickard
- Division of Urology for Sick Children, Toronto, ON, Canada
| | - L Erdman
- Division of Urology for Sick Children, Toronto, ON, Canada
| | - R Edwins
- Division of Urology Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - R Pominville
- Division of Urology Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - J Hannick
- Division of Urology Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - L Woo
- Division of Urology Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - B Viteri
- Division of Nephrology, Children's Hospital of Philadelphia, PA, USA
| | - N D'Souza
- Division of Urology, Children's Hospital of Philadelphia, PA, USA
| | - S E Viswanath
- Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - C Flask
- Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - A Lorenzo
- Division of Urology for Sick Children, Toronto, ON, Canada
| | - Y Fan
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - G E Tasian
- Division of Urology, Children's Hospital of Philadelphia, PA, USA; Department of Biostatistics, Epidemiology and Informatics and Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
12
|
Ostrowski DA, Logan JR, Antony M, Broms R, Weiss DA, Van Batavia J, Long CJ, Smith AL, Zderic SA, Edwins RC, Pominville RJ, Hannick JH, Woo LL, Fan Y, Tasian GE, Weaver JK. Automated Society of Fetal Urology (SFU) grading of hydronephrosis on ultrasound imaging using a convolutional neural network. J Pediatr Urol 2023; 19:566.e1-566.e8. [PMID: 37286464 DOI: 10.1016/j.jpurol.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/14/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Grading of hydronephrosis severity on postnatal renal ultrasound guides management decisions in antenatal hydronephrosis (ANH). Multiple systems exist to help standardize hydronephrosis grading, yet poor inter-observer reliability persists. Machine learning methods may provide tools to improve the efficiency and accuracy of hydronephrosis grading. OBJECTIVE To develop an automated convolutional neural network (CNN) model to classify hydronephrosis on renal ultrasound imaging according to the Society of Fetal Urology (SFU) system as potential clinical adjunct. STUDY DESIGN A cross-sectional, single-institution cohort of postnatal renal ultrasounds with radiologist SFU grading from pediatric patients with and without hydronephrosis of stable severity was obtained. Imaging labels were used to automatedly select sagittal and transverse grey-scale renal images from all available studies from each patient. A VGG16 pre-trained ImageNet CNN model analyzed these preprocessed images. Three-fold stratified cross-validation was used to build and evaluate the model that was used to classify renal ultrasounds on a per patient basis into five classes based on the SFU system (normal, SFU I, SFU II, SFU III, or SFU IV). These predictions were compared to radiologist grading. Confusion matrices evaluated model performance. Gradient class activation mapping demonstrated imaging features driving model predictions. RESULTS We identified 710 patients with 4659 postnatal renal ultrasound series. Per radiologist grading, 183 were normal, 157 were SFU I, 132 were SFU II, 100 were SFU III, and 138 were SFU IV. The machine learning model predicted hydronephrosis grade with 82.0% (95% CI: 75-83%) overall accuracy and classified 97.6% (95% CI: 95-98%) of the patients correctly or within one grade of the radiologist grade. The model classified 92.3% (95% CI: 86-95%) normal, 73.2% (95% CI: 69-76%) SFU I, 73.5% (95% CI: 67-75%) SFU II, 79.0% (95% CI: 73-82%) SFU III, and 88.4% (95% CI: 85-92%) SFU IV patients accurately. Gradient class activation mapping demonstrated that the ultrasound appearance of the renal collecting system drove the model's predictions. DISCUSSION The CNN-based model classified hydronephrosis on renal ultrasounds automatically and accurately based on the expected imaging features in the SFU system. Compared to prior studies, the model functioned more automatically with greater accuracy. Limitations include the retrospective, relatively small cohort, and averaging across multiple imaging studies per patient. CONCLUSIONS An automated CNN-based system classified hydronephrosis on renal ultrasounds according to the SFU system with promising accuracy based on appropriate imaging features. These findings suggest a possible adjunctive role for machine learning systems in the grading of ANH.
Collapse
Affiliation(s)
- David A Ostrowski
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Joseph R Logan
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Translational Research Informatics Group, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maria Antony
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Reilly Broms
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dana A Weiss
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jason Van Batavia
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher J Long
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Stephen A Zderic
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca C Edwins
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Raymond J Pominville
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jessica H Hannick
- Division of Pediatric Urology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Lynn L Woo
- Division of Pediatric Urology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Yong Fan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John K Weaver
- Division of Pediatric Urology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
| |
Collapse
|
13
|
Ching CB, Dickinson K, Karafilidis J, Marchesani N, Mucha L, Antunes N, Razzaghi H, Utidjian L, Yonekawa K, Coplen DE, Muneeruddin S, DeFoor W, Rove KO, Forrest CB, Tasian GE. The real world experience of pediatric primary hyperoxaluria patients in the PEDSnet clinical research network. Eur J Pediatr 2023; 182:4027-4036. [PMID: 37392234 DOI: 10.1007/s00431-023-05077-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/14/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
The rarity of primary hyperoxaluria (PH) challenges our understanding of the disease. The purpose of our study was to describe the course of clinical care in a United States cohort of PH pediatric patients, highlighting health service utilization. We performed a retrospective cohort study of PH patients < 18 years old in the PEDSnet clinical research network from 2009 to 2021. Outcomes queried included diagnostic imaging and testing related to known organ involvement of PH, surgical and medical interventions specific to PH-related renal disease, and select PH-related hospital service utilization. Outcomes were evaluated relative to cohort entrance date (CED), defined as date of first PH-related diagnostic code. Thirty-three patients were identified: 23 with PH type 1; 4 with PH type 2; 6 with PH type 3. Median age at CED was 5.0 years (IQR 1.4, 9.3 years) with the majority being non-Hispanic white (73%) males (70%). Median follow-up between CED and most recent encounter was 5.1 years (IQR 1.2, 6.8). Nephrology and Urology were the most common specialties involved in care, with low utilization of other sub-specialties (12%-36%). Most patients (82%) had diagnostic imaging used to evaluate kidney stones; 11 (33%) had studies of extra-renal involvement. Stone surgery was performed in 15 (46%) patients. Four patients (12%) required dialysis, begun in all prior to CED; four patients required renal or renal/liver transplant. Conclusion: In this large cohort of U.S. PH children, patients required heavy health care utilization with room for improvement in involving multi-disciplinary specialists. What is Known: • Primary hyperoxaluria (PH) is rare with significant implications on patient health. Typical involvement includes the kidneys; however, extra-renal manifestations occur. • Most large population studies describe clinical manifestations and involve registries. What is New: • We report the clinical journey, particularly related to diagnostic studies, interventions, multispecialty involvement, and hospital utilization, of a large cohort of PH pediatric patients in the PEDSnet clinical research network. • There are missed opportunities, particularly in that of specialty care, that could help in the diagnosis, treatment, and even prevention of known clinical manifestations.
Collapse
Affiliation(s)
- Christina B Ching
- Department of Pediatric Urology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Kimberley Dickinson
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Nicole Marchesani
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa Mucha
- Dicerna Pharmaceuticals, Cambridge, MA, USA
| | | | - Hanieh Razzaghi
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Levon Utidjian
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Karyn Yonekawa
- Department of Pediatrics, Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - Douglas E Coplen
- Department of Surgery, Division of Urology, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Samina Muneeruddin
- Department of Pediatrics, Division of Nephrology, AI DuPont Children's Hospital, Wilmington, DE, USA
| | - William DeFoor
- Department of Surgery, Division of Urology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
| | - Kyle O Rove
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA
| | - Christopher B Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Healthcare Management, Perelman School of Medicineat the , University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory E Tasian
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
14
|
Carmen Tong CM, Ellison JS, Tasian GE. Pediatric Stone Disease: Current Trends and Future Directions. Urol Clin North Am 2023; 50:465-475. [PMID: 37385708 DOI: 10.1016/j.ucl.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Pediatric nephrolithiasis is less common in children than in adults but the incidence has been rising rapidly, and it is now a public health and economic burden in the United States. There are challenges unique to children that should be taken into consideration when evaluating and managing pediatric stone disease. In this review, we present the current research on risk factors, emerging new technologies for treatment of stones and recent investigations on prevention of stones in this population.
Collapse
Affiliation(s)
- Ching Man Carmen Tong
- Department of Pediatric Urology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 318, Birmingham, AL 35233, USA.
| | - Jonathan S Ellison
- Department of Urology, Medical College of Wisconsin, Children's Hospital of Wisconsin and Medical College of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| |
Collapse
|
15
|
Khondker A, Chan JY, Malik S, Kim JK, Chua ME, Henderson B, Yadav P, Santos JD, Brownrigg N, Viteri B, Tasian GE, Rickard M, Lorenzo AJ. Primary ablation versus urinary diversion in posterior urethral valve: Systematic review and meta-analysis. J Pediatr Urol 2023; 19:408-417. [PMID: 36906479 PMCID: PMC10824267 DOI: 10.1016/j.jpurol.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE To determine differences in long-term kidney and bladder outcomes in boys with posterior urethral valves (PUV) managed by a primary valve ablation or primary urinary diversion. MATERIALS AND METHODS A systematic search was performed in March 2021. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed measures included kidney outcomes (chronic kidney disease, end-stage renal disease, kidney function) and bladder outcomes. Odds ratios (OR) and mean difference (MD) with 95% confidence interval (CI) were extrapolated from available data for quantitative synthesis. Random-effects meta-analysis and meta-regression were performed according to study design, and potential covariates were assessed with subgroup analysis. The systematic review was prospectively registered on PROSPERO (CRD42021243967). RESULTS Thirty unique studies describing 1547 boys with PUV were included in this synthesis. Overall effect estimates demonstrate that patients undergoing primary diversion have significantly increased odds of developing renal insufficiency [OR 0.60, 95% CI 0.44, 0.80; p < 0.001]. However, when adjusting for baseline kidney function between intervention groups, there was no significant difference in long term kidney outcomes [p = 0.09, 0.35], or the development of bladder dysfunction or requiring clean-intermittent catheterization with primary ablation rather than diversion [OR 0.89, 95% CI 0.49, 1.59; p = 0.68]. CONCLUSIONS Current low-quality evidence suggests that medium-term kidney outcomes in children are similar between primary ablation and primary diversion after adjusting for baseline kidney function, while bladder outcomes are highly heterogenous. Further research with covariate control is warranted to investigate sources of heterogeneity. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Adree Khondker
- Division of Urology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Justin Yh Chan
- Division of Urology, Department of Surgery, University of Toronto, ON, Canada
| | - Shamir Malik
- Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Jin K Kim
- Division of Urology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, ON, Canada
| | - Michael E Chua
- Division of Urology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada
| | - Brittney Henderson
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Priyank Yadav
- Division of Urology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada
| | - Natasha Brownrigg
- Division of Urology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada
| | - Bernarda Viteri
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada.
