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Wenzel J, Seideman C, Semins MJ. Occupational Radiation Exposure During Pregnancy: A Survey of Urologists on Perception, Experience, and Practice Patterns. J Endourol 2024. [PMID: 38661543 DOI: 10.1089/end.2024.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Introduction The field of urology is predominantly male, although now has an increasing number of women in the workforce. Peak reproductive years frequently overlap with residency training and early attending career timelines. Exposure to ionizing radiation is a common occupational hazard in many procedural specialties. Other specialties that use radiation, such as interventional cardiology and interventional radiology, have shown little adjustments in practice patterns and no adverse outcomes amongst pregnant physicians in their fields in the setting of appropriate radiation safety measures. However, the impact of radiation exposure during pregnancy for urologists is largely unknown. Our objective was to determine attitudes and practices of urologists related to radiation exposure, and to characterize the experience of urologists who have previously been pregnant. Methods An anonymous online survey was distributed through relevant society membership bases, which included the Endourological Society and the Society for Women in Urology, and social media. Demographics, practice patterns, and changes to practice patterns were recorded for respondents. Statistical analysis was performed in R studio. Results There were 384 respondents, 255 of whom identified as women. Of these, 164 had been previously pregnant. Female respondents were younger, completed training more recently, and were more likely to have adjusted their caseload due to radiation concerns compared to their male counterparts. Of women who had been pregnant, few had access to policies for who to notify (19%), policies for safety precautions (22%), custom-fitted lead (35%), and maternity lead (20%). Most women (66%) relied on their own research for guidance on radiation safety during pregnancy, while some (41%) also used information from colleagues or mentors. 46% of women would have taken greater precautions during pregnancy than they did. Conclusions Access to proper tools to safely navigate pregnancy is inconsistent amongst practicing urologists. Evidence-based guidelines are needed to better empower pregnant urologists.
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Affiliation(s)
- Jessica Wenzel
- Oregon Health & Science University, 6684, Portland, Oregon, United States;
| | - Casey Seideman
- Oregon Health and Science University, 6684, Urology, 3181 SW Sam Jackson Park Road, CDW6, Portland, Oregon, United States, 97239
- Oregon Health and Science University;
| | - Michelle Jo Semins
- West Virginia University School of Medicine, 12355, Urology, Morgantown, West Virginia, United States;
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Gupta M, Atallah W, Molina W, Semins MJ, Munver R. Clinical Experiences Using the First Ureteroscope with Intrarenal Pressure Monitoring. J Endourol 2023; 37:i-S17. [PMID: 37774101 DOI: 10.1089/end.2023.36010.rtl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Affiliation(s)
- Mantu Gupta
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William Atallah
- Assistant Professor of Urology, Kidney Stone Center, Mount Sinai, New York, New York, USA
- Chief of Endourology at Elmhurst Hospital, Queens, New York, USA
| | - Wilson Molina
- Professor of Urologic Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Michelle Jo Semins
- Chief of the Division of Urology, West Virginia University Wheeling Hospital, Wheeling, West Virginia, USA
- Clinical Professor, West Virginia University Wheeling Hospital, Wheeling, West Virginia, USA
| | - Ravi Munver
- Vice Chair and Chief of Minimally Invasive Robotic Urologic Surgery, and Professor of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA
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Abstract
Introduction: Only 9.9% of practicing urologists in the United States are women. This percentage is even smaller in leadership positions and high-ranking appointments. Endourology is one of the least reported fellowships completed by women urologists. We sought to evaluate how endourologists perceived the climate for women physicians and compare perceptions and experiences of gender equity. Materials and Methods: An IRB approved and validated survey, Culture Conducive to Women's Academic Success (CCWAS) questionnaire was sent out to the Endourological Society listserve. Subcategories of equal access, work-life balance, freedom of gender bias, and leadership support were analyzed. An open comment section was provided for respondents to include their own experiences. Wilcoxon rank-sum and Kruskal-Wallis tests were used to compare CCWAS scores between groups. Results: A total of 104 completed surveys were received. Response rate was 7% (104/1492), 26.9% of which were female. There was a statistically significant difference between male and female respondent CCWAS scores; p < 0.05. The male CCWAS score median was 196.0 (interquartile range [IQR] 176.75-214.0) vs female CCWAS score median of 166.5 (IQR 127.5-210.0). There was no significant difference in CCWAS scores based on years in practice, parental status, or academic vs private practice. Discussion: In this study, male endourologists' perceptions of gender equity were incongruent with the reported experiences of their female colleagues. This indicates that male respondents perceive the culture in their department toward women more positively than their female colleagues. This is suggestive that there are gender-based differences in how gender inequities are perceived and potentially experienced.
