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Edmonds VS, Wymer KM, Humphreys MR, Stern KL. Trends in Patient Complexity, Practice Setting, and Surgeon Reimbursement for Urolithiasis: Do Rural Urologists Pay the Price? Urology 2024; 192:30-35. [PMID: 39032796 DOI: 10.1016/j.urology.2024.07.027] [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: 03/08/2024] [Revised: 05/15/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To evaluate the relationship between patient complexity, practice setting, and surgeon reimbursement for ureteroscopy and percutaneous nephrolithotomy (PCNL). METHODS The "2021 Medicare Physician and Other Provider" file was used to collect Rural-Urban Commuting Area (RUCA) codes and hierarchical condition category (HCC) scores of urologists. Higher HCC score corresponds to higher medical complexity and higher RUCA code corresponds to a more rural area. Medicare reimbursement for ureteroscopy and PCNL were collected. Linear regressions were performed to predict change in reimbursement based on RUCA and HCC scores. RESULTS In 2021, 52,816 procedures under Current Procedural Terminology (CPT) code 52356 (ureteroscopy) and 1649 procedures under 50080 or 50081 (PCNL) were billed to Medicare. Mean reimbursement was $338.24 for ureteroscopy and $957.89 for PCNL. For ureteroscopy, higher HCC score predicted lower reimbursement (P <.001). Higher HCC score predicted higher reimbursement for PCNL (P <.01). Average RUCA for ureteroscopy was higher than for PCNL (P = .02). Rural location predicted lower reimbursement for ureteroscopy (P <.001), however, there was no association for PCNL. CONCLUSION For ureteroscopy, higher-risk patients are associated with lower reimbursement while the opposite holds true for PCNL. Rural practices were associated with lower reimbursement for ureteroscopy, but there was no association between location and PCNL reimbursement. Together, these findings suggest practice pattern variation between ureteroscopy and PCNL and highlight gaps in reimbursement policy. Risk-adjusted reimbursement should be considered to incentivize urologists to treat complex patients within their practice scope.
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Affiliation(s)
| | - Kevin M Wymer
- Mayo Clinic Minnesota, Department of Urology, Rochester, MN
| | | | - Karen L Stern
- Mayo Clinic Arizona, Department of Urology, Phoenix, AZ
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2
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Ahmed EM. Management of nephrolithiasis in the Middle East over a recent decade: A systematic review. Urol Ann 2024; 16:36-42. [PMID: 38415225 PMCID: PMC10896328 DOI: 10.4103/ua.ua_111_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/03/2023] [Accepted: 12/19/2023] [Indexed: 02/29/2024] Open
Abstract
Nephrolithiasis is a prevalent issue around the globe, particularly in hot climates such as Saudi Arabia. This analysis's objectives were to investigate the characteristics of kidney stones in Eastern Saudi Arabia and to provide the following findings: urinary stone composition, gender and age distribution, seasonal variations in stone formation, coexisting diseases linked to stone development, and urinary stone incidence. With comparisons to European and American populations, the primary risk factors for nephrolithiasis in Asian populations are to be determined through this systematic review and meta-analysis. We synthesized data from 13 geographically different studies using a thorough literature search through PubMed, ScienceDirect, and ResearchGate following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses criteria. Potential targets for specialized public health programs were highlighted by the elucidation of differences in health-care-seeking behavior and disparities in health-care access. The results of this systematic analysis give doctors, researchers, and policymakers a thorough understanding of the condition of nephrolithiasis care in Saudi Arabia today. In addition, to maximize the care of nephrolithiasis in this particular group, this review identifies information gaps and highlights the necessity of context-specific guidelines and future research initiatives. All things considered, this systematic review addresses the unique possibilities and problems that exist within the Saudi Arabian health-care sector while also adding to the worldwide conversation on nephrolithiasis.