| |
Collapse
|
16
|
Corneli A, Dombeck C, McKenna K, Harper JD, Antonelli JA, Desai AC, Lai HH, Tasian GE, Ziemba J, McCune R, Piskator B, Al-Khalidi HR, Maalouf NM, Reese PP, Wessells H, Kirkali Z, Scales CD. The Patient Voice: Stent Experiences After Ureteroscopy-Insights from In-Depth Interviews with Participants in the USDRN STENTS Nested Qualitative Cohort Study. J Endourol 2023; 37:642-653. [PMID: 37021358 PMCID: PMC10280172 DOI: 10.1089/end.2022.0810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Purpose: Ureteral stents are commonly used after ureteroscopy and cause significant discomfort, yet qualitative perspectives on patients' stent experiences remain unknown. We describe psychological, functional, and interpersonal effects of post-ureteroscopy stents and whether additional patient-reported assessments may be needed. Materials and Methods: Using a qualitative descriptive study design, we conducted in-depth interviews with a nested cohort of participants in the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS). Participants shared their symptoms with a post-ureteroscopy stent and described symptom bother and impact on daily activities. All interviews were audio-recorded, transcribed, and analyzed using applied thematic analysis. During analysis, participants' experiences with interference in daily activities were categorized into three groups based on their impact: minimal, moderate, and substantial. Results: All 39 participants experienced pain, although descriptions varied and differentiated between feelings of pain vs discomfort. Almost all experienced urinary symptoms. Only a few reported other physical symptoms, although several psychological aspects were identified. In the areas of sleep, mood, life enjoyment, work, exercise, activities of daily living, driving, childcare, and leisure/social activities, the stent had little impact on daily living among participants placed in the minimal group (n = 12) and far greater impact for participants in the substantial group (n = 8). For patients in the moderate group (n = 19), some daily activities were moderately or substantially affected, whereas other activities were minimally affected. Conclusions: Counseling to better prepare patients for the impact of stent-associated symptoms may help mitigate symptom burden. While existing instruments adequately cover most symptoms, additional assessments for other domains, particularly psychological factors, may be needed.
Collapse
Affiliation(s)
- Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Carrie Dombeck
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin McKenna
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jonathan D. Harper
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Jodi A. Antonelli
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alana C. Desai
- Department of Surgery (Urologic Surgery) and Washington University in St. Louis, St. Louis, Missouri, USA
| | - H. Henry Lai
- Department of Surgery (Urologic Surgery) and Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Gregory E. Tasian
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Justin Ziemba
- Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca McCune
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brooke Piskator
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hussein R. Al-Khalidi
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - 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, USA
| | - Peter P. Reese
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hunter Wessells
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Charles D. Scales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Surgery (Urology), Duke Surgical Center for Outcomes Research and Equity in Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
17
|
Tasian GE, Maltenfort MG, Rove K, Ching CB, Ramachandra P, DeFoor B, Fernandez N, Forrest CB, Ellison JS. Ureteral Stent Placement Prior to Definitive Stone Treatment Is Associated With Higher Postoperative Emergency Department Visits and Opioid Prescriptions for Youth Having Ureteroscopy or Shock Wave Lithotripsy. J Urol 2023; 209:1194-1201. [PMID: 36812398 DOI: 10.1097/ju.0000000000003389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Little is known about the impact of ureteral stents on youth having stone surgery. We evaluated the association of ureteral stent placement before or concurrent with ureteroscopy and shock wave lithotripsy with emergency department visits and opioid prescriptions among pediatric patients. MATERIALS AND METHODS We conducted a retrospective cohort study of individuals aged 0-24 years who underwent ureteroscopy or shock wave lithotripsy from 2009-2021 at 6 hospitals in PEDSnet, a research network that aggregates electronic health record data from children's health systems in the United States. The exposure, primary ureteral stent placement, was defined as a stent placed concurrent with or within 60 days before ureteroscopy or shock wave lithotripsy. Associations between primary stent placement and stone-related ED visits and opioid prescriptions within 120 days of the index procedure were evaluated with mixed-effects Poisson regression. RESULTS Two-thousand ninety-three patients (60% female; median age 15 years, IQR 11-17) had 2,477 surgical episodes; 2,144 were ureteroscopy and 333 were shock wave lithotripsy. Primary stents were placed in 1,698 (79%) ureteroscopy episodes and 33 (10%) shock wave lithotripsy episodes. Ureteral stents were associated with a 33% higher rate of emergency department visits (IRR 1.33; 95% CI 1.02-1.73) and a 30% higher rate of opioid prescriptions (IRR 1.30; 95% CI 1.10-1.53). The magnitudes of both associations were greater for shock wave lithotripsy. Results were similar for age <18 and were lost when restricted to concurrent stent placement. CONCLUSIONS Primary ureteral stent placement was associated with more frequent emergency department visits and opioid prescriptions, driven by pre-stenting. These results support elucidating situations where stents are not necessary for youth with nephrolithiasis.
Collapse
Affiliation(s)
- Gregory E Tasian
- Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mitchell G Maltenfort
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kyle Rove
- Department of Surgery, Division of Urology, Children's Hospital Colorado, Aurora, Colorado
| | - Christina B Ching
- Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio
| | - Puneeta Ramachandra
- Department of Surgery, Division of Urology, Nemours Children's Health, Wilmington, Delaware
| | - Bob DeFoor
- Department of Surgery, Division of Urology, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio
| | - Nicolas Fernandez
- Department of Surgery, Division of Urology, Seattle Children's Hospital, Seattle, Washington
| | - Christopher B Forrest
- Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan S Ellison
- Department of Urology, Children's Wisconsin & Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
18
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
19
|
Weaver JK, Martin-Olenski M, Logan J, Broms R, Antony M, Van Batavia J, Weiss DA, Long CJ, Smith AL, Zderic SA, Huang J, Fan Y, Tasian GE. Deep Learning of Videourodynamics to Classify Bladder Dysfunction Severity in Patients With Spina Bifida. J Urol 2023; 209:994-1003. [PMID: 36787376 DOI: 10.1097/ju.0000000000003267] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE Urologists rely heavily on videourodynamics to identify patients with neurogenic bladders who are at risk of upper tract injury, but their interpretation has high interobserver variability. Our objective was to develop deep learning models of videourodynamics studies to categorize severity of bladder dysfunction. MATERIALS AND METHODS We performed a cross-sectional study of patients aged 2 months to 28 years with spina bifida who underwent videourodynamics at a single institution between 2019 and 2021. The outcome was degree of bladder dysfunction, defined as none/mild, moderate, and severe, defined by a panel of 5 expert reviewers. Reviewers considered factors that increase the risk of upper tract injury, such as poor compliance, elevated detrusor leak point pressure, and detrusor sphincter dyssynergia, in determining bladder dysfunction severity. We built 4 models to predict severity of bladder dysfunction: (1) a random forest clinical model using prospectively collected clinical data from videourodynamics studies, (2) a deep learning convolutional neural network of raw data from the volume-pressure recordings, (3) a deep learning imaging model of fluoroscopic images, (4) an ensemble model averaging the risk probabilities of the volume-pressure and fluoroscopic models. RESULTS Among 306 videourodynamics studies, the accuracy and weighted kappa of the ensemble model classification of bladder dysfunction when at least 75% expected bladder capacity was reached were 70% (95% CI 66%,76%) and 0.54 (moderate agreement), respectively. The performance of the clinical model built from data extracted by pediatric urologists was the poorest with an accuracy of 61% (55%, 66%) and a weighted kappa of 0.37. CONCLUSIONS Our models built from urodynamic pressure-volume tracings and fluoroscopic images were able to automatically classify bladder dysfunction with moderately high accuracy.
