71 results on '"David T. Tzou"'
Search Results
2. Heterogeneity in stone culture protocols and endourologist practice patterns: a multi-institutional survey
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David T. Tzou, Karen L. Stern, Brian D. Duty, Ryan S. Hsi, Noah E. Canvasser, Smita De, Ava C. Wong, Charis R. Royal, Meleighe L. Sloss, Justin B. Ziemba, Jonathan D. Harper, Seth K. Bechis, Anna M. Zampini, Michael S. Borofsky, John Roger Bell, Justin I. Friedlander, David A. Leavitt, Amihay Nevo, Nishant D. Patel, Roshan M. Patel, Zeph Okeke, Marcelino E. Rivera, Chiu-Hsieh Hsu, Thomas Chi, Gayatri Vedantam, and William D. Lainhart
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Urology - Abstract
Kidney stone cultures can be beneficial in identifying bacteria not detected in urine, yet how stone cultures are performed among endourologists, under what conditions, and by what laboratory methods remain largely unknown. Stone cultures are not addressed by current clinical guidelines. A comprehensive REDCap electronic survey sought responses from directed (n = 20) and listserv elicited (n = 108) endourologists specializing in kidney stone disease. Questions included which clinical scenarios prompt a stone culture order, how results influence post-operative antibiotics, and what microbiology lab protocols exist at each institution with respect to processing and resulting stone cultures. Logistic regression statistical analysis determined what factors were associated with performing stone cultures. Of 128 unique responses, 11% identified as female and the mean years of practicing was 16 (range 1-46). A specific 'stone culture' order was available to only 50% (64/128) of those surveyed, while 32% (41/128) reported culturing stone by placing a urine culture order. The duration of antibiotics given for a positive stone culture varied, with 4-7 days (46%) and 8-14 days (21%) the most reported. More years in practice was associated with fewer stone cultures ordered, while higher annual volume of percutaneous nephrolithotomy was associated with ordering more stone cultures (p 0.01). Endourologists have differing practice patterns with respect to ordering stone cultures and utilizing the results to guide post-operative antibiotics. With inconsistent microbiology lab stone culture protocols across multiple institutions, more uniform processing is needed for future studies to assess the clinical benefit of stone cultures and direct future guidelines.
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- 2022
3. Multi-Institutional Variation in Performance of Low-Dose Computed Tomography for the Evaluation of Suspected Nephrolithiasis
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Dima Raskolnikov, David T. Tzou, Justin S. Ahn, Seth K. Bechis, Thomas L. Chi, Mathew D. Sorensen, Marshall L. Stoller, and Jonathan D. Harper
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Radiography, Abdominal ,Adult ,Urologic Diseases ,Urology ,Clinical Sciences ,imaging ,Middle Aged ,Radiation Exposure ,Urology & Nephrology ,Radiation Dosage ,X-Ray Computed ,Radiography ,Kidney Calculi ,low dose ,Clinical Research ,Humans ,Biomedical Imaging ,Abdominal ,Tomography, X-Ray Computed ,Tomography ,Retrospective Studies ,CT ,nephrolithiasis - Abstract
Introduction and Objective: Guidelines from the American Urological Association (AUA) and American College of Radiology (ACR) recommend that patients with suspected nephrolithiasis undergo low-dose CT of the kidney, ureter, and bladder (LD CT KUB) as opposed to higher dose conventional imaging. We hypothesized that even at institutions with established LD protocols, higher dose imaging is common. Materials and Methods: We identified four academic medical centers where LD CT KUB protocols were implemented to yield an effective dose (EDose) consistent with national guidelines. Fifty consecutive adult patients who underwent CT KUB specifically for the evaluation of nephrolithiasis were retrospectively reviewed at each site. Patient age, sex, body mass index (BMI), imaging location, and EDose (millisieverts [mSv]) were recorded. Results: Two hundred patients with a mean age of 54 years were identified. Forty-six patients (23%) underwent CT KUB with an EDose ≤4 mSv, accounting for 10% to 48% of each institution's cohort. One hundred sixteen patients had a BMI
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- 2022
4. PD32-10 KIDNEY STONE ENDOTOXIN CONCENTRATION CORRELATES WITH POST-OPERATIVE SEPSIS FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY
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David T. Tzou, Farhan Anwar, Ava C. Wong, David T. Harris, Thomas Chi, and Gayatri Vedantam
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Urology - Published
- 2022
5. Online Kidney Stone Educational Materials Do Not Meet Recommended Readability Standards
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Andrew Bergersen, Barry D. Weiss, Ismail Khan, David T. Tzou, Juan Chipollini, and Ava C. Wong
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Medical education ,business.industry ,Urology ,Medicine ,Health literacy ,Kidney stones ,business ,medicine.disease ,Readability - Abstract
Introduction:The prevalence of kidney stones is rising and there is an increasing demand for reliable, easy to understand information for patients. To evaluate the readability of common Int...
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- 2021
6. Holmium Laser Enucleation of the Prostate Is Safe and Feasible as a Same Day Surgery
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Joel Funk, Kieran Hynes, David T. Tzou, Michael C. Phung, Christian O. Twiss, Aye Lwin, Patrick Evans, Elinora Price, and Jiping Zeng
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Male ,medicine.medical_specialty ,Urology ,Enucleation ,Outpatient surgery ,Prostatic Hyperplasia ,030232 urology & nephrology ,Holmium laser ,Lasers, Solid-State ,Patient Readmission ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Prostate ,medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,Prostatectomy ,Urinary retention ,business.industry ,Middle Aged ,Readmission rate ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Ambulatory Surgical Procedures ,030220 oncology & carcinogenesis ,Feasibility Studies ,Disease characteristics ,medicine.symptom ,business ,Complication - Abstract
OBJECTIVE To assess the safety, feasibility and treatment outcomes of holmium laser enucleation of the prostate (HoLEP) as a same day surgery (SDS). METHODS HoLEPs performed from November 2013 to December 2018 at our institution were reviewed retrospectively. Inclusion criteria for same day surgery (SDS) included living in the local metropolitan area with access to local hospital and Eastern Cooperative Oncology Group (ECOG) 0-2, regardless of prostate size and anticoagulation status. Those patients who were discharged directly from the postoperative care unit were identified as SDS cases. Patients admitted overnight after HoLEP during the same period were used as a matched cohort. Patient demographics, disease characteristics and treatment outcomes were compared. RESULTS A total of 377 patients were identified, including 199 SDS and 178 non-SDS patients. No statistical difference was present between the 2 groups regarding the post-op complication and readmission rates. The non-SDS group had a significantly higher percentage of patients with history of urinary retention, lower pre-op Qmax, and larger prostate volume. The SDS group had shorter operative time, length of stay (LOS), and catherization time (all P CONCLUSION Same day outpatient surgery for HoLEP is safe in patients who live in close proximity and have ECOG status 0-2. Our readmission rate and complication rate are comparable to those reported in the literature with markedly decreased LOS. Long-term functional outcome is not compromised by SDS.
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- 2020
7. Low Income and Nonwhite Race are Strongly Associated with Worse Quality of Life in Patients with Nephrolithiasis
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Jeremy Goodman, Sri Sivalingam, Ben H. Chew, Roger L. Sur, Kristina L. Penniston, Thomas Chi, Timothy D. Averch, Necole M. Streeper, Jodi Antonelli, Manint Usawachintachit, David T. Tzou, Tessnim R Ahmad, Shalonda Reliford-Titus, Clinton Wu, Vernon M. Pais, Davis P. Viprakasit, Vincent G. Bird, and Stephen Y. Nakada
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Male ,Low income ,Urology ,media_common.quotation_subject ,030232 urology & nephrology ,Kidney Calculi ,03 medical and health sciences ,Race (biology) ,0302 clinical medicine ,Quality of life (healthcare) ,Risk Factors ,Surveys and Questionnaires ,medicine ,Humans ,In patient ,Prospective Studies ,Poverty ,media_common ,Health related quality of life ,business.industry ,Racial Groups ,Health related ,Health Status Disparities ,Middle Aged ,medicine.disease ,Unemployment ,Chronic Disease ,Income ,Quality of Life ,Female ,Kidney stones ,business ,Demography - Abstract
Kidney stones are a source of significant morbidity which have been shown to negatively impact health related quality of life. We sought to understand the association between health related quality of life, socioeconomic status and race among patients with kidney stones.Patients with stones at a total of 11 stone centers across the United States completed the WISQOL (Wisconsin Stone Quality of Life questionnaire). The patient ZIP Code™ was used to estimate household income. A mixed effects regression model was constructed for analysis with ZIP Code as the random intercept.A total of 2,057 stone formers completed the WISQOL. Lower income was independently associated with significantly lower health related quality of life (β = 0.372, p = 0.014), as were nonwhite race (β = -0.299, p = 0.001), unemployed work status (β = -0.291, p = 0.008), female gender (β = -0.204, p0.001), body mass index greater than 40 kg/mLower income, nonwhite race and unemployed work status were independently associated with lower health related quality of life among patients with kidney stones. While clinical characteristics such as body mass and stone disease severity were also associated with health related quality of life, this study shows that socioeconomic factors are similarly important. Further research to understand the specific mechanisms by which socioeconomic status and race impact health may lend insight into methods to optimize clinical treatment of stone formers and patients with other chronic diseases.
