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Wang M, Lai CH, Ji J, Hu H, Ni R, Liu J, Yu L, Hu H. Association of health-related quality of life with urinary tract infection among kidney stone formers. Urolithiasis 2024; 52:103. [PMID: 38960942 PMCID: PMC11222279 DOI: 10.1007/s00240-024-01601-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024]
Abstract
Kidney stones and infections significantly affect patients' health-related quality of life (HRQOL); however, the relationship between urinary tract infections (UTIs) and HRQOL in patients with kidney stones remains unclear. This study aimed to investigate the relationship using the validated Chinese version of the Wisconsin Stone Quality of Life questionnaire (C-WISQOL). We prospectively recruited 307 patients with kidney stones to complete the C-WISQOL before and after stone removal. The participants were diagnosed with UTI based on the presence of pyuria or bacteriuria with or without clinical symptoms. The psychometric properties of the C-WISQOL were statistically analyzed. Multivariate linear regression was used to predict the risk factors for impaired HRQOL in patients with stones and UTIs. The questionnaire is a reliable and robust tool for evaluating HRQOL in Chinese-speaking patients with urolithiasis. The UTI and kidney stone co-occurrence was significantly associated with female sex, diabetes mellitus, more previous stone events, higher antibiotic usage, positive stone- or UTI-related symptoms, and postoperative residual stones. The preoperative C-WISQOL scores and improvement in the HRQOL after stone removal in patients clinically diagnosed with UTI were significantly inferior to those in patients without UTI. The regression analyses showed that worse HRQOL was predicted by more previous stone events and positive stone- or UTI-related symptoms. In contrast, the presence of diabetes mellitus and postoperative residual stone fragments predicted a lower improvement in the HRQOL. These findings underscore UTI's harmful impact on perioperative HRQOL in patients with kidney stones and could help strategies benefit those patients.
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Affiliation(s)
- Mingrui Wang
- Department of Urology, Peking University People's Hospital, Beijing, China
- The institute of applied lithotripsy technology, Peking University, Beijing, China
| | - Chin-Hui Lai
- Department of Urology, Peking University People's Hospital, Beijing, China
- The institute of applied lithotripsy technology, Peking University, Beijing, China
| | - Jiaxiang Ji
- Department of Urology, Peking University People's Hospital, Beijing, China
- The institute of applied lithotripsy technology, Peking University, Beijing, China
| | - Haopu Hu
- Department of Urology, Peking University People's Hospital, Beijing, China
- The institute of applied lithotripsy technology, Peking University, Beijing, China
| | - Runfeng Ni
- Department of Urology, Peking University People's Hospital, Beijing, China
- The institute of applied lithotripsy technology, Peking University, Beijing, China
| | - Jun Liu
- Department of Urology, Peking University People's Hospital, Beijing, China
- The institute of applied lithotripsy technology, Peking University, Beijing, China
| | - Luping Yu
- Department of Urology, Peking University People's Hospital, Beijing, China
- The institute of applied lithotripsy technology, Peking University, Beijing, China
| | - Hao Hu
- Department of Urology, Peking University People's Hospital, Beijing, China.
- The institute of applied lithotripsy technology, Peking University, Beijing, China.
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Okada T, Hamamoto S, Taguchi K, Okada S, Inoue T, Ando R, Okada A, Yasui T. Quality of life after urinary stone surgery based on Japanese Wisconsin Stone Quality of Life questionnaire: multicenter analysis from SMART study group. Urolithiasis 2023; 51:113. [PMID: 37707652 DOI: 10.1007/s00240-023-01486-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Abstract
We aimed to evaluate the impact of surgical treatment for urinary stones on perioperative health-related quality of life (HRQOL) using the Japanese Wisconsin Stone Quality of Life questionnaire (J-WISQOL), an HRQOL measure designed for patients with urinary stones. This study prospectively enrolled 123 patients with urinary stones who visited three academic hospitals for stone treatment. The participants completed the J-WISQOL within 4 weeks before and after the urinary stone treatment. Treatments included shock wave lithotripsy (SWL), ureteroscopy lithotripsy, and endoscopic combined intrarenal surgery. J-WISQOL was assessed for age, stone size and location, type of treatment, stone-free status, postoperative ureteral stent placement, hospital stay, and complications in all patients. Patients with stones in the ureter had significantly greater social impact D1 and disease impact D3 than those with stones in the kidney. In a comparison of pre- and postoperative J-WISQOL, patients without postoperative ureteral stent placement scored significantly higher on social impact D1 and disease impact D3. Patients with shorter hospital stays had significantly higher social impact D1 and disease impact D3 (p < 0.001) than those with longer hospital stays. SWL significantly improved the total score, social impact D1, and disease impact D3 compared with other treatments. Perioperative HRQOL in patients with urinary stones is particularly affected by the type of treatment, ureteral stent placement, and hospital stay, which should be considered in surgical selection and patient decision-making.
