179 results on '"Vernon M. Pais"'
Search Results
2. Contemporary best practice urolithiasis in pregnancy
- Author
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Marie-Therese I. Valovska and Vernon M. Pais
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Urolithiasis is the most common nonobstetric complication in the gravid patient. The experience can provoke undue stress for the mother, fetus, and management team. The physiologic changes of pregnancy render the physical exam and imaging studies less reliable than in the typical patient. Diagnosis is further complicated by the need for careful selection of imaging modality in order to maximize diagnostic utility and minimize obstetric risk to the mother and ionizing radiation exposure to the fetus. Ultrasound remains the first-line diagnostic imaging modality in this group, but other options are available if results are inconclusive. A trial of conservative management is uniformly recommended. In patients who fail spontaneous stone passage, treatment may be temporizing or definitive. While temporizing treatments have classically been deemed the gold standard, ureteroscopic stone removal is now acknowledged as a safe and highly effective definitive treatment approach. Ultimately, a multidisciplinary, team-based approach involving the patient, her obstetrician, urologist, radiologist, and anesthesiologist is needed to devise a maximally beneficial management plan.
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- 2018
- Full Text
- View/download PDF
3. Repetitive ureteral stenting for management of transplant graft ureteral obstruction
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Lester S. Borden Jr, Vernon M. Pais Jr, and Dean G. Assimos
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kidney transplantation ,ureteral obstruction ,catheterization ,stent ,graft survival ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
PURPOSE: To review the use of repetitive stenting in the management of patients with ureteral obstruction after renal transplantation, with an emphasis on technique and functional graft outcome. MATERIALS AND METHODS: Five adult renal allograft recipients with ureteral obstruction were managed with repetitive ureteral stenting. Their hospital records, office notes, and operative reports were reviewed. RESULTS: All patients were successfully managed with retrograde ureteral stenting. They underwent an average of 8.8 stent changes over a mean 34.5 month follow up. No decline in renal function was observed. CONCLUSIONS: Repetitive stenting is a viable treatment option for select patients with renal allograft ureteral obstruction.
- Published
- 2006
- Full Text
- View/download PDF
4. The Fate of Residual Fragments after PCNL: Results from the EDGE Research Consortium
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Victor KF Wong, Jessica Que, Emily K. Kong, Garen Abedi, Naren Nimmagadda, Anthony Emmott, Ryan F Paterson, Dirk Lange, Colin Lundeen, Amihay Nevo, Kevin Shee, Jonathan P Moore, Vernon M. Pais, Jr., Roger L. Sur, Seth Bechis, Nicole Miller, Ryan Hsi, Bodo E. Knudsen, Michael W Sourial, Mitchell R Humphreys, Karen Lynne Stern, Brian H. Eisner, and BEN H CHEW
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Urology - Published
- 2023
5. Risk of Symptomatic Kidney Stones During and After Pregnancy
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Vernon M. Pais, Andrea G. Kattah, Api Chewcharat, Vesna D. Garovic, Andrew D. Rule, Lisa E. Vaughan, John C. Lieske, Felicity Enders, Charat Thongprayoon, and Rajiv Kumar
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Pregnancy ,education.field_of_study ,medicine.medical_specialty ,business.industry ,Obstetrics ,Medical record ,Population ,030232 urology & nephrology ,medicine.disease ,Logistic regression ,Article ,03 medical and health sciences ,0302 clinical medicine ,Increased risk ,Urolithiasis ,Nephrology ,medicine ,Humans ,Laparoscopy ,Observational study ,Kidney stones ,030212 general & internal medicine ,education ,business ,Hydronephrosis - Abstract
RATIONALE & OBJECTIVE: While there are several well-known anatomical and physiological changes during pregnancy that could contribute to kidney stone formation, evidence that they increase the risk of kidney stones during pregnancy is lacking. This study aimed to determine whether there was an increased risk of a first-time symptomatic kidney stone during and after pregnancy. STUDY DESIGN: A population-based matched case-control study. SETTING & PARTICIPANTS: 945 female first-time symptomatic kidney stone formers aged 15–45 years and 1,890 age-matched female controls in Olmsted County, Minnesota from 1984–2012. Index date was the date of onset of a symptomatic kidney stone for both the case and their matched controls. EXPOSURE: The primary exposure was pregnancy with assessment for variation in risk across different time intervals before, during, and after pregnancy. Medical records were manually reviewed to determine the conception and delivery dates for pregnancies. OUTCOME: Medical record-validated first-time symptomatic kidney stone. ANALYTIC APPROACH: Conditional and unconditional multivariable logistic regression analysis. RESULTS: Compared to non-pregnant women, the odds of a symptomatic kidney stone in women was similar in the first trimester (OR, 0.92; p=0.8), began to increase during the second trimester (OR, 2.00; p=0.007), further increased during the third trimester (OR, 2.69; p=0.001), peaked at 0–3 months after delivery (OR, 3.53; p1 year ago) was also associated with a first-time symptomatic kidney stone (OR, 1.27; p=0.01). LIMITATIONS: Observational study design in predominantly white population. The exact timing of stone formation cannot be determined. CONCLUSIONS: Pregnancy increases the risk of a first-time symptomatic kidney stone. This risk peaks close to delivery and then improves by 1 year after delivery, though a modest risk of a kidney stone still exists beyond 1 year after delivery.
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- 2021
6. Informing the Management of Asymptomatic Nephrolithiasis: Markov Decision Analysis for the 1 cm Renal Stone
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Robin Djang, James E. Stahl, and Vernon M. Pais
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medicine.medical_specialty ,Renal stone ,medicine.diagnostic_test ,Markov chain ,business.industry ,Urology ,medicine.medical_treatment ,Shock wave lithotripsy ,Asymptomatic ,Surgery ,nervous system ,Extracorporeal shockwave therapy ,medicine ,Ureteroscopy ,medicine.symptom ,business ,Watchful waiting ,Decision analysis - Abstract
Introduction:The management of an incidentally discovered, asymptomatic renal stone includes watchful waiting, shock wave lithotripsy, ureteroscopy with basket extraction of fragmented ston...
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- 2021
7. The Duration of Stone Disease and the Impact of a Stone Event on Patients' Quality of Life
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Brendan L. Raizenne, Claudia Deyirmendjian, Seth K. Bechis, Roger L. Sur, Stephen Y. Nakada, Jodi A. Antonelli, Necole M. Streeper, Sri Sivalingam, Davis P. Viprakasit, Timothy D. Averch, Jaime Landman, Thomas Chi, Vernon M. Pais, Ben H. Chew, Vincent G. Bird, Sero Andonian, Noah E. Canvasser, Jonathan D. Harper, Kristina L. Penniston, and Naeem Bhojani
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Kidney Calculi ,Cross-Sectional Studies ,Risk Factors ,Urology ,Surveys and Questionnaires ,Quality of Life ,Humans - Published
- 2022
8. Is Stone-free Status After Surgical Intervention for Kidney Stones Associated With Better Health-related Quality of Life? - A Multicenter Study From the North American Stone Quality of Life Consortium
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Shuang Li, Vernon M. Pais, Stephen Y. Nakada, Matthew Galida, Ben H. Chew, Kristina L. Penniston, Eric Raffin, David R. Brown, Suzanne Boltz, Kymora B. Scotland, Necole M. Streeper, and Justin Y.H. Chan
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Adult ,Male ,medicine.medical_specialty ,Urology ,Stone free ,030232 urology & nephrology ,Emotional functioning ,Kidney Calculi ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Surveys and Questionnaires ,Intervention (counseling) ,Internal medicine ,Humans ,Medicine ,Longitudinal Studies ,Postoperative Period ,Prospective Studies ,Aged ,Retrospective Studies ,Aged, 80 and over ,Health related quality of life ,business.industry ,Middle Aged ,medicine.disease ,Institutional review board ,Cross-Sectional Studies ,Treatment Outcome ,Multicenter study ,030220 oncology & carcinogenesis ,North America ,Quality of Life ,Urologic Surgical Procedures ,Female ,Kidney stones ,business - Abstract
OBJECTIVE To compare the health-related quality of life (HRQOL) of patients with residual fragments after surgical intervention for kidney stones to patients that are stone-free using the disease-specific Wisconsin stone quality of life (WISQOL) questionnaire. Kidney stones contribute to impaired HRQOL, which is increasingly recognized as an important healthcare outcome measurement. MATERIALS AND METHODS With institutional review board approval, 313 adult patients who underwent surgical intervention for kidney stones at 4 sites completed a WISQOL questionnaire. We retrospectively collected surgical data including presence of residual fragments on post-operative imaging. We calculated standardized WISQOL total and domain scores (0-100), which included items related to social functioning (D1), emotional functioning (D2), stone-related impact (D3), and vitality (D4). Scores were compared between patients with residual fragments to those who were stone-free after surgical intervention. RESULTS Demographics did not differ between groups, overall mean age 54.6 ± 13.5 and 55.4% female. There was no significant difference in total WISQOL score for patients with residual fragments (n = 124) compared to patients that were stone-free (n = 189), 110.5 ± 27.8 vs 115.4 ± 23.6 respectively, (P = .12). Interestingly, patients with residual fragments who underwent secondary surgery were found to have significantly lower total WISQOL score (88.4 ± 30.1 vs 116.6 ± 25.0, P CONCLUSION Stone-free status after surgical intervention is not associated with better HRQOL when compared with patients whose surgeries left residual fragments. Indeed, further surgical intervention on residual fragments to achieve stone-free status may actually result in worse HRQOL.
