Holmium laser enucleation of the prostate (HoLEP) is a size-independent option for benign prostatic hyperplasia surgical management. Since lower urinary tract symptoms (LUTS) are a quality-of-life ...issue, studies should prioritize patient-reported outcomes (PROs). This HoLEP review assesses PROs inclusion in the top 20 cited HoLEP studies and defines their limitations. PROs were categorized by domain: LUTS, incontinence, sexual function, pain, hematuria, and patient satisfaction. On review, no top-cited study included all PRO domains. The nuanced patient experience after HoLEP could be better defined via standardized utilization of validated PROs, while also improving comparability between HoLEP studies.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Testicular compartment syndrome requires timely diagnosis and intervention but may be challenging. We present a case discussing the presentation and management of testicular compartment syndrome ...following testicular trauma in an 11-year-old male. The patient presented 24 hours after testicular trauma from a kick with testicular enlargement and sharp pain. Ultrasound showed markedly decreased blood flow and a reactive hydrocele. Testis-sparing intervention included emergent tunica albuginea incision, debridement, and tunica vaginalis flap.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Pediatric nephrolithiasis is increasing in incidence and presents differently compared to adults. We report a case of nephrolithiasis in a pediatric patient, presenting with complaints of emesis, ...anuria, hematuria, and abdominal distension, leading to a diagnosis of bilateral obstructing cystine stones requiring bilateral percutaneous nephrolithotomy. Pediatric patients with anuria should be evaluated for bilateral nephrolithiasis as an etiology. Calculous anuria requires prompt recognition of the pathologic process and relief of the obstruction with close follow-up and supportive care until definitive stone management. Bilateral percutaneous nephrolithotomy can provide definitive surgical intervention without significant morbidity.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Holmium laser enucleation of the prostate (HoLEP) is often offered for symptomatic prostatic enlargement at high risk for bleeding. However, prior studies define clinically significant hematuria ...(CSH) narrowly as the need for blood transfusion or significant decrease in hemoglobin. We sought to evaluate risk factors contributing to a broader definition of CSH, which may contribute to alteration of clinical course.
We analyzed 164 patients in a prospectively maintained database who underwent HoLEP at a single institution across two surgeons from November 2020 to April 2023. HoLEP was performed using Moses 2.0 (Boston Scientific) laser and the Piranha enucleation system (Richard Wolf). We defined CSH broadly as follows: clot retention, return to operating room, perioperative management variation due to hematuria, or continued gross hematuria past 1 month postoperatively. Univariable and multivariable ANOVAs were used. Multivariable analysis of CSH risk based on the use of antiplatelet (AP) agents or anticoagulants included correction for age, enucleation time (surrogate for case difficulty), and prostate volume.
17.7% (29/164) of our patients developed CSH after HoLEP. Longer enucleation time was a mild risk factor for developing CSH (multivariate odds ratio OR 1.01,
= 0.02). The strongest predictor of CSH was the use of anticoagulation or AP agents (OR 2.71
< 0.02 on univariable analysis, OR 2.34
< 0.02 on multivariable analysis), even when aspirin 81 mg was excluded.
With a broadened definition, 18% of patients developed CSH following HoLEP, which impacted the clinical course. Our data suggest that the current definition of significant hematuria is too narrow and does not capture many patients whose clinical course is affected by hematuria. While safe, anticoagulants and APs significantly predicted an increased CSH risk, and patients should be counseled accordingly.
This study investigates gender-based disparities in health-related quality of life (HRQOL) outcomes among kidney stone patients and explores potential contributing factors.
A retrospective review of ...medical records at the University of Rochester Medical Center was conducted on 2199 new urolithiasis patients who completed the Wisconsin Stone Quality of Life Questionnaire (WISQOL) standardized on a 0 to 100 scale. Demographic and clinical data were collected. Statistical analyses included univariate tests, chi-squared tests, and multivariate linear regression.
Of the 2199 kidney stone patients, 1085 (49.3%) were women. Women reported significantly lower quality of life (QoL) scores compared with men (71.6
80.7;
< 0.001), and this persisted across all domains, including social impact (80.2
86.9;
< 0.001), emotional impact (67.3
77.1;
< 0.001), disease impact (67.3
77.1;
< 0.001), and impact vitality (62.6
72.9;
< 0.001). Female gender was identified as an independent predictor of diminished QoL scores, along with younger age, symptomatic status, number of surgeries, and presence of a psychosocial comorbidity.
Our findings suggest that women with kidney stones experience lower HRQOL compared with men, even accounting for clinical and demographic factors. Although this study provides preliminary insights, additional research is needed to validate these findings in broader and more varied populations.
Emphysematous pyelonephritis (EPN) developing in the contralateral kidney after ureteroscopic laser lithotripsy is an unusual clinical presentation and has never been reported in the literature. ...After ensuring sterile urine culture a 73-year-old female underwent left ureteroscopy, laser lithotripsy and stent placement for 15mm lower calyceal renal calculus. She was discharged same day and stent removed after 4 days. 1 week later she was admitted with sepsis and found to have EPN in the right kidney, with no evidence of stone or infection in the operated kidney. High index of clinical suspicion and prompt management resulted in successful outcome.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To present a robot-assisted surgical technique for overcoming challenges of a patient with prior pelvic surgeries and bowel in the radiation target.