Collapse
Affiliation(s)
- John K Weaver
- Department of Urology, Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Madalyne Martin-Olenski
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph Logan
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Translational Research Informatics Group, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Reiley Broms
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maria Antony
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jason Van Batavia
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dana A Weiss
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher J Long
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ariana L Smith
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen A Zderic
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jing Huang
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Tasian
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
20
|
Weaver JK, Martin-Olenski M, Logan J, Broms R, Antony M, Van Batavia J, Weiss DA, Long CJ, Smith AL, Zderic SA, Huang J, Fan Y, Tasian GE. Reply By Authors. J Urol 2023; 209:1003. [PMID: 37026634 DOI: 10.1097/ju.0000000000003267.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- John K Weaver
- Department of Urology, Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Madalyne Martin-Olenski
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph Logan
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Translational Research Informatics Group, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Reiley Broms
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maria Antony
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jason Van Batavia
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dana A Weiss
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher J Long
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ariana L Smith
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen A Zderic
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jing Huang
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Tasian
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
21
|
Herrera CD, Guerra CE, Narayan V, Guzzo TJ, Mamtani R, Lee DJ, Tasian GE, Talwar R. Financial toxicity in prostate cancer survivors: A national cross-sectional assessment of subjective financial burden. Urol Oncol 2023; 41:105.e1-105.e8. [PMID: 36372635 DOI: 10.1016/j.urolonc.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/06/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND In prostate cancer (CaP) survivorship, subjective financial burden (SFB), an aspect of financial toxicity, has not been studied using a national sample. Our goal was to explore and identify factors associated with patient-reported SFB in CaP survivors. MATERIALS AND METHODS We conducted a retrospective, cross-sectional study of 264 adult individuals with a history of CaP that completed the AHRQ - Medical Expenditures Panel Survey - Household Component and Cancer Self-Administered Questionnaire Supplement in 2016 or 2017. Primary outcomes were the presence of cancer-related SFB and the severity of this burden. Multivariable ordinal logistic regression and logistic regression models were used to identify factors associated with the severity of SFB and different domains of burden. RESULTS Most participants were non-Hispanic white, had 3 or more comorbidities and had a median age of 72 years. 62.1% of survivors indicated SFB associated with their CaP care and long-term effects. 49.2% of CaP survivors indicated coping SFB, 27.7% psychological, and 29.2% material. Older (OR: 0.95, 95%CI 0.92-0.98) was associated with less SFB. Low-income level (OR: 2.1, 95%CI 1.01-4.36) was associated with higher SFB. Hispanic survivors (OR: 2.8 95%CI 1.1-7.4) indicated more psychologic SFB. Presence of a caregiver was noted as a predictor of material (OR 2.6, 95%CI 1.45-4.49) and psychological (OR: 2.2, 95%CI 1.13-3.91) SFB. CONCLUSIONS Many CaP survivors experience SFB and associated factors differ in domain of financial burden. This provides evidence and groundwork for understanding financial burden and improving the quality of counseling and care for this population.
Collapse
Affiliation(s)
- Christopher D Herrera
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Carmen E Guerra
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Vivek Narayan
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ronac Mamtani
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Daniel J Lee
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Ruchika Talwar
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
22
|
Walton RF, Yeh C, Shannon R, Rosoklija I, Rague JT, Johnson EK, Alpern ER, Ellison JS, Routh JC, Tasian GE, Chu DI. Variation in care between pediatric and adult patients presenting with nephrolithiasis to tertiary care pediatric emergency departments in the United States (2009-2020). J Pediatr Urol 2022; 18:742.e1-742.e11. [PMID: 35945144 PMCID: PMC9771899 DOI: 10.1016/j.jpurol.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/06/2022] [Accepted: 07/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Individuals with nephrolithiasis frequently present to the Emergency Department (ED). Safety and quality principles are often applied in pediatric EDs to children presenting with nephrolithiasis, such as limiting ionizing radiation exposure and opioid analgesics. However, it is unknown whether pediatric EDs apply these same principles to adult patients who present with nephrolithiasis. We hypothesized that adult patients would be associated with higher use of radiation-based imaging and opioid analgesics. OBJECTIVE To assess variations in diagnostic and treatment interventions and hospital utilization between pediatric and adult patients presenting to the pediatric ED with nephrolithiasis. STUDY DESIGN A retrospective cohort study was conducted, examining outcomes for pediatric (<18-years-old) versus adult (≥18-years-old) patients in 42 pediatric EDs from 2009 to 2020 using the Pediatric Health Information System (PHIS) database. Patients with an ICD-9/10 principal diagnosis code of nephrolithiasis with no nephrolithiasis-related visits within the prior 6 months were included. Primary outcomes were imaging, medications, and surgical interventions. Secondary outcomes were hospital admissions, 90-day ED revisits, and 90-day readmissions. Generalized linear mixed models with random effects were used to adjust for confounding and clustering. RESULTS In total, 16,117 patients with 17,837 encounters were included. Most hospitals were academic (95.2%), and a plurality were located in the South (38.1%). Most patients were <18-years-old (84.4%, median (interquartile range): 15 (12-17)-years-old), female (57.9%), and White (76.3%), and 17.1% were Hispanic/Latino. Most had no complex chronic conditions (89.2%) and no chronic disease per pediatric medical complexity algorithm (51.5%). For the primary outcome, adults, relative to pediatric patients, who presented to the pediatric ED with nephrolithiasis had higher adjusted odds of receiving computerized tomography (CT) scans (Odds Ratio [OR] 1.43 [95% Confidence Interval [CI] 1.29-1.59]) and opioid analgesics (OR 1.45 [95%CI 1.33-1.58]) (Summary Figure). Secondary outcomes showed that adults, relative to pediatric patients, had lower adjusted odds of hospital admissions, 90-day ED revisits, and 90-day readmissions. DISCUSSION Our results suggest that certain pediatric safety and quality principles, such as limiting ionizing radiation exposure and opioid analgesic prescriptions, are not being equally applied to pediatric and adult patients who present to pediatric EDs with nephrolithiasis. The mechanism of these findings remains to be elucidated. CONCLUSIONS Variations in care for individuals with nephrolithiasis reflect an opportunity for quality improvement in pediatric EDs and inform work exploring optimal care pathways for all patients presenting to the pediatric ED with nephrolithiasis.
Collapse
Affiliation(s)
- Ryan F Walton
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Chen Yeh
- Northwestern University, Department of Preventive Medicine, Division of Biostatistics, Chicago, IL, USA.
| | - Rachel Shannon
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Ilina Rosoklija
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - James T Rague
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Emilie K Johnson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Elizabeth R Alpern
- Northwestern University, Department of Pediatrics, Division of Emergency Medicine, Chicago, IL, USA.
| | - Jonathan S Ellison
- Children's Wisconsin and Medical College of Wisconsin, Milwaukee, WI, USA.
| | | | | | - David I Chu
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| |
Collapse
|
23
|
Babajide R, Lembrikova K, Ziemba J, Ding J, Li Y, Fermin AS, Fan Y, Tasian GE. Automated Machine Learning Segmentation and Measurement of Urinary Stones on CT Scan. Urology 2022; 169:41-46. [PMID: 35908740 PMCID: PMC9936246 DOI: 10.1016/j.urology.2022.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/06/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVES To evaluate the performance of an engineered machine learning algorithm to identify kidney stones and measure stone characteristics without the need for human input. METHODS We performed a cross-sectional study of 94 children and adults who had kidney stones identified on non-contrast CT. A previously developed deep learning algorithm was trained to segment renal anatomy and kidney stones and to measure stone features. The performance and speed of the algorithm to measure renal anatomy and kidney stone features were compared to the current gold standard of human measurement performed by 3 independent reviewers. RESULTS The algorithm was 100% sensitive and 100% specific in detecting individual kidney stones. The mean stone volume segmented by the algorithm was smaller than that of human reviewers and had moderate overlap (Dice score: 0.66). There was substantial variation between human reviewers in total segmented stone volume (Jaccard score: 0.17) and volume of the single largest stone (Jaccard score: 0.33). Stone segmentations performed by the machine learning algorithm more precisely approximated stone borders than those performed by human reviewers on qualitative assessment. CONCLUSION An engineered machine learning algorithm can identify and characterize stones more accurately and reliably than humans, which has the potential to improve the precision and efficiency of assessing kidney stone burden.
Collapse
Affiliation(s)
- Rilwan Babajide
- University of Chicago Pritzker School of Medicine, Chicago, IL
| | | | - Justin Ziemba
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Surgery, Division of Urology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - James Ding
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Yuemeng Li
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; The Center for Biomedical Image Computing and Analytics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Antoine Selman Fermin
- Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Yong Fan
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; The Center for Biomedical Image Computing and Analytics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Gregory E Tasian
- Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
24
|
Otero HJ, Weiss DA, Tasian GE, Back SJ. Too much of a good thing: Learning the limits of the UTD risk classification in clinical practice. J Pediatr Urol 2022; 18:397-398. [PMID: 35484073 DOI: 10.1016/j.jpurol.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/03/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Dana A Weiss
- Department of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory E Tasian
- Department of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
25
|
Harper JD, Desai AC, Antonelli JA, Tasian GE, Ziemba JB, Al-Khalidi HR, Lai HH, Maalouf NM, Reese PP, Wessells HB, Kirkali Z, Scales CD. Quality of life impact and recovery after ureteroscopy and stent insertion: insights from daily surveys in STENTS. BMC Urol 2022; 22:53. [PMID: 35387623 PMCID: PMC8988384 DOI: 10.1186/s12894-022-01004-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/10/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Our objective was to describe day-to-day evolution and variations in patient-reported stent-associated symptoms (SAS) in the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS), a prospective multicenter observational cohort study, using multiple instruments with conceptual overlap in various domains. METHODS In a nested cohort of the STENTS study, the initial 40 participants having unilateral ureteroscopy (URS) and stent placement underwent daily assessment of self-reported measures using the Brief Pain Inventory short form, Patient-Reported Outcome Measurement Information System measures for pain severity and pain interference, the Urinary Score of the Ureteral Stent Symptom Questionnaire, and Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index. Pain intensity, pain interference, urinary symptoms, and bother were obtained preoperatively, daily until stent removal, and at postoperative day (POD) 30. RESULTS The median age was 44 years (IQR 29,58), and 53% were female. The size of the dominant stone was 7.5 mm (IQR 5,11), and 50% were located in the kidney. There was consistency among instruments assessing similar concepts. Pain intensity and urinary symptoms increased from baseline to POD 1 with apparent peaks in the first 2 days, remained elevated with stent in situ, and varied widely among individuals. Interference due to pain, and bother due to urinary symptoms, likewise demonstrated high individual variability. CONCLUSIONS This first study investigating daily SAS allows for a more in-depth look at the lived experience after URS and the impact on quality of life. Different instruments measuring pain intensity, pain interference, and urinary symptoms produced consistent assessments of patients' experiences. The overall daily stability of pain and urinary symptoms after URS was also marked by high patient-level variation, suggesting an opportunity to identify characteristics associated with severe SAS after URS.