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- 2019
8. PD04-04 FATTY ACID BINDING PROTEIN 4 DRIVES CALCIFICATION IN THE DEVELOPMENT OF KIDNEY STONE DISEASE
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Sunita P. Ho, Kazumi Taguchi, Manint Usawachintachit, Rei Unno, Benjamin A. Sherer, Shuzo Hamamoto, Misun Kang, Marshall L. Stoller, Thomas Chi, Takahiro Yasui, Atsushi Okada, David T. Tzou, and Teruaki Sugino
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medicine.medical_specialty ,Endocrinology ,business.industry ,Kidney stone disease ,Urology ,Internal medicine ,medicine ,business ,medicine.disease ,Fatty acid-binding protein ,Calcification - Published
- 2020
9. MP47-11 DEVELOPMENT OF A LOW-COST, HIGH-FIDELITY SIMULATOR FOR ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY (PCNL) TRAINING
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Marissa Lovett, David T. Tzou, Michael C. Phung, David E. Biffar, Allan J. Hamilton, and Benjamin R. Lee
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medicine.medical_specialty ,High fidelity ,business.industry ,Urology ,medicine.medical_treatment ,Medicine ,Medical physics ,business ,Percutaneous nephrolithotomy ,Ultrasound guided - Published
- 2020
10. MP15-06 INDICATIONS FOR STENT OMISSION AFTER URETEROSCOPIC LITHOTRIPSY: A PROSPECTIVE TRIAL FROM THE REGISTRY FOR STONES OF THE KIDNEY AND URETER (RESKU)
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David Bayne, Kaitlan Cobb, Helena Chang, Brian Duty, Mathew Sorensen, David T. Tzou, Roger L. Sur, David F. Friedlander, Thomas Chi, Seth Bechis, Jonathan D. Harper, Marshall L. Stoller, Robert P. Fisher, and Ian Metzler
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Kidney ,medicine.medical_specialty ,Ureter ,medicine.anatomical_structure ,Prospective trial ,business.industry ,Urology ,medicine.medical_treatment ,medicine ,Stent ,Ureteroscopic lithotripsy ,business ,Surgery - Published
- 2020
11. MP12-08 DECREASED READABILITY OF ONLINE KIDNEY STONE EDUCATIONAL MATERIALS
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David T. Tzou, Barry D. Weiss, Ismail Khan, Andrew Bergersen, and Juan Chipollini
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medicine.medical_specialty ,business.industry ,Urology ,Family medicine ,medicine ,Kidney stones ,medicine.disease ,Health outcomes ,business ,Readability ,Limited health literacy - Abstract
INTRODUCTION AND OBJECTIVE:Limited health literacy has been associated with worse health outcomes across multiple medical conditions, yet how this relates to patients with kidney stones has yet to ...
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- 2020
12. Increasing Body Mass Index Steepens the Learning Curve for Ultrasound-guided Percutaneous Nephrolithotomy
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David Bayne, Alan W. Shindel, Kazumi Taguchi, Manint Usawachintachit, David T. Tzou, and Thomas Chi
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Nephrolithotomy, Percutaneous ,Kidney ,Logistic regression ,Article ,Body Mass Index ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Obesity ,Prospective Studies ,Kidney surgery ,Percutaneous nephrolithotomy ,Prospective cohort study ,Ultrasonography, Interventional ,Aged ,Aged, 80 and over ,business.industry ,Local regression ,Middle Aged ,Surgery, Computer-Assisted ,Learning curve ,030220 oncology & carcinogenesis ,Female ,Clinical Competence ,Radiology ,business ,Body mass index ,Learning Curve ,Cohort study - Abstract
OBJECTIVE: To define how the learning curve for success in ultrasound-guided PCNL is impacted by body mass index (BMI). Previous research has shown ultrasound-guided percutaneous nephrolithotomy (PCNL) to be an effective method of nephrolithiasis treatment comparable to fluoroscopy guided PCNL. A common concern for the ultrasound-guided approach is potential imaging difficulty in the obese patient population. METHODS: A prospective cohort study of consecutive patients undergoing PCNL with ultrasound guidance for renal tract access was performed. Clinical data collected included success in gaining renal access with ultrasound guidance, patient BMI, and clinical outcomes over time. Nonparametric LOWESS regression modeling was performed in R using locally weighted scatterplot smoother (R version 3.3.3) for gradations of patients by BMI group (40). RESULTS: A total of 150 cases were examined. Case number and BMI were evaluated as continuous variables. Multivariate logistic regression revealed that BMI (p = 0.010; OR 0.93) and case number (p40 group is downward and right-shifted relative to the other two groups. CONCLUSION: The learning curve for successful ultrasound-guided PCNL is impacted by patient BMI as well as case number. Increasing BMI makes access more challenging when performing ultrasound-guided PCNL.
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- 2018
13. Management of Suspected Bladder Injury and Capsular Perforation After Holmium Laser Enucleation of the Prostate
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Kieran Hynes, David T. Tzou, Aye Lwin, and Joel Funk
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medicine.medical_specialty ,Adenoma ,business.industry ,Urology ,medicine.medical_treatment ,Perforation (oil well) ,Enucleation ,030232 urology & nephrology ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Prostate ,030220 oncology & carcinogenesis ,medicine ,Extraperitoneal space ,Complication ,business ,Transurethral resection of the prostate ,Open Prostatectomy - Abstract
Background: Holmium laser enucleation of the prostate (HoLEP) is an attractive and well-studied alternative to transurethral resection of the prostate and open prostatectomy for the treatment of benign prostatic hyperplasia. There remains an established steep learning curve with relatively few complications described in the literature. A unique risk of HoLEP is injury of the bladder during morcellation of the adenoma and potential iatrogenic intraperitoneal bladder rupture. We present a rare complication of HoLEP demonstrated by two patients in which capsular perforation resulted in subsequent abdominal distention secondary to a large amount of irrigation fluid that leaked into the extraperitoneal space. Uniquely, these cases were managed differently, and serve as guidance to the HoLEP practitioner in postoperative management. Case Presentations: The first case involved a 74-year-old male who was found to have significant abdominal distention at the end of the procedure. Given an acute change in stability and concern for bladder injury during morcellation, a minilaparotomy was performed only to reveal extraperitoneal extravasation without intraperitoneal bladder injury or perforation. In the second case, a 78-year-old male undergoing HoLEP had a similar presentation of significant abdominal distention at the conclusion of morcellation. Given a low suspicion for any bladder injury, the patient was managed conservatively with diuretics. He was subsequently discharged on postoperative day 1. Conclusion: Capsular perforation is not a rare phenomenon that occurs during HoLEP. Rarely, perforations can lead to extravasation of irrigation fluid into the extraperitoneal space masquerading as a potential bladder injury related to morcellation because of the associated abdominal distention. This presentation can occur in large glands or early in a surgeon's learning curve when operative times are longer. When there is clear evidence to suggest there is no bladder injury, these cases can be managed conservatively and avoid the morbidity of an abdominal exploration.
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- 2018
14. Micro-Costing Analysis Demonstrates Comparable Costs for LithoVue Compared to Reusable Flexible Fiberoptic Ureteroscopes
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Manint Usawachintachit, Thomas Chi, Dylan Isaacson, Kazumi Taguchi, Ian Metzler, Benjamin A. Sherer, Marshall L. Stoller, and David T. Tzou
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Operating Rooms ,Consumables ,Urologists ,Urology ,030232 urology & nephrology ,03 medical and health sciences ,0302 clinical medicine ,Equipment Reuse ,Ureteroscopy ,Fiber Optic Technology ,Humans ,Medicine ,Operations management ,Prospective Studies ,Clinical care ,Disposable Equipment ,URETEROSCOPE ,business.industry ,Equipment Design ,Workflow ,030220 oncology & carcinogenesis ,Micro costing ,Costs and Cost Analysis ,Ureteroscopes ,business - Abstract
Reusable ureteroscope durability and need for repair are significant sources of expense and inefficiency for patients and urologists. Utilization of LithoVue™, a disposable flexible digital ureteroscope, may address some of these concerns. To identify its economic impact on clinical care, we performed a micro-cost comparison between flexible reusable fiberoptic ureteroscopes (URF-P6™) and LithoVue.For this prospective, single-center micro-costing study, all consecutive ureteroscopies performed during 1 week each in July and August 2016 utilized either URF-P6 or LithoVue ureteroscopes respectively. Workflow data were collected, including intraoperative events, postoperative reprocessing cycle timing, consumables usage, and ureteroscope cost data.Intraoperative data analysis showed mean total operating room time for URF-P6 and LithoVue cases were 93.4 ± 32.3 and 73.6 ± 17.4 minutes, respectively (p = 0.093). Mean cost of operating room usage per case was calculated at $1618.72 ± 441.39 for URF-P6 and $1348.64 ± 237.40 for LithoVue based on institutional cost rates exclusive of disposables. Postoperative data analysis revealed costs of $107.27 for labor and consumables during reprocessing for URF-P6 cases. The costs of ureteroscope repair and capital acquisition for each URF-P6 case were $957.71 and $116.02, respectively. The total ureteroscope cost per case for URF-P6 and LithoVue were $2799.72 and $2852.29, respectively.Micro-cost analysis revealed that the cost of LithoVue acquisition is higher per case compared to reusable fiberoptic ureteroscopes, but savings are realized in labor, consumables, and repair. When accounting for these factors, the total cost per case utilizing these two ureteroscopes were comparable.