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- 2021
9. The impact of the number of lifetime stone events on quality of life: results from the North American Stone Quality of Life Consortium
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Ben H. Chew, Roger L. Sur, Shlomi Tapiero, Vincent G. Bird, Vernon M. Pais, Jodi Antonelli, Stephen Y. Nakada, Kristina L. Penniston, Noah Canvasser, Sero Andonian, Sri Sivalingam, Zhamshid Okhunov, Naeem Bhojani, Luke Limfuco, Roshan M. Patel, Thomas Chi, Davis P. Viprakasit, Necole M. Streeper, Timothy D. Averch, Jaime Landman, and Seth K. Bechis
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Adult ,Male ,Urology ,030232 urology & nephrology ,Independent predictor ,Kidney Calculi ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Recurrence ,medicine ,Humans ,Renal colic ,Stone disease ,Aged ,business.industry ,Emergency department ,Middle Aged ,medicine.disease ,Regimen ,Cross-Sectional Studies ,North America ,Quality of Life ,Etiology ,Female ,Kidney stones ,Self Report ,medicine.symptom ,business ,Demography - Abstract
To evaluate the impact of chronic stone recurrence on an individual's quality of life using the validated Wisconsin Stone Quality of Life (WISQOL) questionnaire. We collected cross-sectional data on patients with kidney stones from 14 institutions in North America. A stone event was defined as renal colic, stone-related procedure or emergency department visit. The regression analyses using general linear models and pairwise comparison determined the impact of the number of stone events on quality of life. The median number of stone events among the 2205 patients who completed the questionnaire was 3 (IQR 1-6). The mean total score was 107.4 ± 28.7 (max 140 points). The number of lifetime stone events was an independent predictor of lower quality of life (p 0.001), specifically, score declined significantly beyond five events. Compared with patients who experienced a single stone event, there was a 0.4, 2.5, and 6.9 point decline in the adjusted mean WISQOL score after 2-5, 6-10, or 10 events, respectively. The cumulative number of lifetime stone events was associated with a lower quality of life when more than five stone events were occurred. These findings underscore the importance of efforts to determine the underlying metabolic etiology of urolithiasis in the recurrent stone former, and the institution of a regimen to place their stone disease in remission.
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- 2021
10. Opioids and Kidney Stones
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Karen Stern, Brian H. Eisner, Kevan M. Sternberg, Christina Kottooran, and Vernon M. Pais
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0301 basic medicine ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,030232 urology & nephrology ,Medical practice ,medicine.disease ,Analgesics, Opioid ,Kidney Calculi ,03 medical and health sciences ,Treatment Outcome ,030104 developmental biology ,0302 clinical medicine ,Opioid ,Nephrology ,Kidney stone disease ,Ureteroscopy ,medicine ,Humans ,Kidney stones ,Intensive care medicine ,business ,Surgical interventions ,medicine.drug - Abstract
In recent years, the use of opioids in medical practice has come under significant scrutiny. This, in part, is owing to evidence of overprescription and overuse of opioid medications, as well as the unintended consequences and side effects for patients who take these medications. Here, we review the role of opioids and the responsible use of these medications with respect to kidney stone disease and surgical interventions for kidney stones.
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- 2021
11. Estimating the health‐related quality of life of kidney stone patients: initial results from the Wisconsin Stone Quality of Life Machine‐Learning Algorithm (WISQOL‐MLA)
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David-Dan Nguyen, Stephen Y. Nakada, Thomas Chi, Naeem Bhojani, Necole M. Streeper, Kristina L. Penniston, Roger L. Sur, Jaime Landman, Jodi Antonelli, Jonathan D. Harper, Timothy D. Averch, Seth K. Bechis, Noah Canvasser, Jack W. Luo, Davis P. Viprakasit, Sri Sivalingam, Sero Andonian, Ben H. Chew, Vincent G. Bird, Vernon M. Pais, and Xing Han Lu
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Adult ,Male ,Multivariate statistics ,Urology ,030232 urology & nephrology ,MEDLINE ,Machine Learning ,Correlation ,Kidney Calculi ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,medicine ,Humans ,Aged ,business.industry ,Middle Aged ,medicine.disease ,Regression ,030220 oncology & carcinogenesis ,Quality of Life ,Female ,Kidney stones ,Self Report ,Gradient boosting ,business ,Algorithm ,Body mass index - Abstract
OBJECTIVE To build the Wisconsin Stone Quality of Life Machine-Learning Algorithm (WISQOL-MLA) to predict urolithiasis patients' health-related quality of life (HRQoL) based on demographic, symptomatic and clinical data collected for the validation of the Wisconsin Stone Quality-of-Life (WISQOL) questionnaire, an HRQoL measurement tool designed specifically for patients with kidney stones. MATERIAL AND METHODS We used data from 3206 stone patients from 16 centres. We used gradient-boosting and deep-learning models to predict HRQoL scores. We also stratified HRQoL scores by quintile. The dataset was split using a standard 70%/10%/20% training/validation/testing ratio. Regression performance was evaluated using Pearson's correlation. Classification was evaluated with an area under the receiver-operating characteristic curve (AUROC). RESULTS Gradient boosting obtained a test correlation of 0.62. Deep learning obtained a correlation of 0.59. Multivariate regression achieved a correlation of 0.44. Quintile stratification of all patients in the WISQOL dataset obtained an average test AUROC of 0.70 for the five classes. The model performed best in identifying the lowest (0.79) and highest quintiles (0.83) of HRQoL. Feature importance analysis showed that the model weighs in clinically relevant factors to estimate HRQoL, such as symptomatic status, body mass index and age. CONCLUSIONS Harnessing the power of the WISQOL questionnaire, our initial results indicate that the WISQOL-MLA can adequately predict a stone patient's HRQoL from readily available clinical information. The algorithm adequately relies on relevant clinical factors to make its HRQoL predictions. Future improvements to the model are needed for direct clinical applications.