Collapse
Affiliation(s)
- Jonathan D. Harper
- grid.34477.330000000122986657Department of Urology, University of Washington School of Medicine, Seattle, WA 98195 USA
| | - Alana C. Desai
- grid.4367.60000 0001 2355 7002Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO USA
| | - Jodi A. Antonelli
- grid.267313.20000 0000 9482 7121Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Gregory E. Tasian
- grid.239552.a0000 0001 0680 8770Division of Pediatric Urology, Department of Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Justin B. Ziemba
- grid.411115.10000 0004 0435 0884Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA USA
| | - Hussein R. Al-Khalidi
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC USA
| | - H. Henry Lai
- grid.4367.60000 0001 2355 7002Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO USA ,grid.4367.60000 0001 2355 7002Department of Anesthesiology, Washington University School of Medicine, St Louis, MO USA
| | - Naim M. Maalouf
- grid.267313.20000 0000 9482 7121Department of Internal Medicine, Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Peter P. Reese
- grid.25879.310000 0004 1936 8972Renal-Electrolyte and Hypertension Division, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA ,grid.25879.310000 0004 1936 8972Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Hunter B. Wessells
- grid.34477.330000000122986657Department of Urology, University of Washington School of Medicine, Seattle, WA 98195 USA
| | - Ziya Kirkali
- grid.419635.c0000 0001 2203 7304National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD USA
| | - Charles D. Scales
- grid.26009.3d0000 0004 1936 7961Departments of Surgery and Population Health Science, Duke Surgical Center for Outcomes Research, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC USA
| | | |
Collapse
|
26
|
Carey RM, Shah AA, Brant JA, Tasian GE, Ziemba JB. Response to Letter to the Editor Regarding "An Analysis of the US News & World Report Methodology for Attribution of Specialty Care in Otolaryngology and Urology". Otolaryngol Head Neck Surg 2022; 166:403-404. [PMID: 35138979 DOI: 10.1177/01945998211008913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
27
|
Tasian GE, Denburg MR, Ellison JS. Early-Onset Kidney Stone Disease-Consequences and Opportunities. JAMA Pediatr 2021; 175:1203-1204. [PMID: 34491264 DOI: 10.1001/jamapediatrics.2021.2966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gregory E Tasian
- Division of Pediatric Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Michelle R Denburg
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,Division of Pediatric Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | |
Collapse
|
28
|
Yong R, Tasian GE, Kraft KH, Roberts WW, Maxwell A, Ellison JS. Laser access and utilization preferences for pediatric ureteroscopy: A survey of the Societies of Pediatric Urology. Can Urol Assoc J 2021; 16:E155-E160. [PMID: 34672934 DOI: 10.5489/cuaj.7326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to evaluate laser access and practice variability for pediatric ureteroscopy (URS) across the Societies of Pediatric Urology (SPU) to identify opportunities and barriers for future technology promulgation and evidence dissemination. METHODS A 25-question survey was sent electronically to members of the SPU. The questionnaire assessed surgeon and hospital characteristics, treatment preferences based on an index case, and information about available laser units. Descriptive and comparative statistical analyses were performed to assess patterns of care and laser accessibility across the SPU. RESULTS A total of 105 of 711 (15%) recipients responded. Seventy-seven respondents (73%) reported laser ownership, which was associated with greater after-hours laser access (87% vs. 13%, p<0.01). Fifty-eight individuals provided additional laser specifications, of whom 21 (36%) used a high-power laser unit (>60 W). Standard-power lasers were used more frequently in free-standing children's hospitals, as compared to those working within a larger hospital complex (75% vs. 50%, p=0.049). Variation existed in treatment preferences with respect to dusting (33, 34%), fragmentation (18, 19%), or a hybrid approach (46 respondents, 48%). Stone clearance was the most important consideration irrespective of treatment choice. CONCLUSIONS Variability in surgical preferences and accessibility to laser units exist across pediatric urologists who performing URS. Laser ownership and access to newer technologies vary across practices and may influence treatment options. Understanding access to laser technology will be important when considering opportunities for surgical optimization to improve patient outcomes through future studies.
Collapse
Affiliation(s)
- Ray Yong
- Department of Urology, Medical College of Wisconsin, Wauwatosa, WI, United States
| | - Gregory E Tasian
- Department of Urology, University of Pennsylvania Perelman School of Medicine; Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, MI, United States
| | - William W Roberts
- Department of Urology, University of Michigan, Ann Arbor, MI, United States
| | - Adam Maxwell
- Department of Urology, University of Washington, Seattle, WA, United States
| | - Jonathan S Ellison
- Department of Urology, Medical College of Wisconsin, Wauwatosa, WI, United States.,Department of Urology, Medical College of Wisconsin; Division of Pediatric Urology, Children's Hospital of Wisconsin, Milwaukee, WI, United States
| |
Collapse
|
29
|
Flanders TM, Lang SS, Ko TS, Andersen KN, Jahnavi J, Flibotte JJ, Licht DJ, Tasian GE, Sotardi ST, Yodh AG, Lynch JM, Kennedy BC, Storm PB, White BR, Heuer GG, Baker WB. Optical Detection of Intracranial Pressure and Perfusion Changes in Neonates With Hydrocephalus. J Pediatr 2021; 236:54-61.e1. [PMID: 34004191 PMCID: PMC8403158 DOI: 10.1016/j.jpeds.2021.05.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/30/2021] [Accepted: 05/10/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To demonstrate that a novel noninvasive index of intracranial pressure (ICP) derived from diffuse optics-based techniques is associated with intracranial hypertension. STUDY DESIGN We compared noninvasive and invasive ICP measurements in infants with hydrocephalus. Infants born term and preterm were eligible for inclusion if clinically determined to require cerebrospinal fluid (CSF) diversion. Ventricular size was assessed preoperatively via ultrasound measurement of the fronto-occipital (FOR) and frontotemporal (FTHR) horn ratios. Invasive ICP was obtained at the time of surgical intervention with a manometer. Intracranial hypertension was defined as invasive ICP ≥15 mmHg. Diffuse optical measurements of cerebral perfusion, oxygen extraction, and noninvasive ICP were performed preoperatively, intraoperatively, and postoperatively. Optical and ultrasound measures were compared with invasive ICP measurements, and their change in values after CSF diversion were obtained. RESULTS We included 39 infants, 23 with intracranial hypertension. No group difference in ventricular size was found by FOR (P = .93) or FTHR (P = .76). Infants with intracranial hypertension had significantly higher noninvasive ICP (P = .02) and oxygen extraction fraction (OEF) (P = .01) compared with infants without intracranial hypertension. Increased cerebral blood flow (P = .005) and improved OEF (P < .001) after CSF diversion were observed only in infants with intracranial hypertension. CONCLUSIONS Noninvasive diffuse optical measures (including a noninvasive ICP index) were associated with intracranial hypertension. The findings suggest that impaired perfusion from intracranial hypertension was independent of ventricular size. Hemodynamic evidence of the benefits of CSF diversion was seen in infants with intracranial hypertension. Noninvasive optical techniques hold promise for aiding the assessment of CSF diversion timing.
Collapse
Affiliation(s)
- Tracy M Flanders
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Shih-Shan Lang
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Tiffany S Ko
- Division of Neurology, Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Kristen N Andersen
- Division of Neurology, Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Jharna Jahnavi
- Division of Neurology, Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - John J Flibotte
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Daniel J Licht
- Division of Neurology, Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Gregory E Tasian
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; Division of Urology, Children's Hospital of Philadelphia
| | - Susan T Sotardi
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania
| | | | - Benjamin C Kennedy
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Phillip B Storm
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Brian R White
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Gregory G Heuer
- Division of Neurosurgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Wesley B Baker
- Division of Neurology, Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania.
| |
Collapse
|
30
|
Chu DI, Ehlayel AM, Ginsberg JP, Meyers KE, Benton M, Thomas M, Carlson C, Kolon TF, Tasian GE, Greenberg JH, Furth SL, Denburg MR. Kidney Outcomes and Hypertension in Survivors of Wilms Tumor: A Prospective Cohort Study. J Pediatr 2021; 230:215-220.e1. [PMID: 33290810 PMCID: PMC7914174 DOI: 10.1016/j.jpeds.2020.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/23/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the prevalence of therapy-related kidney outcomes in survivors of Wilms tumor (WT). STUDY DESIGN This prospective cohort study included survivors of WT who were ≥5 years old and ≥1 year from completing therapy, excluding those with preexisting hypertension, prior dialysis, or kidney transplant. Participants completed 24-hour ambulatory blood pressure monitoring (ABPM). Abnormal blood pressure (BP) was defined as ≥90th percentile. Masked hypertension was defined as having normal office BP and abnormal ABPM findings. Urine was analyzed for kidney injury molecule-1, interleukin-18, epidermal growth factor, albumin, and creatinine. The estimated glomerular filtration rate (eGFR) was calculated using the bedside chronic kidney disease in children equation. Recent kidney ultrasound examinations and echocardiograms were reviewed for contralateral kidney size and left ventricular hypertrophy, respectively. Clinical follow-up data were collected for approximately 2 years after study enrollment. RESULTS Thirty-two participants (median age, 13.6 years [IQR, 10.5-16.3 years]; 75% stage 3 or higher WT) were evaluated at a median of 8.7 years (IQR, 6.5-10.8 years) after therapy; 29 participants underwent unilateral radical nephrectomy, 2 bilateral partial nephrectomy, and 1 radical and contralateral partial nephrectomy. In this cohort, 72% received kidney radiotherapy and 75% received doxorubicin. Recent median eGFR was 95.6 mL/min/1.73 m2 (IQR, 84.6-114.0; 11 [34%] had an eGFR of <90 mL/min/1.73 m2). Abnormal ABPM results were found in 22 of 29 participants (76%), masked hypertension in 10 of 29 (34%), and microalbuminuria in 2 of 32 (6%). Of the 32 participants, 22 (69%) had abnormal epidermal growth factor; few had abnormal kidney injury molecule-1 or interleukin-18. Seven participants with previous unilateral nephrectomy lacked compensatory contralateral kidney hypertrophy. None had left ventricular hypertrophy. CONCLUSIONS In survivors of WT, adverse kidney outcomes were common and should be closely monitored.