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Affiliation(s)
- Leigh H Martin
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Sara L Best
- Department of Urology, University of Wisconsin, Wisconsin, USA
| | - Michelle Jo Semins
- Department of Urology, West Virginia University, Wheeling, West Virginia, USA
| | - Roxanne E Haslam
- Department of Urology, Oregon Health and Science University, Portland, Oregon, USA
| | - Rebecca Agnor
- Biostatistics Shared Resources, Knight Cancer Institute, Portland, Oregon, USA
| | - Casey A Seideman
- Department of Pediatric Urology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
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Sharbaugh AJ, Pelzman DL, Semins MJ. Obstructing ureteral calculus causing massive hydronephrosis in a renal allograft. Can J Urol 2022; 29:11329-11331. [PMID: 36245206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Nephrolithiasis is a rare complication of renal transplantation. Patients with an obstructing calculus in a renal allograft often lack the usual renal colic symptoms, and therefore present with atypical symptoms. Treatment of obstructing calculi is imperative to prevent renal allograft failure and other complications. We report the case of a 46-year-old man who presented 28 years after renal transplant with renal failure and massive hydronephrosis secondary to an obstructing calculus.
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Affiliation(s)
- Adam J Sharbaugh
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Daniel L Pelzman
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michelle Jo Semins
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Urology, West Virginia University Medicine, Morgantown, West Virginia, USA
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Sharbaugh A, Morgan Nikonow T, Kunkel G, Semins MJ. Contemporary best practice in the management of staghorn calculi. Ther Adv Urol 2019; 11:1756287219847099. [PMID: 35173810 PMCID: PMC8842174 DOI: 10.1177/1756287219847099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/09/2019] [Indexed: 12/19/2022] Open
Abstract
Staghorn calculi are complex renal stones that occupy the majority of the renal collecting system. These stones are associated with high morbidity and can lead to recurrent urinary tract infections, urosepsis, renal deterioration, and death if left untreated. Managing patients with staghorn calculi can be challenging. Fortunately, advances in technology and endourology techniques have enabled urologists to effectively treat these stones with minimal morbidity to the patient. This article describes the contemporary best practices in the initial evaluation, management, and follow up of patients with staghorn calculi to help the practicing urologist navigate this complex condition.
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Affiliation(s)
- Adam Sharbaugh
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tara Morgan Nikonow
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gregory Kunkel
- Drexel University College of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michelle Jo Semins
- Department of Urology, University of Pittsburgh Medical Center, 1350 Locust Street, Suite G100A Building C, Pittsburgh, PA 15219, USA
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Abstract
Patients with nephrolithiasis are exposed to significant quantities of ionizing radiation with the potential to cause secondary malignancy. This risk is magnified by the high recurrence rate of nephrolithiasis. In this article, we identify the risks of ionizing radiation as they pertain to patients with nephrolithiasis. We then identify evidence-based techniques for mitigating patient radiation exposure in the preoperative, intraoperative, and postoperative settings. Key factors include limiting the use of computed tomographic imaging, appropriate modulation of fluoroscopy settings, and minimizing rates of stone recurrence.
