Ureteral Stent Removal Research Articles

PD50-11 THE PATIENT VOICE: EXPERIENCES WITH URETERAL STENT REMOVAL – A URINARY STONE DISEASE RESEARCH NETWORK (USDRN) STUDY

You have accessJournal of UrologyCME1 May 2022PD50-11 THE PATIENT VOICE: EXPERIENCES WITH URETERAL STENT REMOVAL – A URINARY STONE DISEASE RESEARCH NETWORK (USDRN) STUDY Carrie Dombeck, Charles Scales, Kevin McKenna, Teresa Swezey, Jodi Antonelli, Alana Desai, Jonathan Harper, Michele Curatolo, Naim Maalouf, Peter Reese, Rebecca McCune, Hussein Al-Khalidi, Ziya Kirkali, and Amy Corneli Carrie DombeckCarrie Dombeck More articles by this author , Charles ScalesCharles Scales More articles by this author , Kevin McKennaKevin McKenna More articles by this author , Teresa SwezeyTeresa Swezey More articles by this author , Jodi AntonelliJodi Antonelli More articles by this author , Alana DesaiAlana Desai More articles by this author , Jonathan HarperJonathan Harper More articles by this author , Michele CuratoloMichele Curatolo More articles by this author , Naim MaaloufNaim Maalouf More articles by this author , Peter ReesePeter Reese More articles by this author , Rebecca McCuneRebecca McCune More articles by this author , Hussein Al-KhalidiHussein Al-Khalidi More articles by this author , Ziya KirkaliZiya Kirkali More articles by this author , and Amy CorneliAmy Corneli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002621.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral stents are often employed after ureteroscopy, and subsequently require removal. Despite this requirement, to date, no studies have qualitatively described patients’ experiences with removing indwelling ureteral stents following ureteroscopy for stone disease. The objective of this study was to describe the qualitative experiences of patients undergoing ureteral stent removal. METHODS: The USDRN Study to Enhance Understanding of Stent-Associated Symptoms (STENTS) is a prospective observational cohort study that included a nested cohort of participants who completed qualitative in-depth interviews (n=38) within 30 days after stent removal. Participants were asked to reflect on (1) painful or bothersome aspects of stent removal (2) symptoms immediately after removal, and (3) symptoms in the days after removal. All interviews were audio-recorded, transcribed, and analyzed using a rigorous qualitative method (applied thematic analysis). RESULTS: Of the 38 participants, 21 (55%) were female, with ages ranging from 13 to 77 years. Interviews were conducted 7–30 days (median = 16 days) after stent removal. Almost all participants (n=31) reported experiencing either pain or discomfort at some point during stent removal, but this was of short duration for most. Many (n=21) also described anticipatory anxiety related to the procedure, and several (n=11) discussed discomfort arising from lack of privacy, embarrassment, or feeling exposed (Table). Interactions with medical providers had the potential to ease patient concerns, or conversely, to increase discomfort. Following stent removal, several participants (n=18) described persistence of pain and/or urinary symptoms, but for most, these largely resolved within 24 hours. Only a few reported lingering symptoms more than a day after stent removal. CONCLUSIONS: Our findings expand the understanding of patient experiences during and shortly after ureteral stent removal, and importantly, identify opportunities for improvement. Patients experience psychological distress related to stent removal, which has not been described previously. Optimal communication before and during the removal procedure, and about the possibility of delayed pain, may improve patient experience. Source of Funding: NIH/NIDDK © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e840 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carrie Dombeck More articles by this author Charles Scales More articles by this author Kevin McKenna More articles by this author Teresa Swezey More articles by this author Jodi Antonelli More articles by this author Alana Desai More articles by this author Jonathan Harper More articles by this author Michele Curatolo More articles by this author Naim Maalouf More articles by this author Peter Reese More articles by this author Rebecca McCune More articles by this author Hussein Al-Khalidi More articles by this author Ziya Kirkali More articles by this author Amy Corneli More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP23-14 REDUCING READMISSIONS FOLLOWING RADICAL CYSTECTOMY THROUGH QUALITY IMPROVEMENT