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Affiliation(s)
- Ehab Mahmoud Ahmed
- Department of Urology, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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3
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Ghoulian J, Nourian A, Dalimov Z, Ghiraldi EM, Friedlander JI. Percutaneous Nephrolithotomy Access: A Meta-Analysis Comparing Access by Urologist vs Radiologist. J Endourol 2023; 37:8-14. [PMID: 36136905 DOI: 10.1089/end.2022.0308] [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] [Indexed: 01/10/2023] Open
Abstract
Introduction: Percutaneous nephrolithotomy is a minimally invasive procedure indicated for the management of staghorn calculi or renal calculi >2.0 cm. Percutaneous renal access is a critical step in this procedure and can be performed by either urologists or interventional radiologists. The purpose of this study is to perform a meta-analysis to compare outcomes between urologist and interventional radiologist-mediated access. Methods: An electronic literature search was conducted to identify studies comparing urologist- and interventional radiologist-acquired access. Studies must have included both urologist- and intervention radiologist-acquired access data but were excluded if (1) not in English; (2) abstract without full text; (3) unable to determine who acquired access; and (4) only included either urologist or interventional radiologist data. Meta-analysis comparison was generated with the Review Manager 5.4 software. Results: After screening the abstracts and title, 55 relevant studies were identified. Nine articles were utilized in the meta-analysis. Urologist-acquired access was associated with a greater stone-free rate (risk ratio [RR] = 1.10; 95% confidence interval [CI], 1.01-1.20), a reduction in major complications (RR = 0.69; 95% CI, 0.53-0.92), and a shorter hospital stay (mean difference -0.40; 95% CI, -0.64 to -0.16) in comparison with radiologist-acquired access. Urologist-acquired access was associated with greater blood loss (mean difference 0.46; 95% CI, 0.32-0.60) when compared with interventional radiology-acquired access. No significant differences were found with regard to unusable access, multiple tracts, supracostal access, ancillary procedure requirement, operative time, minor complications, and transfusions. Conclusions: Urologist-acquired access may be associated with a higher stone-free rate and a reduction in major complications, whereas interventional radiologist-mediated access may be associated with a reduction in blood loss, despite similar transfusion rates.
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Affiliation(s)
- Joshua Ghoulian
- Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
- Department of Urology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Alex Nourian
- Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Zafardjan Dalimov
- Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Eric M Ghiraldi
- Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
- Division of Urologic Oncology and Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Justin I Friedlander
- Department of Urology, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
- Division of Urologic Oncology and Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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Gebreselassie KH, Gebrehiwot FG, Hailu HE, Beyene AD, Hassen SM, Mummed FO, Issack FH. Emergency Decompression of Obstructive Uropathy Using Percutaneous Nephrostomy: Disease Pattern and Treatment Outcome at Two Urology Centers in Ethiopia. Open Access Emerg Med 2022; 14:15-24. [PMID: 35046735 PMCID: PMC8761074 DOI: 10.2147/oaem.s344744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Obstructive uropathy (OU) is a potentially life-threatening urologic emergency that requires urgent decompression. Percutaneous nephrostomy (PCN) is a commonly performed procedure to decompress OU. The objective of this study is to assess disease patterns and treatment outcome at two urologic centers in Ethiopia. METHODS A cross-sectional study was conducted on 110 patients who underwent emergency PCN from October 1, 2019 to September 30, 2020. Data were collected by a retrospective chart review. SPSS 25 was used for analysis. Descriptive statistics and logistic regression were utilized to assess disease pattern and significant predictors. A p-value of <0.05 on multivariate logistic regression was considered statistically significant. RESULTS Females accounted for 70% of cases and mean age at presentation was 48 ± 12.9 years. Bilateral OU was diagnosed in 60% of patients and 77.3% of obstructions occurred at the level of the ureter. Malignancies were diagnosed in >80% of patients among which cervical cancer was the commonest (37.3%) followed by bladder cancer (17.3%). Acute kidney injury (AKI) accounted for 70% of the presenting indications for PCN. Success rate after emergency PCN was 75.5% and 41.8% of the cases developed post-procedure complications. Factors that predicted successful outcome include male gender [AOR = 5.72 (1.13-28.92), 95% CI; p = 0.035], severe hydronephrosis pre-operatively [AOR = 7.12 (1.32-38.45), 95% CI; p = 0.022], and use of combined imaging (ultrasound and fluoroscope) to guide PCN [AOR = 12.91 (1.13-46.54), 95% CI; p = 0.039]. On the other hand, postoperative complication is a negative predictor [AOR = 0.26 (0.08-0.86), 95% CI; p = 0.027]. CONCLUSION In this study, overall success of emergency PCN is low. Presence of severe hydronephrosis predicts technical ease and better outcome of PCN. Procedures performed under ultrasound and fluoroscope guidance also improve outcome. Postoperative complication rate is high in this study and mandates strict preventive measures as it predicts unfavorable outcome.