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Affiliation(s)
- Todd Samuel Yecies
- Department of Urology, University of Pittsburgh Medical Center, 200 Lothrop Street, Kaufman Building, 701, Pittsburgh, PA 15213, USA
| | - Michelle Jo Semins
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Abstract
Introduction: Funguria is encountered in 1% to 5% of cultured urine specimens and may be a result of specimen contamination, colonization, or invasive infection. The characteristics and outcomes of patients with funguria undergoing endourologic intervention have not been evaluated. Materials and Methods: Patients with preoperative funguria undergoing endourologic intervention were retrospectively identified. Preoperative funguria was defined as a urine culture containing >10,000 colony forming units of fungus within 30 days of the operative intervention. Univariable and multivariable regression was performed to identify predictors of postoperative systemic inflammatory response syndrome (SIRS). Results: A total of 65 patients with preoperative funguria were identified, of whom 49 (75.4%) underwent ureteroscopy and 16 (24.6%) underwent percutaneous nephrolithotomy. Average patient age was 55.1 ± 18.3 years, body mass index was 31.8 ± 11.0, and Charlson comorbidity index was 2.52 ± 2.0. Twenty-three patients (35.4%) carried a diagnosis of neurogenic bladder, of whom 18 (27.7%) required indwelling or intermittent catheterization. In total 57 patients (87.7%) had been exposed to antibiotics in the 3 months before intervention. Eighteen (27.7%) patients met SIRS criteria postoperatively, of whom 11 (16.9%) required intensive care unit (ICU) admission. Three (4.6%) and two (3.1%) patients developed postoperative fungemia and bacteremia, respectively. All cases of fungemia were caused by Candida glabrata. On univariable analysis, presence of an indwelling catheter (p = 0.009), presence of a known neurological diagnosis (p = 0.02), presence of C. glabrata on preoperative culture (p = 0.04), and longer operative time (p = 0.04) were predictive of development of postoperative SIRS. No significant predictors were identified on multivariable analysis. Conclusions: Patients with preoperative funguria have high rates of comorbid illness, urinary catheterization, and recent exposure to antibiotics. This patient population is at high risk of perioperative infectious complications after endourologic intervention.
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Affiliation(s)
- Todd Yecies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anand Mohapatra
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michelle Jo Semins
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Semins MJ. Commentary to 'pediatric and young adult ureteroscopy'. J Pediatr Urol 2018; 14:362. [PMID: 29909191 DOI: 10.1016/j.jpurol.2018.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Michelle Jo Semins
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Morgan TN, Shahait M, Maganty A, Ost M, Jackman S, Averch T, Semins MJ. Conservative Management of Staghorn Calculi: When Is It Safe? J Endourol 2018; 32:541-545. [DOI: 10.1089/end.2018.0002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Mohammad Shahait
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Ost
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen Jackman
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy Averch
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michelle Jo Semins
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
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10
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Morgan TN, Shahait M, Maganty A, Ost M, Jackman S, Averch T, Semins MJ. Response to Hamilton et al. re: Conservative Management of Staghorn Calculi: When Is It Safe? by Morgan et al. J Endourol 2018; 32:547. [PMID: 29782190 DOI: 10.1089/end.2018.29038.mor] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Mohammad Shahait
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Ost
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen Jackman
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy Averch
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michelle Jo Semins
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Semins MJ, Matlaga BR. Strategies to optimize shock wave lithotripsy outcome: Patient selection and treatment parameters. World J Nephrol 2015; 4:230-234. [PMID: 25949936 PMCID: PMC4419132 DOI: 10.5527/wjn.v4.i2.230] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/11/2014] [Accepted: 12/19/2014] [Indexed: 02/06/2023] Open
Abstract
Shock wave lithotripsy (SWL) was introduced in 1980, modernizing the treatment of upper urinary tract stones, and quickly became the most commonly utilized technique to treat kidney stones. Over the past 5-10 years, however, use of SWL has been declining because it is not as reliably effective as more modern technology. SWL success rates vary considerably and there is abundant literature predicting outcome based on patient- and stone-specific parameters. Herein we discuss the ways to optimize SWL outcomes by reviewing proper patient selection utilizing stone characteristics and patient features. Stone size, number, location, density, composition, and patient body habitus and renal anatomy are all discussed. We also review the technical parameters during SWL that can be controlled to improve results further, including type of anesthesia, coupling, shock wave rate, focal zones, pressures, and active monitoring. Following these basic principles and selection criteria will help maximize success rate.