You have accessJournal of UrologyCME1 May 2022MP23-14 REDUCING READMISSIONS FOLLOWING RADICAL CYSTECTOMY THROUGH QUALITY IMPROVEMENT Lee White, Caleb Seufert, Bogdana Schmidt, Peter Dy, Stacy Cox, Mia Singh, Joanne Meneses, and Eila Skinner Lee WhiteLee White More articles by this author , Caleb SeufertCaleb Seufert More articles by this author , Bogdana SchmidtBogdana Schmidt More articles by this author , Peter DyPeter Dy More articles by this author , Stacy CoxStacy Cox More articles by this author , Mia SinghMia Singh More articles by this author , Joanne MenesesJoanne Meneses More articles by this author , and Eila SkinnerEila Skinner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002562.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) for invasive for invasive bladder cancer is a highly morbid surgery. At 21 to 31%, the national 30 day RC readmission rate is significantly higher than for other urologic procedures. Early rehospitalization has become a focus due to the impact on patient experience, high cost, and associated poor downstream health outcomes. Under the auspices of the Stanford Clinical Effectiveness and Leadership Training Program, we set out to reduce the 30-day readmission rate due to infection to 10%, from the current rate at Stanford of 17.9%. METHODS: We determined the baseline readmission rate at Stanford from ACS NSQUIP and billing data, and manual review of all RCs at Stanford from 2018-2020. We identified an ‘intervention bundle’ to reduce cystectomy readmissions: preoperative nutrition referral, enrolling patients in SeamlessMD perioperative education platform, standardized teaching for patients during hospitalization, removal of ureteral stents by postoperative day 4, methenamine urinary tract infection prophylaxis, and outpatient care coordination with followup visit at 3, 10, and 17 days post-discharge. RESULTS: We identified 217 baseline cases from 2018-20 with a readmission rate of 28-32%, of which 18-21% were due to intraabdominal and urinary tract infection. In the 3 months since our intervention, we performed 14 radical cystectomies. 1 patient was admitted to an outside hospital with pain. One patient was admitted with a urinary tract infection. These represent a 14% overall readmission rate and 7% readmission rate for infection. Process measures have also improved. Days to stent removal has improved from 21.3 days to 7.7 days. Days to clinic follow-up improved from 6.3 days to 3.6 days. CONCLUSIONS: Our intervention reduced readmissions from 17.9% to <10%, or an estimated 6-10 prevented readmissions annually, with corresponding impact of $1-1.5M. Insights from this initiative provide a template for improving important clinical metrics using data from chart and literature review. This Quality Improvement initiative included a spectrum of practitioners. Reducing readmission following cystectomy may yield strategies and answers to reduce readmission following other complex and morbid surgeries. These answers can improve the experience for patients at Stanford and beyond. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e387 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lee White More articles by this author Caleb Seufert More articles by this author Bogdana Schmidt More articles by this author Peter Dy More articles by this author Stacy Cox More articles by this author Mia Singh More articles by this author Joanne Meneses More articles by this author Eila Skinner More articles by this author Expand All Advertisement PDF downloadLoading ...