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Affiliation(s)
- Tomoki Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Shinsuke Okada
- Department of Urology, Gyotoku General Hospital, Chiba, Japan
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Hospital, Hyogo, Japan
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
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Li S, Knoedler MA, Haas CR, Nakada SY, Penniston KL. Development and Preliminary Validation of the 6-Item Short Form of the Wisconsin Stone Quality of Life Questionnaire. Urology 2023; 177:48-53. [PMID: 37031845 DOI: 10.1016/j.urology.2023.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE To develop a short form of the Wisconsin Stone Quality of Life (WISQOL): 1) identify the smallest subset of items from WSIQOL that accurately predict patients' health-related quality of life (HRQOL), and 2) in a clinical patient population, test these items-grouped together to form the WISQOL-short form (SF) - and assess its convergent validity. MATERIALS AND METHODS The items for the WISQOL-SF were identified based on classic item analysis theory. Patients who previously completed the original 28-item WISQOL were randomly split into 2 groups of equal size. Scores for the WISQOL were calculated for one group while those for the WISQOL-SF were calculated for the other. Cronbach's alpha coefficients were calculated. Impacts of demographic and clinical factors as well as stone and symptom status at the time of WISQOL completion were examined. RESULTS Patients (n = 740) who completed the WISQOL between 6/2017 and 11/2021 were included. Patients were 48% male, 54.1 ± 14.6 years old, and had a BMI of 31.2 ± 8.1. After item analysis and reduction, the six items ultimately included in the WISQOL-SF represented 2 of the 4 domains (social and emotional) of the original WISQOL. The internal consistency of the WISQOL-SF was similar to the original (Cronbach's alpha 0.943 vs. 0.973). No differences for health-related quality of life were found between groups (P = .567). CONCLUSION The WISQOL-SF demonstrated the expected differences for gender and between patients with and without stone-related symptoms at the time of WISQOL completion. The WISQOL-SF showed good consistency and produced similar HRQOL scores to the full-form WISQOL.
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Affiliation(s)
- Shuang Li
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Margaret A Knoedler
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Christopher R Haas
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kristina L Penniston
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Wong DG, Monda S, Vetter J, Lai H, Olsen MA, Keller M, Desai A. Time Course and Risk Factors for Repeat Procedures After Ureteroscopy or Shockwave Lithotripsy. Urology 2023; 174:42-47. [PMID: 36574909 PMCID: PMC10494519 DOI: 10.1016/j.urology.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/14/2022] [Accepted: 12/14/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine risk factors and time course for repeat procedures after ureteroscopy (URS) or shockwave lithotripsy (SWL) procedure using a large employer-based claims database. METHODS We identified all patients who underwent treatment for ureteral or renal stone with URS or SWL from January 1, 2007 to December 31, 2014 using the IBM MarketScan Commercial Database. Repeat stone procedure was evaluated after a 90-day grace period from the index procedure. Patients were followed until December 31, 2017. We performed multivariate analyses using Cox proportional hazards to determine independent risk factors for repeat procedure after the initial stone removal. RESULTS A total of 189,739 patients underwent a SWL or URS and were included in the study. The incidence of repeat procedure per 100 person years was 6.8, and 4.4 after SWL and URS, respectively. The median time to reoperation was 12.5 months for SWL and 14.6 months for URS. On multivariable analysis, SWL was associated with an increased risk of repeat procedure compared to URS. (HR = 1.63). Paralysis, neurogenic bladder and inflammatory bowel disease were also associated with an increased risk of repeat procedure (HR = 1.66, 1.40, and 1.36 respectively) CONCLUSION: In a large national cohort, patients with paralysis and neurogenic bladder had a significantly higher risk of repeat stone procedure. SWL was associated with higher risk of repeat procedure than URS. Urologists can use these data to identify and counsel patients at high risk for need for recurrent procedure.