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Affiliation(s)
- Julie M. Riley
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Division of Urology, University of New Mexico, Albuquerque, New Mexico
| | - Anne G. Dudley
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michelle Jo Semins
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Abstract
Kidney stones are very common and unfortunately do not spare the pregnant population. Anatomical and pathophysiological changes occur in the pregnant female that alter the risk for development of nephrolithiasis. Acute renal colic during pregnancy is associated with significant potential risks to both mother and fetus. Diagnosis is often challenging because good imaging options without radiation use are limited. Management of diagnosed nephrolithiasis is unique in the pregnant population and requires multi-disciplinary care. Herein, we review the metabolic alterations during pregnancy that may promote kidney stone formation, the complications associated with acute renal colic in the pregnant state, and our proposed diagnostic and management algorithms when dealing with this clinical scenario.
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14
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Loeb S, Semins MJ, Matlaga BR. Novel technique for fragment removal after percutaneous management of large-volume neobladder calculi. Urology 2012; 80:474-6. [PMID: 22857764 DOI: 10.1016/j.urology.2012.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 04/11/2012] [Accepted: 05/07/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe a novel method for fragment evacuation after percutaneous lithotripsy of neobladder calculi. METHODS The technique was developed using a Urovac bladder evacuator, which was attached to a standard 30F Amplatz working sheath. RESULTS The attachment of the Urovac evacuator to the Amplatz sheath rapidly evacuated large quantities of stone material. Careful attention should be paid to maintaining low-pressure irrigation by ensuring the bladder is not overly full and the Urovac device is not vigorously manipulated, to minimize the likelihood of bladder injury. CONCLUSION Percutaneous ultrasonic/hydraulic lithotripsy for large-volume neobladder calculi often results in a substantial burden of stone fragments that can be difficult to clear using standard techniques. Attaching a Urovac bladder evacuator to the 30F Amplatz sheath can simplify the management of this task.
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Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, New York, NY, USA
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Abstract
Nephrolithiasis is a highly prevalent condition with a high recurrence rate that has a large impact on the quality of life of those affected. It also poses a great financial burden on society. There have been great advancements in the surgical treatment of stone disease over the past several decades. The evolution of surgical technique appears to have overshadowed the importance of prevention of stone disease despite evidence showing medical therapies significantly decreasing stone recurrence rates. Herein we review the metabolic evaluation of stone formers with the use of specific blood and urine tests. We complete our discussion with a review of the medical management of stone formers providing both general recommendations as well as reviewing focused therapies for specific metabolic abnormalities and medical conditions.
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Affiliation(s)
- Michelle Jo Semins
- The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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16
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Abstract
BACKGROUND AND PURPOSE As surgical technology continues to advance, stone baskets are becoming increasingly miniaturized. We performed a study to define the effect of miniaturized stone baskets on ureteroscope irrigation flow and deflection. MATERIALS AND METHODS We compared the three smallest available stone baskets: Boston Scientific 1.3F OptiFlex, Cook 1.5F N-Circle, and Sacred Heart 1.5F Halo, measuring their effect on irrigant flow and deflection of three flexible ureteroscopes. RESULTS All devices adversely affected irrigation flow and active deflection of all of the ureteroscopes (P<0.05). The 1.3F device, however, exhibited significantly less of an effect on both parameters. Irrigation flow was 28% greater with the 1.3F device than it was for the 1.5F devices. The device's effect on active deflection was 43% less with the 1.3F device than it was for the 1.5F devices. CONCLUSION Any device placed through the working channel of a ureteroscope will have a deleterious effect on the ureteroscope's irrigant flow and active deflection. As the caliber of the device decreases, however, its effect on these parameters appears to be reduced. Our present data suggest that the 1.3F basket has significantly less of an effect on both the irrigant flow and deflection of a flexible ureteroscope than do the 1.5F devices.