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- 2018
15. Identifying factors associated with need for flexible ureteroscope repair: a Western Endourology STone (WEST) research consortium prospective cohort study
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Manint Usawachintachit, Thomas Chi, Eric Taylor, Krishna Ramaswamy, Mathew D. Sorensen, Dylan Isaacson, Roger L. Sur, Kazumi Taguchi, David T. Tzou, David Wenzler, Angela Xu, Uwais B. Zaid, Carissa Chu, Jonathan D. Harper, Brian Duty, and Marshall L. Stoller
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Adult ,Male ,medicine.medical_specialty ,Urology ,030232 urology & nephrology ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Urolithiasis ,Lithotripsy ,Ureteroscopy ,Humans ,Medicine ,Prospective Studies ,Perioperative Period ,Prospective cohort study ,Flexible ureteroscope ,URETEROSCOPE ,medicine.diagnostic_test ,business.industry ,General surgery ,Training level ,Equipment Design ,Perioperative ,United States ,Equipment Failure Analysis ,Lithotrite ,030220 oncology & carcinogenesis ,Ureteroscopes ,Female ,Ureter ,business - Abstract
Maintenance of flexible ureteroscopes can involve high costs and administrative burden. Instrument fragility necessitates eventual repair, rendering scopes inaccessible during refurbishment. We conducted a multi-institutional prospective cohort study to identify perioperative factors influencing flexible ureteroscope durability. Patients undergoing flexible ureteroscopy (URS) at six United States endourology centers were enrolled between August 2014 and June 2015. Surgeon self-reported concern and satisfaction with scope performance as well as upward and downward angles of deflection for each scope tip were measured before and after each procedure. The need for scope repair was determined by the operating surgeon at the time of the procedure and recorded. 424 URS cases using 74 flexible ureteroscopes were identified. Scope repair was required in 28 cases (6.6%) involving 26 scopes (35.1%). Upon univariate analysis, shorter patient height, absence of guidewire use, presence of a ureteral access sheath (UAS), longer procedure time, larger stone size, lithotrite type, surgeon training level, and self-reported concern were associated with scope repair. Upon multivariate analysis, UAS use (OR = 2.53, p = 0.005) and degree loss of scope upward flexion during a case (OR = 1.02, p = 0.03) increased the odds of a scope needing repair while the use of safety guidewire decreased the odds of a scope repair (OR = 0.50, p = 0.045). Lithotrite use and surgeon concern were associated with degree loss of scope upward flexion. The use of a UAS, absence of a safety guidewire, and the loss of upward ureteroscope flexion should be considered when evaluating means of optimizing reusable ureteroscope durability.
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- 2017
16. Contrast Enhanced Ultrasound as a Radiation-Free Alternative to Fluoroscopic Nephrostogram for Evaluating Ureteral Patency
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Maureen P. Kohi, Marshall L. Stoller, Andrew Taylor, Thomas Chi, Helena C. Chang, Manint Usawachintachit, David T. Tzou, Stefanie Weinstein, and John Mongan
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Male ,medicine.medical_specialty ,Ureteral Calculi ,Percutaneous ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Contrast Media ,Nephrolithotomy, Percutaneous ,030218 nuclear medicine & medical imaging ,Kidney Calculi ,03 medical and health sciences ,0302 clinical medicine ,Medical imaging ,medicine ,Humans ,Fluoroscopy ,Prospective Studies ,Prospective cohort study ,Percutaneous nephrolithotomy ,Ultrasonography ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Institutional review board ,Treatment Outcome ,Female ,Radiology ,Ureter ,business ,Body mass index ,Contrast-enhanced ultrasound - Abstract
We compared contrast enhanced ultrasound and fluoroscopic nephrostography in the evaluation of ureteral patency following percutaneous nephrolithotomy.This prospective cohort, noninferiority study was performed after obtaining institutional review board approval. We enrolled eligible patients with kidney and proximal ureteral stones who underwent percutaneous nephrolithotomy at our center. On postoperative day 1 patients received contrast enhanced ultrasound and fluoroscopic nephrostogram within 2 hours of each other to evaluate ureteral patency, which was the primary outcome of this study.A total of 92 pairs of imaging studies were performed in 82 patients during the study period. Five study pairs were excluded due to technical errors that prevented imaging interpretation. Females slightly predominated over males with a mean ± SD age of 50.5 ± 15.9 years and a mean body mass index of 29.6 ± 8.6 kg/mA contrast enhanced ultrasound nephrostogram can be safely performed to evaluate for ureteral patency following percutaneous nephrolithotomy. This imaging technique was mostly concordant with fluoroscopic findings. Most discordance was likely attributable to the higher sensitivity for patency of contrast enhanced ultrasound compared to fluoroscopy.
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- 2017
17. Optimizing RNA Extraction of Renal Papilla Biopsy Tissue in Kidney Stone Formers: A New Methodology for Genomic Study
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Marshall L. Stoller, Thomas Chi, Benjamin A. Sherer, Takahiro Yasui, Manint Usawachintachit, David T. Tzou, Kazumi Taguchi, Rei Unno, Yongmei Wang, Shuzo Hamamoto, and Atsushi Okada
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Male ,Nephrolithotomy ,Biopsy ,medicine.medical_treatment ,030232 urology & nephrology ,0302 clinical medicine ,percutaneous nephrolithotomy ,Experimental Endourology ,Prospective Studies ,Ureteroscopy ,Percutaneous ,Upper urinary tract ,Kidney Medulla ,medicine.diagnostic_test ,Genomics ,Middle Aged ,Urology & Nephrology ,medicine.anatomical_structure ,Hematocrit ,Randall's plaque ,030220 oncology & carcinogenesis ,Renal papilla ,Female ,Adult ,medicine.medical_specialty ,Urology ,Clinical Sciences ,Nephrolithotomy, Percutaneous ,Kidney Calculi ,03 medical and health sciences ,medicine ,Humans ,Tissue Collection ,Percutaneous nephrolithotomy ,Aged ,business.industry ,kidney stone disease ,medicine.disease ,RNA extraction ,Kidney stone disease ,Case-Control Studies ,Multivariate Analysis ,RNA ,Kidney stones ,business ,renal papilla biopsy - Abstract
IntroductionEndoscopic tools have provided versatile examination and treatment for kidney stone procedures. Despite endourologists researching urinary stone disease using endoscopes to collect tissue, this tissue collection method is limited. Endoscopically removed tissues are small in size, restricting the types of genome-based examination possible. We investigated a new method of renal papilla biopsy and RNA extraction to establish a genomic research methodology for kidney stone disease.Patients and methodsWe conducted a prospective multi-institutional study and collected renal papilla specimens from consecutive percutaneous nephrolithotomy and ureteroscopy (URS) cases performed for removal of upper urinary tract stones. Renal papilla tissue was extracted using ureteroscopic biopsy forceps after stone removal. RNA was extracted using two different extraction kits, and their quantity and quality were examined. Additionally, the impact of biopsy on surgical complications was compared between cases performed with and without biopsy by matched case-control analysis adjusted for age, gender, body mass index, bilaterality, and stone burden.ResultsA total of 90 biopsies from 49 patients were performed, and the median duration between specimen collection and RNA extraction was 61 days. Both univariate and multivariate analyses showed BIGopsy® forceps usage significantly increased the total yield (p = 0.004) and quality (p = 0.001 for A260/280, p = 0.004 for A260/A230) of extracted RNA. Extraction using the RNeasy Micro Kit® also improved A260/A230, whereas reduced RNA integrity number of extracted RNA by univariate and multivariate analyses (p = 0.002 and p
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- 2017
18. Ultrasound Guidance Reduces Percutaneous Nephrolithotomy Cost Compared to Fluoroscopy
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Manint Usawachintachit, Ian Metzler, Errol Lobo, Matthew Hudnall, Brittany Harrison, David T. Tzou, and Thomas Chi
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Adult ,Male ,Nephrolithotomy ,medicine.medical_specialty ,Total cost ,Cost-Benefit Analysis ,Urology ,medicine.medical_treatment ,Operative Time ,Clinical Sciences ,030232 urology & nephrology ,Nephrolithotomy, Percutaneous ,Article ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Models ,Clinical Research ,medicine ,Humans ,Fluoroscopy ,Prospective Studies ,Percutaneous nephrolithotomy ,Prospective cohort study ,Ultrasonography ,Aged ,Percutaneous ,Academic Medical Centers ,Models, Statistical ,Cost–benefit analysis ,medicine.diagnostic_test ,business.industry ,X-Rays ,Ultrasound ,Health Care Costs ,Statistical ,Middle Aged ,Urology & Nephrology ,Surgery ,Ultrasound guidance ,030220 oncology & carcinogenesis ,Biomedical Imaging ,Operative time ,Female ,business - Abstract
Objective To examine the cost factors associated with ultrasound and fluoroscopic guidance for percutaneous nephrolithotomy (PCNL) and to determine which method can be performed at a lower cost per case. Methods A cost comparison study was performed utilizing clinical data from a prospectively maintained research database. We included the most recent 33 consecutive ultrasound-guided PCNL cases in 2016 and the most recent 40 consecutive fluoroscopy-guided PCNL cases before the operative surgeon transitioned to ultrasound guidance in May 2014. The total operative time and clinical outcomes were examined. Costs were extracted from the institution accounting systems and given a uniform multiplier to protect institutional financial reporting confidentiality. Comparisons were made using the Student t test and the chi-squared test. Results After excluding outliers, 71 PCNL procedures were included in the analysis. Demographic data and stone characteristics were not different between ultrasound-guided and fluoroscopy-guided groups. However, the mean operative time for ultrasound-guided PCNL was significantly shorter (99.8 ± 27.0 vs 144.9 ± 55.1 minutes, P
- Published
- 2017
19. Feasibility of Retrograde Ureteral Contrast Injection to Guide Ultrasonographic Percutaneous Renal Access in the Nondilated Collecting System
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Stefanie Weinstein, John Mongan, David T. Tzou, Manint Usawachintachit, Kazumi Taguchi, and Thomas Chi
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Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Contrast Media ,Pilot Projects ,Stone size ,Collection system ,Injections ,030218 nuclear medicine & medical imaging ,Kidney Calculi ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Percutaneous nephrolithotomy ,Ultrasonography, Interventional ,Aged ,Nephrostomy, Percutaneous ,business.industry ,Ultrasound ,Imaging and Noninvasive Therapy ,Middle Aged ,Surgery ,Contrast injection ,Feasibility Studies ,Female ,Retrograde ureteral ,Radiology ,business ,Contrast-enhanced ultrasound - Abstract
Ultrasound-guided percutaneous nephrolithotomy (PCNL) has become increasingly utilized. Patients with nondilated collecting systems represent a challenge: the target calix is often difficult to visualize. Here we report pilot study results for retrograde ultrasound contrast injection to aid in percutaneous renal access during ultrasound-guided PCNL.From April to July 2016, consecutive patients over the age of 18 years with nondilated collecting systems on preoperative imaging who presented for PCNL were enrolled. B-mode ultrasound imaging was compared with contrast-enhanced mode with simultaneous retrograde injection of Optison™ via an ipsilateral ureteral catheter.Five patients (four males and one female) with renal stones underwent PCNL with retrograde ultrasound contrast injection during the study period. Mean body mass index was 28.3 ± 5.6 kg/mRetrograde ultrasound contrast injection as an aide for renal puncture during PCNL is a feasible technique. By improving visualization of the collecting system, it facilitates needle placement in challenging patients without hydronephrosis. Future larger scale studies comparing its use to standard ultrasound-guided technique will be required to validate this concept.
