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Cost and effectiveness of different treatment alternatives in urinary stone practice.

https://arctichealth.org/en/permalink/ahliterature213735
Source
Scand J Urol Nephrol. 1995 Dec;29(4):437-47
Publication Type
Article
Date
Dec-1995
Author
K. Lehtoranta
Author Affiliation
Department of Urology, Helsinki University Central Hospital, Finland.
Source
Scand J Urol Nephrol. 1995 Dec;29(4):437-47
Date
Dec-1995
Language
English
Publication Type
Article
Keywords
Cost-Benefit Analysis
Endoscopy - economics
Finland
Hospital Costs
Humans
Kidney Calculi - economics - therapy
Kidney Pelvis - surgery
Length of Stay - economics
Lithotripsy - economics
Nephrostomy, Percutaneous - economics
Patient Care Team - economics
Retrospective Studies
Ureteral Calculi - economics - therapy
Abstract
The cost and effectiveness of seventy-six consecutive percutaneous nephrolithotomy (PNL) procedures performed during the years 1990-1992, a sample of 425 ESWL patients with 675 treatments from 1991-1992, and 45 successive open pyelolithotomies (PL) performed before the advent of the new stone treatment techniques during the years 1981-1985, were studied for each of the treatment modalities. The costs were counted per patient and based on the cumulative charge of the procedures, cost for in-patient care, and treatment of additional procedures and operatively treated complications. The results showed that the great majority of ESWL patients were treated at a low cost and with few additional procedures and complications compared to PNL, particularly, when stones smaller than 20 mm were treated. Considering all the patients, the cumulative mean hospital cost per patient without the cost for the follow-up was as follows, FIM (pound): PL 33860(4200), PNL 63360(7860), and ESWL 17430(2160). The remarkable number of additional and auxiliary measures (including the pre- and post-operative ESWL procedures) resulted in considerable extra costs for the PNL patients until they were rendered stone-free. Another series comprising 42 successive patients with 48 stone basket procedures (SB) from the years 1981-1985 was retrospectively compared to 42 patients with 50 ureteroscopic stone extractions (URS) between January 1985 and April 1988 before the beginning of the ESWL practice in Finland as well as to 54 patients with 79 ESWL treatments for a lower ureteric stone during the years 1991-1992. The stone-free status after the three procedures until one month was 71, 66, and 60%, with no statistically significant difference. In the group of lower ureteric stones the cumulative mean hospital cost per patient was as follows, FIM (pound): SB 19520(2420), URS 17750(2200), and ESWL 17810(2210). Also in the treatment of lower ureteric stones, ESWL is an equally cost-effective method representing an alternative worth consideration, particularly for patients preferring a minimally invasive urinary stone treatment.
PubMed ID
8719361 View in PubMed
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Cost-effective laparoscopic pyeloplasty: single center experience.

https://arctichealth.org/en/permalink/ahliterature182701
Source
Int J Urol. 2003 Nov;10(11):563-8
Publication Type
Article
Date
Nov-2003
Author
Ashok Kumar Hemal
Rajiv Goel
Apul Goel
Author Affiliation
Department of Urology, All India Institute of Medical Sciences, New Delhi, India. akhemal@hotmail.com
Source
Int J Urol. 2003 Nov;10(11):563-8
Date
Nov-2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Child
Cost-Benefit Analysis
Female
Follow-Up Studies
Humans
Kidney Pelvis - surgery
Laparoscopy - economics - methods
Male
Middle Aged
Retroperitoneal Space - surgery
Treatment Outcome
Ureteral Obstruction - surgery
Urologic Surgical Procedures - economics - methods
Abstract
Laparoscopic pyeloplasty (LPP) is a minimally invasive treatment option for ureteropelvic junction (UPJ) obstruction. We report here our experience of performing cost-effective LPP on 24 patients at a single center.
Between October 1999 and March 2002, LPP was performed in 24 patients (17 male, seven female; age range 8-51 years) including two patients who had failed previous endourologic treatments. In two patients with concomitant renal stones, laparoscopic pyelolithotomy was also performed. LPP was conducted in a cost-reductive manner by both transperitoneal (n = 12) and retroperitoneal (n = 12) access. To reduce the cost, an indigenous balloon to create the retroperitoneal space, reusable ports, ordinary polyglactin suture and intracorporeal free-hand suturing were employed. To reduce operative time, antegrade stenting was also performed in some cases.