Collapse
Affiliation(s)
- David I. Chu
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago,Feinberg School of Medicine at Northwestern University
| | | | - Jill P. Ginsberg
- Division of Oncology, Children’s Hospital of Philadelphia,Perelman School of Medicine at the University of Pennsylvania
| | - Kevin E. Meyers
- Perelman School of Medicine at the University of Pennsylvania,Division of Nephrology, Children’s Hospital of Philadelphia
| | | | - Melissa Thomas
- Division of Nephrology, Children’s Hospital of Philadelphia
| | - Claire Carlson
- Division of Oncology, Children’s Hospital of Philadelphia
| | - Thomas F. Kolon
- Perelman School of Medicine at the University of Pennsylvania,Division of Urology, Children’s Hospital of Philadelphia
| | - Gregory E. Tasian
- Perelman School of Medicine at the University of Pennsylvania,Division of Urology, Children’s Hospital of Philadelphia
| | | | - Susan L. Furth
- Perelman School of Medicine at the University of Pennsylvania,Division of Nephrology, Children’s Hospital of Philadelphia
| | - Michelle R. Denburg
- Perelman School of Medicine at the University of Pennsylvania,Division of Nephrology, Children’s Hospital of Philadelphia
| |
Collapse
|
31
|
Scales CD, Lai HH, Desai AC, Antonelli JA, Maalouf NM, Tasian GE, Reese PP, Curatolo M, Weinfurt K, Al-Khalidi HR, Wessells H, Kirkali Z, Harper JD. Study to Enhance Understanding of Stent-Associated Symptoms: Rationale and Study Design. J Endourol 2020; 35:761-768. [PMID: 33081503 DOI: 10.1089/end.2020.0776] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Ureteral stents are commonly employed after ureteroscopy to treat urinary stone disease, but the devices impose a substantial burden of stent-associated symptoms (SAS), including pain and urinary side effects. The NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) Urinary Stone Disease Research Network sought to develop greater understanding of SAS causes and severity among individuals treated ureteroscopically for ureteral or renal stones. Materials and Methods: We designed a prospective, observational cohort study comprising adolescents and adults undergoing ureteroscopic intervention for ureteral or renal stones. Participants will undergo detailed symptom assessment using validated questionnaires, a psychosocial assessment, and detailed collection of clinical and operative data. Quantitative sensory testing will be utilized to assess pain sensitization. In addition, a small cohort (∼40 individuals) will participate in semi-structured interviews to develop more granular information regarding their stent symptoms and experience. Biospecimens (blood and urine) will be collected for future research. Results: The Study to Enhance Understanding of sTent-associated Symptoms (STENTS) enrolled its first participant in March 2019 and completed nested qualitative cohort follow-up in August 2019. After a planned pause, enrollment for the main study cohort resumed in September 2019 and is expected to be completed in 2021. Conclusion: STENTS is expected to provide important insights into the mechanisms and risk factors for severe ureteral SAS after ureteroscopy. These insights will generate future investigations to mitigate the burden of SAS among individuals with urinary stone disease.
Collapse
Affiliation(s)
- Charles D Scales
- Departments of Surgery and Population Health Sciences, Duke Surgical Center for Outcomes Research, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - H Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alana C Desai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jodi A Antonelli
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Naim M Maalouf
- Department of Internal Medicine and Charles, Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gregory E Tasian
- Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter P Reese
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Renal-Electrolyte and Hypertension Division, Department of Medicine, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michele Curatolo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kevin Weinfurt
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hussein R Al-Khalidi
- Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hunter Wessells
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
32
|
Scales CD, Desai AC, Harper JD, Lai HH, Maalouf NM, Reese PP, Tasian GE, Al-Khalidi HR, Kirkali Z, Wessells H. Prevention of Urinary Stones With Hydration (PUSH): Design and Rationale of a Clinical Trial. Am J Kidney Dis 2020; 77:898-906.e1. [PMID: 33212205 DOI: 10.1053/j.ajkd.2020.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/15/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Although maintaining high fluid intake is an effective low-risk intervention for the secondary prevention of urinary stone disease, many patients with stones do not increase their fluid intake. STUDY DESIGN We describe the rationale and design of the Prevention of Urinary Stones With Hydration (PUSH) Study, a randomized trial of a multicomponent behavioral intervention program to increase and maintain high fluid intake. Participants are randomly assigned (1:1 ratio) to the intervention or control arm. The target sample size is 1,642 participants. SETTING & PARTICIPANTS Adults and adolescents 12 years and older with a symptomatic stone history and low urine volume are eligible. Exclusion criteria include infectious or monogenic causes of urinary stone disease and comorbid conditions precluding increased fluid intake. INTERVENTIONS All participants receive usual care and a smart water bottle with smartphone application. Participants in the intervention arm receive a fluid intake prescription and an adaptive program of behavioral interventions, including financial incentives, structured problem solving, and other automated adherence interventions. Control arm participants receive guideline-based fluid instructions. OUTCOMES The primary end point is recurrence of a symptomatic stone during 24 months of follow-up. Secondary end points include changes in radiographic stone burden, 24-hour urine output, and urinary symptoms. LIMITATIONS Periodic 24-hour urine volumes may not fully reflect daily behavior. CONCLUSIONS With its highly novel features, the PUSH Study will address an important health care problem. FUNDING National Institute of Diabetes and Digestive and Kidney Diseases. TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT03244189.
Collapse
Affiliation(s)
- Charles D Scales
- Urologic Surgery and Population Health Science, Duke Surgical Center for Outcomes Research, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
| | - Alana C Desai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - H Henry Lai
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - 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
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Gregory E Tasian
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Pediatric Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Hussein R Al-Khalidi
- Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Hunter Wessells
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | | |
Collapse
|
33
|
Talwar R, Dobbs RW, Stambakio H, Lin G, Tasian GE, Ziemba JB. A Longitudinal Cohort Study of Pain Intensity and Interference After Ureteroscopy for Nephrolithiasis Without Postoperative Opioids. Urology 2020; 147:81-86. [PMID: 33049231 DOI: 10.1016/j.urology.2020.09.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To better understand the degree and time to resolution of pain in the postoperative period, we captured patient-reported pain intensity and interference prospectively in patients following ureteroscopy for nephrolithiasis. MATERIALS AND METHODS Adults undergoing ureteroscopy for renal/ureteral stones from 11/2018 to 1/2020 were eligible for inclusion. All received nonopioid postoperative pain control. Patients prospectively completed Patient-Reported Outcome Measurement Information System-Pain Intensity and Patient-Reported Outcome Measurement Information System-Pain Interference instruments preoperatively on postoperative day (POD) 0 and via email on POD 1, 7, and 14. Scores are reported as T-scores (normalized to US population, mean = 50) with changes of 5 (0.5 standard deviation) considered clinically significant. RESULTS A total of 126 patients completed enrollment at POD 0 (POD 1 = 74, POD 7 = 61, POD 14 = 47). Compared to US means, intensity and interference were significantly different at all time point comparisons (Wilcoxon rank test; all P <.001) except intensity at POD 7 (P = .09) and interference at POD 14 (P = .12). For both, there was a significant difference at each time comparison (repeated measures ANOVA; all P <.05). Increasing age was predictive of lower intensity (Confidence Interval (CI): -0.31 to -0.04; P = .012) and interference (CI: -0.36 to -0.06; P =.01) at POD 1. The presence of a postoperative stent was predictive of higher intensity (CI: 0.68-10.81; P = .03) and interference (CI: 0.61-12.96; P = .03) at POD 7. Increasing age remained a predictor of lower interference at POD 1 on multivariable analysis (CI: -0.46 to -0.01; P = .03). CONCLUSION Pain intensity and interference are elevated immediately, but intensity normalizes by POD 7, while interference remains elevated until POD 14. Age and indwelling ureteral stent influence both intensity and interference.
Collapse
Affiliation(s)
- Ruchika Talwar
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA.
| | - Ryan W Dobbs
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hanna Stambakio
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - George Lin
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Justin B Ziemba
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
34
|
Yin S, Peng Q, Li H, Zhang Z, You X, Fischer K, Furth SL, Fan Y, Tasian GE. Multi-instance Deep Learning of Ultrasound Imaging Data for Pattern Classification of Congenital Abnormalities of the Kidney and Urinary Tract in Children. Urology 2020; 142:183-189. [PMID: 32445770 PMCID: PMC7387180 DOI: 10.1016/j.urology.2020.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/08/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To reliably and quickly diagnose children with posterior urethral valves (PUV), we developed a multi-instance deep learning method to automate image analysis. METHODS We built a robust pattern classifier to distinguish 86 children with PUV from 71 children with mild unilateral hydronephrosis based on ultrasound images (3504 in sagittal view and 2558 in transverse view) obtained during routine clinical care. RESULTS The multi-instance deep learning classifier performed better than classifiers built on either single sagittal images or single transverse images. Particularly, the deep learning classifiers built on single images in the sagittal view and single images in the transverse view obtained area under the receiver operating characteristic curve (AUC) values of 0.796 ± 0.064 and 0.815 ± 0.071, respectively. AUC values of the multi-instance deep learning classifiers built on images in the sagittal and transverse views with mean pooling operation were 0.949 ± 0.035 and 0.954 ± 0.033, respectively. The multi-instance deep learning classifiers built on images in both the sagittal and transverse views with a mean pooling operation obtained an AUC of 0.961 ± 0.026 with a classification rate of 0.925 ± 0.060, specificity of 0.986 ± 0.032, and sensitivity of 0.873 ± 0.120, respectively. Discriminative regions of the kidney located using classification activation mapping demonstrated that the deep learning techniques could identify meaningful anatomical features from ultrasound images. CONCLUSION The multi-instance deep learning method provides an automatic and accurate means to extract informative features from ultrasound images and discriminate infants with PUV from male children with unilateral hydronephrosis.