- Published
- 2017
20. X-ray–free Ultrasound-guided Percutaneous Nephrolithotomy: How to Select the Right Patient?
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David T. Tzou, Manint Usawachintachit, Jianxing Li, Thomas Chi, and Weiguo Hu
- Subjects
Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Hydronephrosis ,Nephrolithotomy, Percutaneous ,Stone size ,Article ,Staghorn stone ,Kidney Calculi ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Fluoroscopy ,Prospective Studies ,Percutaneous nephrolithotomy ,Prospective cohort study ,Aged ,Ultrasonography ,medicine.diagnostic_test ,business.industry ,Patient Selection ,Middle Aged ,medicine.disease ,Dilatation ,Ultrasound guided ,Surgery ,Surgery, Computer-Assisted ,030220 oncology & carcinogenesis ,Female ,Radiology ,business - Abstract
Objective To identify factors associated with successful ultrasound guidance for each surgical step of ultrasound-guided percutaneous nephrolithotomy (PCNL). Patients and Methods Consecutive patients undergoing PCNL between March 2015 and June 2016 were prospectively enrolled. An attempt was made to use ultrasound guidance in renal access, tract dilation, and nephrostomy tube placement for each patient. For steps during which ultrasound guidance was unsuccessful, fluoroscopic screening was applied. Regression analysis identified patient characteristics associated with successful use of ultrasound guidance. Results A total of 96 patients composed this cohort, with a mean body mass index of 28.7 kg/m 2 . Mean stone size was 33.1 ± 18.9 mm, and no hydronephrosis was found in 63.5% of cases. Fluoroscopic screening was required for renal access in 27 cases (28.1%), tract dilation in 38 (39.6%), and nephrostomy tube placement in 80 (83.3%). Multivariate analysis demonstrated that successful ultrasound guidance was significantly associated with the presence of hydronephrosis for renal access and the absence of staghorn calculi for tract dilation. Ultrasound-guided nephrostomy tube placement appeared linked to surgeon experience. Conclusion To achieve completely x-ray–free ultrasound-guided PCNL, the ideal patient should have a hydronephrotic collecting system with no staghorn stone present. For practitioners looking to adopt ultrasound guidance into their PCNL practice, these represent the most appropriate patients to safely initiate a surgical experience.
- Published
- 2017
21. Ultrasound-guided Access and Dilation for Percutaneous Nephrolithotomy in the Supine Position: A Step-by-Step Approach
- Author
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Marshall L. Stoller, Ian Metzler, Thomas Chi, David T. Tzou, and Manint Usawachintachit
- Subjects
medicine.medical_specialty ,Supine position ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Axillary lines ,Nephrolithotomy, Percutaneous ,Patient Positioning ,Article ,03 medical and health sciences ,0302 clinical medicine ,Supine Position ,Humans ,Medicine ,Fluoroscopy ,Percutaneous nephrolithotomy ,Ultrasonography, Interventional ,Rib cage ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Dilatation ,Prone position ,030220 oncology & carcinogenesis ,Dilator ,Radiology ,business - Abstract
Introduction Ultrasound guidance for percutaneous nephrolithotomy (PCNL) has gained acceptance amongst urologists given its numerous advantages over fluoroscopy. While traditionally performed in the prone position, this video demonstrates a step-by-step approach to performing PCNL in the supine position, solely under ultrasound guidance. Materials and Methods Once in the modified supine (Galdakao-modified Valdivia) position, important anatomic landmarks are identified. It is important to first orient the ultrasound probe such that its cranial side corresponds to the left of the ultrasound screen. After optimizing a target calyx, keeping the needle in the imaging plane of the probe facilitates renal access. Tract dilation under ultrasound guidance is then achieved by keeping the wire and dilators in the same imaging plane. Results The 11th and 12th ribs, paraspinous muscle, iliac crest, midaxillary line, and costal margin are the anatomic landmarks that orient the probe to the location of the kidney. Placing the ultrasound probe in the midaxillary line, parallel to the 11th rib allows the operator to identify key renal landmarks: the renal cortex, peri-pelvic fat, collecting system, kidney stone with its associated postacoustic shadow, and the intended target calyx. Controlling the needle is easiest in the longitudinal view, as the needle can be visualized from skin to target. Dilation under ultrasound relies on keeping the wire in view. The tip of the 10-French dilator is based on the location where the wire image disappears as the dilator advances. The balloon dilator tip is visualized on ultrasound reaching the appropriate depth just inside the collecting system, at which time balloon inflation results in complete dilation of the tract. Conclusions This video provides a step-by-step approach demonstrating that PCNL can be performed in the supine position using only ultrasound-guidance. This approach facilitates renal access in this position and obviates the need for radiation exposure.
- Published
- 2019
22. Techniques - Ultrasound-guided percutaneous nephrolithotomy: How we do it
- Author
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Hassan Razvi, Marshall L. Stoller, Jennifer Bjazevic, David Bayne, Darren Beiko, Thomas Chi, Naeem Bhojani, and David T. Tzou
- Subjects
medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Clinical Sciences ,Oncology and Carcinogenesis ,030232 urology & nephrology ,MEDLINE ,Techniques in Urology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Fluoroscopy ,Medical physics ,Percutaneous nephrolithotomy ,Update in Urology ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Urology & Nephrology ,Ultrasound guided ,Radiation exposure ,Oncology ,Ultrasonography ,business ,Endourology - Abstract
Ultrasonography has emerged as an alternative to fluoroscopy for image-guided percutaneous nephrolithotomy (PCNL) in many countries. Compared to fluoroscopy-guided PCNL (F-PCNL), ultrasound-guided PCNL (US-PCNL) is easier to learn and reduces radiation exposure to patients and providers. Despite these advantages, uptake of ultrasound-guided PCNL (US-PCNL) in Canada has been almost nonexistent, largely because it is not incorporated into urologists’ training. In this article, we seek to familiarize Canadian urologists with this approach by describing our step-by-step technique for US-PCNL. Additionally, we provide keys to successful implementation of this technique.