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Affiliation(s)
- Daniel G Wong
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO.
| | - Steve Monda
- Department of Urologic Surgery, University of California Davis School of Medicine, Sacramento, CA
| | - Joel Vetter
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Henry Lai
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Margaret A Olsen
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Matthew Keller
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Alana Desai
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
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Gauhar V, Castellani D, Chew BH, Smith D, Chai CA, Fong KY, Teoh JYC, Traxer O, Somani BK, Tailly T. Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group. Ther Adv Urol 2023; 15:17562872231198629. [PMID: 37701535 PMCID: PMC10493056 DOI: 10.1177/17562872231198629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background Assessment of residual fragments (RFs) is a key step after treatment of kidney stones. Objective To evaluate differences in RFs estimation based on unenhanced computerized tomography (CT) versus X-rays/ultrasound after retrograde intrarenal surgery (RIRS) for kidney stones. Design A retrospective analysis of data from 20 centers of adult patients who had RIRS was done (January 2018-August 2021). Methods Exclusion criteria: ureteric stones, anomalous kidneys, bilateral renal stones. Patients were divided into two groups (group 1: CT; group 2: plain X-rays or combination of X-rays/ultrasound within 3 months after RIRS). Clinically significant RFs (CSRFs) were considered RFs ⩾ 4 mm. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Multivariable logistic regression analysis was performed to evaluate independent predictors of CSRFs. Results A total of 5395 patients were included (1748 in group 1; 3647 in group 2). After matching, 608 patients from each group with comparable baseline and stone characteristics were included. CSRFs were diagnosed in 1132 patients in the overall cohort (21.0%). Post-operative CT reported a significantly higher number of patients with RFs ⩾ 4 mm, before (35.7% versus 13.9%, p < 0.001) and after matching (43.1% versus 23.9%, p < 0.001). Only 21.8% of patients in the matched cohort had an ancillary procedure post-RIRS which was significantly higher in group 1 (74.8% versus 47.6%, p < 0.001). Age [OR 1.015 95% confidence interval (CI) 1.009-1.020, p < 0.001], stone size (OR 1.028 95% CI 1.017-1.040, p < 0.001), multiple stones (OR 1.171 95% CI 1.025-1.339, p = 0.021), lower pole stone (OR 1.853 95% CI 1.557-2.204, p < 0.001) and the use of post-operative CT scan (OR 5.9883 95% CI 5.094-7.037, p < 0.001) had significantly higher odds of having CSRFs. Conclusions CT is the only reliable imaging to assess the burden of RFs following RIRS and urologist should consider at least one CT scan to determine the same and definitely plan reintervention only based on CT rather than ultrasound and X-ray combination.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, Ancona 60126, Italy
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | - Daron Smith
- Institute of Urology, University College Hospital London, London, UK
| | - Chu Ann Chai
- Urology Unit, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
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Girgiss C, Berger J, Chen TT, Kelly EM, Kong EK, Flores AR, Abedi G, Bechis SK, Monga M, Sur RL. Standardizing perioperative medications to be used in an enhanced recovered after surgery (ERAS) program is feasible in percutaneous nephrolithotomy patients. J Endourol 2022; 36:1265-1270. [PMID: 35545870 DOI: 10.1089/end.2022.0153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The objective of this process improvement project was to determine the effect of enhanced recovery after surgery (ERAS) protocol for percutaneous nephrolithotomy (PCNL) patients with respect to quality of life and pain management in the post-operative recovery period. METHODS An electronic-based medical record ERAS orders protocol for PCNL was instituted at an academic medical center in July of 2020. The protocol utilized a pain control regimen designed to minimize opioid medication use post-operatively. We prospectively evaluated PCNL patients' quality of life via the Wisconsin Stone Quality of Life survey (WISQOL) and Patient-Reported Outcomes Measurement System (PROMIS) at routine perioperative visits. To assess any opioid reduction benefit of the ERAS protocol, we reviewed an age-matched historical cohort n = 66 (prior to ERAS implementation) to serve as a comparison cohort with respect to opioid usage. RESULTS After an inception cohort of 95 patients, 55 ERAS patients remained available for assessment with the WISQOL and PROMIS surveys. In comparison to the non-ERAS cohort, the ERAS cohort represented larger stones, more supine positioning, higher blood loss, shorter hospital stay and more use of access sheath. ERAS patients received a significantly lower amount of opioids compared to non-ERAS patients upon discharge narcotic usage (116.13 morphine milliequivalent (MME) vs. 39.57 MME, p=0.0001). Compared to their pre-operative evaluation, the ERAS cohort had significantly improved quality of life scores at 1 week which sustained through 8 weeks post-operatively. Moreover, pain intensity and pain interference scores were improved at 8 weeks post-operatively for ERAS patients compared to their pre-operative time point. CONCLUSIONS We demonstrate that standardizing medications in early efforts towards a PCNL ERAS protocol is feasible and allows for reduced opioid use by patients while achieving early and sustained post-procedure quality of life.