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Affiliation(s)
| | | | - Haimanot Ewnetu Hailu
- Department of Public Health, Saint Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
| | - Andualem Deneke Beyene
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University (AAU), Addis Ababa, Ethiopia
| | - Seid Mohammed Hassen
- Urology Unit, Department of Surgery, Saint Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
| | - Ferid Ousman Mummed
- Urology Unit, Department of Surgery, Saint Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
| | - Feysel Hassen Issack
- Urology Unit, Department of Surgery, Saint Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia
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Metzler IS, Holt S, Harper JD. Surgical Trends in Nephrolithiasis: Increasing De Novo Renal Access by Urologists for Percutaneous Nephrolithotomy. J Endourol 2021; 35:769-774. [PMID: 33430693 DOI: 10.1089/end.2020.0888] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose: Percutaneous nephrolithotomy (PCNL) has wide variability in the methods of renal access. In many centers, this is done as a separate nephrostomy procedure by interventional radiology, while other urologists gain initial access themselves during the PCNL. We aimed to characterize these trends to confirm the need for continued training in this aspect of PCNL. Methods: Using MarketScan insurance claims, we examined surgical volume for ureteroscopy (URS), extracorporeal shockwave lithotripsy (SWL), and PCNL during 2007-2017. For PCNL, current procedural terminology (CPT) codes were used to identify the provider performing the de novo renal access over time. We stratified postoperative outcomes for PCNL by provider type. Results: From 2007 to 2017, the annual proportion of PCNL procedures peaked at 4.5%, with a recent decline in 2016 and 2017 to 3.2%. URS steadily increased from 46.3% to 60.0% of procedures, and SWL mirrored that change with a decrease from 50.0% to 36.7%. Within 19,743 PCNLs, there was a notable increase from 12.8% to 32.3% in the number of procedures with urologists performing de novo renal access. Most cases (40.0%) still had a de novo access code assigned to a radiologist. Length-of-stay, readmission, transfusion, and secondary stone procedure rates were higher in the radiologist-gained access PCNLs. Conclusions: URS has surpassed SWL as the most common stone procedure. While the proportion of PCNLs has remained fairly stable over the last decade, urologists obtaining their own de novo access have increased substantially. Continued outreach efforts focused on urologist-obtained access may further increase this proportion and improve outcomes for PCNL.
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Affiliation(s)
- Ian S Metzler
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sarah Holt
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
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6
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Kamal WK, Alhazmy A, Alharthi M, Al Solumany A. Trends of percutaneous nephrolithotomy in Saudi Arabia. Urol Ann 2021; 12:352-359. [PMID: 33776332 PMCID: PMC7992526 DOI: 10.4103/ua.ua_100_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 11/07/2019] [Indexed: 11/16/2022] Open
Abstract
Objective: The objective of the study was to present the current practice patterns on percutaneous nephrolithotomy (PCNL) in Saudi Arabia and to compare it with the international patterns and to observe the adherence to the guidelines. Materials and Methods: A survey consisting of 28 questions was sent to urologists working in Saudi Arabia using a Google Forms questionnaire. The questioner covered most aspects of performing PCNL starting from preparing the patient till discharging him. Results: One hundred and thirty-two replied to the survey. Almost 70.2% performed PCNL and 59.1% of them learned PCNL during residency. The access was obtained by the urologists in 80.3% from the participants, 68.2% of them uses fluoroscopic guidance for the puncture. The majority (80.3%) perform PCNL in the prone position. Nearly 69.7% use the balloon dilators and 16.7% use the Amplatz dilators. For kidney drainage, 60.6% place a nephrostomy tube and a double-J stent (DJ stent) together and 4.5% perform tubeless PCNL (DJ stent only). About 45.5% stated that the introduction of flexible ureteroscopy decreased the rate of doing PCNL for >20%. Conclusions: Data obtained from a group of urologists in Saudi Arabia showed that the majority of urologists practicing in Saudi Arabia perform PCNL. They usually learn PCNL during residency. We observe that the majority of urologists attach to the original patterns in PCNL, i.e., they predominantly prefer the prone position and use fluoroscopy to gain the PCNL access. Furthermore, the data showed that new trends in PCNL did not gain a lot of momentum as few practices miniaturized PCNL and tubeless PCNL. The majority use balloon dilators and combined ultrasonic/pneumatic lithotripters. The complication rate encountered by the participants is concomitance with the published international figures. The introduction of flexible ureteroscopy highly decreased the rate of doing PCNL for most urologists.