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Affiliation(s)
- Ahmed Magheli
- Department of Urology, Charité University Medicine Berlin, Berlin, Germany
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Semins MJ, Bartik L, Chew BH, Hyams ES, Humphreys M, Miller NL, Shah O, Paterson RF, Matlaga BR. Multicenter analysis of postoperative CT findings after percutaneous nephrolithotomy: defining complication rates. Urology 2011; 78:291-4. [PMID: 21269663 DOI: 10.1016/j.urology.2010.11.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 10/21/2010] [Accepted: 11/03/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To perform a multi-institutional study to characterize CT-detected complications after PNL. Computed tomography (CT) is commonly performed after percutaneous nephrolithotomy (PNL). One benefit of this imaging modality is the detection of procedure-related complications. Presently, the incidence of such complications is not well-defined. PATIENTS AND METHODS PNL procedures performed at 5 stone referral centers between July 2007 and June 2008 were reviewed. All patients undergoing CT within 24 hours after surgery were selected for further analysis. All CT studies were reviewed by a staff radiologist. RESULTS One-hundred ninety-seven patients satisfied the study inclusion criteria. A body mass index >30 was present in 27.5% of patients. Treated stone burden was staghorn in 70 (35.5%), >2 cm in 72 (36.5%), and <2 cm in 55 (28%). Six treated renal units (3%) were ectopic; 45.4% of calculi were predominantly lower pole. Thoracic complications encountered were atelectasis in 88 (44.7%), pleural effusion in 17 (8.6%), pneumothorax in 3 (1.5%), hemothorax in 2 (1%), and hydrothorax in 1 (0.5%). Renal complications were perinephric hematoma in 15 (7.6%), collecting system perforation in 4 (2%), subcapsular hematoma in 3 (1.5%), urinoma in 2 (1%), and pseudoaneurysm in 1 (0.5%). There was 1 trans-splenic nephrostomy without splenic hematoma. No injuries to hollow viscera were detected. Two patients (1%) were found to have ascites. CONCLUSIONS Major post-PNL complications detected by CT are uncommon, and when encountered, they are generally amenable to conservative management.
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Semins MJ, George S, Allaf ME, Matlaga BR. Ureteroscope cleaning and sterilization by the urology operating room team: the effect on repair costs. J Endourol 2009; 23:903-5. [PMID: 19445639 DOI: 10.1089/end.2008.0489] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Flexible ureteroscopes are fragile devices, and the costs associated with their repair and replacement can be considerable. Although surgical use can degrade ureteroscope function, the cleaning and sterilization process can also cause great damage. We performed a study to define the effect of having the urology nursing staff process and sterilize all ureteroscopes, rather than the central processing core; the total repair cost and cost per use were analyzed. MATERIALS AND METHODS From April 2007 to March 2008, all ureteroscopes were processed by the urology nursing staff. We analyzed the average cost per use as a measure of the effectiveness of this strategy. For all endoscopic stone removal cases, a flexible ureteroscope is opened onto the operative field; therefore, after every endoscopic procedure, the flexible ureteroscope needs processing and sterilizing. The number of times each ureteroscope was processed and the type and cost of repairs were recorded. RESULTS From April 2007 to March 2008, 11 ureteroscopes were processed 478 times; average uses before repair was 28.1. Seven ureteroscopes were returned for repair because of: loss of deflection (2); loss of fiberoptic bundles (2); failed leak test (3). No ureteroscope damage was because of processing. The total repair cost in this 12-month period was $57,664.50. Amortizing repair costs over use gives a value of $120.63 cost per use. CONCLUSIONS Training the urology nursing staff to clean and sterilize ureteroscopes is a reasonable means to reduce processing-related damages.