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- 2020
12. Metabolic Syndrome Negatively Impacts Stone-Specific Quality of Life
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Noah Canvasser, Davis P. Viprakasit, Vincent G. Bird, Seth K. Bechis, Roger L. Sur, Naeem Bhojani, Jodi Antonelli, Vernon M. Pais, Stephen Y. Nakada, Kristina L. Penniston, Jonathan R.Z. Lim, Thomas Chi, Necole M. Streeper, Ben H. Chew, Sri Sivalingam, Jonathan D. Harper, Kymora B. Scotland, Sero Andonian, Timothy D. Averch, and Jaime Landman
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medicine.medical_specialty ,Quality of life (healthcare) ,Atherosclerotic cardiovascular disease ,business.industry ,Urology ,Internal medicine ,medicine ,MEDLINE ,Metabolic syndrome ,medicine.disease ,Disease cluster ,business - Abstract
Purpose: Metabolic syndrome (MetS) is a cluster of metabolic diseases that is linked to atherosclerotic cardiovascular disease. MetS has also been linked to increased nephrolithiasis. However, limi...
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- 2020
13. Nephrolithiasis: a multidisciplinary approach for a multifaceted disease
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Alexandra B. DeBow, Kevin Krughoff, and Vernon M. Pais
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Kidney Calculi ,medicine.medical_specialty ,Nephrology ,business.industry ,Multidisciplinary approach ,Humans ,Medicine ,General Medicine ,Disease ,Nephrolithiasis ,business ,Intensive care medicine - Published
- 2021
14. Opioid Stewardship in Urology: Quality Improvement Summit 2018
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Tudor Borza, Richard J. Barth, Behfar Ehdaie, Chad Brummett, Jennifer F. Waljee, Margaret Rukstalis, Jonah J. Stulberg, Gregory Auffenberg, Angela Smith, Timothy D. Averch, Matthew E. Nielsen, Brooke Chidgey, Scott K. Winiecki, Vernon M. Pais, James M. Dupree, Meghan Sperandeo-Fruge, and Benjamin Davies
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medicine.medical_specialty ,geography ,Quality management ,Summit ,geography.geographical_feature_category ,business.industry ,Urology ,Opioid use ,030232 urology & nephrology ,Pain management ,03 medical and health sciences ,0302 clinical medicine ,Opioid ,030220 oncology & carcinogenesis ,medicine ,Stewardship ,Urological Surgical Procedures ,business ,medicine.drug - Abstract
Introduction:We summarize the 2018 AUA (American Urological Association) Quality Improvement Summit, Opioid Stewardship in Urology, highlighting appropriate urological opioid use as well as...
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- 2020
15. Kidney stones and the opioid epidemic
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Kevin Krughoff and Vernon M. Pais
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medicine.medical_specialty ,Opioid epidemic ,business.industry ,Urology ,Public health ,Analgesic ,030232 urology & nephrology ,MEDLINE ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Opioid ,030220 oncology & carcinogenesis ,medicine ,Kidney stones ,Renal colic ,medicine.symptom ,Intensive care medicine ,business ,Opioid addiction ,medicine.drug - Abstract
Purpose of review A public health emergency has been declared in response to rising opioid addiction and opioid-related deaths in the United States. As kidney stones have been identified as an important source of initial and repeated opioid exposures, this review seeks to describe the scope of the problem and report relevant alternatives to opioid analgesia for stones. Recent findings Recent literature summarizing the extent of opioid use among those with stones is reviewed. A number of opioid-minimizing strategies and analgesic regimens have been proposed and studied. A review of these modifications and alternatives is provided. Summary Both symptomatic renal colic and surgical interventions to address stones may prompt need for analgesia. Reducing prescribed opioids reduces both patient use and risk of diversion. Modifications in surgical technique, administration of local anesthetics, and use of systemic nonopioid analgesics have all been successfully employed.
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- 2020
16. Influence of Men’s Attitudes toward Health and Health Insurance on Prostate Specific Antigen Screening for the Early Detection of Prostate Cancer
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Lawrence M. Dagrosa, Michael E. Rezaee, Vernon M. Pais, and Charlotte E. Ward
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Oncology ,medicine.medical_specialty ,business.industry ,Urology ,030232 urology & nephrology ,Early detection ,medicine.disease ,03 medical and health sciences ,Prostate-specific antigen ,Prostate cancer ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Health insurance ,business - Abstract
Introduction:The majority of guidelines currently recommend shared decision making for men 55 to 69 years old who are considering prostate specific antigen screening, and proceeding based o...
- Published
- 2019
17. Complaint of Testicular Discomfort in Patient with Esophageal Adenocarcinoma
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Bing Ren, Alan Schned, Kevin Krughoff, and Vernon M. Pais
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medicine.medical_specialty ,business.industry ,030232 urology & nephrology ,Esophageal adenocarcinoma ,Cancer ,Case Report ,General Medicine ,Disease ,Esophageal cancer ,medicine.disease ,Diseases of the genitourinary system. Urology ,New onset ,Lymphoma ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Medicine ,In patient ,Physical exam ,RC870-923 ,Radiology ,business - Abstract
We report a case of esophageal cancer with solitary metastasis to the testicle in a 71-year-old man. The tumor was picked up on physical exam following new onset complaints of pain and swelling. While most testicular masses in older men are due to lymphoma, this case highlights the need to consider metastatic disease as a source of new symptoms in patients with a recent cancer diagnosis.
- Published
- 2021
18. MP65-15 DOES OBSERVATION OF ASYMPTOMATIC TREATMENT-NAIVE RENAL STONES IMPAIR HEALTH-RELATED QUALITY OF LIFE? -RESULTS FROM THE NORTH AMERICAN STONE QUALITY OF LIFE RESEARCH CONSORTIUM
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Necole M. Streeper, Ben H. Chew, Eric Raffin, Matthew Galida, Shuang Li, Stephen Y. Nakada, Kristina L. Penniston, Suzanne Boltz, David Brown, Justin Y.H. Chan, and Vernon M. Pais
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Health related quality of life ,Therapy naive ,medicine.medical_specialty ,business.industry ,Urology ,Medicine ,medicine.symptom ,business ,Intensive care medicine ,Asymptomatic ,Quality of Life Research - Published
- 2021
19. Editorial Comment
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Michael E, Rezaee and Vernon M, Pais
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Urology - Published
- 2022
20. A rare initial diagnosis of cystinuria during pregnancy
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Kevin Shee and Vernon M. Pais
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Pregnancy ,Pediatrics ,medicine.medical_specialty ,Nephrology ,business.industry ,MEDLINE ,Medicine ,General Medicine ,Cystinuria ,business ,medicine.disease - Published
- 2020
21. Editorial Commentary
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Britney L. Atwater, Michael E. Rezaee, and Vernon M. Pais
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Urology - Published
- 2022
22. A Decision Analysis of Observation vs Immediate Reintervention for Asymptomatic Residual Fragments Less than 4 mm Following Ureteroscopic Lithotripsy
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An Qi Wang, Michael E. Lipkin, Hilary Brotherhood, Manoj Monga, Tracy Marien, Yui Hui H. Chang, Vernon M. Pais, Michal Ursiny, Courtney Yong, Roger L. Sur, Ojas Shah, Brian R. Matlaga, Nicole L. Miller, Mitchell R. Humphreys, Benjamin H. Chew, Alan Yaghoubian, Cameron M. Charchenko, Bodo E. Knudsen, Dirk Lange, Brian H. Eisner, and Amy E. Krambeck
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medicine.medical_specialty ,Cost effectiveness ,business.industry ,Urology ,030232 urology & nephrology ,Residual ,Asymptomatic ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,Ureteroscopic lithotripsy ,medicine.symptom ,business ,Decision analysis - Abstract
Introduction:We performed a decision analysis model of the cost-effectiveness of observation vs intervention for asymptomatic residual fragments less than 4 mm in diameter following uretero...
- Published
- 2019
23. 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.