PD55-03 PATIENT-REPORTED OUTCOMES FOLLOWING HOME URETERAL STENT REMOVAL AFTER URETEROSCOPY

You have accessJournal of UrologyCME1 May 2022PD55-03 PATIENT-REPORTED OUTCOMES FOLLOWING HOME URETERAL STENT REMOVAL AFTER URETEROSCOPY John Graves, John Bell, Amul Bhalodi, Will Cranford, Adam Dugan, and Jason Bylund John GravesJohn Graves More articles by this author , John BellJohn Bell More articles by this author , Amul BhalodiAmul Bhalodi More articles by this author , Will CranfordWill Cranford More articles by this author , Adam DuganAdam Dugan More articles by this author , and Jason BylundJason Bylund More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002635.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urologists often place temporary indwelling ureteral stents after ureteroscopy, but little is known about ideal stent dwell time and we lack rigorously-gathered data about tolerance. We are seeking to study the effect of stent duration on patient-reported outcomes by having patients remove their stent at three vs. seven days postoperatively, and then conducting a phone survey to assess outcomes. METHODS: Patients undergoing uncomplicated ureteroscopy for stone disease are screened for eligibility. Exclusion criteria include bilateral ureteroscopy, solitary kidney, need for additional procedure, or pregnancy. Patients are randomized to remove the stent at home either three or seven days after surgery. A few days after scheduled removal, an independent clinical research associate calls to collect data regarding stent tolerance, removal, and unscheduled calls or ER visits. RESULTS: To date, 80 patients have been randomized to either three (n=44, 55.7%) or seven (n=35, 44.3%) days. Seventy-two (90%) have been successfully contacted. Nearly 80% reported removal on the planned day. A prior ureteral stent was present in 31 patients (44.2%) and a ureteral access sheath was used in 33 cases (47.1%). Thirteen patients (18.6%) reported no problem with their stent, while 55 (64.3%) reported mild or moderate bother and 12 (17.2%) described either severe bother or absolute misery. Only four patients (5.8%) required narcotics for greater than two days after removal. While most patients (n=56, 80%) experienced 30 minutes or less of severe pain (impaired function) after removal, 11 (15.7%) reported this pain for greater than six hours. More patients (n=27, 38.5%) experienced mild/moderate pain ("bothersome but not limiting") for greater than six hours. Significantly more patients without a prior stent reported at least a moderate bother compared to those with one (61.5% vs 25.8%, p=0.006) and more patients without sheath use visited the ER than those with (33% vs 11.1%, p=0.04). Insufficient patients have been accrued thus far to address the question of 3 vs 7 day stent duration. CONCLUSIONS: Most patients adhere to planned stent removal date, tolerate the stent well, do not call a provider or visit the emergency department, and do not experience severe pain following stent removal. The most common issue after stent removal is self-limited pain. Patients with a prior stent report less discomfort, and when an access sheath is used, patients are less likely to present to the ED. These numbers can help counsel patients regarding home ureteral stent removal and guide future efforts to optimize stent use. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e948 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Graves More articles by this author John Bell More articles by this author Amul Bhalodi More articles by this author Will Cranford More articles by this author Adam Dugan More articles by this author Jason Bylund More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Whiston Snare Technique for Loop Extraction of Stents (WHISTLES): A novel technique for the intraureteric assembly of a loop snare for the retrograde extraction of a migrated ureteric stent

Background: While ureteric stent removal remains a frequently performed endourological procedure stent migration either proximally or distally can present the endourologist with a significant intraoperative dilemma. In cases where the stent is of large calibre or impacted into the mucosa of the ureter, retrieval may prove refractory to traditional approaches. Objective: To present a further novel procedure: The Whiston Snare Technique for Loop Extraction of Stents (WHISTLES) which allows for intraureteric assembly of a tightening loop through a ureteric catheter thus permitting safe retrieval of a migrated stent. Methods: We describe the procedure as it was performed and have recreated the steps in a laboratory environment. This demonstrates an adaptation of existing materials readily found in most urological theatres and is not a prototypical device. Results: The procedure was successfully performed to allow extraction of the migrated ureteric stent. Conclusion: WHISTLES is a reproducible method for the retrieval of migrated ureteric stents where traditional techniques have failed. Level of evidence: 5

A1047 - Ureteric stent removal by string: A cost saving technique during pandemic

A1047 - Ureteric stent removal by string: A cost saving technique during pandemic

Early Removal of Ureteral Stent After Kidney Transplant Could Decrease Incidence of Urinary Tract Infection: A Systematic Review and Meta-Analysis.