Collapse
Affiliation(s)
- Shi Yin
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Qinmu Peng
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Hongming Li
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Zhengqiang Zhang
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Xinge You
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Katherine Fischer
- Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Susan L Furth
- Department of Pediatrics, Division of Pediatric Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Gregory E Tasian
- Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, The University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
35
|
Shah AA, Carey RM, Brant JA, Tasian GE, Ziemba JB. An Analysis of the US News & World Report Methodology for Attribution of Specialty Care in Otolaryngology and Urology. Otolaryngol Head Neck Surg 2020; 164:336-338. [PMID: 32689893 DOI: 10.1177/0194599820941016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
US News & World Report (USNWR) rankings can assist patients with choosing where to receive their specialty care. USNWR methodology assumes that the specialty caring for hospitalized patients is equivalent to the specialty assigned by administrative coding. We examined the frequency of discordance between USNWR methodology-assigned specialty and the actual specialty care received for 2 surgical specialties, otolaryngology (ENT) and urology (GU). Our analysis included inpatient deaths identified by USNWR coding for these specialties from 2013 to 2017 at a single academic tertiary care center. We found that a minority of patients with deaths attributed by USNWR to these 2 specialties were actually cared for by ENT (6/14; 43%) or GU (3/19; 16%). Only 5 of 14 (36%) and 2 of 19 (11%) deaths were potentially associated with ENT and GU care, respectively. We identified a significant discordance between USNWR-assigned specialty and the actual specialty care received.
Collapse
Affiliation(s)
- Ankur A Shah
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan M Carey
- Department of Otolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason A Brant
- Department of Otolaryngology-Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Center for Pediatric Clinical Effectiveness and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justin B Ziemba
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| |
Collapse
|
36
|
Hosier GW, McGregor T, Beiko D, Tasian GE, Booth C, Whitehead M, Siemens DR. Increased risk of new persistent opioid use in pediatric and young adult patients with kidney stones. Can Urol Assoc J 2020; 14:237-244. [PMID: 33626317 DOI: 10.5489/cuaj.6796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Adolescents and young adults are a vulnerable patient population for development of substance use disorder. However, the long-term impact of opioid prescribing in young adult patients with renal colic is not known. Our objective was to describe rates of opioid prescription and identify risk factors for persistent opioid use in patients age 25 years or younger with renal colic from kidney stones. METHODS Using previously validated, linked administrative databases, we performed a population-based, retrospective cohort study of opioid-naive patients age 25 years or younger with renal colic between July 1, 2013 and September 30, 2017 in Ontario. All family practitioner, urgent care, and specialist visits in the province were captured. Our primary outcome was persistent opioid use, defined as filling a prescription for an opioid between 91 and 180 days after initial visit. Ontario uses a narcotic monitoring system, which captures all opioids dispensed in the province. RESULTS Of the 6962 patients identified, 56% were prescribed an opioid at presentation and 34% of those were dispensed more than 200 oral morphine equivalents. There was persistent opioid use in 313 (8.1%) patients who filled an initial opioid prescription. In adjusted analysis, those prescribed an opioid initially had a significantly higher risk of persistent opioid use (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.50-2.29) and opioid overdose (OR 3.45; 1.08-11.04). There was a dose-dependent increase in risk of persistent opioid use with escalating initial opioid dose. History of mental illness (OR 1.32; 1.02-1.71) and need for surgery (OR 1.71; 1.24-2.34) were also associated with persistent opioid use. CONCLUSIONS Among patients with kidney stones age 25 years or younger, filling an opioid prescription after presentation is associated with an increased risk of persistent opioid use 3-6 months later and a higher risk of serious long-term complications, such as opioid overdose.
Collapse
Affiliation(s)
| | | | - Darren Beiko
- Department of Urology, Queen's University, Kingston, ON
| | - Gregory E Tasian
- Department of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Christopher Booth
- Department of Oncology, Queen's University, Kingston, ON, Canada.,Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Marlo Whitehead
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - D Robert Siemens
- Department of Urology, Queen's University, Kingston, ON.,Department of Oncology, Queen's University, Kingston, ON, Canada
| |
Collapse
|
37
|
Yin S, Peng Q, Li H, Zhang Z, You X, Fischer K, Furth SL, Tasian GE, Fan Y. Computer-Aided Diagnosis of Congenital Abnormalities of the Kidney and Urinary Tract in Children Using a Multi-Instance Deep Learning Method Based on Ultrasound Imaging Data. Proc IEEE Int Symp Biomed Imaging 2020; 2020:1347-1350. [PMID: 33850604 DOI: 10.1109/isbi45749.2020.9098506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Ultrasound images are widely used for diagnosis of congenital abnormalities of the kidney and urinary tract (CAKUT). Since a typical clinical ultrasound image captures 2D information of a specific view plan of the kidney and images of the same kidney on different planes have varied appearances, it is challenging to develop a computer aided diagnosis tool robust to ultrasound images in different views. To overcome this problem, we develop a multi-instance deep learning method for distinguishing children with CAKUT from controls based on their clinical ultrasound images, aiming to automatic diagnose the CAKUT in children based on ultrasound imaging data. Particularly, a multi-instance deep learning method was developed to build a robust pattern classifier to distinguish children with CAKUT from controls based on their ultrasound images in sagittal and transverse views obtained during routine clinical care. The classifier was built on imaging features derived using transfer learning from a pre-trained deep learning model with a mean pooling operator for fusing instance-level classification results. Experimental results have demonstrated that the multi-instance deep learning classifier performed better than classifiers built on either individual sagittal slices or individual transverse slices.
Collapse
Affiliation(s)
- Shi Yin
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China.,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Qinmu Peng
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Hongming Li
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Zhengqiang Zhang
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Xinge You
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Katherine Fischer
- Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Susan L Furth
- Department of Pediatrics, Division of Pediatric Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Gregory E Tasian
- Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Department of Biostatistics, Epidemiology, and Informatics, The University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| |
Collapse
|
38
|
Denburg MR, Koepsell K, Lee JJ, Gerber J, Bittinger K, Tasian GE. Perturbations of the Gut Microbiome and Metabolome in Children with Calcium Oxalate Kidney Stone Disease. J Am Soc Nephrol 2020; 31:1358-1369. [PMID: 32381601 DOI: 10.1681/asn.2019101131] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/22/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The relationship between the composition and function of gut microbial communities and early-onset calcium oxalate kidney stone disease is unknown. METHODS We conducted a case-control study of 88 individuals aged 4-18 years, which included 44 individuals with kidney stones containing ≥50% calcium oxalate and 44 controls matched for age, sex, and race. Shotgun metagenomic sequencing and untargeted metabolomics were performed on stool samples. RESULTS Participants who were kidney stone formers had a significantly less diverse gut microbiome compared with controls. Among bacterial taxa with a prevalence >0.1%, 31 taxa were less abundant among individuals with nephrolithiasis. These included seven taxa that produce butyrate and three taxa that degrade oxalate. The lower abundance of these bacteria was reflected in decreased abundance of the gene encoding butyryl-coA dehydrogenase (P=0.02). The relative abundance of these bacteria was correlated with the levels of 18 fecal metabolites, and levels of these metabolites differed in individuals with kidney stones compared with controls. The oxalate-degrading bacterial taxa identified as decreased in those who were kidney stone formers were components of a larger abundance correlation network that included Eggerthella lenta and several Lactobacillus species. The microbial (α) diversity was associated with age of stone onset, first decreasing and then increasing with age. For the individuals who were stone formers, we found the lowest α diversity among individuals who first formed stones at age 9-14 years, whereas controls displayed no age-related differences in diversity. CONCLUSIONS Loss of gut bacteria, particularly loss of those that produce butyrate and degrade oxalate, associates with perturbations of the metabolome that may be upstream determinants of early-onset calcium oxalate kidney stone disease.
Collapse
Affiliation(s)
- Michelle R Denburg
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristen Koepsell
- Division of Pediatric Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jung-Jin Lee
- Division of Gastroenterology, Department of Pediatrics, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jeffrey Gerber
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kyle Bittinger
- Division of Gastroenterology, Department of Pediatrics, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gregory E Tasian
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania .,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Pediatric Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
39
|
Ellison JS, Tasian GE. The Impact of Sex and Gender on Clinical Care and Research Design in Nephrolithiasis. Urology 2020; 151:54-57. [PMID: 32387245 DOI: 10.1016/j.urology.2020.04.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan S Ellison
- Department of Urology, Medical College of Wisconsin; Division of Pediatric Urology, Children's Hospital of Wisconsin, Milwaukee, WI.
| | - Gregory E Tasian
- Department of Urology, University of Pennsylvania Perelman School of Medicine; Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
40
|
Yin S, Peng Q, Li H, Zhang Z, You X, Fischer K, Furth SL, Tasian GE, Fan Y. Automatic kidney segmentation in ultrasound images using subsequent boundary distance regression and pixelwise classification networks. Med Image Anal 2020; 60:101602. [PMID: 31760193 PMCID: PMC6980346 DOI: 10.1016/j.media.2019.101602] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/22/2019] [Accepted: 11/07/2019] [Indexed: 12/28/2022]
Abstract
It remains challenging to automatically segment kidneys in clinical ultrasound (US) images due to the kidneys' varied shapes and image intensity distributions, although semi-automatic methods have achieved promising performance. In this study, we propose subsequent boundary distance regression and pixel classification networks to segment the kidneys automatically. Particularly, we first use deep neural networks pre-trained for classification of natural images to extract high-level image features from US images. These features are used as input to learn kidney boundary distance maps using a boundary distance regression network and the predicted boundary distance maps are classified as kidney pixels or non-kidney pixels using a pixelwise classification network in an end-to-end learning fashion. We also adopted a data-augmentation method based on kidney shape registration to generate enriched training data from a small number of US images with manually segmented kidney labels. Experimental results have demonstrated that our method could automatically segment the kidney with promising performance, significantly better than deep learning-based pixel classification networks.