Laparoscopic Anderson-Hynes pyeloplasty was performed in 16, Foley Y-V pyeloplasty in five and Fenger pyeloplasty in three patients. One patient required conversion to open surgery due to tension at the anastomosis site during Anderson-Hynes pyeloplasty. The mean operating time, blood loss, analgesic (pethidine) requirement, duration of drain and hospital stay for the retroperitoneal and transperitoneal groups were 170.3 and 187.6 min, 102.2 and 145.9 mL, 125 and 136.4 mg, 2.1 and 2.5 days, and 3.4 and 4.3 days, respectively. No significant complications were encountered apart from prolonged ileus in three patients in the transperitoneal group. The mean follow-up period was 10.8 months with a range of 2-24 months. Postoperative renal scan was performed at 3 months in 21 patients, and 1 year in 11 patients. There was evidence of equivocal obstruction in one patient, but there were no obstructions in the remaining patients.
Although LPP is technically demanding, it is emerging as a viable, minimally invasive alternative to open pyeloplasty for UPJ obstruction with a success rate similar to that of open pyeloplasty. It allows the duplication of open surgery steps (unlike endoscopic procedures), thereby providing durable and sustained results. LPP can also be performed safely, effectively and efficiently in a cost-efficient manner.
PubMed ID
14633078 View in PubMed
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Early postoperative ultrasound after open pyeloplasty in children with prenatal hydronephrosis helps identify low risk of recurrent obstruction.

https://arctichealth.org/en/permalink/ahliterature119565
Source
J Urol. 2012 Dec;188(6):2347-53
Publication Type
Article
Date
Dec-2012
Author
Rodrigo L P Romao
Walid A Farhat
Joao L Pippi Salle
Luis H P Braga
Victor Figueroa
Darius J Bägli
Martin A Koyle
Armando J Lorenzo
Author Affiliation
Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Source
J Urol. 2012 Dec;188(6):2347-53
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Age Factors
Cohort Studies
Confidence Intervals
Female
Fetal Diseases - surgery - ultrasonography
Follow-Up Studies
Hospitals, Pediatric
Humans
Hydronephrosis - surgery - ultrasonography
Infant
Kidney Pelvis - surgery - ultrasonography
Male
Ontario
Postoperative Care - methods
Predictive value of tests
Pregnancy
Preoperative Care - methods
ROC Curve
Recurrence - prevention & control
Retrospective Studies
Risk assessment
Severity of Illness Index
Time Factors
Treatment Outcome
Ultrasonography, Doppler - methods
Ultrasonography, Prenatal - methods
Urologic Surgical Procedures - methods
Abstract
Prediction of successful pyeloplasty can be challenging, particularly in asymptomatic children treated for worsening prenatally diagnosed hydronephrosis. We evaluated early noninvasive objective predictors of success in this population.
We reviewed patients who underwent pyeloplasty for asymptomatic, prenatally detected, worsening hydronephrosis treated between 2000 and 2010 with followup greater than 1 year. For all patients renal pelvis anteroposterior diameter in a mid transverse view and Society for Fetal Urology hydronephrosis grade were evaluated preoperatively and 3 to 4 months postoperatively. Aside from subjective evaluation based on change in hydronephrosis grade, we estimated the percentage of improvement in anteroposterior diameter (preoperative diameter--postoperative diameter/preoperative diameter). Repeat intervention after pyeloplasty arbitrarily defined failure. Patients were categorized into 3 groups, ie no failure on followup ultrasound (group 1), no failure with postoperative nuclear scan to document success (group 2) and failed pyeloplasty (group 3). ROC curves were plotted to correlate 4 variables with failure, namely preoperative anteroposterior diameter, postoperative anteroposterior diameter, percent improvement in anteroposterior diameter and subjective change in grade.
Of 229 patients 192 (84%) who met inclusion criteria had ultrasound at 3 to 4 months postoperatively available. Mean age at surgery was 19 months and mean ± SD followup was 49.9 ± 27.7 months. Percent improvement in anteroposterior diameter and postoperative anteroposterior diameter measure were the most reliable variables to predict failure (AUC 0.88 and 0.86, respectively, p 0.05). A percent improvement in anteroposterior diameter of 38% or greater or postoperative anteroposterior diameter of 11.5 mm or less was associated with success, with sensitivity of 100% and specificity of 61% and 55%, respectively.
Percent improvement in anteroposterior diameter and postoperative pelvic anteroposterior diameter measure can provide objective guidance as to which patients need closer monitoring during followup, and can help select children at low risk for repeat intervention after pyeloplasty.