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Affiliation(s)
| | - Ali Alhazmy
- Department of Urology, King Fahd Hospital, Jeddah, Saudi Arabia
| | - Majed Alharthi
- Department of Urology, King Fahd Hospital, Jeddah, Saudi Arabia
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7
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Borofsky MS, Rivera ME, Dauw CA, Krambeck AE, Lingeman JE. Electromagnetic Guided Percutaneous Renal Access Outcomes Among Surgeons and Trainees of Different Experience Levels: A Pilot Study. Urology 2020; 136:266-271. [DOI: 10.1016/j.urology.2019.08.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/11/2019] [Accepted: 08/20/2019] [Indexed: 01/18/2023]
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8
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Knudsen BE. EDITORIAL COMMENT. Urology 2020; 136:270-271. [DOI: 10.1016/j.urology.2019.08.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/20/2019] [Indexed: 10/25/2022]
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9
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Nguyen DD, Luo JW, Tailly T, Bhojani N. Percutaneous Nephrolithotomy Access: A Systematic Review of Intraoperative Assistive Technologies. J Endourol 2019; 33:358-368. [DOI: 10.1089/end.2019.0085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
| | - Jack W. Luo
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Thomas Tailly
- Urology Department, University Hospital Ghent, Ghent, Belgium
| | - Naeem Bhojani
- Division of Urology, University of Montreal Health Center (CHUM), Montreal, Canada
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10
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Bayne DB, Chi TL. Assessing Cost-Effectiveness of New Technologies in Stone Management. Urol Clin North Am 2019; 46:303-313. [PMID: 30961862 DOI: 10.1016/j.ucl.2018.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Diagnosis, treatment, and follow-up are all influential in determining the overall cost to the health care system for kidney stones. New innovations in the field of nephrolithiasis have been abundant, including disposable ureteroscopes, ultrasound-guided approaches to percutaneous nephrolithotomy, and advanced laser lithotripters. Identifying cost-effective treatment strategies encourages practitioners to be thoughtful about providing value-based high-quality care and remains on important principle in the treatment of urinary stone disease.
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Affiliation(s)
- David B Bayne
- Urology, University of California San Francisco, San Francisco, CA, USA.
| | - Thomas L Chi
- Urology, University of California San Francisco, San Francisco, CA, USA
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11
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Leow JJ, Valiquette AS, Chung BI, Chang SL, Trinh QD, Korets R, Bhojani N. Costs variations for percutaneous nephrolithotomy in the U.S. from 2003-2015: A contemporary analysis of an all-payer discharge database. Can Urol Assoc J 2018; 12:407-414. [PMID: 29940133 DOI: 10.5489/cuaj.5280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION We sought to evaluate population-based costs variations and predictors of outlier costs for percutaneous nephrolithotomy (PCNL) in the U.S. METHODS Using the Premier Healthcare Database, we identified all patients diagnosed with kidney/ureter calculus who underwent PCNL from 2003-2015. We evaluated 90-day direct hospital costs, defining high- and low-cost surgery as those >90th and <10th percentile, respectively. We constructed a multilevel, hierarchical regression model and calculated the pseudo-R2 of each variable, which translates to the percentage variability contributed by that variable on 90-day direct hospital costs. RESULTS A total of 114 581 patients underwent PCNL during the 12-year study period. Mean cost in the low-cost group was $5787 (95% confidence interval [CI] 5716-5856) vs. $38 590(95% CI 37 357-39 923) in the high-cost group. Cost variations were substantially impacted by patient (63.7%) and surgical (18.5%) characteristics and less so by hospital characteristics (3.9%). Significant predictors of high costs included more comorbidities (≥2 vs. 0: odds ratio [OR] 1.81; p=0.01) and hospital region (Northeast vs. Midwest: OR 2.04; p=0.03). Predictors of low cost were hospital bed size of 300-499 beds (OR 1.35; p<0.01) and urban hospitals (OR 2.77; p=0.01). Factors less likely to be associated with low-cost PCNL were more comorbidities (Charlson Comorbidity Index [CCI] ≥2: OR 0.69; p<0.0001), larger hospitals (OR 0.61; p=0.01), and teaching hospitals (OR 0.33; p<0.0001). CONCLUSIONS Our contemporary analysis demonstrates that patient and surgical characteristics had a significant effect on costs associated with PCNL. Poor comorbidity status contributed to high costs, highlighting the importance of patient selection.