Collapse
Affiliation(s)
- Shi Yin
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - Qinmu Peng
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China; Shenzhen Huazhong University of Science and Technology Research Institute, China.
| | - Hongming Li
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - Zhengqiang Zhang
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Xinge You
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China; Shenzhen Huazhong University of Science and Technology Research Institute, China
| | - Katherine Fischer
- Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - Susan L Furth
- Department of Pediatrics, Division of Pediatric Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - Gregory E Tasian
- Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States; Department of Biostatistics, Epidemiology, and Informatics, The University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, United States.
| |
Collapse
|
41
|
Yin S, Peng Q, Li H, Zhang Z, You X, Liu H, Fischer K, Furth SL, Tasian GE, Fan Y. Multi-instance Deep Learning with Graph Convolutional Neural Networks for Diagnosis of Kidney Diseases Using Ultrasound Imaging. Uncertain Safe Util Machine Learn Med Imaging Clin Image Based Proced (2019) 2019; 11840:146-154. [PMID: 31893285 PMCID: PMC6938161 DOI: 10.1007/978-3-030-32689-0_15] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Ultrasound imaging (US) is commonly used in nephrology for diagnostic studies of the kidneys and lower urinary tract. However, it remains challenging to automate the disease diagnosis based on clinical 2D US images since they provide partial anatomic information of the kidney and the 2D images of the same kidney may have heterogeneous appearance. To overcome this challenge, we develop a novel multi-instance deep learning method to build a robust classifier by treating multiple 2D US images of each individual subject as multiple instances of one bag. Particularly, we adopt convolutional neural networks (CNNs) to learn instance-level features from 2D US kidney images and graph convolutional networks (GCNs) to further optimize the instance-level features by exploring potential correlation among instances of the same bag. We also adopt a gated attention-based MIL pooling to learn bag-level features using full-connected neural networks (FCNs). Finally, we integrate both instance-level and bag-level supervision to further improve the bag-level classification accuracy. Ablation studies and comparison results have demonstrated that our method could accurately diagnose kidney diseases using ultrasound imaging, with better performance than alternative state-of-the-art multi-instance deep learning methods.
Collapse
Affiliation(s)
- Shi Yin
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Qinmu Peng
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Hongming Li
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Zhengqiang Zhang
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Xinge You
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Hangfan Liu
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Katherine Fischer
- Department of Surgery, Division of Pediatric Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Susan L Furth
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Gregory E Tasian
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Surgery, Division of Pediatric Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
42
|
Christakos A, Bowen DK, Doolin EJ, Tasian GE, Kolon TF. Case report: Ampicillin-induced stone formation causing bilateral ureteral obstruction during pelvic surgery. Urol Case Rep 2019; 24:100851. [PMID: 31211062 PMCID: PMC6562285 DOI: 10.1016/j.eucr.2019.100851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/13/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Athena Christakos
- Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Diana K Bowen
- Department of Surgery, Division of Urology, Children's Hospital of Philadelphia, USA
| | - Edward J Doolin
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Gregory E Tasian
- Department of Surgery, Division of Urology, Children's Hospital of Philadelphia, USA
| | - Thomas F Kolon
- Department of Surgery, Division of Urology, Children's Hospital of Philadelphia, USA
| |
Collapse
|
43
|
Tasian GE, Ross M, Song L, Audrain-McGovern J, Wiebe D, Warner SG, Henderson B, Patel A, Furth SL. Ecological Momentary Assessment of Factors Associated with Water Intake among Adolescents with Kidney Stone Disease. J Urol 2019; 201:606-614. [PMID: 30076905 DOI: 10.1016/j.juro.2018.07.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Maintaining high water intake decreases kidney stone recurrence but is difficult to do. Strategies to reduce stone recurrence among adolescents are lacking. We conducted an ecological momentary assessment study to identify factors associated with water intake in adolescents with nephrolithiasis. MATERIALS AND METHODS The study population consisted of 15 female and 10 male patients 12 to 18 years old with at least 1 prior kidney stone. For 7 days participants used "smart" bottles to self-monitor water intake and received questionnaires randomly 4 times daily, which were completed in real time on mobile devices. The questionnaires ascertained awareness of water intake volume, awareness of water intake goals, perceived need to drink, access to water, alternative beverage consumption and attitudes toward bathrooms. Linear mixed effects models were fit to estimate the association between momentary responses and daily water intake. RESULTS During 175 person-days 595 assessments (85%) were completed. Median daily water intake was 1,304 ml (IQR 848-1,832) and 20% of participants met their intake goal for 4 days or more. Unawareness of water intake volume was associated with drinking 690 ml less water per day (p = 0.04). A strong self-perceived need to drink more was associated with drinking 1,954 ml less water each day compared to no self-perceived need to drink more (p <0.01). Unawareness of intake goals was weakly associated with drinking 1,129 ml less water each day (p = 0.1). Access to water, alternative beverage consumption and bathroom aversion were not associated with water intake. CONCLUSIONS Unawareness of water volume consumed and low responsiveness to perceived need to drink more were associated with low water intake. Interventions that help adolescents recognize when and identify how to increase water intake may be effective in decreasing stone recurrence.
Collapse
Affiliation(s)
- Gregory E Tasian
- Department of Surgery, Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle Ross
- Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lihai Song
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Janet Audrain-McGovern
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas Wiebe
- Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven G Warner
- Department of Surgery, Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brittney Henderson
- Department of Surgery, Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anisha Patel
- Department of Pediatrics, Stanford University, Stanford, California
| | - Susan L Furth
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
44
|
Chu DI, Abraham AG, Tasian GE, Denburg MR, Ross ME, Zderic SA, Furth SL. Urologic care and progression to end-stage kidney disease: a Chronic Kidney Disease in Children (CKiD) nested case-control study. J Pediatr Urol 2019; 15:266.e1-266.e7. [PMID: 30962011 PMCID: PMC6588473 DOI: 10.1016/j.jpurol.2019.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/13/2019] [Accepted: 03/11/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Children with chronic kidney disease (CKD) risk progressing to end-stage kidney disease (ESKD). The majority of CKD causes in children are related to congenital anomalies of the kidney and urinary tract, which may be treated by urologic care. OBJECTIVE To examine the association of ESKD with urologic care in children with CKD. STUDY DESIGN This was a nested case-control study within the Chronic Kidney Disease in Children (CKiD) prospective cohort study that included children aged 1-16 years with non-glomerular causes of CKD. The primary exposure was prior urologic referral with or without surgical intervention. Incidence density sampling matched each case of ESKD to up to three controls on duration of time from CKD onset, sex, race, age at baseline visit, and history of low birth weight. Conditional logistic regression analysis was performed to estimate rate ratios (RRs) for the incidence of ESKD. RESULTS Sixty-six cases of ESKD were matched to 153 controls. Median age at baseline study visit was 12 years; 67% were male, and 7% were black. Median follow-up time from CKD onset was 14.9 years. Seventy percent received urologic care, including 100% of obstructive uropathy and 96% of reflux nephropathy diagnoses. Cases had worse renal function at their baseline visit and were less likely to have received prior urologic care. After adjusting for income, education, and insurance status, urology referral with surgery was associated with 50% lower risk of ESKD (RR 0.50 [95% confidence interval [CI] 0.26-0.997), compared to no prior urologic care (Figure). After excluding obstructive uropathy and reflux nephropathy diagnoses, which were highly correlated with urologic surgery, the association was attenuated (RR 0.72, 95% CI 0.24-2.18). DISCUSSION In this study, urologic care was commonly but not uniformly provided to children with non-glomerular causes of CKD. Underlying specific diagnoses play an important role in both the risk of ESKD and potential benefits of urologic surgery. CONCLUSION Within the CKiD cohort, children with non-glomerular causes of CKD often received urologic care. Urology referral with surgery was associated with lower risk of ESKD compared to no prior urologic care but depended on specific underlying diagnoses.
Collapse
Affiliation(s)
- D I Chu
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - A G Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G E Tasian
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M R Denburg
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M E Ross
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - S A Zderic
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - S L Furth
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
45
|
Yin S, Zhang Z, Li H, Peng Q, You X, Furth SL, Tasian GE, Fan Y. FULLY-AUTOMATIC SEGMENTATION OF KIDNEYS IN CLINICAL ULTRASOUND IMAGES USING A BOUNDARY DISTANCE REGRESSION NETWORK. Proc IEEE Int Symp Biomed Imaging 2019; 2019:1741-1744. [PMID: 31803348 PMCID: PMC6892163 DOI: 10.1109/isbi.2019.8759170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
It remains challenging to automatically segment kidneys in clinical ultrasound images due to the kidneys' varied shapes and image intensity distributions, although semi-automatic methods have achieved promising performance. In this study, we developed a novel boundary distance regression deep neural network to segment the kidneys, informed by the fact that the kidney boundaries are relatively consistent across images in terms of their appearance. Particularly, we first use deep neural networks pre-trained for classification of natural images to extract high-level image features from ultrasound images, then these feature maps are used as input to learn kidney boundary distance maps using a boundary distance regression network, and finally the predicted boundary distance maps are classified as kidney pixels or non-kidney pixels using a pixel classification network in an end-to-end learning fashion. Experimental results have demonstrated that our method could effectively improve the performance of automatic kidney segmentation, significantly better than deep learning based pixel classification networks.