In this systematic review and meta-analysis, our aim was to explore the optimal timing of ureteric stent removal after kidney transplant. For our analyses, we searched the Cochrane Central Register of Controlled Trials, PubMed, and Embase databases for all randomized clinical trials that evaluated the timing of stent removal after kidney transplant. Patients with early versus late stent removal were compared. Seven eligible studies published from 2012 to 2018, which included 1277 patients, were found to be within the scope of our study. Significant differences were shown between early versus late stent removal groups with regard to development of urinary tract infections (relative risk of 0.42; 95% CI, 0.26-0.685; P < .001). In a further subgroup analysis of incidence of urinary tract infection with consideration of heterogeneity, early stent removal was also favored (relative risk at 2 and 3 weeks of 0.36 and 0.35, respectively; P < .001 for both). However, with regard to incidence of major urologic complications, there were no significant differences between early and late stent removal (odds ratio at 2 and 3 weeks of 2.79 and 1.97, respectively; P = .18 and P = .26, respectively). There were also no significant differences between groups in risk of development of urinary leakage (odds ratio at 2 weeks of 3.02, P = .18; and relative risk at 3 weeks of 2.00, P = .27). With regard to ureteral stenosis, only 3 cases were reported in the late stent removal group. Our study demonstrated that early ureteral stent removal (that is, not later than 3 weeks) could significantly decrease the incidence of urinary tract infections without affecting incidence of major urological complications. We suggest that the appropriate timing of stent removal should be within 14 to 21 days.

POSB415 Predicting Factors of Complicated Ureteral Stent Removal in Patients with Kidney Stone in the United States

Cystoscopy-based stent removal (CBSR) is a common procedure following ureteroscopy with stent placement. Complicated stent removal CPT® code 52315 is designated for encrusted stents as defined by the AUA. No previous research has examined the stent removal usage pattern in a real-world practice. This study investigated factors associated with complicated stent removal among commercially insured patients in the US.

The Function Improved of the Newly Designed Magnetic-End Ureteric Stenting Retrieval Device: A Clinical Prospective Randomized and Control Trial in a Multicenter Study.

Objective To demonstrate the advantage of our newly designed magnetic ureteric stenting retrieval device over traditional nonmagnetic ureteric stents and other retrieval devices without cystoscopy intervention on clinical application and cost-related outcomes. Patients and Methods. A total of 333 patients were recruited into two study groups: magnetic-end ureteral stent (Group A) and conventional ureteral stent (Group B). The effects were evaluated by Ureteral Stent Symptom Questionnaire (USSQ) scores, complications of the indwelling stent, visual analog scale (VAS) pain scores at stent removal, and cost-analysis outcomes between the magnetic ureteric stenting retrieval device and traditional double-J ureteral stent (DJUS) removed by cystoscopy. Results The VAS of the pain score of patients undergoing magnetic stent removal with the retrieval device was 2 ± 0.97, whereas that of patients undergoing conventional ureteral stent removal with cystoscopy was 5.76 ± 1.53 (p < 0.001). The removal of magnetic stents by a retrieval device proved to be less painful than cystoscopy-mediated stent removal (p < 0.001). Obviously, the total cost for the magnetic stent removal was much lower than the conventional ureteral stent removal, although the magnetic stent costs more than the conventional ureteral stent. The improved magnetic stent used in our study showed a remarkable cost saving of 705/111 USD Chinese Yuan (CNY) per patient when compared with the conventional ureteral stent. Conclusion We reported the integrated design features of the improved magnetic stent in the world, which was granted a patent in China. USSQ scores and rate of complications in the magnetic stent were as equally acceptable as a conventional stent. Furthermore, successful stent insertion rate reached 100% by both the antegrade and retrograde approaches, and no failure case of magnetic stent removal was reported in our study.

Case - Renal artery pseudoaneurysm: A life-threatening occurrence following thulium laser lithotripsy.

Introduction Renal artery pseudoaneurysm post-laser lithotripsy is a rare and potentially life-threatening complication. Traditionally, the most common modalities used for treatment of urinary tract stones were holmium laser lithotripsy and extracorporeal shockwave lithotripsy. However, thulium laser has recently gained momentum in the treatment of urinary tract stones with increasing use and availability in healthcare systems. We report a case of renal artery pseudoaneurysm post-thulium laser lithotripsy who presented in hemorrhagic shock after ureteral stent removal and was subsequently stabilized by endovascular embolization.