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Affiliation(s)
- Jeffrey J Leow
- Division of Urology and Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Urology, Tan Tock Seng Hospital, Singapore
| | | | - Benjamin I Chung
- Department of Urology, Stanford University, Stanford, CA, United States
| | - Steven L Chang
- Division of Urology and Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Lank Centre for Genitourinary Oncology, Dana-Farber/Brigham and Women's Cancer Centre, Harvard Medical School, Boston, MA, United States
| | - Quoc-Dien Trinh
- Division of Urology and Centre for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Lank Centre for Genitourinary Oncology, Dana-Farber/Brigham and Women's Cancer Centre, Harvard Medical School, Boston, MA, United States
| | - Rus Korets
- Veterans Affairs Boston Healthcare System, Harvard Medical School, Boston, MA, United States
| | - Naeem Bhojani
- Department of Urology, Université de Montréal, Montreal, QC, Canada
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12
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Barghouthy Y, Kourmpetis V, Dekalo S, Bar-Yosef Y, Conti S, Greenstein A, Sofer M. A Novel Method for Repositioning Suboptimally Preoperatively Placed Nephrostomy Tubes for Percutaneous Nephrolithotomy Without Renal Repuncture. J Endourol 2018; 35:908-911. [PMID: 29325429 DOI: 10.1089/end.2017.0725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Nephrostomy tubes (NTs) inserted in emergency settings by interventional radiologists are frequently unsuitable for subsequent percutaneous nephrolithotomy (PCNL). We report a novel method of adjusting these NTs to be used as PCNL tracts and avoid renal repuncture. Patients and Methods: A retrospective search of 981 consecutive PCNLs performed in our institution between 2002 and 2017 identified all patients with preoperatively inserted NTs. The NTs unsuitable for PCNL were adjusted by a novel approach in which a 5-mm incision was made at the ideal puncture location (IPL) as indicated under fluoroscopic guidance. The preinserted NT was removed after passing a guidewire into the kidney. A dissector clamp was introduced through the entry wound of the removed NTs to bluntly dissect a retroperitoneal tunnel and pull out the distal tip of guidewire through the IPL, while its proximal segment was maintained in the kidney. The newly positioned guidewire was used for PCNL tract preparation without repuncturing the kidney. Results: The NTs were located in the mid calix, lower calix, and renal pelvis in 6 (26%), 13 (57%), and 4 (17%) cases, respectively. The NT was suitable for PCNL in 5 (22%) cases, a new renal access was performed in 3 (13%), and the novel adjustment approach was used in 15 (65%), all successfully. The place of entry was moved an average of 6 cm (range 47) and the angle between the tract axis and the calix axis was reduced by 65° in average. The procedure was done uneventfully in an average of 4 minutes. Conclusions: The novel method of adjusting preoperatively inserted NTs for PCNL by repositioning their original entry location to the IPL offers the possibility of avoiding kidney repuncture. It is feasible, safe, and easy to implement, and it spares potential morbidity related to additional puncturing of the kidney.
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Affiliation(s)
- Yazeed Barghouthy
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Endourology Unit, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Vasileios Kourmpetis
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Snir Dekalo
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yuval Bar-Yosef
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Simon Conti
- Department of Urology, Stanford Health Care, Stanford University, Stanford, California
| | - Alexander Greenstein
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Endourology Unit, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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