- Published
- 2019
23. Ultrasound-Guided Morcellation During Difficult Holmium Laser Enucleation of the Prostate (HoLEP)
- Author
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David Bayne, Ian Metzler, Jeremy Goodman, Catherine Tsai, David T. Tzou, and Thomas Chi
- Subjects
Male ,medicine.medical_specialty ,Urology ,Enucleation ,Urinary Bladder ,030232 urology & nephrology ,Holmium laser ,Prostatic Hyperplasia ,Lasers, Solid-State ,Morcellation ,Proof of Concept Study ,Article ,03 medical and health sciences ,0302 clinical medicine ,Prostate ,medicine ,Humans ,Intraoperative Complications ,Ultrasonography ,Prostatectomy ,business.industry ,Ultrasound ,Ultrasound guided ,Catheter ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Prostate surgery ,Morcellator ,Radiology ,Laser Therapy ,business - Abstract
Objective To demonstrate how bladder ultrasound can be useful in completing morcellation during difficult Holmium Laser Enucleation of the Prostate (HoLEP). As HoLEP has emerged as a standard of care for the treatment of benign prostatic hyperplasia, multiple studies have reported the potentially catastrophic complication of bladder injury during morcellation. This video aims to assist any urologist performing HoLEP by providing step-by-step instruction for using ultrasound to complete morcellation safely. Methods Enucleation is performed using a 26-French continuous flow scope, off-set laser bridge with a laser stabilization catheter, and a 550 µm holmium laser fiber. Once the median and lateral lobes have been enucleated, the outer sheath is removed and the nephroscope is inserted to facilitate morcellation. Under dual inflow irrigation, the Piranha morcellator (Richard Wolf, Knittlingen, Germany) is introduced and set to the manufacturer's recommended settings of 1500 rpm. A 3.5-MHz convex abdominal ultrasound transducer (Hitachi Prosound Alpha 7; Hitachi Aloka Medical America, Wallingford, CT) under B-mode is used to visualize the bladder, predominantly in the sagittal orientation. Morcellation proceeds under simultaneous ultrasound and direct cystoscopic guidance. Results The distended bladder is visualized concurrently with the ultrasound and via the nephroscope as the Piranha engages the adenoma and begins morcellation. Once the adenoma is engaged, the operator then drops their hands to place the morcellator in the center of the bladder. Ultrasound provides real-time feedback as to the location of the morcellator in relation to the adenoma and bladder. Conclusion This video highlights the use of intraoperative bladder ultrasound as a visual aid to assist during the morcellation portion of HoLEP. This proof of concept demonstrates that ultrasound can be an additional tool to utilize during difficult cases when cystoscopic visualization during morcellation is limited.
- Published
- 2019
24. Influence of Socioeconomic Factors on Stone Burden at Presentation to Tertiary Referral Center: Data From the Registry for Stones of the Kidney and Ureter
- Author
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Manint Usawachintachit, Manuel Armas-Phan, Marshall L. Stoller, Scott Wiener, David Bayne, David T. Tzou, Timothy T. Brown, and Thomas Chi
- Subjects
Adult ,Male ,Urologic Diseases ,Pediatrics ,medicine.medical_specialty ,Multivariate analysis ,Ureteral Calculi ,Kidney Disease ,Referral ,Adolescent ,Urology ,Population ,Clinical Sciences ,030232 urology & nephrology ,Article ,Tertiary Care Centers ,03 medical and health sciences ,Kidney Calculi ,Young Adult ,0302 clinical medicine ,Ureter ,Clinical Research ,80 and over ,Medicine ,Humans ,Registries ,education ,Child ,Preschool ,Socioeconomic status ,Retrospective Studies ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,Retrospective cohort study ,Middle Aged ,Urology & Nephrology ,medicine.disease ,United States ,medicine.anatomical_structure ,Socioeconomic Factors ,Child, Preschool ,030220 oncology & carcinogenesis ,Kidney stones ,Female ,business ,Body mass index - Abstract
Objective To determine social factors associated with advanced stone disease (defined as unilateral stone burden >2 cm) at time of presentation to a regional stone referral center. Little is known about social determinants of urolithiasis. We hypothesize that socioeconomic factors impact kidney stone severity at intake to referral centers. Methods A retrospective review of the prospectively collected data from the Registry for Stones of the Kidney and Ureter from 2015 to 2018 was conducted to evaluate patient characteristics predictive of having a large (>2 cm) unilateral kidney stone. Data on patient age, gender, body mass index, diabetes, race, language, education level, infection, distance, income, referring regional urologist density, American Society of Anesthesiologists score, and stone analysis were evaluated. Results Complete imaging and patient variable data was present in 650 of 1142 patients including 197 patients with unilateral stone burden >2 cm. On multivariate analysis, obesity, lower education level, increased distance from the referral center, and symptoms of infection predicted for unilateral stone burden greater than 2 cm. Among 191 patients with stone analysis data present, stone type, income, and urologist density predicted for unilateral stone burden greater than 2 cm. Conclusion In addition to known biological risk factors, patients with lower education levels and from regions of lower mean income were found to be more likely to present to our tertiary care center with stone burden greater than 2 cm. More research is needed to elucidate the social and societal determinants of advanced stone disease and the impact this has on population costs for stone treatment.
- Published
- 2019
25. The Impact of Stone Multiplicity on Surgical Decisions for Patients with Large Stone Burden: Results from ReSKU
- Author
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Washington Sl rd, David T. Tzou, Samuel Zetumer, Marshall L. Stoller, Scott Wiener, Thomas Chi, Manuel Armas-Phan, and David Bayne
- Subjects
Male ,Nephrolithotomy ,Kidney Disease ,Databases, Factual ,medicine.medical_treatment ,030232 urology & nephrology ,General Research ,0302 clinical medicine ,Medicine ,percutaneous nephrolithotomy ,Ureteroscopy ,Registries ,Prospective Studies ,Societies, Medical ,Percutaneous ,medicine.diagnostic_test ,Middle Aged ,Urology & Nephrology ,kidney stone ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Adult ,Urologic Diseases ,medicine.medical_specialty ,stone multiplicity ,Urology ,Clinical Sciences ,Guidelines as Topic ,Nephrolithotomy, Percutaneous ,Kidney Calculi ,03 medical and health sciences ,Databases ,kidney calculi ,Clinical Research ,Medical ,Humans ,Percutaneous nephrolithotomy ,Ureterolithiasis ,Factual ,Retrospective Studies ,Aged ,Renal stone ,business.industry ,General surgery ,renal stone ,Length of Stay ,medicine.disease ,United States ,cumulative stone diameter ,Multivariate Analysis ,Kidney stones ,Ureter ,business ,Societies - Abstract
Introduction: American Urological Association (AUA) guidelines recommend percutaneous nephrolithotomy (PCNL) for total stone burden greater than 20 mm, yet it is unclear if the number of stones affects adherence to this guideline. We aim to assess the impact of stone multiplicity on the choice of ureteroscopy (URS) vs PCNL as a first-line therapy for patients with high burden (>20 mm), and examine whether the AUA guideline-discordant care impacts patient outcomes. Materials and Methods: Data were collected from the Registry for Stones of the Kidney and Ureter (ReSKU) database, a prospectively collected registry of patients with stone disease. Multivariate logistic regression (MLR) was used to estimate the association between stone multiplicity and the decision to perform URS for high stone burden (>20 mm) patients. MLR was further used to estimate the association between performing URS and the following outcomes: stone-free rate, need for a second operation, and complications. Postoperative hospital stay was compared between patients receiving URS vs PCNL using Student's t-test. Results: One hundred twenty-five patients were included in this analysis. For patients with total stone burden exceeding 20 mm, those with more than three stones had roughly nine times the likelihood of undergoing URS over PCNL compared with patients with a single stone (adjusted odds ratio 9.21, confidence interval [95% CI] 2.55-40.58, p = 0.001). Stone-free rates, Clavien-Dindo scores, and frequency of second-look operations did not differ significantly between URS and PCNL patients. URS patients were discharged an average of 1.26 days earlier than patients who received PCNL (95% CI 0.72-1.81, p 20 mm will undergo URS and who will undergo PCNL. These deviations from AUA guidelines do not appear to worsen patient outcomes. These results suggest that careful consideration of each patient may warrant deviation from guidelines.
- Published
- 2019
26. Computed Tomography Radiation Exposure Among Referred Kidney Stone Patients: Results from the Registry for Stones of the Kidney and Ureter
- Author
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David Bayne, David T. Tzou, Jonathan D. Harper, Thomas Chi, Marshall L. Stoller, Roger L. Sur, Mathew D. Sorensen, Ryan S. Hsi, Helena C. Chang, Kazumi Taguchi, Samuel Zetumer, Shalonda Reliford-Titus, Dylan Isaacson, Manint Usawachintachit, Seth K. Bechis, Brian Duty, and Zhen J. Wang
- Subjects
Male ,Kidney Disease ,kidney stones ,030232 urology & nephrology ,Computed tomography ,General Research ,Effective dose (radiation) ,0302 clinical medicine ,Abdomen ,Registries ,Tomography ,Referral and Consultation ,radiation dose limit ,Kidney ,medicine.diagnostic_test ,CT Abdomen ,Middle Aged ,Radiation Exposure ,Urology & Nephrology ,X-Ray Computed ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,low-dose CT ,Biomedical Imaging ,Female ,Radiology ,ionizing radiation ,CT ,Adult ,Urologic Diseases ,medicine.medical_specialty ,Ureteral Calculi ,Urology ,Clinical Sciences ,effective dose ,Radiation Dosage ,03 medical and health sciences ,Kidney Calculi ,Ureter ,medicine ,Humans ,Radiation Injuries ,Pelvis ,Aged ,business.industry ,medicine.disease ,Radiation exposure ,Kidney stones ,Tomography, X-Ray Computed ,business - Abstract
Purpose: Kidney stone patients routinely have CT scans during diagnostic work-up before being referred to a tertiary center. How often these patients exceed the recommended dose limits for occupational radiation exposure of >100 mSv for 5 years and >50 mSv in a single year from CT alone remains unknown. This study aimed to quantify radiation doses from CTs received by stone patients before their evaluation at a tertiary care stone clinic. Methods: From November 2015 to March 2017, consecutive new patients enrolled into the Registry for Stones of the Kidney and Ureter (ReSKU™) had the dose-length product of every available CT abdomen/pelvis within 5 years of their initial visit recorded, allowing for an effective dose (EDose) calculation. Multivariate logistic regression analysis identified factors associated with exceeding recommended dose limits. Models were created to test radiation reducing effects of low-dose and phase-reduction CT protocols. Results: Of 343 noncontrast CTs performed, only 29 (8%) were low-dose CTs (calculated EDose 20 mSv and >50 mSv/year, respectively. Increased body mass index, number of scans, and multiphase scans were associated with exceeding exposure thresholds (p 50%. Conclusions: Stone patients referred to a tertiary stone center may receive excessive radiation from CT scans alone. Unnecessary phases and underutilization of low-dose CT protocols continue to take place. Enacting new approaches to CT protocols may spare stone patients from exceeding recommended dose limits.