Novel method to decrease the exposure time of the extraction string of the ureteral stent and its efficiency and safety verification in the clinic

Ureteral stent removal by an extraction string is advantageous. However, the increased risk of complications attributed to the continuous exposure of the string outside the urethra must be managed. This paper introduces a method to decrease the exposure time, and conducts a retrospective study to verify its efficiency and safety. A total of 231 male patients undergoing routine ureteroscopy (URS) were included, and all of them accepted indwelling ureteral stents with strings. Among them, 123 patients (Normal-S group) underwent the normal method to determine the length of string (Lstring), which was shortened to 4 cm (cm) past the urethral meatus; 108 patients (Novel-S group) underwent the novel method (Lstring = Lurethra + 2 cm), the length of urethra (Lurethra) was measured during ureteroscopy by ureteroscope body. The demographic characteristics, stent indwelling and removal-related variables, complications, and medical costs in each group were recorded. There was no significant difference in demographic characteristics, the rate of UTI, the operative duration of URS, or the VAS pain scores for stent removal between the 2 groups. For the Novel-S group, the stent dwelling time was longer, the self-rated discomfort and symptom, the stent dislodgement rate, the numbers of clinic or emergency visits and the overall medical cost post operation was lower in comparison with the Normal-S group, while the rate of removal of stents by hand was lower, the time for removing ureteral stents was longer. This novel method improved stenting comfort, avoided ureteral stent dislodgement, decreased complications, and lowered medical costs, it was safe and reliable and merits widespread application.

LUTS-Normal Stent VS Carbothene Stent in a Health Center- Retrospective and Prospective Study

Background: Ureteral stent removal is associated with some post operative symptoms such as changes in the frequency of urine,frequent nocturia, occasional episodes of blood stained urine,pain in the suprapubic region which occurs due to the material composition and the dimensions of the stent as well. Polyurethane stent are regularly used in the operation theatres but in the recent years carbothane stent has showed some efficacy and hence necessitates a comparison.&#x0D; Objectives: To study the prevalence of symptoms of lower urinary tract symptoms in patients with polyurethane stent and carbothane stents&#x0D; Materials and Methodology: A prospective study was conducted among patients who had their stent removed to the Department of Urology in a tertiary health care hospital from January 2021 to April 2021. A simple random sampling technique was employed and 40 patients were identified for the study. The relationship between the different stents and the onset of symptoms&#x0D; Results: It is seen that the onset of lower urinary tract symptoms had an equal incidence among the two genders hence the presence of symptoms plays a crucial role in distinguishing the efficacy of the stents. Here in this study only 5% of carbothane stent patients had changes in frequency of micturition where as 65% polyurethane stent patients reported change frequency similarly 60% of polyurethane stent patients had changes in Frequency of nocturia whereas same was reported in 20% of the patients. Loss of urine before reaching the toilet was the primary complaint in 30 % of polyurethane stent patients but only 2% of carbothane stent patients occasionally had this complaint. Apparently the stream of urine was occasionally continuous in 70% of polyurethane stent patients but was always continuous in 85% of carbothane stent patients. A sense of incomplete evacuation was experienced by 40% of polyurethane stent patients but only 1% of carbothane stent patients had such complications Similarly pain in the suprapubic region, straining oneself while micturition and presence of hematuria was experienced by a greater percentage of polyurethane stent patients than that of carbothane stent patients.&#x0D; Conclusion: It is seen that carbothane stent have a better patient compliance and a low onset of lower urinary tract symptoms when compared to the normal polyurethane stent and hence medical management of the symptoms was required in the postoperative period

The Economic Burden of Cystoscopy-Based Ureteral Stent Removal in the United States: An Analysis of Nearly 30,000 Patients.

Ureteral stents are commonly placed after ureteroscopy. We examined the rate of cystoscopy-based stent removal (CBSR) following ureteroscopy for stone disease and its economic burden in the United States. Adults undergoing ureteroscopy and stenting (index surgery) for stone disease between 2014 and 2018 were identified using the IBM® MarketScan® Commercial Database. Patients were categorized as those with CBSR or without CBSR within 6 months post-index surgery. Rate and location of CBSR were assessed. To estimate the economic burden of CBSR, medical costs (2019 U.S. dollars) paid by insurers were calculated at 6 months post-index surgery. A generalized linear model examined the association of CBSR with total costs adjusting for patient characteristics. Among 29,535 patients meeting the inclusion criteria, 56.5% had CBSR within 6 months. Median time to CBSR was 9 days; 70% of patients with CBSR had their stent removed in the office. Medical costs for CBSR patients were significantly higher than those for nonCBSR patients ($7,808 vs $6,231; p <0.0001). The difference was driven by the cost of CBSR ($1,132 vs $0; p <0.0001) and health care utilization for stone disease ($2,464 vs $2,121; p <0.0001). CBSR was associated with a 17% increase in medical costs compared to nonCBSR (OR: 1.17; 95% CI 3.03, 3.46). Over 50% of patients had CBSR within 6 months following ureteroscopy. Medical costs for patients undergoing CBSR were significantly higher and driven by the cost of CBSR and resource utilization for stone disease. Ureteral stents that avoid CBSR can lower medical costs to the health care system.