Collapse
Affiliation(s)
- Shi Yin
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Zhengqiang Zhang
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Hongming Li
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Qinmu Peng
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Xinge You
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Susan L Furth
- Department of Pediatrics, Division of Pediatric Nephrology, Philadelphia, PA, 19104, USA
| | - Gregory E Tasian
- Department of Surgery, Division of Pediatric Urology, Philadelphia, PA, 19104, USA
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| |
Collapse
|
46
|
Vicedo-Cabrera AM, Goldfarb DS, Kopp RE, Song L, Tasian GE. Sex differences in the temperature dependence of kidney stone presentations: a population-based aggregated case-crossover study. Urolithiasis 2019; 48:37-46. [PMID: 30900001 DOI: 10.1007/s00240-019-01129-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/10/2019] [Indexed: 10/27/2022]
Abstract
Previous studies assumed a uniform relationship between heat and kidney stone presentations. Determining whether sex and other characteristics modify the temperature dependence of kidney stone presentations has implications for explaining differences in nephrolithiasis prevalence and improving projections of the effect of climate change on nephrolithiasis. We performed an aggregated case-crossover study among 132,597 children and adults who presented with nephrolithiasis to 68 emergency departments throughout South Carolina from 1997 to 2015. We used quasi-Poisson regression with distributed lag non-linear models to estimate sex differences in the cumulative exposure and lagged response between maximum daily wet-bulb temperatures and emergent kidney stone presentations, aggregated at the ZIP-code level. We also explored interactions by age, race, payer, and climate. Compared to 10 °C, daily wet-bulb temperatures at the 99th percentile were associated with a greater increased relative risk (RR) of kidney stone presentations over 10 days for males (RR 1.73; 95% CI 1.56, 1.91) than for females (RR 1.15; 95% CI 1.01, 1.32; interaction P < 0.001). The shape of the lagged response was similar for males and females, with the greatest risk estimated for the 2 days following high temperatures. There were weak differences by age, race, and climatic zone, and no differences by payer status. The estimated risk of presenting emergently with kidney stones within 10 days of high daily wet-bulb temperatures was substantially greater among men than women, and similar between patients with public and private insurance. These findings suggest that the higher risk among males may be due to sexually dimorphic physiologic responses rather than greater exposure to ambient temperatures.
Collapse
Affiliation(s)
- Ana M Vicedo-Cabrera
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, England, WC1E 7HT, UK
| | - David S Goldfarb
- Division of Nephrology, New York University School of Medicine, New York, NY, 10016, USA
| | - Robert E Kopp
- Department of Earth and Planetary Sciences, Institute of Earth, Ocean and Atmospheric Sciences, Rutgers University, New Brunswick, NJ, 08901, USA
| | - Lihai Song
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Gregory E Tasian
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA. .,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, 19104, USA. .,Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. .,Department of Surgery, Division of Urology, The Children's Hospital of Philadelphia, Wood Center, 3rd Floor 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| |
Collapse
|
47
|
Lee AS, McGarry L, Bowen DK, Tasian GE. Patient Characteristics Associated With Completion of 24-hour Urine Analyses Among Children and Adolescents With Nephrolithiasis. Urology 2019; 127:102-106. [PMID: 30796989 DOI: 10.1016/j.urology.2019.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/01/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To inform the development of strategies to improve adherence to guidelines, we sought to identify characteristics of pediatric patients with nephrolithiasis associated with completing 24-hour urine analyses. MATERIALS AND METHODS We performed a retrospective cohort study of patients with nephrolithiasis aged 3-18years treated in a large pediatric healthcare system from May 2012 to May 2017. Multivariable Cox models were fit to estimate the association between patient characteristics and completion of a 24-hour urine analysis. RESULTS Among 623 patients, 317 (50.9%) completed a 24-hour urine collection. Median age was 14.4years (interquartile range [IQR] 10.5, 16.3). In adjusted analyses, age at diagnosis (hazard ratio [HR] 1.03; 95% confidence interval [CI] 1.01-1.07), renal colic on presentation (HR 1.72; 95% CI 1.15-2.58), and family history of nephrolithiasis (HR 1.50; 95% CI 1.17-1.93) were associated with an increased likelihood of completion of a 24-hour urine. Public/government assistance insurance (HR 0.68; 95% CI 0.48-0.96) was associated with decreased likelihood of completing a 24-hour urine. CONCLUSION Patients who had prior painful experiences with stones (renal colic), and potential better understanding of nephrolithiasis (family history, older age on presentation) were more likely to complete a 24-hour urine. Those patients with public insurance/government assistance were less likely to complete a 24-hour urine. These results can be used to develop strategies to improve pediatric patients' adherence to completing 24-hour urine collections.
Collapse
Affiliation(s)
- Albert S Lee
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA
| | - Laura McGarry
- Department of Urology, Einstein Healthcare Network, Philadelphia, PA
| | - Diana K Bowen
- Division of Urology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gregory E Tasian
- Department of Surgery, Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA.
| |
Collapse
|
48
|
Zheng Q, Furth SL, Tasian GE, Fan Y. Computer-aided diagnosis of congenital abnormalities of the kidney and urinary tract in children based on ultrasound imaging data by integrating texture image features and deep transfer learning image features. J Pediatr Urol 2019; 15:75.e1-75.e7. [PMID: 30473474 PMCID: PMC6410741 DOI: 10.1016/j.jpurol.2018.10.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/20/2018] [Accepted: 10/25/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Anatomic characteristics of kidneys derived from ultrasound images are potential biomarkers of children with congenital abnormalities of the kidney and urinary tract (CAKUT), but current methods are limited by the lack of automated processes that accurately classify diseased and normal kidneys. OBJECTIVE The objective of the study was to evaluate the diagnostic performance of deep transfer learning techniques to classify kidneys of normal children and those with CAKUT. STUDY DESIGN A transfer learning method was developed to extract features of kidneys from ultrasound images obtained during routine clinical care of 50 children with CAKUT and 50 controls. To classify diseased and normal kidneys, support vector machine classifiers were built on the extracted features using (1) transfer learning imaging features from a pretrained deep learning model, (2) conventional imaging features, and (3) their combination. These classifiers were compared, and their diagnosis performance was measured using area under the receiver operating characteristic curve (AUC), accuracy, specificity, and sensitivity. RESULTS The AUC for classifiers built on the combination features were 0.92, 0.88, and 0.92 for discriminating the left, right, and bilateral abnormal kidney scans from controls with classification rates of 84%, 81%, and 87%; specificity of 84%, 74%, and 88%; and sensitivity of 85%, 88%, and 86%, respectively. These classifiers performed better than classifiers built on either the transfer learning features or the conventional features alone (p < 0.001). DISCUSSION The present study validated transfer learning techniques for imaging feature extraction of ultrasound images to build classifiers for distinguishing children with CAKUT from controls. The experiments have demonstrated that the classifiers built on the transfer learning features and conventional image features could distinguish abnormal kidney images from controls with AUCs greater than 0.88, indicating that classification of ultrasound kidney scans has a great potential to aid kidney disease diagnosis. A limitation of the present study is the moderate number of patients that contributed data to the transfer learning approach. CONCLUSIONS The combination of transfer learning and conventional imaging features yielded the best classification performance for distinguishing children with CAKUT from controls based on ultrasound images of kidneys.
Collapse
Affiliation(s)
- Q Zheng
- Department of Radiology, School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; School of Computer and Control Engineering, Yantai University, Yantai, 264005, China
| | - S L Furth
- Department of Pediatrics, Division of Pediatric Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - G E Tasian
- Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, The University of Pennsylvania, Philadelphia, PA, USA
| | - Y Fan
- Department of Radiology, School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| |
Collapse
|
49
|
Abstract
Once considered rare, pediatric nephrolithiasis has become a critical field of study in the last decade due to the rapid increase in incidence. Understanding the changing epidemiology and lifelong implications of pediatric stone disease is critically important to effectively manage the individual patient as well as identify risk factors for childhood onset that could be modified. Determining the role of diagnostic imaging in children is a unique challenge as limiting radiation and imaging stewardship should be priorities. Approaches to management have also changed, as technology continues to evolve and both medical and surgical options expand.
Collapse
Affiliation(s)
- Diana K Bowen
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine and The Children's Hospital of Philadelphia, 3rd Floor, Wood Building, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Gregory E Tasian
- Division of Urology, Center for Pediatric Clinical Effectiveness, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, 3rd Floor, Wood Building, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| |
Collapse
|
50
|
Kurtzman JT, Song L, Ross ME, Scales CD, Chu DI, Tasian GE. Urology Consultation and Emergency Department Revisits for Children with Urinary Stone Disease. J Urol 2018; 200:180-186. [PMID: 29474848 PMCID: PMC6002942 DOI: 10.1016/j.juro.2018.02.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE We determined the association between urology consultation and emergency department revisits for children with urinary stones. MATERIALS AND METHODS This retrospective cohort study included patients 18 years old or younger who presented to an emergency department in South Carolina with a urinary stone from 1997 to 2015. The primary exposure was urology consultation during the index emergency department visit. The primary outcome was a stone related emergency department revisit occurring within 180 days of discharge from an index emergency department visit. Secondary outcomes included computerized tomography use, inpatient admission and emergent surgery. RESULTS Of 5,642 index emergency department visits for acute urinary stones 11% resulted in at least 1 stone related emergency department revisit within 180 days. Of revisits 59% occurred within 30 days of discharge and 39% were due to pain. The odds of emergency department revisit were highest within the first 48 hours of discharge home (OR 22.6, 95% CI 18.0 to 28.5) and rapidly decreased thereafter. Urology consultation was associated with a 37% lower adjusted odds of emergency department revisit (OR 0.63, 95% CI 0.44 to 0.90) and 68% lower odds of computerized tomography use across all emergency department visits (OR 0.32, 95% CI 0.15 to 0.69). Among patients who revisited the emergency department the frequency of pain complaints was 27% in those with a urological consultation at the index visit and 39% in those without. CONCLUSIONS Urology consultation was associated with decreased emergency department revisits and computerized tomography use in pediatric patients with urinary stones. Future studies should identify patients who benefit most from urology consultation and ascertain processes of care that decrease emergency department revisits among high risk patients.
Collapse
Affiliation(s)
| | - Lihai Song
- Center for Pediatric Clinical Effectiveness, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle E Ross
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles D Scales
- Division of Urologic Surgery and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - David I Chu
- Department of Surgery, Division of Pediatric Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Tasian
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|