- Published
- 2019
27. MP80-16 PERCUTANEOUS RENAL TRACT DILATION CAN BE SAFELY GUIDED UNDER ULTRASOUND IMAGING
- Author
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David Bayne, Tom Chi, Tim Liang, David T. Tzou, Manuel Armas-Phan, Marshall L. Stoller, and Scott Wiener
- Subjects
medicine.medical_specialty ,Percutaneous ,business.industry ,Urology ,Ultrasound imaging ,Dilation (morphology) ,Medicine ,Radiology ,business - Published
- 2019
28. PD38-03 FATTY ACID BINDING PROTEIN 4 IS AN ESSENTIAL MOLECULE FOR THE DEVELOPMENT OF KIDNEY STONES: A NEW UNDERSTANDING OF WHY OBESITY AND NEPHROLITHIASIS GO HAND IN HAND
- Author
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Marshall L. Stoller, Kazumi Taguchi, Ling Chen, Shuzo Hamamoto, Misun Kang, Benjamin A. Sherer, David T. Tzou, Manint Usawachintachit, Thomas Chi, Takahiro Yasui, Sunita P. Ho, and Rei Unno
- Subjects
Biochemistry ,business.industry ,Urology ,medicine ,Kidney stones ,medicine.disease ,business ,Obesity ,Fatty acid-binding protein - Published
- 2019
29. V02-01 ULTRASOUND-GUIDED MORCELLATION DURING DIFFICULT HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP)
- Author
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David T Tzou, Ian S Metzler, Catherine Tsai, Jeremy Goodman, and Thomas Chi
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Urology - Published
- 2019
30. PD63-02 IMPACT OF THE AFFORDABLE CARE ACT ON PAYER DISTRIBUTION FOR UROLOGIC STONE SURGERY IN THE STATE OF CALIFORNIA
- Author
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David Bayne, David T. Tzou, Marshall L. Stoller, Scott Wiener, and Thomas Chi
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State (polity) ,business.industry ,Urology ,media_common.quotation_subject ,Health insurance ,Medicine ,Distribution (economics) ,Medical emergency ,business ,medicine.disease ,media_common - Published
- 2019
31. MP29-07 TRAVEL PATTERNS FOR PATIENTS UNDERGOING STONE SURGERY IN THE STATE OF CALIFORNIA, 2005-2016
- Author
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David Bayne, Thomas Chi, David T. Tzou, Marshall L. Stoller, and Scott Wiener
- Subjects
medicine.medical_specialty ,State (polity) ,business.industry ,Urology ,media_common.quotation_subject ,Family medicine ,Medicine ,Census ,business ,media_common - Abstract
INTRODUCTION AND OBJECTIVES:According to the 2017 American Urological Association census, 62.2% of counties in the United States are without any practicing urologists and 89.3% of urologists practi...
- Published
- 2019
32. MP29-06 DELAYS IN PRESENTATION TO UROLOGISTS FOR URINARY STONE DISEASE INCREASE UTILIZATION OF HEALTH CARE RESOURCES
- Author
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David Bayne, Manint Usawachintachit, Tom Chi, Manuel Armas-Phan, David T. Tzou, Marshall L. Stoller, and Scott Wiener
- Subjects
medicine.medical_specialty ,Univariate analysis ,Multivariate analysis ,business.industry ,Urology ,General surgery ,Logistic regression ,medicine.disease ,Exact test ,Health care ,Medicine ,Kidney stones ,Presentation (obstetrics) ,business ,Urinary stone disease - Abstract
INTRODUCTION AND OBJECTIVES:Greater than 60% of counties in the United States have no urologists; does this impact stone patient management? Are stone clearance rates impacted by delays in getting to see an urologist? Our objective is to investigate the impact of delays to presentation to urology clinics and delays to surgery on need for repeat kidney stone interventions.METHODS:A retrospective review of the prospectively collected data from Sept 2015 to July 2018 was conducted to investigate the relationship between delay to seeing an urologist and delay to stone surgery. Data on unilateral stone size, patient age, race, gender, education level, BMI, ASA score, procedure type, mean income per zip code, distance from hospital, history of prior stone surgery, and English as a primary language were included. Univariate analysis was performed in R using Fisher's Exact test and Welch Two Sample t-test. Multivariate analysis was performed using logistic regression. Statistical analysis was performed in R versi...
- Published
- 2019
33. MP35-06 ASSESSING THE UROLOGIC TRAINEE'S LEARNING CURVE FOR ULTRASOUND GUIDED RENAL PUNCTURES DURING PERCUTANEOUS NEPHROLITHOTOMY
- Author
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Kelly Walker, Manuel Armas-Phan, David Bayne, Tom Chi, Adam J. Gadzinski, Marshall L. Stoller, Scott Wiener, Ian Metzler, and David T. Tzou
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,medicine.medical_treatment ,Medicine ,Radiology ,business ,Percutaneous nephrolithotomy ,Ultrasound guided - Published
- 2019
34. Fatty acid-binding protein 4 downregulation drives calcification in the development of kidney stone disease
- Author
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Marshall L. Stoller, Sunita P. Ho, Atsushi Okada, Manint Usawachintachit, Thomas Chi, Takahiro Yasui, Rei Unno, Misun Kang, Teruaki Sugino, Ling Chen, Benjamin A. Sherer, Kazumi Taguchi, David T. Tzou, and Shuzo Hamamoto
- Subjects
0301 basic medicine ,Pathology ,medicine.medical_specialty ,030232 urology & nephrology ,Down-Regulation ,Fatty Acid-Binding Proteins ,Kidney ,03 medical and health sciences ,Kidney Calculi ,0302 clinical medicine ,Downregulation and upregulation ,medicine ,Humans ,Kidney Medulla ,business.industry ,medicine.disease ,Major duodenal papilla ,030104 developmental biology ,medicine.anatomical_structure ,Nephrology ,Kidney stone disease ,Renal papilla ,Knockout mouse ,Kidney stones ,business ,Calcification - Abstract
Nephrolithiasis is a significant source of morbidity, and its incidence has increased significantly over the last decades. This rise has been attributed to concurrent increasing rates of obesity, associated with a 3-time risk of developing NL. To date, the mechanism by which obesity is linked to stone formation has not been elucidated. We aimed to utilize a transcriptomics approach to discover the missing link between these two epidemic diseases. We investigated gene expression profiling of nephrolithiasis patients by two RNA-sequencing approaches: comparison between renal papilla tissue with and without the presence of calcified Randall's plaques (RP), and comparison between the papilla, medulla, and cortex regions from within a single recurrent stone forming kidney. Results were overlaid between differently expressed genes found in the patient cohort and in the severely lithogenic kidney to identify common genes. Overlay of these two RNA-sequencing datasets demonstrated there is impairment of lipid metabolism in renal papilla tissue containing RP linked to downregulation of fatty acid binding protein (FABP) 4. Immunohistochemistry of human kidney specimens and microarray analysis of renal tissue from a nephrolithiasis mouse model confirmed that FABP4 downregulation is associated with renal stone formation. In a FABP4 knockout mouse model, FABP4 deficiency resulted in development of both renal and urinary crystals. Our study revealed that FABP4 plays an important, previously unrecognized role in kidney stone formation, providing a feasible mechanism to explain the link between nephrolithiasis and metabolic syndrome.