A rare complication of ureteral stent removal: Answers

A rare complication of ureteral stent removal: Answers

A rare complication of ureteral stent removal: Questions.

A rare complication of ureteral stent removal: Questions.

MP17-09 ECONOMIC IMPACT OF ADVANCED PRACTICE PROVIDERS PERFORMING MINOR UROLOGIC PROCEDURES

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures I (MP17)1 Sep 2021MP17-09 ECONOMIC IMPACT OF ADVANCED PRACTICE PROVIDERS PERFORMING MINOR UROLOGIC PROCEDURES Nir Tomer, Alexander Small, David Kolomer, and Michael Palese Nir TomerNir Tomer More articles by this author , Alexander SmallAlexander Small More articles by this author , David KolomerDavid Kolomer More articles by this author , and Michael PaleseMichael Palese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002002.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minor urologic procedures (MUPs) such as cystoscopy, ureteral stent removal and prostate biopsy are typically performed by urologists, however advanced practice providers (APPs) are increasingly gaining autonomy to perform these procedures across the United States. This expansion of responsibility has been controversial. Our study aimed to examine recent trends of APPs performing MUPs and model the future economic impact of these trends. METHODS: We queried the Medicare Provider Utilization and Payment Data database between 2012 and 2018 for MUPs including cystoscopy (CPT 52000), ureteral stent removal (CPT 52310), and ultrasound guided prostate biopsy (CPT 55700). Provider type, number of procedures performed, and cost per procedure were extracted and evaluated. APPs were defined as physician assistants and nurse practitioners who independently billed for procedures. A predictive trend model was used to calculate potential cost-savings. RESULTS: Over seven years, APP’s performed on average 0.60% of cystoscopies, 1.07% of stent removals and 0.44% of prostate biopsies. The percent of APPs performing MUPs grew each year, with cystoscopy growing 0.10%/year, stent removal growing 0.16%/year, and prostate biopsies growing 0.04%/year. Based on this trend, APPs are expected to perform 4.98% of cystoscopies, 6.32% of stent removals, and 2.19% of prostate biopsies by 2050 (Figure). On average, the Medicare reimbursement for a physician performing cystoscopy, stent removal, and prostate biopsy compared to an APP was $25.97, $33.33, and $36.88 higher respectively. During the study period, APPs performing MUPs has saved Medicare $1,300,000. Based on the current trend of increasing APPs performing MUPs, Medicare is projected to save $43,100,000 over the next 30 years (Figure). CONCLUSIONS: These data show that there is a slow and steady rise in APP’s performing MUP’s among Medicare patients. The trend is projected to save substantial cost to the healthcare system and has important implications for expanding access to care given the aging population, high volume of MUPs performed each year and increasing reliance on APPs in urology. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e311-e311 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nir Tomer More articles by this author Alexander Small More articles by this author David Kolomer More articles by this author Michael Palese More articles by this author Expand All Advertisement Loading ...

