Urology Practice最新文献

Introduction: The US supply disruption of surgical irrigation fluids in September 2024 prompted the need for fluid conservation and potential deferral of urology procedures. We characterized fluid use in common endoscopic procedures to articulate recommendations for irrigation fluid stewardship and case prioritization during fluid shortages.

Methods: We reviewed case volumes and irrigation fluid use for endoscopic urological procedures at our institution during January-September 2024. We convened a panel of high-volume urologists and used a 3-step modified Delphi method to determine consensus recommendations for fluid stewardship and case prioritization.

Results: Among 6155 cases, the procedures consuming the highest mean per-case fluid volumes were prostate enucleation (26.6 L), transurethral resection of the prostate (16.7 L), percutaneous nephrolithotomy (12.4 L), and robotic water-jet prostate ablation (10.9 L). These 4 procedures comprised 17% of all cases but consumed 42% of total fluid volume. To prioritize procedures for potential deferral, procedures were stratified into 3 fluid tiers based on fluid consumption and 3 urgency tiers based on clinical indication. Combining both fluid and urgency tiers, we identified 5 procedural priority levels in which lower priority cases that consume more fluid and treat less urgent indications are deferred first. Finally, we defined 4 fluid stewardship principles addressing patient and trainee needs.

Conclusions: Among endoscopic urology cases, the 4 most fluid-intensive procedures consume 42% of surgical irrigation fluid. A case prioritization framework that accounts for fluid consumption and clinical urgency can help urology practices navigate potential case deferrals. Fluid stewardship principles may optimize fluid conservation to minimize adverse impact on patients and trainees.

Introduction: Our goal was to understand health care utilization by comparing hospital encounters among individuals with spina bifida and the general population and to identify the factors associated with utilization.

Methods: Using the Department of Health Care Access and Information database (1995-2017), individuals with spina bifida were identified and matched to controls by birth year. The primary outcome measures were the number of hospital encounters (stratified as ≤2 vs ≥3 encounters) and the time between the first and second encounters. Univariate, multivariate, and subgroup analyses were performed to identify factors associated with ≥ 3 encounters.

Results: When compared to controls, individuals with spina bifida had more ≥ 3 hospital encounters (69% vs 29%), spent more days in the hospital (58 days vs 13 days), and had a higher average charge per hospital stay ($433,537 vs $99,975, P < .001 for all). After adjusting for covariates, we found that having spina bifida was associated with increased hospital encounters compared to controls (odds ratio 3.95, 95% CI 3.77-4.14, P < .001). Individuals with spina bifida were found to have less time between their first and second encounters (2.5 vs 3.3 years, P < .001). Within the spina bifida population, sex, race, ethnicity, comorbidities, and nonprivate insurance were associated with ≥ 3 encounters.

Conclusions: Spina bifida is associated with more hospital encounters and fewer days between first and second encounters compared to the general population. These findings highlight factors driving increased utilization of resources, thereby empowering providers to better support this vulnerable population.

Introduction: We sought to determine the utilization of various benign prostatic hyperplasia (BPH) procedures among patients diagnosed with BPH in the US to better understand the dispersion of the various BPH technologies.

Methods: The AUA Quality (AQUA) registry was used to identify patients with a diagnosis of BPH from January 2014 to December 2021. Patient characteristics and procedure characteristics were abstracted. Trends were analyzed using Mann-Kendall tests, and a 2-way analysis of variance test was used to compare treatment utilization.

Results: Of 2,202,107 men diagnosed with BPH in our cohort, 53% (1,173,366) were managed with at least 1 BPH medication, and 7.8% (172,681) received a BPH treatment. Compared to 2014, prostatic urethral lift (n = 178), water vapor thermal therapy (n = 1116), and other genitourinary procedures (n = 254) increased by 3730%, 123%, and 853%, respectively. Regional and racial variations existed based on treatment type. There was significant regional variation in time to intervention based on the state and age of the patient.

Conclusions: The management of BPH has undergone temporal changes throughout the study period. The treatment modalities for BPH vary by region and race in a real-world context.

Introduction: Placing ureteral stents at the ureteroileal anastomosis for radical cystectomy with ileal conduit (RCIC) has long been common practice. Recently, some providers have begun omitting stents. We sought to investigate differences in perioperative and 30-day outcomes between patients who underwent RCIC with and without stents placed at the ureteroileal anastomosis.

Methods: We identified RCICs performed between 2019 and 2021 in the National Surgical Quality Improvement Program database and corresponding Cystectomy-Targeted Participant Use File. Baseline demographics, comorbidities, and operative parameters were compared via Pearson's χ² and t tests between stented and stentless RCICs. Outcomes of interest, including rates of UTIs, acute kidney injury, renal failure requiring dialysis, ileoileal anastomotic leaks, ureteral obstruction, urinary leak or fistula formation, reoperations, and 30-day hospital readmissions, were compared using Pearson's χ². All statistical tests were 2-tailed with P < .05 considered significant.

Results: A total of 5418 RCICs were identified. Four hundred ninety-eight (9.2%) were stentless. There were no differences in baseline demographics or comorbidities. Significantly fewer stented patients had robotic-assisted operations (23% vs 29%, P < .01). Stented patients had lower rates of urinary leak or fistula formation (3.1% vs 4.8%, P = .04). There was no significant difference in 30-day rates of UTIs, acute kidney injuries, renal failure, ileoileal anastomotic leaks, ureteral obstruction, reoperations, and readmissions. Limitations include retrospective design and lack of longitudinal tracking past 30 days.

Conclusions: Stentless patients had noninferior outcomes compared to stented patients in most important 30-day outcomes. Our analysis suggests that stents may not be necessary in ileal conduit urinary diversion procedures.