A 72-year-old male required treatment for ...biochemically recurrent prostate cancer. In 2006, he presented with Prostate-Specific Antigen (PSA) 5.74 ng/mL, Gleason 3 + 3 prostate cancer. He underwent a robot-assisted radical prostatectomy for pT2aNx adenocarcinoma with negative margins. In 2008, he was found to have muscle-invasive high-grade papillary urothelial carcinoma and underwent robot-assisted radical cystectomy and ileal conduit for pT2bN0 urothelial carcinoma. In 2017, he had prostate cancer biochemical recurrence, with a PSA of 0.27 ng/mL. Pelvic CT showed small bowel in his prostatic bed behind the pubic bone. A robot-assisted lysis of adhesions and placement of a tissue expander in the prostatic fossa was performed. Three robotic ports and 1 assistant port were utilized. The sigmoid and small bowel were displaced during lysis of adhesions. The deflated tissue expander was inserted through the midline trocar site, inflated intra-abdominally, and filled with 330 cc of saline. The tissue expander was secured with proline sutures in a dependent position. The patient subsequently underwent Intensity-modulated radiation therapy of 66 Gy to the prostatic fossa. Eleven days after finishing intensity-modulated radiation therapy, he underwent successful laparoscopic removal of the tissue expander. PSA nadir was <0.02 ng/mL.
The patient tolerated intensity-modulated radiation therapy without complications. There were no gastrointestinal complaints following radiation therapy.
Robotic placement of a tissue expander in patients who have undergone multiple pelvic surgeries is feasible and may reduce radiation morbidity.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Urology has seen shifts in the management of many urologic conditions with the advent of noninvasive procedures that rely on multidisciplinary radiological modalities. This study seeks to analyze ...changes in urologists, radiologists, and advanced practice providers (APPs) performing uroradiology procedures over time.
The Centers for Medicare & Medicaid Services Physician/Procedure Summary data from 2010 to 2021 were utilized to examine uroradiology Current Procedural Terminology codes billed by urologists, radiologists, and APPs. Percent of total reimbursement and higher volume procedure count (after excluding providers with <11 procedures by per year) by each provider field was calculated and analyzed for changes in distribution from 2010 to 2021.
There were significant changes in all procedures when examining procedure reimbursement distribution in 2010 to 2021 (
< .001). During the period, urology saw decreases in reimbursement proportion as large as 28.7% for kidney cryoablation and increases as large as 14.2% for nephrostomy tube removals. Radiology saw the largest decreases in reimbursement proportion with an 18.9% decrease for nephrostograms, while the largest increase was 23.6% for suprapubic tube placements. APPs saw the largest increase in suprapubic tube changes reimbursement proportion, which rose 14.2% from 2010 to 2021. There were significant changes in proportion in all procedures, except for antegrade stent, renal cryoablation, renal biopsy, and renal thermoablation.
Uroradiology procedures have seen shifts in the distribution of which provider type performs each procedure. Most large changes in reimbursement and procedure proportion were shifted between urology and radiology, with APPs seeing smaller changes.
The impact of Medicare reimbursement changes on urology office visit reimbursements has not been fully examined. This study aims to analyze the impact of urology office visit Medicare reimbursements ...from 2010 to 2021, with a focus on 2021 Medicare payment reforms.
The Centers for Medicare and Medicaid Services Physician/Procedure Summary data from 2010-2021 were utilized to examine office visit CPT (Current Procedural Terminology) new patient visit codes 99201-99205 and established patient visit codes 99211-99215 by urologists. Mean office visit reimbursements (2021 USD), CPT specific reimbursements, and proportion of level of service were compared.
The 2021 mean visit reimbursement was $110.95, up from $99.42 in 2020 and $94.44 in 2010 (both
001). From 2010 to 2020, all CPT codes, except for 99211, had a decrease in mean reimbursement. From 2020 to 2021, there was an increase in mean reimbursement for CPT codes 99205, 99212-99215 and decreases in 99202, 99204 and 99211 (
001). New and established patient urology office visits had significant migration of billing codes from 2010 to 2021 (
001). New patient visits were most commonly as 99204, which increased from 47% in 2010 to 65% in 2021 (
001). The most commonly billed established patient urology visit was 99213 until 2021 when 99214 became the most common at 46% (
001).
Urologists have seen increases in mean reimbursements for office visits both before and after the 2021 Medicare payment reform. Contributing factors consist of increased established patient visit reimbursements despite decreased new patient visit reimbursements, and changes in level of CPT code billings.
This study aimed to investigate the association between social vulnerability, as measured by the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI), and the quality of life ...(QoL) of kidney stone patients using the validated Wisconsin Stone Quality of Life Questionnaire (WISQOL).
A retrospective analysis was conducted on medical records of new urolithiasis patients who completed the WISQOL at the University of Rochester Medical Center kidney stone clinic. The primary outcome was WISQOL score, which was measured across multiple domains. SVI was used to assess social vulnerability. Neighborhoods with high SVI were defined by a threshold greater than or equal to the 75th percentile nationally. Demographic and clinical data were collected. Statistical analyses, including univariate tests and multivariate linear regression, were performed to evaluate the relationships between social vulnerability and disease-specific QoL.
A total of 1718 patients were included in the study. One hundred five subjects (6.1%) were from neighborhoods of high social vulnerability. Patients residing in neighborhoods with high social vulnerability (SVI quartile) reported significantly lower QoL scores (69.1 vs 77.2;
= .001) and this persisted across all domains, including social impact (32.6 vs 35.1;
= .002), emotional impact (25.2 vs 27.5;
= .006), disease impact (28.5 vs 31.4;
= .001), and vitality (10.3 vs 11.2;
= .015). Younger age, female sex, and higher number of comorbidities were identified as independent predictors of lower QoL scores. However, non-White race and Latinx ethnicity did not exhibit a significant association with QoL scores.
These findings highlight the negative impact of high social vulnerability on QoL, emphasizing the importance of considering socioeconomic factors in patient care. These results emphasize the need for targeted interventions to support vulnerable populations. While this study offers initial insights, further research is essential to corroborate these outcomes across larger and more diverse populations.