PD35-06 IATROGENIC URETERAL INJURY REPAIR: COMPARISON BETWEEN EARLY AND DELAYED REPAIR

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (PD35)1 Sep 2021PD35-06 IATROGENIC URETERAL INJURY REPAIR: COMPARISON BETWEEN EARLY AND DELAYED REPAIR Tarek Taha, Ben Sionov, Ami Sidi, and Alexander Tsivian Tarek TahaTarek Taha More articles by this author , Ben SionovBen Sionov More articles by this author , Ami SidiAmi Sidi More articles by this author , and Alexander TsivianAlexander Tsivian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002039.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Iatrogenic injury of the ureter during various surgeries is a potential risk for late complications and poses therapeutic challenges. Repairing of the ureteral injury may reduce the risk of future complications and restore early functioning of the affected organ. The timing for repair is not yet agreed upon by most surgeons, some tend to perform urinary diversion using nephrostomy or JJ stent insertion, and some recommend immediate repair of the injury. In our study we aim to compare perioperative and postoperative outcomes between early and late repair of iatrogenic ureteral injury METHODS: Between January 2006 and August 2019, 44 patients with iatrogenic ureteral injuries were gathered retrospectively. Patients were divided into two groups: Group A (n=28) patients who had an early repair injury (<1 week) and Group B (n=16) patients who underwent late repair of ureteral injury (>2 weeks). The comparison between the two groups was performed using operative parameters and events that were recorded postoperatively and during the follow-up period RESULTS: Median follow-up period was similar between both groups (18.8 vs 21.3-month, p=0.35), median age in group A was higher than group B (51.3 vs 42.6, p=0.28). Median operative time was shorter in group A compared to group B but is statistically insignificant (152.7 vs 165.7 min, p=0.15). Median estimated blood loss intraoperatively was slightly higher in group A compared to group B (88.1 vs 41.8, p=0.16). The median length stay was similar between both groups (3.6 vs 4, p=0.21). The median time to urethral catheter removal was shorter in group B (5.8 vs 7 days, p=0.01) and the median time to ureteral stent removal was similar between both groups (4.8 vs 4.6 week, P = 0.33), no complications occurred during surgery in either group. During the postoperative and follow-up period, 6 complications (21.4%) were recorded in group-A versus 3 (18.75%) in group-B. All complications were Clavien I, II. There was no difference in creatinine value in both groups at 1 month (0.84 vs 0.94, p=0.214),6 month (0.82 vs 0.82, p=031) and 12 months (0.91 vs 0.94, p=0.31) postoperatively During follow-up, two patients from group A (7.1%) and two patients from Group B (12.5%) underwent re-repair due to re-stenosis in the anastomotic area CONCLUSIONS: In our study, there were no differences in the outcomes between early and delayed repair. Early repair is recommended to reduce the suffering and the frustration of the patients due to the complication after their primary surgery or because of the using of PCN and JJ stent until the definitive repairing surgery of the ureteral injury Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e590-e591 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tarek Taha More articles by this author Ben Sionov More articles by this author Ami Sidi More articles by this author Alexander Tsivian More articles by this author Expand All Advertisement Loading ...

MP47-20 DOUBLE-BLIND, PLACEBO-CONTROLLED RANDOMIZED CONTROLLED TRIAL OF NSAID PRIOR TO URETERAL STENT REMOVAL IN PEDIATRIC PATIENTS