- Published
- 2019
24. The association of nephrolithiasis with prescription opioid use
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Brian D. Sites and Vernon M. Pais
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Adult ,Male ,medicine.medical_specialty ,Ureteral Calculi ,Multivariate analysis ,Cross-sectional study ,030232 urology & nephrology ,Anxiety ,Drug Prescriptions ,Odds ,Cohort Studies ,Kidney Calculi ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Internal medicine ,Humans ,Medicine ,Medical prescription ,Depression (differential diagnoses) ,Depression ,business.industry ,General Medicine ,Middle Aged ,United States ,Analgesics, Opioid ,Cross-Sectional Studies ,Opioid ,Nephrology ,Cohort ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
OBJECTIVE To characterize opioid utilization among those with nephrolithiasis in a national cohort. MATERIALS AND METHODS We performed cross sectional analysis of participants in the Medical Expenditure Panel Surveys during 2008 - 2014. Sample weights were employed for analysis of complex survey design. Those reporting occurrence of "renal or ureteral calculus" during the survey period represented the cohort of stone formers (SFs). Receipt of opioid prescription as well as total number of opioid prescriptions filled over study period were noted. RESULTS Of 65,397 adult participants - weighted to represent 209,043,539 - 1.29% reported occurrence of nephrolithiasis. SFs were older, had higher BMI, and higher likelihood of depression and anxiety. Compared with those without nephrolithiasis, SFs had higher prevalence of opioid use (59.5 vs. 20.2%, p < 0.0001). On multivariate analysis, the odds of receiving an opioid prescription were increased greater than 5 times in SFs compared with those without stones (OR 5.61, 95% CI 4.59 - 6.85). Assessing each individual's total number of opioid prescriptions revealed SFs had a greater mean number of opioid prescriptions filled than those without nephrolithiasis (2.53 vs. 0.97, p < 0.001). Among SFs receiving opioids, depression and anxiety were both associated with a significantly greater number of opioid prescriptions (6.80 vs. 3.66, p < 0.001; and 8.91 vs. 3.38, p = 0.008, respectively). CONCLUSION A majority of those with renal stone occurrence receive prescription opioids. Of particular note, the presence of either depression or anxiety is associated with larger total number of opioid prescriptions over the study period. .
- Published
- 2019
25. The Effect of Thiazide and Potassium Citrate Use on the Health Related Quality of Life of Patients with Urolithiasis
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Eric Raffin, Stephen Y. Nakada, Vincent G. Bird, Davis P. Viprakasit, Kristina L. Penniston, Sri Sivalingam, Timothy D. Averch, Roger L. Sur, Jodi Antonelli, Ben H. Chew, and Vernon M. Pais
- Subjects
Male ,medicine.medical_specialty ,Gastrointestinal Diseases ,Sodium Chloride Symporter Inhibitors ,Urology ,Potassium ,030232 urology & nephrology ,chemistry.chemical_element ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Urolithiasis ,Potassium Citrate ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Fatigue ,Thiazide ,Health related quality of life ,business.industry ,Health related ,Middle Aged ,Sexual Dysfunction, Physiological ,Cross-Sectional Studies ,Treatment Outcome ,chemistry ,Quality of Life ,Female ,business ,medicine.drug - Abstract
To our knowledge it is unknown whether the benefits of medical management of urolithiasis outweigh the potential side effects of the medications used, including potassium citrate and thiazide diuretics. Therefore, we evaluated the relationship between potassium citrate or thiazides and overall stone related health related quality of life.Cross-sectional data were obtained on stone forming enrollees in the North American Stone Quality of Life Consortium. We used the WISQOL (Wisconsin Stone Quality of Life) questionnaire to compare health related quality of life between patients treated and not treated with potassium citrate or thiazide type diuretics. Additionally, the likelihood of gastrointestinal complaints was compared between those prescribed and not prescribed potassium citrate. The likelihood of fatigue and sexual complaints was also compared in those prescribed and not prescribed thiazides.Of the 1,511 subjects, including 787 males and 724 females, 279 were on potassium citrate and 238 were on thiazides at study enrollment. Patients prescribed potassium citrate had higher health related quality of life in each domain vs those not prescribed potassium citrate (p0.001). Patients prescribed thiazides had higher health related quality of life in each domain compared to those not prescribed thiazide (all p0.01). Those prescribed potassium citrate were less likely than those not prescribed potassium citrate to report nausea, stomach upset or cramps (OR 0.57, p0.001). Patients prescribed thiazides were less likely than those not prescribed thiazides to report fatigue (OR 0.63, p = 0.004) or reduced sexual interest and/or activity (OR 0.64, p = 0.005).Among stone formers the use of potassium citrate and thiazides was associated with better health related quality of life across all WISQOL domains without an increased likelihood of gastrointestinal complaints and fatigue or sexual complaints, respectively. These findings may be useful when counseling patients regarding the initiation of potassium citrate or thiazides for medical management of nephrolithiasis.
- Published
- 2018
26. Gender Equivalence in the Prevalence of Nephrolithiasis among Adults Younger than 50 Years in the United States
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Gina Tundo, Sari Khaleel, and Vernon M. Pais
- Subjects
Adult ,Male ,medicine.medical_specialty ,National Health and Nutrition Examination Survey ,Urology ,030232 urology & nephrology ,Logistic regression ,Odds ,Kidney Calculi ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Epidemiology ,Prevalence ,medicine ,Humans ,Sex Distribution ,business.industry ,Health Status Disparities ,Odds ratio ,Middle Aged ,Nutrition Surveys ,United States ,030220 oncology & carcinogenesis ,Relative risk ,Cohort ,Female ,business ,Body mass index ,Demography - Abstract
Although urolithiasis affects each gender, conventional teaching proposes that men are 3 times more likely to have stones. However, clinical practice refutes such a disparity, particularly among working age adults. Small studies have suggested an erosion of this gender gap. Therefore, we examined the relationship between gender and stone prevalence among American adults younger than 50 years.We analyzed the NHANES (National Health and Nutrition Examination Survey) 2007 to 2012 cohort. Weighted proportions and multivariate logistic regression of the cohort and pertinent subgroups were assessed to determine the prevalence and the odds of nephrolithiasis.The cohort of 17,658 subjects, which was weighted to represent the American population of 218,828,951 adults, was 48.1% male. In our cohort of 8,888 adults weighted to represent 123,976,786 subjects younger than 50 years, which was 49.3% male and 50.7% female, there was no difference in stone prevalence (6.3% in males and 6.4% in females, p = 0.85). On unadjusted logistic regression of those younger than 50 years men were no more likely to report a stone history (OR 0.98, p = 0.85). Multivariate logistic regression adjusting for diabetes, obesity, ethnicity, age, and water, sodium and protein intake confirmed no difference in stone prevalence between the genders (OR 1.1, p = 0.51).Among adults of working and child rearing ages in the United States the much touted gender disparity in nephrolithiasis is not present. Prior assessments of gender based stone prevalence may have failed to specifically assess this economically critical demographic or there may in fact be an ongoing epidemiological change. Recognition that women are as likely as men to form stones in this cohort suggests the need to better elucidate the pathophysiology of stones in women.
- Published
- 2018
27. Stent duration and increased pain in the hours after ureteral stent removal
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Michael E, Rezaee, Annah J, Vollstedt, Tammer, Yamany, Manoj, Monga, Amy, Krambeck, Ojas, Shah, Roger L, Sur, Anna M, Zampini, Kymora B, Scotland, Ben H, Chew, Brian H, Eisner, and Vernon M, Pais
- Subjects
Adult ,Male ,Pain, Postoperative ,Time Factors ,Adolescent ,Middle Aged ,Prosthesis Failure ,Kidney Calculi ,Young Adult ,Humans ,Female ,Stents ,Self Report ,Ureter ,Device Removal ,Aged ,Retrospective Studies - Abstract
INTRODUCTION To assess the relationship between pain after ureteral stent removal and patient and procedural factors.A validated survey designed to assess the relationship between quality of life and treatment decisions in kidney stone disease was randomly distributed to patients with a history of a ureteral stent in seven medical centers across North America participating in an endourology research collaborative between July 2016 and June 2018. The primary outcome was increased pain after ureteral stent removal. Statistical analyses were performed using Chi-square and multiple logistic regression.A total of 327 surveys were analyzed. Twenty seven percent of patients reported increased pain in the hours after ureteral stent removal. Patients with a stent ≤ 7 days were significantly more likely to experience pain after stent removal compared to those with a stent7 days (33.3% versus 22.8%, p = 0.04). Female gender (OR: 2.41, 95% CI: 1.42-4.10) was associated with increased pain after stent removal, while increasing age was inversely associated (OR: 0.52, 95% CI: 0.36-0.74). After adjustment, patients with a stent7 days were significantly less likely to report pain in the hours after removal (OR: 0.59, 95% CI: 0.35-0.99).Approximately one in four patients will experience increased pain after ureteral stent removal. Female patients, younger patients, and patients with a stent ≤ 7 days were more likely to experience an increase in pain immediately following stent removal. Understanding factors associated with post-stent removal pain may be helpful in counseling patients at high risk stent removal morbidity.