PubMed ID
23088981 View in PubMed
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Outcome analysis and cost comparison between externalized pyeloureteral and standard stents in 470 consecutive open pyeloplasties.

https://arctichealth.org/en/permalink/ahliterature155638
Source
J Urol. 2008 Oct;180(4 Suppl):1693-8; discussion1698-9
Publication Type
Article
Date
Oct-2008
Author
Luis H P Braga
Armando J Lorenzo
Walid A Farhat
Darius J Bägli
Antoine E Khoury
Joao L Pippi Salle
Author Affiliation
Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario Canada.
Source
J Urol. 2008 Oct;180(4 Suppl):1693-8; discussion1698-9
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Adult
Anesthesia, General
Decision Trees
Drainage - economics - instrumentation
Female
Hospital Costs
Humans
Kidney Pelvis - surgery
Length of Stay
Male
Ontario
Operating Rooms - economics
Retrospective Studies
Stents - economics
Treatment Outcome
Ureteral Obstruction - surgery
Urologic Surgical Procedures - economics - instrumentation - methods
Abstract
Despite the widespread use of ureteral stents for pyeloplasty by pediatric urologists there is ongoing controversy regarding the most advantageous type of transanastomotic drainage. We compared patients who underwent placement of an externalized pyeloureteral Salle intraoperative pyeloplasty stent (Cook Urological, Spencer, Indiana) to those who had a standard Double-J ureteral stent placed to assess the benefits, drawbacks and costs of each modality during open pyeloplasty.
Our study sample comprised 470 age matched children who underwent primary open pyeloplasty in an 11-year period. A total of 242 patients (51.5%) underwent Double-J ureteral stent insertion and 228 (48.5%) underwent placement of a Salle intraoperative pyeloplasty stent at surgery. Operative time, hospital stay, overall complication and success rates, type of complications and hospital costs were compared between the 2 groups.
Median age was 18 months and median followup was 39 months. Mean hospital stay was 3.0 and 3.1 days in children with a Double-J ureteral and a Salle intraoperative pyeloplasty stent, respectively (p = 0.7). The overall complication rate was 9.9% (24 of 242 patients) for the Double-J ureteral stent vs 8.3% (19 of 228) for the Salle intraoperative pyeloplasty stent (p = 0.6). Complications in patients with a Double-J ureteral stent consisted of urinoma in 3, return visits due to bladder spasms in 7 or catheter obstruction in 6 and readmission due to pyelonephritis in 5. Complications in children with a Salle intraoperative pyeloplasty stent involved urinoma in 1, prolonged drainage through the Penrose drain in 5 and readmission due to pyelonephritis in 1. Recurrent ureteropelvic junction obstruction developed in 12 cases per group. The success rate was 95.0% (230 of 242 cases) and 94.7% (216 of 228) for the Double-J ureteral and the Salle intraoperative pyeloplasty stent, respectively (p = 0.2). Hospital charges, including the surgical procedure, postoperative hospitalization and cystoscopy or a clinical visit for catheter removal, in patients with a Double-J ureteral and a Salle intraoperative pyeloplasty stent were $9,825 and $9,260, respectively.
The 2 ureteral stents are equivalent in regard to overall complication and success rates after pyeloplasty. However, Salle intraoperative pyeloplasty stent insertion was associated with a Canadian $565 cost decrease per patient and most importantly the preclusion of a second general anesthesia for catheter removal.
Notes
Comment In: J Urol. 2009 Jul;182(1):399-40019467676
PubMed ID
18708220 View in PubMed
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Percutaneous antegrade endopyelotomy: long-term results from one institution.

https://arctichealth.org/en/permalink/ahliterature181457
Source
Urology. 2004 Feb;63(2):230-4
Publication Type
Article
Date
Feb-2004
Author
Bodo E Knudsen
Anthony J Cook
James D Watterson
Darren T Beiko
Linda Nott
Hassan Razvi
John D Denstedt
Author Affiliation
Division of Urology, University of Western Ontario, London, Ontario, Canada.
Source
Urology. 2004 Feb;63(2):230-4
Date
Feb-2004
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Catheterization
Child
Child, Preschool
Device Removal
Female
Follow-Up Studies
Humans
Kidney Pelvis - surgery
Laser Therapy
Male
Middle Aged
Nephrostomy, Percutaneous
Ontario
Retrospective Studies
Stents
Treatment Outcome
Ureteral Obstruction - surgery
Urinary Catheterization
Abstract
To assess the long-term efficacy of percutaneous antegrade endopyelotomy for the treatment of ureteropelvic junction (UPJ) obstruction performed at a single institution during a 10-year period. We provide alterations in investigation and management strategies on the basis of the results.