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Affiliation(s)
- Michelle Jo Semins
- James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Semins MJ, Trock BJ, Matlaga BR. The effect of shock wave rate on the outcome of shock wave lithotripsy: a meta-analysis. J Urol 2007; 179:194-7; discussion 197. [PMID: 18001796 DOI: 10.1016/j.juro.2007.08.173] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Indexed: 12/22/2022]
Abstract
PURPOSE Although experimental evidence suggests that the rate of shock wave delivery can affect the outcome of shock wave lithotripsy, clinical studies produce conflicting results. We performed a systematic review and meta-analysis to define the effect of shock wave rate on the outcome of shock wave lithotripsy. MATERIALS AND METHODS A search of MEDLINE and EMBASE was performed and all randomized controlled trials comparing SWL treatment at 60 shocks per minute to 120 shocks per minute were included in the analysis. Data from 4 trials (589 patients) were pooled. The primary outcome measure was treatment outcome (success, failure), as defined by the authors of the source studies. The difference in the proportion of patients with a successful treatment outcome was compared between the 60 and 120 shocks per minute groups as a risk difference, and risk differences were pooled across the 4 trials with a fixed effects model. RESULTS Patients treated at a rate of 60 shocks per minute had a significantly greater likelihood of a successful treatment (risk difference 10.2, 95% CI 3.7-16.8, p = 0.002). CONCLUSIONS Our meta-analysis suggests that patients treated at a rate of 60 shocks per minute have a significantly greater likelihood of a successful treatment outcome than patients treated at a rate of 120 shocks per minute.
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Affiliation(s)
- Michelle Jo Semins
- James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Abstract
BACKGROUND A 32-year-old healthy woman from China was diagnosed with a bladder mass during pelvic ultrasonography, carried out during the work-up of a miscarriage. Cystoscopy by the Department of Obstetrics and Gynecology confirmed the presence of a bladder mass, after which she was referred to our department for evaluation and management. The patient was asymptomatic at presentation. She denied urologic symptoms and did not have a history of smoking or industrial exposure to carcinogens. INVESTIGATIONS Laboratory test results and urine studies were unremarkable. Cytology revealed benign cells with numerous micro-organisms. Intravenous pyelography revealed a 1 x 2 cm filling defect in the mid posterior bladder compatible with a mass. There were no upper urinary tract defects. We performed cystoscopy with transurethral resection of the bladder tumor. DIAGNOSIS Pathology revealed cystitis glandularis. MANAGEMENT The patient was followed up with repeat cystoscopy after 4 months; there was no evidence of recurrence. She was scheduled for surveillance after a further 3 months, but was lost to follow-up.
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Affiliation(s)
- Michelle Jo Semins
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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Semins MJ, Chancellor MB. Diagnosis and management of patients with overactive bladder syndrome and abnormal detrusor activity. ACTA ACUST UNITED AC 2006; 1:78-84; quiz 109. [PMID: 16474519 DOI: 10.1038/ncpuro0054] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Accepted: 10/29/2004] [Indexed: 11/09/2022]
Abstract
Overactive bladder syndrome (OABS) is a widely recognized syndrome with symptoms that can include urinary urgency, frequency, nocturia, and incontinence. Although there may be several causative factors for OABS, detrusor overactivity is the most common. In addition, urinary incontinence can also be due to a distinct but equally bothersome condition underactive bladder syndrome, or detrusor underactivity. The incomplete bladder emptying that characterizes detrusor underactivity often arises from impaired contractile function of the detrusor muscle. The variations in etiologies of the two syndromes necessitate patient evaluations tailored to individual symptom presentation. Increased awareness of the differences between the manifestations of OABS and underactive bladder syndrome call for specific approaches to the management of bladder dysfunction.
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