- Published
- 2021
28. Nephrolithiasis: a multidisciplinary approach for a multifaceted disease
- Author
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Krughoff, Kevin, primary, DeBow, Alexandra B., additional, and Jr., Vernon M. Pais, additional
- Published
- 2021
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29. Beyond Prevalence: Annual Cumulative Incidence of Kidney Stones in the United States
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Vernon M. Pais, William Meeks, Gina Tundo, and Annah Vollstedt
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,business.industry ,Urology ,Incidence (epidemiology) ,Incidence ,Middle Aged ,medicine.disease ,United States ,Cohort Studies ,Kidney Calculi ,Epidemiology ,medicine ,Prevalence ,Humans ,Kidney stones ,Cumulative incidence ,Female ,business ,Demography - Abstract
It is well documented that the prevalence of nephrolithiasis is increasing in adults in the United States over time. Approximately 11% of men and 7% of women have reported a lifetime history of nephrolithiasis in cross-sectional studies. However, the burden of acute management may be better assessed from annual cumulative incidence. This accounting of new stone occurrences, however, is not well described on a national scale.The Medical Expenditure Panel Survey is a set of large-scale health care utilization surveys of families, individuals, their health care providers and employers, with surveys administered every 6 months for the duration of each individual's 2-year panel. We queried the survey data of adult participants between 2005 and 2015, with analysis conducted with provided weights and strata to allow our findings to be representative of the civilian noninstitutionalized U.S. adult population. Those with diagnosed renal or ureteral calculi as noted by ICD-9 codes were included as our incident stone formers.In 2005, the mean age of stone formers was 45 years. Of stone formers 52.2% were male, 91% were White and 47.6% were in the Southern U.S. The incidence of stone occurrences was 0.6% (177/33,961 individuals, weighted to represent population of 1,923,322/296,185,002 individuals). By 2015, the mean age was 51.7 years, with 52% male, 83% White and 38.2% residing in the Southern U.S. Between 2005 and 2015, the overall incidence increased from 0.6% to 0.9% (p0.001).Based on this large-scale, nationally representative analysis of adults in the United States, the estimated annual cumulative incidence of stone occurrence is approaching 1%. Moreover, this incidence appears to be increasing over time, rising from 0.6% in 2005 to 0.9% in 2015. These data may help to better anticipate the need for urological care for stone disease and direct resource distribution.
- Published
- 2021
30. Mitigation of dorsal lithotomy related positioning injuries in super obesity
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Kaylee, Luck and Vernon M, Pais
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Kidney Calculi ,Supine Position ,Ureteroscopy ,Humans ,Obesity - Published
- 2020
31. Implications of Erdheim-Chester disease and percutaneous renal access
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Lael, Stieglitz and Vernon M, Pais
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Male ,Erdheim-Chester Disease ,Kidney Calculi ,Humans ,Retroperitoneal Fibrosis ,Nephrolithotomy, Percutaneous ,Aged - Abstract
Erdheim-Chester disease (ECD) is a rare systemic histiocytosis with urologic manifestations in a majority of affected patients. An important manifestation is a pronounced retroperitoneal fibrosis with reported dense inflammatory rind surrounding the kidneys. We report a case of a patient with large stone burden necessitating percutaneous nephrolithotomy and the implications related to his Erdheim-Chester-related retroperitoneal fibrotic changes. Foreknowledge of these implications may inform perioperative counseling and surgical planning to maximize opportunity for successful outcomes.
- Published
- 2020
32. Diagnostic Imaging for Kidney Stones-Reply
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Andrew D. Rule, John C. Lieske, and Vernon M. Pais
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Diagnostic Imaging ,medicine.medical_specialty ,Kidney Calculi ,business.industry ,medicine ,Medical imaging ,MEDLINE ,Humans ,Kidney stones ,General Medicine ,Radiology ,medicine.disease ,business - Published
- 2020
33. Understanding the relationship between health insurance and kidney stones: an examination of NHANES data
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Kinan, Bachour, Michael E, Rezaee, Amanda R, Swanton, and Vernon M, Pais
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Adult ,Male ,Insurance, Health ,Middle Aged ,Nutrition Surveys ,Insurance Coverage ,United States ,Kidney Calculi ,Young Adult ,Socioeconomic Factors ,Prevalence ,Humans ,Female ,Retrospective Studies - Abstract
To investigate the relationship between socioeconomic factors, specifically insurance status, and kidney stones using a nationally representative cohort.A retrospective secondary data analysis of National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2014 was performed. Using univariate statistics and multiple logistic regressions, we examined the relationship between socioeconomic factors and kidney stone history.The weighted national prevalence of nephrolithiasis between ages 20 and 64 was 7.7% of a population of over 95.3 million. Fifty-three percent of the total population was female. The mean age was 42 years and the mean body mass index (BMI) was 28.7. The prevalence of nephrolithiasis was higher among individuals who had state-assisted insurance compared to those with private insurance (10.3% versus 7.3%, p = 0.005). On univariate regression analysis, having a college education was protective against stones compared to having less than a high-school degree (OR 0.62, 95% CI 0.43-0.84; p = 0.009). Income was also significantly associated with kidney stone prevalence. After adjusting for race, BMI, gender, water intake, income, and education level through multivariable analysis, having private insurance was associated with lower odds of developing nephrolithiasis compared to having state-assisted insurance (OR 0.62, 95% CI 0.44-0.89; p = 0.01).Individuals with state-assisted insurance were found to have significantly increased odds of a kidney stone compared to those with private insurance. Urologists, primary care, and policy makers should recognize this disparity exists and target opportunities to elucidate mechanisms and provide intervention for this high-risk group.
- Published
- 2020
34. The use of outpatient opioid medication for acute renal colic and ureteral stents: Insights from a multi-institutional patient survey
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Manoj Monga, Annah Vollstedt, Amy E. Krambeck, Michael E. Rezaee, Ojas Shah, Brian H. Eisner, Roger L. Sur, Vernon M. Pais, Anna Zampini, and Ben H. Chew
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Adult ,Male ,medicine.medical_specialty ,Ureteral Calculi ,Acute Renal Colic ,medicine.medical_treatment ,Quality of life ,Patient age ,Internal medicine ,Outpatients ,medicine ,Humans ,Renal colic ,Renal Colic ,Aged ,Aged, 80 and over ,business.industry ,Stent ,General Medicine ,Ureteral stents ,Middle Aged ,Analgesics, Opioid ,surgical procedures, operative ,Opioid ,Nephrology ,Acute Disease ,Quality of Life ,Patient survey ,Female ,Stents ,medicine.symptom ,business ,medicine.drug - Abstract
Aims To investigate the main reasons for use of opioids during acute episodes of renal colic and for ureteral stent symptoms post-operatively. Material and methods A survey assessing the impact of decreased quality of life and use of opioid pain medication was distributed to patients with a history of ureteral stent at seven academic centers between July 2016 and June 2018. Results A total of 365 surveys were completed. Opioid use for stone (63.9%) and stent-related pain (39.0%) was common among respondents. When assessing whether patients used more opioids for stone or stent-related pain, 47.7% reported using more for stone pain while 15.0% reported using more for stent pain. 22.6% of patients required opioids for stent-related pain and not stone pain. Increasing patient age was found to be negatively associated with using opioids for stent-related pain (OR: 0.4, 95% CI: 0.3 - 0.6). Increasing age was also found to be negatively associated with opioid use for stone pain (OR: 0.6, 95% CI: 0.4 - 0.8). Patients with a greater number of prior stones had 3.2 times the odds of using opioids for stone pain, in our adjusted model (95% CI: 2.1 - 4.7). Conclusion Patients with more prior stone episodes are more likely to have used opioids for their most recent episode. Although ureteral stents have been shown to be associated with a decreased quality of life, we showed that the use of opioids for stent-related pain is less than that for stone pain. Younger patients are less likely to tolerate a stent without opioid analgesics.