From July 1990 to June 2001, 80 patients with clinical and radiographic evidence of UPJ obstruction underwent percutaneous endopyelotomy for the treatment of primary (n = 61) or secondary (n = 19) UPJ obstruction. The mean patient age was 35 years (range 4 to 76). Percutaneous endopyelotomy was performed in a standard fashion using either a hooked-knife (n = 77) or holmium laser (n = 3).
With a mean patient follow-up of 55 months (range 16 to 138), the overall success rate was 67% (53 of 79). The success rate for primary and secondary UPJ obstruction was 65% (39 of 60) and 74% (14 of 19), respectively. The mean time to failure was 15 months (range 1 to 79). Operative intervention for 24 of 26 patients with failure included open pyeloplasty (n = 18, 75%), indwelling ureteral stenting (n = 2, 8%), retrograde balloon dilation (n = 1, 4%), and nephrectomy (n = 3, 13%). Two asymptomatic patients with recurrent radiographic evidence of obstruction elected conservative follow-up. Significant crossing vessels were encountered at open pyeloplasty in 15 (83%) of 18 patients.
Our long-term results of percutaneous endopyelotomy demonstrated somewhat lower success rates than that reported in published studies. Long-term follow-up is critical in identifying late failures. The high prevalence of crossing vessels encountered at open pyeloplasty provided further evidence to support its role in endopyelotomy failure. Routine preoperative helical computed tomography to detect significant crossing vessels is recommended. Patients with crossing vessels are likely better served with operative techniques that specifically address this issue, namely open or laparoscopic pyeloplasty.
PubMed ID
14972459 View in PubMed
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Practice trends in contemporary management of adult ureteropelvic junction obstruction.

https://arctichealth.org/en/permalink/ahliterature184710
Source
Urology. 2003 Jul;62(1):22-5; discussion 25-6
Publication Type
Article
Date
Jul-2003
Author
Robert Marcovich
Avrum I Jacobson
Joel P A Aldana
Benjamin R Lee
Arthur D Smith
Author Affiliation
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040-1496, USA.
Source
Urology. 2003 Jul;62(1):22-5; discussion 25-6
Date
Jul-2003
Language
English
Publication Type
Article
Keywords
Academic Medical Centers - statistics & numerical data
Adult
Canada
Case Management - statistics & numerical data - trends
Health Surveys
Humans
Kidney Pelvis - surgery
Laparoscopy - utilization
Physician's Practice Patterns - statistics & numerical data - trends
Societies, Medical
United States
Ureteral Obstruction - surgery
Urologic Surgical Procedures - trends - utilization
Urology
Abstract
To determine current practice patterns in the surgical treatment of ureteropelvic junction obstruction in the United States and Canada.
An e-mail survey was sent to 56 academic endourologists regarding the number of procedures performed in the previous year for ureteropelvic junction obstruction, factors considered in the choice of procedure, and whether community urologists in their area were performing laparoscopic pyeloplasty or endopyelotomy.
The response rate was 66% (37 of 56). More respondents were performing endopyelotomy (91%) than laparoscopic pyeloplasty (51%), and nearly one half were performing open pyeloplasty. The mean number of procedures performed by respondents in the previous year was 9.5 endopyelotomies, 4 laparoscopic pyeloplasties, and 2.5 open pyeloplasties. A number of factors had an impact on the practitioners' choice of procedure, including the presence of a crossing vessel and massive hydronephrosis, secondary ureteropelvic junction obstruction, the surgeon's training, procedure cost, operative time, expected success rate, degree of invasiveness, and patient preference. Nearly one fifth of respondents said they would choose laparoscopic pyeloplasty as first-line therapy regardless of anatomic considerations. Seventy-eight percent stated that community urologists in their area were performing endopyelotomy routinely or occasionally compared with only 3% who stated community urologists in their area were performing laparoscopic pyeloplasty.
Laparoscopic pyeloplasty is still in its early stages. Although laparoscopic pyeloplasty has a greater success rate, endopyelotomy continues to be more commonly performed in academic centers. Laparoscopic pyeloplasty has not yet made significant inroads into community practice. Several factors, especially the surgeons' training, have an impact on the choice of procedure. Open pyeloplasty is still performed by a significant number of academic endourologists.
PubMed ID
12837413 View in PubMed
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7 records – page 1 of 1.