You have accessJournal of UrologyPediatric Urology III (MP47)1 Sep 2021MP47-20 DOUBLE-BLIND, PLACEBO-CONTROLLED RANDOMIZED CONTROLLED TRIAL OF NSAID PRIOR TO URETERAL STENT REMOVAL IN PEDIATRIC PATIENTS N. Valeska Halstead, Kyle Rove, Brett Wiesen, Alan Bielsky, and Jeffrey Campbell N. Valeska HalsteadN. Valeska Halstead More articles by this author , Kyle RoveKyle Rove More articles by this author , Brett WiesenBrett Wiesen More articles by this author , Alan BielskyAlan Bielsky More articles by this author , and Jeffrey CampbellJeffrey Campbell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002068.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral spasm, common with ureteral stents, is partially mediated by prostaglandins and may be suppressed by cyclooxygenase inhibitors like NSAIDs. Practices currently vary widely for pain management in patients with ureteral stents, sometimes including opioids. We aimed to determine if NSAID given prior to stent removal would reduce postoperative pain. We hypothesized there would be at least a 75% reduction in postoperative severe pain in patients receiving ibuprofen compared to placebo. METHODS: We performed a double-blind, placebo-controlled randomized controlled trial on pediatric urology patients with an indwelling ureteral stent undergoing removal in the operating room from 2014–2019. 20 patients in each arm were needed to achieve 80% power to detect a 75% reduction in the estimated 55% incidence of severe postoperative (α=0.05). Patients ≥4 years old who had a unilateral stent placed after treatment of urolithiasis or ureteropelvic junction obstruction were randomized to NSAID or placebo in a 1:1 ratio at least 15 minutes prior to scheduled stent removal. Patients estimated pain using Faces Pain Scale-Revised (FPS-R) or visual analogue scale (VAS) prior to and 24 hours after stent removal. RESULTS: 254 patients undergoing stent removal were assessed for eligibility and 44 randomized patients were analyzed using intention to treat analysis. The cohorts were demographically similar and received similar anesthesia treatment. There was no significant difference in maximum PACU pain score (p=0.540) or use of in-hospital opioids (p=0.626) between the two groups. No difference was seen in the incidence of severe post-operative pain (p=1.0), thus rejecting our hypothesis. Significant worsened postoperative pain (pain score increases of ≥2 between time points) decreased from 22.7% to 9.1% between placebo and NSAID, but this did not reach significance (p=0.410). CONCLUSIONS: There was no difference in postoperative pain for patients undergoing ureteral stent removal given preoperative NSAID versus placebo. The incidence of severe pain before and after stent removal was low, ranging from 4.5–9.1%. Our study may have been underpowered given the low incidence of severe pain. Research to minimize pain/stress of operations should continue in order to optimize patient outcomes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e831-e831 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information N. Valeska Halstead More articles by this author Kyle Rove More articles by this author Brett Wiesen More articles by this author Alan Bielsky More articles by this author Jeffrey Campbell More articles by this author Expand All Advertisement Loading ...

Forget Forgotten Stents: Review of Ureteral Stent Tracking Systems.

Our objective was to assess existing systems for tracking ureteral stents after urological surgery and determine if these systems impact the rate of retained and forgotten stents. We performed a scoping review using the search terms ("ureteral stents" "ureteral catheters" "nephroureteral stents" "nephroureteral catheters" or "double J stents") and ("tracking" or "lost stents" or "forgotten stents"). Two of the authors individually selected relevant articles based on title and abstract and performed full review of manuscripts and references. Nine different studies focusing on forgotten ureteral stents were identified. Tracking mechanisms included electronic medical records algorithms, cellphone, chat or computer-based applications. Rates of lost or delayed removal of stents in hospitals prior to using a tracking system were 0%-13%. With a tracking mechanism, the rate of lost or delayed removal was reduced to 1% or less in the studies we identified. Stent tracking systems successfully reduced delayed removal of ureteral stents and reduced the rates of retained stents; however, these systems are institution specific, and no universal solution is readily available. Such a solution would be beneficial for the urological community to investigate further and for industry partners to invest in.

Outpatient ureteric stent removal following kidney transplantation.

Lay Summary During a kidney transplant, a plastic tube (stent) is placed in the ureter, connecting the new kidney to the bladder, in order to keep the new join open during the initial phase of transplantation. The stent is then removed after a few weeks via a camera procedure (cystoscopy), as it is no longer needed. The present study compared performing this in the operating theatre or in clinic for transplanted patients using a new single-use type of camera with an integrated grasper system. The results have shown that it is safe and cost-effective to do this in clinic, despite patients being susceptible to infection after transplantation.

Technical Notes on Fluoroscopy-Guided Removal of Metallic Ureteral Stents

This report describes various techniques for fluoroscopy-guided removal of metallic ureteral stents. Fifteen patients underwent 17 fluoroscopy-guided removal procedures of 22 metallic ureteral stents. The simple or modified snare or retrieval hook technique was primarily used for antegrade access, whereas the loop snare technique was primarily used for retrograde access. Overall, 64.7% of the stents were removed using the initial retrieval technique, and 82.4% of the stents were removed using an adjunct technique. Procedure-related complications included hematuria in 41.2% of cases and resolved spontaneously in all patients. Fluoroscopy-guided removal of metallic ureteral stents is safe and effective.