- Published
- 2020
35. Outcomes of Conservative Management of Splenic Injury Incurred During Percutaneous Nephrolithotomy
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Vernon M. Pais, Manoj Monga, Ben H. Chew, Nicole L. Miller, Bodo E. Knudsen, Mark Noble, John D. Denstedt, Vivian Paredes-Bhushan, and Eric Raffin
- Subjects
medicine.medical_specialty ,Blood transfusion ,Percutaneous ,Urology ,medicine.medical_treatment ,Splenectomy ,030232 urology & nephrology ,Context (language use) ,Nephrolithotomy, Percutaneous ,Conservative Treatment ,03 medical and health sciences ,Kidney Calculi ,0302 clinical medicine ,medicine ,Humans ,Embolization ,Percutaneous nephrolithotomy ,Nephrostomy, Percutaneous ,Retrospective Studies ,business.industry ,Bleed ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Nephrostomy ,business - Abstract
Purpose: Splenic injury is a rare complication after left-sided percutaneous nephrolithotomy (PCNL). Although initial observation is often espoused, the natural history of nonoperative conservative management is not well established and the implications of splenic injury are not fully defined in this context. We sought to describe outcomes of conservative management of splenic injury incurred at PCNL. Patients and Methods: We performed a multi-institutional retrospective review of individual patients who underwent PCNL complicated by trans-splenic nephrostomy access injury. Demographic info, intraoperative data, management strategies, and outcomes were reviewed. Results: Nine patients suffered splenic injury after left PCNL. All patients had supracostal upper pole access under fluoroscopic guidance. Splenic injury was identified by computed tomography (CT) in the eight of nine (89%) who had imaging on first postoperative day. All eight patients were managed conservatively with nephrostomy dwell time of 2-21 days, one of whom (11%) required blood transfusion. The remaining patient (11%)-who had tubeless PCNL without postoperative imaging presented 5 days postoperatively with a delayed bleed and underwent emergent splenectomy. Seven of the nine (78%) were managed nonoperatively and without need for transfusion or embolization. Conclusion: The majority of patients incurring splenic injury during PCNL can be managed conservatively with maintenance of nephrostomy tube for ≥2 days. Consequences of unrecognized splenic injury may include splenic bleed and may prompt transfusion and/or splenectomy, underscoring role of routine postoperative CT to allow timely diagnosis, particularly in those undergoing upper pole supracostal left-sided percutaneous renal access.
- Published
- 2020
36. MP03-19 REGIONAL DIFFERENCES AND THE IMPACT ON STONE-RELATED QUALITY OF LIFE: RESULTS FROM THE NORTH AMERICAN STONE QUALITY OF LIFE CONSORTIUM
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Timothy D. Averch, Vernon M. Pais, Stephen Y. Nakada, Roshan M. Patel, Francis A. Jefferson, Sero Andonian, Noah Canvasser, Zhamshid Okhunov, Roger L. Sur, Ben H. Chew, Shlomi Tapiero, Davis P. Viprakasit, Thomas Chi, Necole M. Streeper, Luke Limfueco, Kristina L. Penniston, Jaime Landman, Jodi Antonelli, Ralph V. Clayman, Sri Sivalingam, and Vincent G. Bird
- Subjects
Quality of life (healthcare) ,business.industry ,Urology ,Environmental health ,Medicine ,business ,Regional differences - Abstract
INTRODUCTION AND OBJECTIVE:Urolithiasis is associated with a decreased health-related quality of life. The Wisconsin Stone Quality of Life (WISQOL) questionnaire is a validated instrument to evalua...
- Published
- 2020
37. Kidney stones and the opioid epidemic: recent developments and review of the literature
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Kevin, Krughoff and Vernon M, Pais
- Subjects
Analgesics, Opioid ,Kidney Calculi ,Pain, Postoperative ,Risk Factors ,Humans ,Pain Management ,Urologic Surgical Procedures ,Analgesia ,Opioid Epidemic ,Opioid-Related Disorders ,Renal Colic ,United States - Abstract
A public health emergency has been declared in response to rising opioid addiction and opioid-related deaths in the United States. As kidney stones have been identified as an important source of initial and repeated opioid exposures, this review seeks to describe the scope of the problem and report relevant alternatives to opioid analgesia for stones.Recent literature summarizing the extent of opioid use among those with stones is reviewed. A number of opioid-minimizing strategies and analgesic regimens have been proposed and studied. A review of these modifications and alternatives is provided.Both symptomatic renal colic and surgical interventions to address stones may prompt need for analgesia. Reducing prescribed opioids reduces both patient use and risk of diversion. Modifications in surgical technique, administration of local anesthetics, and use of systemic nonopioid analgesics have all been successfully employed.
- Published
- 2019
38. What are the main challenges to the pharmacological management of cystinuria?
- Author
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Andrew D. Rule, Vernon M. Pais, and Michael E. Rezaee
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Pharmacology ,medicine.medical_specialty ,business.industry ,Surgical care ,Pharmacological management ,MEDLINE ,General Medicine ,Disease ,Cystinuria ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,030220 oncology & carcinogenesis ,medicine ,Pharmacology (medical) ,Stone formers ,Intensive care medicine ,business ,030217 neurology & neurosurgery - Abstract
Cystinuria is a rare urologic condition affecting approximately 0.1% of incident stone formers and accounting for 1–2% of urolithiasis cases requiring surgical care [1,2]. The disease is characteri...
- Published
- 2019
39. The effect of travel distance on health-related quality of life for patients with nephrolithiasis
- Author
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Roger L. Sur, Sri Sivalingam, Jodi Antonelli, Vincent G. Bird, Kristina L. Penniston, Laura Elizabeth Wiener, Gary G. Koch, Davis P. Viprakasit, Thomas Chi, Timothy D. Averch, Necole M. Streeper, Ben H. Chew, Stephen Y. Nakada, Vernon M. Pais, and Gopal Narang
- Subjects
Health related quality of life ,Healthcare use ,medicine.medical_specialty ,business.industry ,Urology ,030232 urology & nephrology ,Mean age ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,Quality of life ,030220 oncology & carcinogenesis ,Internal medicine ,Etiology ,medicine ,Anxiety ,Kidney stones ,medicine.symptom ,business ,Disease burden ,Original Research - Abstract
Introduction: Urolithiasis causes a significant impact on health-related quality of life (HRQOL). Patients with kidney stones have high levels of stress and anxiety. Symptom resolution often requires treatment. Travel distance is a barrier to care but little is known about its effects on HRQOL. We hypothesize that increased distance to treatment site is associated with decreased HRQOL. Methods: Patients with a history of stones were enrolled at 11 tertiary centers as part of the QOL Stone Consortium of North America. HRQOL data were obtained using the Wisconsin Stone Quality of Life questionnaire (WISQOL). We calculated distance between patient and treatment site using national ZIP codes. We used linear models to evaluate the effect of distance on HRQOL, while also considering demographics data, stones/symptom status, and distance. Results: Of the 1676 enrolled patients, 52% were male, 86% non-Latino White, and the mean age was 53 years. Mean distance to treatment site was 63.3 km (range: 0–3774), with 74% reporting current stones and 45% current symptoms. WISQOL score and distance were negatively correlated for patients reporting current stones and symptoms (p=0.0010). Linear modelling revealed decreased WISQOL scores for patients with symptoms as distance increased from treatment site (p=0.0001), with a 4.7-point decrease for every 100 km traveled. Conclusions: Stone disease imposes significant burden on patients’ HRQOL due to a variety of factors. Patients with active stone symptoms report worse HRQOL with increased distance to their treatment site. Possible etiologies include travel burden, increased disease burden, decreased healthcare use, and delays in care.