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Affiliation(s)
- Carol Girgiss
- University of California San Diego School of Medicine, 12220, 9400 Campus Point Dr., La Jolla, California, United States, 92037;
| | - Jonathan Berger
- UC San Diego, 8784, Urology, San Diego, California, United States;
| | - Tony T Chen
- University of California San Diego School of Medicine, 12220, La Jolla, California, United States;
| | - Erika M Kelly
- University of California San Diego School of Medicine, 12220, La Jolla, California, United States;
| | - Emily K Kong
- UC San Diego, 8784, Urology, 915 Quintara St, San Francisco, California, United States, 94116;
| | - Alec R Flores
- University of California San Diego School of Medicine, 12220, La Jolla, California, United States;
| | - Garen Abedi
- University of California Irvine, 8788, Urology, 333 The City Blvd W., Suite 2100, Orange, California, United States, 92868;
| | - Seth K Bechis
- University of California San Diego Health System, 21814, Urology, San Diego, California, United States;
| | - Manoj Monga
- University of California San Diego, 8784, Urology, 200 w arbor dr, San Diego, California, United States, 92103;
| | - Roger L Sur
- UC San Diego, 8784, Urology, Department of Urology, 200 Arbor Drive #8897, San Diego, California, United States, 92130.,UC San Diego, 8784, Roger Sur, Department of Urology, 200 Arbor Drive #8897, San Diego, California, United States, 92130;
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Wymer KM, Sharma V, Juvet T, Klett DE, Borah BJ, Koo K, Rivera M, Agarwal D, Humphreys MR, Potretzke AM. Cost-effectiveness of Retrograde Intrarenal Surgery, Standard and Mini Percutaneous Nephrolithotomy, and Shock Wave Lithotripsy for the Management of 1-2cm Renal Stones. Urology 2021; 156:71-77. [PMID: 34274389 DOI: 10.1016/j.urology.2021.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/01/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To perform a cost-effectiveness evaluation comparing the management options for mid-size (1-2cm) renal stones including percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and shockwave lithotripsy (SWL). METHODS A Markov model was created to compare cost-effectiveness of PCNL, mini-PCNL, RIRS, and SWL for 1-2cm lower pole (index patient 1) and PCNL, RIRS, and SWL for 1-2 cm non-lower pole (index patient 2) renal stones. A literature review provided stone free, complication, retreatment, secondary procedure rates, and quality adjusted life years (QALYs). Medicare costs were used. The incremental cost-effectiveness ratio (ICER) was compared with a willingness-to-pay(WTP) threshold of $100,000/QALY. One-way and probabilistic sensitivity analyses were performed. RESULTS At 3 years, costs for index patient 1 were $10,290(PCNL), $10,109(mini-PCNL), $5,930(RIRS), and $10,916(SWL). Mini-PCNL resulted in the highest QALYs(2.953) followed by PCNL(2.951), RIRS(2.946), and SWL(2.943). This translated to RIRS being most cost-effective followed by mini-PCNL(ICER $624,075/QALY) and PCNL(ICER $946,464/QALY). SWL was dominated with higher costs and lower effectiveness. For index patient 2, RIRS dominated both PCNL and SWL. For index patient 1: mini-PCNL and PCNL became cost effective if cost ≤$5,940 and ≤$5,390, respectively. SWL became cost-effective with SFR ≥75% or cost ≤$1,236. On probabilistic sensitivity analysis, the most cost-effective strategy was RIRS in 97%, mini-PCNL in 2%, PCNL in 1%, and SWL in 0% of simulations. CONCLUSION For 1-2cm renal stones, RIRS is most cost-effective. However, mini and standard PCNL could become cost-effective at lower costs, particularly for lower pole stones.
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Affiliation(s)
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN; Department of Urology, David Geffen School of Medicine; University of California, Los Angeles, CA; Greater Los Angeles VA, Health Services Research and Development Program, Los Angeles, CA
| | | | - Dane E Klett
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Bijan J Borah
- Department of Health Services Research, Mayo Clinic, Rochester, MN
| | - Kevin Koo
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Deepak Agarwal
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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