- Published
- 2019
35. Ultrasound guidance can be used safely for renal tract dilatation during percutaneous nephrolithotomy
- Author
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David Bayne, Thomas Chi, Manuel Armas-Phan, Marshall L. Stoller, Scott Wiener, and David T. Tzou
- Subjects
Adult ,Image-Guided Biopsy ,Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Hydronephrosis ,Nephrolithotomy, Percutaneous ,03 medical and health sciences ,Kidney Calculi ,0302 clinical medicine ,medicine ,Fluoroscopy ,Humans ,Prospective Studies ,Surgical positions ,Percutaneous nephrolithotomy ,Aged ,Ultrasonography ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Middle Aged ,medicine.disease ,Dilatation ,Lithotomy position ,Surgery ,Exact test ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Complication ,business ,Cohort study - Abstract
Author(s): Armas-Phan, Manuel; Tzou, David T; Bayne, David B; Wiener, Scott V; Stoller, Marshall L; Chi, Thomas | Abstract: OBJECTIVES:To compare clinical outcomes in patients who underwent percutaneous nephrolithotomy (PCNL) with renal tract dilatation performed under fluoroscopic guidance vs renal tract dilatation with ultrasound guidance. PATIENTS AND METHODS:We conducted a prospective observational cohort study, enrolling successive patients undergoing PCNL between July 2015 and March 2018. Included in this retrospective analysis were cases where the renal puncture was successfully obtained with ultrasound guidance. Cases were then grouped according to whether fluoroscopy was used to guide renal tract dilatation or not. All statistical analyses were performed using Stata version 15.1 including univariate (Fisher's exact test, Welch's t-test) and multivariate analyses (binomial logistic regression, ordinal logistic regression, and linear regression). RESULTS:A total of 176 patients underwent PCNL with successful ultrasonography-guided renal puncture, of whom 38 and 138 underwent renal tract dilatation with fluoroscopic vs ultrasound guidance, respectively. There were no statistically significant differences in patient age, gender, body mass index (BMI), preoperative hydronephrosis, stone burden, procedure laterality, number of dilated tracts, and calyceal puncture location between the two groups. Among ultrasound tract dilatations, a higher proportion of patients were placed in the modified dorsal lithotomy position as opposed to prone, and a significantly shorter operating time was observed. Only modified dorsal lithotomy position remained statistically significant after multivariate regression. There were no statistically significant differences in postoperative stone clearance, complication rate, or intra-operative estimated blood loss. A 5-unit increase in a patient's BMI was associated with 30% greater odds of increasingly severe Clavien-Dindo complications. A 5-mm decrease in the preoperative stone burden was associated with 20% greater odds of stone-free status. No variables predicted estimated blood loss with statistical significance. CONCLUSIONS:Renal tract dilatation can be safely performed in the absence of fluoroscopic guidance. Compared to using fluoroscopy, the present study demonstrated that ultrasonography-guided dilatations can be safely performed without higher complication or bleeding rates. This can be done using a variety of surgical positions, and future studies centred on improving dilatation techniques could be of impactful clinical value.
- Published
- 2019
36. Response to Stutz et al. re: 'Management of Suspected Bladder Injury and Capsular Perforation After Holmium Laser Enucleation of the Prostate'
- Author
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Aye Lwin, Joel Funk, and David T. Tzou
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Prostate ,Urology ,Enucleation ,Perforation (oil well) ,Bladder injury ,medicine ,Holmium laser ,business ,Letter to the Editor ,Surgery - Published
- 2018
37. Reply by Authors
- Author
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Andrew M. Bergersen, Ismail Khan, Ava C. Wong, Juan J. Chipollini, Barry D. Weiss, and David T. Tzou
- Subjects
Urology - Published
- 2021
38. PD35-11 MULTI-INSTITUTIONAL VARIATION IN PERFORMANCE OF LOW DOSE COMPUTERIZED TOMOGRAPHY FOR THE EVALUATION OF SUSPECTED NEPHROLITHIASIS
- Author
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Mathew Sorensen, David T. Tzou, Seth Bechis, Marshall L. Stoller, Dima Raskolnikov, Ian Metzler, Jonathan D. Harper, Justin Ahn, and Thomas Chi
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,Low dose ,medicine ,Radiology ,Tomography ,business ,Sievert - Abstract
INTRODUCTION AND OBJECTIVE:American Urological Association (AUA) guidelines recommend low dose (
- Published
- 2020
39. Editorial Comment
- Author
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David T. Tzou and Thomas Chi
- Subjects
Urology ,Humans ,Urography ,Tomography, X-Ray Computed ,Hematuria - Published
- 2018
40. MP13-09 THE IMPACT OF FAMILY HISTORY ON UROLITHIASIS SEVERITY OF DISEASE: FINDINGS FROM RESKU
- Author
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Marshall L. Stoller, Manint Usawachintachit, Thomas Chi, Benjamin A. Sherer, Kazumi Taguchi, and David T. Tzou
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,Family medicine ,medicine ,Disease ,Family history ,business - Published
- 2018
41. PD35-10 RENAL TRACT DILATION IS A SIGNIFICANT SOURCE OF RADIATION EXPOSURE DURING PERCUTANEOUS NEPHROLITHOTOMY: RESULTS FROM THE REGISTRY FOR STONES OF THE KIDNEY AND URETER (RESKU)
- Author
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Manint Usawachintachit, David T. Tzou, Samuel Zetumer, Kazumi Taguchi, Marshall L. Stoller, Manuel Armaz Villaneda, Thomas Chi, and Shalonda Reliford-Titus
- Subjects
Kidney ,medicine.medical_specialty ,business.industry ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Radiation exposure ,03 medical and health sciences ,Dilation (metric space) ,0302 clinical medicine ,medicine.anatomical_structure ,Ureter ,medicine ,Percutaneous nephrolithotomy ,business - Published
- 2018
42. PD37-10 RADIATION EXPOSURE FROM CT SCANS FOR UROLITHIASIS: RESULTS FROM THE REGISTRY FOR STONES OF THE KIDNEY AND URETER (RESKU)
- Author
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Manint Usawachintachit, Kazumi Taguchi, Benjamin A. Sherer, Shalonda Reliford-Titus, Marshall L. Stoller, David T. Tzou, Dylan Isaacson, Thomas Chi, and Samuel Zetumer
- Subjects
Radiation exposure ,Kidney ,medicine.medical_specialty ,Ureter ,medicine.anatomical_structure ,business.industry ,Urology ,medicine ,Radiology ,business - Published
- 2018
43. MP50-15 AUTOMATED DATA EXTRACTION FROM AN INTEGRATED ELECTRONIC HEALTH RECORDS DATA REGISTRY YIELDS HIGHER ACCURACY THAN MANUAL ENTRY: RESULTS FROM THE REGISTRY FOR STONES OF THE KIDNEY AND URETER (RESKU)
- Author
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Marshall L. Stoller, Tessnim R Ahmad, David T. Tzou, Samuel Zetumer, Shalonda Reliford-Titus, and Thomas Chi
- Subjects
Automated data ,medicine.medical_specialty ,Ureter ,medicine.anatomical_structure ,business.industry ,Urology ,Extraction (chemistry) ,medicine ,Radiology ,Health records ,business - Published
- 2018
44. MP13-07 INCOME IS STRONGLY ASSOCIATED WITH KIDNEY STONE DISEASE-SPECIFIC QUALITY OF LIFE
- Author
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Thomas Chi, Necole M. Streeper, Jodi Antonelli, Roger L. Sur, David T. Tzou, RD Kristina L. Penniston, Vincent G. Bird, Frcsc Sri Sivalingam, Vernon M. Paise, BA Shalonda Reliford-Titus, BS Tessnim R. Ahmad, Stephen Y. Nakada, Md, Facs, Frcs, Timothy D. Averch, Facs Davis P. Viprakasit, Ben H. Chew, BA Jeremy Goodman, and Clinton Wu
- Subjects
medicine.medical_specialty ,Quality of life (healthcare) ,business.industry ,Kidney stone disease ,Urology ,Medicine ,business ,Intensive care medicine ,medicine.disease - Published
- 2018
45. Clinical Outcomes for Cystinuria Patients with Unilateral Versus Bilateral Cystine Stone Disease
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Marshall L. Stoller, Matthew Hudnall, Benjamin A. Sherer, Kazumi Taguchi, Manint Usawachintachit, Ryan S. Hsi, David T. Tzou, and Thomas Chi
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Urologic Diseases ,Adult ,Male ,medicine.medical_specialty ,Kidney Disease ,Urology ,Urinary system ,Clinical Sciences ,030232 urology & nephrology ,Cystine ,Renal and urogenital ,Renal function ,General Research ,Kidney ,03 medical and health sciences ,chemistry.chemical_compound ,Kidney Calculi ,0302 clinical medicine ,Clinical Research ,medicine ,Humans ,Stone disease ,Retrospective Studies ,Aged ,Cystinuria ,business.industry ,renal function ,Middle Aged ,Urology & Nephrology ,Renal anatomy ,medicine.disease ,clinical outcomes ,Surgery ,medicine.anatomical_structure ,chemistry ,030220 oncology & carcinogenesis ,Case-Control Studies ,San Francisco ,Female ,Stone formers ,business ,Glomerular Filtration Rate - Abstract
INTRODUCTION:Cystinuria is a genetic disorder marked by elevated urinary cystine excretion and recurrent cystine nephrolithiasis. Interestingly, despite seemingly similar contralateral renal anatomy, a subset of cystinuric patients consistently form stones in only one kidney. The aim of this study is to evaluate clinical outcomes in unilateral vs bilateral cystine stone formers. PATIENTS AND METHODS:We performed a retrospective case-control study of cystinuric patients evaluated and treated at the University of California, San Francisco between 1994 and 2015 and categorized patients as either unilateral or bilateral stone formers. Clinical presentation, baseline patient demographics, stone procedures, medical therapy regimens, and long-term renal function were compared between the two groups. RESULTS:A total of 42 cystine stone patients (22 female, 20 male) were included in the analysis. The median age at first presentation was 18.5 years and median age at study conclusion was 45.5 years. Two-thirds of patients (n = 28) had a history of bilateral stones, whereas one-third (n = 14) had unilateral stones. Medical therapy regimens were similar between groups. Despite an increased average number of lifetime surgeries (7.5 sessions for bilateral vs 3.7 sessions for unilateral, p
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- 2018
46. Ultrasound-Guided Morcellation During Holmium Laser Enucleation of the Prostate
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David T. Tzou, Marshall L. Stoller, Thomas Chi, and Ian Metzler
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Urologic Diseases ,medicine.medical_specialty ,Adenoma ,Urology ,Enucleation ,030232 urology & nephrology ,Holmium laser ,Case Report ,03 medical and health sciences ,0302 clinical medicine ,Prostate ,morcellation ,Medicine ,Cancer ,HoLEP ,business.industry ,ultrasound ,Prostate Cancer ,Ultrasound ,Prostate Adenoma ,medicine.disease ,Ultrasound guided ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,BPH ,Biomedical Imaging ,Morcellator ,business - Abstract
Background: Holmium laser enucleation of the prostate (HoLEP) has emerged as an accepted standard of care for the treatment of benign prostatic hyperplasia. This surgery relies on morcellation of the prostate adenoma once enucleation of the transition zone has been completed. Caution is required during this portion of the operation, as engaging bladder mucosa within the morcellator can result in bladder injury, a rare but potentially catastrophic complication of HoLEP. Morcellation of the prostatic tissue can be additionally challenging if visualization is poor from either equipment failure or increased bleeding from a highly vascularized prostate. Case Presentation: We report the case of a 66-year-old Caucasian man with an estimated 158 g prostate who underwent HoLEP at our institution. Enucleation was uneventful; however, upon placement of the nephroscope to begin morcellation, it was immediately evident that the lens of the nephroscope was damaged as there was extremely poor visualization. Without a replacement nephroscope available, this would have normally resulted in aborting the case and returning another day to complete the morcellation. Concurrent bladder ultrasonography was performed and allowed for additional visual feedback to the operator, helping guide the morcellator to safely engage the enucleated adenoma and complete the operation. Conclusion: This case report demonstrates the ability of performing the morcellation portion of HoLEP mainly with the visualization provided by concurrent bladder ultrasonography. By providing additional imaging feedback to the operator, ultrasound can be a complementary tool to assist in safely performing morcellation in situations of suboptimal cystoscopic visualization during HoLEP.