- Published
- 2019
40. Response to: Khusid, Atallah, and Gupta re: 'Metabolic Syndrome Negatively Impacts Stone-Specific Quality of Life' by Lim et al
- Author
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Stephen Y. Nakada, Naeem Bhojani, Vernon M. Pais, Seth K. Bechis, Sri Sivalingam, Timothy D. Averch, Roger L. Sur, Kymora B. Scotland, Davis P. Viprakasit, Thomas Chi, Necole M. Streeper, Kristina L. Penniston, Jonathan R.Z. Lim, Jaime Landman, Noah Canvasser, Vincent G. Bird, Jonathan D. Harper, Ben H. Chew, Jodi Antonelli, and Sero Andonian
- Subjects
Metabolic Syndrome ,Gerontology ,Quality of life (healthcare) ,business.industry ,Urology ,Quality of Life ,medicine ,Humans ,Metabolic syndrome ,medicine.disease ,business - Published
- 2020
41. Reply by Authors
- Author
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Robin Djang, James E. Stahl, and Vernon M. Pais
- Subjects
Urology - Published
- 2021
42. Association of Pregnancy with Stone Formation among Women in the United States: A NHANES Analysis 2007 to 2012
- Author
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Sari Khaleel, L. Reinstatler, and Vernon M. Pais
- Subjects
Adult ,medicine.medical_specialty ,National Health and Nutrition Examination Survey ,Urology ,030232 urology & nephrology ,Gravidity ,Logistic regression ,Kidney Calculi ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Prevalence ,medicine ,Humans ,Young adult ,Retrospective Studies ,Gynecology ,030219 obstetrics & reproductive medicine ,Child rearing ,business.industry ,Retrospective cohort study ,Nutrition Surveys ,medicine.disease ,United States ,Pregnancy Complications ,Female ,Kidney stones ,business ,Body mass index ,Demography - Abstract
Lithogenic urinary changes develop during pregnancy. Such changes may increase stone proclivity thereafter in working and child rearing aged women. However, to our knowledge such an association has not been previously identified.We analyzed nationally representative data from the 2007 to 2012 NHANES (National Health and Nutrition Examination Survey) to assess the association between pregnancy and nephrolithiasis.The weighted national prevalence of nephrolithiasis among women 50 years or younger was 6.4% (95% CI 5.4-7.6). The prevalence of nephrolithiasis was significantly higher among women who had been pregnant compared with those who had never been pregnant (7.5% vs 3.2%, p = 0.0004). On univariate regression those who had been pregnant had more than twice the odds of having had kidney stones (OR 2.44, 95% CI 1.50-3.98). An increased likelihood of nephrolithiasis in those with a history of pregnancy persisted on multivariable logistic regression adjusting for age, ethnicity, obesity, history of diabetes, gout, hormone use, water intake and high sodium diet (OR 2.13, 95% CI 1.31-3.45). Finally, the adjusted prevalence of nephrolithiasis increased significantly with an increasing number of pregnancies from 5.2% in those with 0 reported pregnancies to 12.4% in those with 3 or more pregnancies (p = 0.001).Nephrolithiasis is strongly associated with prior pregnancies. Among women of reproductive age the odds of stones are greater than doubled in those who had been pregnant compared with those who had never been pregnant. Nephrolithiasis prevalence also increases with the increasing number of pregnancies. Future investigation and identification of modifiable risk factors among pregnant patients may allow for a reduction in the burden of stone disease in women.
- Published
- 2017
43. Incidence and implications of silent hydronephrosis following percutaneous nephrolithotomy
- Author
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Lawrence M. Dagrosa, Rachel A. Moses, and Vernon M. Pais
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Adult ,Male ,medicine.medical_specialty ,Ureteral Calculi ,medicine.medical_treatment ,Urinary system ,Population ,030232 urology & nephrology ,Hydronephrosis ,Asymptomatic ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Ureteroscopy ,medicine ,Humans ,Percutaneous nephrolithotomy ,education ,Aged ,Nephrostomy, Percutaneous ,Retrospective Studies ,Ultrasonography ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Nephrology ,Asymptomatic Diseases ,Nephrostomy ,Female ,Ureteral Stricture ,medicine.symptom ,business ,Ureteral Obstruction - Abstract
Objective While routine renal imaging following ureteroscopy for urinary calculi has been recommended to screen for asymptomatic "silent" obstruction, the rate of silent obstruction following percutaneous nephrolithotomy (PCNL) remains poorly defined, and no consensus recommendations exist on routine postoperative imaging. At our institution, we sought to assess the incidence of silent hydronephrosis (SH), as a screen for obstruction, following PCNL. Methods The records of all 162 patients who met study inclusion criteria were reviewed. Of this group, 112 patients presented for their scheduled renal ultrasonography 4 - 6 weeks following stent removal to screen for SH. Asymptomatic patients found to have ultrasonographic evidence of hydronephrosis were further analyzed. Results SH was noted in 16% (18/112) of patients. Two required subsequent ureteroscopic stone extraction (1.8%), one of which also underwent endoureterotomy for a ureteral stricture. Four patients (22%) had stable hydronephrosis and declined functional imaging, 2 patients (11%) had a known partial ureteropelvic junction obstruction and declined intervention. SH resolved spontaneously in 50% (9/18) with a mean time to resolution of 6.3 months. There was no difference in stone complexity based on Guy's stone score between groups, 2.8 (± 0.92) vs. 2.4 (± 1.03), p = 0.34. Although not statistically significant, patients with SH were more likely to have had residual stone fragments postoperatively, 39% (7/18) vs. 19% (18/94), p = 0.067. Conclusions SH following, PCNL was identified in 16% of this screened population, with the majority requiring no intervention. However, SH may be attributed to residual stone or stricture, which may have been otherwise unrecognized in up to 2% of patients undergoing PCNL. Consideration should be given for routine postoperative ultrasound to screen for silent obstruction following PCNL. .
- Published
- 2017
44. MP03-08 ASSOCIATION OF PRIOR PREGNANCY WITH 24-HOUR URINE COMPOSITION AND STONE RISK
- Author
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Marie-Therese I. Valovska, Vernon M. Pais, and Vivian Paredes Bhushan
- Subjects
Pregnancy ,business.industry ,Urology ,Urinary system ,Lifetime prevalence ,Physiology ,urologic and male genital diseases ,medicine.disease ,humanities ,body regions ,Medicine ,Hypercalciuria ,sense organs ,skin and connective tissue diseases ,business ,24 h urine - Abstract
INTRODUCTION AND OBJECTIVE:Pregnancy is associated with an increased lifetime prevalence of nephrolithiasis. During pregnancy, purported changes in urinary milieu include hypercalciuria and alkalin...