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- 2018
47. Variation in Radiologic and Urologic Computed Tomography Interpretation of Urinary Tract Stone Burden: Results From the Registry for Stones of the Kidney and Ureter
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David T. Tzou, Roger L. Sur, Jonathan D. Harper, Manint Usawachintachit, Zhen J. Wang, Mathew D. Sorensen, Dylan Isaacson, Brian Duty, Shalonda Reliford-Titus, Kazumi Taguchi, Benjamin A. Sherer, Thomas Chi, Nancy K. Hills, Ryan S. Hsi, and Marshall L. Stoller
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Male ,Urologic Diseases ,medicine.medical_specialty ,Ureteral Calculi ,Kidney Disease ,Urology ,Urinary stone ,Urinary system ,Concordance ,Clinical Sciences ,030232 urology & nephrology ,Renal and urogenital ,Computed tomography ,Stone size ,Article ,Mean difference ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Kidney Calculi ,0302 clinical medicine ,Ureter ,medicine ,Humans ,Registries ,Prospective Studies ,Tomography ,Urological ,medicine.diagnostic_test ,business.industry ,Diagnostic Techniques, Urological ,Guideline ,Middle Aged ,Urology & Nephrology ,X-Ray Computed ,Radiography ,Diagnostic Techniques ,medicine.anatomical_structure ,Biomedical Imaging ,Female ,Radiology ,Tomography, X-Ray Computed ,business - Abstract
OBJECTIVE:To compare the measured stone burden recorded between urologists and radiologists, and examine how these differences could potentially impact stone management. As current urologic stone surgery guideline recommendations are based on stone size, accurate stone measurements are crucial to direct appropriate treatment. This study investigated the discrepant interpretation that often exists between urologic surgeons and radiologists' estimation of patient urinary stone burden. MATERIALS AND METHODS:From November 2015 through August 2016, new patients prospectively enrolled into the Registry for Stones of the Kidney and Ureter (ReSKU) were included if they had computed tomography images available and an accompanying official radiologic report at the time of their urologist provider visit. Stone number and aggregate stone size were compared between the urologic interpretation and the corresponding radiologic reports. RESULTS:Of 219 patients who met the inclusion criteria, concordance between urologic and radiologic assessment of aggregate stone size was higher for single stone sizing (63%) compared with multiple stones (32%). Statistical significance was found in comparing the mean difference in aggregate stone size for single and multiple stones (P
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- 2018
48. Defining the Costs of Reusable Flexible Ureteroscope Reprocessing Using Time-Driven Activity-Based Costing
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Tessnim R Ahmad, Samuel Zetumer, Kazumi Taguchi, Dylan Isaacson, Ian Metzler, Thomas Chi, Marshall L. Stoller, Benjamin A. Sherer, Manint Usawachintachit, and David T. Tzou
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Operating Rooms ,Urology ,Clinical Sciences ,030232 urology & nephrology ,Ureteroscopy and Percutaneous Procedures ,03 medical and health sciences ,0302 clinical medicine ,cost analysis ,Clinical Research ,parasitic diseases ,Ureteroscopy ,Equipment Reuse ,Medicine ,Humans ,Operations management ,Activity-based costing ,Flexible ureteroscope ,Infection Control ,URETEROSCOPE ,business.industry ,Prevention ,ureteroscope ,Sterilization ,Urology & Nephrology ,time-driven activity-based costing ,030220 oncology & carcinogenesis ,Time and Motion Studies ,Ureteroscopes ,Cost analysis ,Costs and Cost Analysis ,Equipment Failure ,sterile processing ,business - Abstract
PurposeCareful decontamination and sterilization of reusable flexible ureteroscopes used in ureterorenoscopy cases prevent the spread of infectious pathogens to patients and technicians. However, inefficient reprocessing and unavailability of ureteroscopes sent out for repair can contribute to expensive operating room (OR) delays. Time-driven activity-based costing (TDABC) was applied to describe the time and costs involved in reprocessing.Materials and methodsDirect observation and timing were performed for all steps in reprocessing of reusable flexible ureteroscopes following operative procedures. Estimated times needed for each step by which damaged ureteroscopes identified during reprocessing are sent for repair were characterized through interviews with purchasing analyst staff. Process maps were created for reprocessing and repair detailing individual step times and their variances. Cost data for labor and disposables used were applied to calculate per minute and average step costs.ResultsTen ureteroscopes were followed through reprocessing. Process mapping for ureteroscope reprocessing averaged 229.0 ± 74.4 minutes, whereas sending a ureteroscope for repair required an estimated 143 minutes per repair. Most steps demonstrated low variance between timed observations. Ureteroscope drying was the longest and highest variance step at 126.5 ± 55.7 minutes and was highly dependent on manual air flushing through the ureteroscope working channel and ureteroscope positioning in the drying cabinet. Total costs for reprocessing totaled $96.13 per episode, including the cost of labor and disposable items.ConclusionsUtilizing TDABC delineates the full spectrum of costs associated with ureteroscope reprocessing and identifies areas for process improvement to drive value-based care. At our institution, ureteroscope drying was one clearly identified target area. Implementing training in ureteroscope drying technique could save up to 2 hours per reprocessing event, potentially preventing expensive OR delays.
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- 2017
49. MP95-14 IMPACT OF RACE AND SOCIOECONOMIC STATUS ON STONE CHARACTERISTICS: RESULTS FROM RESKU – THE REGISTRY FOR STONES OF THE KIDNEY AND URETER
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Mathew Sorensen, Thomas Chi, David T. Tzou, Benjamin A. Sherer, Marshall L. Stoller, Kazumi Taguchi, Robert M. Sweet, Brian Duty, Manint Usawachintachit, Jonathan D. Harper, and Roger L. Sur
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medicine.medical_specialty ,Race (biology) ,Kidney ,medicine.anatomical_structure ,Ureter ,business.industry ,Urology ,General surgery ,medicine ,business ,Socioeconomic status - Published
- 2017
50. Ultrasound Use in Urinary Stones: Adapting Old Technology for a Modern-Day Disease
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Thomas Chi, Manint Usawachintachit, David T. Tzou, and Kazumi Taguchi
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medicine.medical_specialty ,Image-Guided Therapy ,Urology ,Urinary system ,medicine.medical_treatment ,Urologists ,030232 urology & nephrology ,Disease ,History, 21st Century ,03 medical and health sciences ,FESTSCHRIFTArthur D. Smith, MD ,Kidney Calculi ,0302 clinical medicine ,Urolithiasis ,Lithotripsy ,medicine ,Humans ,Medical physics ,Ureteroscopy ,Percutaneous nephrolithotomy ,Nephrostomy, Percutaneous ,Ultrasonography ,medicine.diagnostic_test ,business.industry ,Ultrasound ,History, 20th Century ,medicine.disease ,Surgery ,Treatment Outcome ,Surgery, Computer-Assisted ,030220 oncology & carcinogenesis ,Kidney stones ,business ,Urinary stone disease - Abstract
Ultrasound has become a mainstay tool in urologists' armamentarium for the diagnosis and management of nephrolithiasis. From starting as a rudimentary form of imaging, it has come to play a more prominent role over time, paralleling evolution in ultrasound technology. Throughout the medical community there is a growing emphasis on reducing the amount of ionizing radiation delivered to patients during routine imaging. As such there has been a resurgence of interest in ultrasound given its lack of associated radiation exposure and proven effectiveness as a diagnostic and therapeutic imaging modality. Herein, we provide a review of the history of ultrasound, how the use of ultrasound is expanding in both diagnosis and treatment of urinary stone disease, and finally how promising applications of ultrasound are shaping the future of kidney stone management.
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- 2017
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