- Published
- 2020
45. Does Omission of Ureteral Stents Increase Risk of Unplanned Return Visit? A Systematic Review and Meta-Analysis
- Author
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Cody M. Rissman, Rebecca Smith, Elizabeth A. Stedina, and Vernon M. Pais
- Subjects
medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Nephrolithiasis ,Patient Readmission ,Risk Assessment ,law.invention ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Randomized controlled trial ,law ,Ureteroscopy ,medicine ,Humans ,Intensive care medicine ,Methodological quality ,Randomized Controlled Trials as Topic ,medicine.diagnostic_test ,business.industry ,Stent ,Emergency department ,Ureteral stents ,030220 oncology & carcinogenesis ,Meta-analysis ,Emergency medicine ,Urologic Surgical Procedures ,Stents ,Observational study ,Controlled Clinical Trials as Topic ,Ureter ,Emergency Service, Hospital ,business - Abstract
Post-ureteroscopy ureteral stent omission remains controversial. Although omission is associated with reduced postoperative discomfort, concern remains for early obstruction. We performed a systematic review and meta-analysis of trials to compare the risk of unplanned visits with vs without a stent following ureteroscopy for nephrolithiasis.Randomized, controlled trials and observational studies comparing post-ureteroscopic stent omission vs placement and reporting unplanned visits within 30 days were identified via a search of MEDLINE® (1946 to 2015), CENTRAL (Cochrane Central Register of Controlled Trials, 1898 to 2015), Embase® (1947 to 2015), ClinicalTrials.gov (1997 to 2015), AUA (American Urological Association) Annual Meeting abstracts (2011 to 2015) and reference lists of included articles as last updated in October 2015. Two reviewers independently extracted data and assessed methodological quality. ORs, RRs and weighted mean differences were calculated as appropriate for each outcome.Of the initial 1,992 studies 17 in a total of 1,943 participants met inclusion criteria. Unstented patients were significantly more likely to have an unplanned medical visit compared to those who received a post-ureteroscopy stent (OR 1.63, 95% CI 1.15-2.30). Unstented patients had shorter operative time (weighted mean difference -3.19 minutes, 95% CI -5.64--0.74) and were less likely to experience dysuria (RR 0.39, 95% CI 0.25-0.62). They were also less likely to experience postoperative infection (OR 0.89, 95% CI 0.59-1.33) and pain (OR 0.64, 95% CI 0.39-1.05), although these results were not significant.Stent omission is associated with an increased risk of unplanned medical visits despite reduced symptoms compared to those in stented patients. Patients and physicians should weigh these trade-offs when considering post-ureteroscopy stent placement.
- Published
- 2016
46. Percutaneous nephrolithotomy versus retrograde intrarenal surgery for treatment of renal stones in adults
- Author
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Vernon M. Pais, Michael S. Borofsky, Maylynn Ding, Robin Parker, Philipp Dahm, and Leah Soderberg
- Subjects
Medicine General & Introductory Medical Sciences ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,education ,medicine ,Pharmacology (medical) ,Percutaneous nephrolithotomy ,business ,Surgery - Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of percutaneous nephrolithotomy versus retrograde intrarenal surgery for treatment of renal stones in adults.
- Published
- 2019
47. The Durability of Active Surveillance in Patients with Asymptomatic Kidney Stones: A Systematic Review
- Author
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Dongheon Lee, Natalie B.V. Riblet, Vernon M. Pais, Benjamin A.Y. Cher, Sreevaishali Rajendran, and David S. Han
- Subjects
medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Nephrolithotomy, Percutaneous ,Asymptomatic ,03 medical and health sciences ,Kidney Calculi ,0302 clinical medicine ,Lithotripsy ,Unnecessary Procedure ,medicine ,Ureteroscopy ,Humans ,In patient ,Intensive care medicine ,Watchful Waiting ,business.industry ,Disease Management ,medicine.disease ,030220 oncology & carcinogenesis ,Asymptomatic Diseases ,Kidney stones ,medicine.symptom ,business ,Watchful waiting - Abstract
Introduction: The natural progression of asymptomatic kidney stones remains unclear. Such knowledge may promote value-aligned care for patients and reduce potentially unnecessary procedure...
- Published
- 2019
48. Association of Patient Age and Gender with Kidney Stone Related Quality of Life
- Author
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Tianming Gao, Vernon M. Pais, Stephen Y. Nakada, Kristina L. Penniston, Ben H. Chew, Roger L. Sur, Thomas Chi, Timothy D. Averch, Necole M. Streeper, Jodi Antonelli, Vincent G. Bird, Karen Stern, Davis P. Viprakasit, and Sri Sivalingam
- Subjects
Gerontology ,Adult ,Male ,Urology ,030232 urology & nephrology ,03 medical and health sciences ,Diagnostic Self Evaluation ,Kidney Calculi ,0302 clinical medicine ,Quality of life (healthcare) ,Sex Factors ,Patient age ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,Prospective cohort study ,Health related quality of life ,business.industry ,Age Factors ,Middle Aged ,medicine.disease ,Cross-Sectional Studies ,Quality of Life ,Kidney stones ,Female ,business - Abstract
Kidney stone formers have lower health related quality of life than nonstone formers. The North American Stone Quality of Life Consortium is a multicenter, longitudinal, prospective study of health related quality of life in patients with kidney stones using the WISQOL (Wisconsin Stone Quality of Life Questionnaire) with data on 2,052 patients from a total of 11 centers. This study is a subanalysis of cross-sectional data looking at the association of age, gender and race on health related quality of life of stone formers.We performed multivariable analyses of ordinal logistic regression analyses to determine the impact of age, gender and race on health related quality of life, adjusting for other baseline covariates. The proportional odds assumption of ordinal logistic regression was checked. Total score and scores on 4 subdomains (social functioning, emotional functioning, stone related impact and vitality) were included.Median total score for all patients was 80.4. On multivariable analysis older patients had a significantly higher total health related quality of life score than younger patients (per 10-year increase OR 1.25, p0.0001). Male patients had higher scores than females (OR 1.56, p = 0.0003) and nonCaucasian patients had lower health related quality of life than nonLatino Caucasian patients (OR 0.63, p = 0.0045).Younger and female patients with kidney stones have lower health related quality of life than older and male patients, respectively. NonCaucasian patients with stones also have lower health related quality of life. The clinical impact of these findings might include future implications for patient counseling, including dietary and medical management of stone disease, and potential changes to the paradigm of the surgical management of stones.
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- 2019
49. Regional Variation in Shock Wave Lithotripsy Utilization Among Medicare Patients with Nephrolithiasis
- Author
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Michael E. Rezaee, Vernon M. Pais, Gina Tundo, and Philip P. Goodney
- Subjects
Male ,medicine.medical_specialty ,Practice patterns ,business.industry ,Urology ,030232 urology & nephrology ,Medicare beneficiary ,Shock wave lithotripsy ,Medicare ,United States ,03 medical and health sciences ,Kidney Calculi ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Lithotripsy ,medicine ,Humans ,Female ,Practice Patterns, Physicians' ,business ,Procedures and Techniques Utilization ,Aged - Abstract
OBJECTIVE To characterize shock wave lithotripsy (SWL) utilization and assess for regional variation in the use of this procedure across the United States. MATERIALS AND METHODS We examined SWL and URS utilization among Medicare Beneficiaries with a diagnosis of nephrolithiasis for the years 2006, 2009, and 2014. Adjusted utilization rates were calculated per 1000 beneficiaries accounting for age, sex, and race. Utilization rates were examined nationally and by hospital referral region (HRR). RESULTS A total of 511,495, 604,493, and 806,652 Medicare beneficiaries had a diagnosis of nephrolithiasis in 2006, 2009, and 2014, respectively. The adjusted rate of SWL per 1000 beneficiaries with nephrolithiasis decreased from 59.4/1000 in 2006 to 52.2/1000 and 45.5/1000 in 2009 and 2014 (13.9% decrease, P < .001). Variation was observed in SWL utilization; up to a 12-fold difference between HRRs (9.2/1000 in Winchester, VA to 105.8/1000 in Lincoln, NE). The adjusted rate of URS per 1000 beneficiaries increased by 10.2% (P < .001) between 2006 and 2014. However, the percent decrease in SWL utilization did not correlate with the percent increase in URS utilization when examined by HRR (P = .66). CONCLUSION Variation exists in the utilization of SWL among Medicare beneficiaries (12-fold difference). This variation is likely secondary to a series of supply, urologist, and patient-specific factors. SWL utilization decreased between 2006 and 2014, while URS increased. Stone procedure type is likely highly dependent on where patients receive their urologic care.
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- 2019
50. MP08-11 FAILURE OF THE ELECTRONIC STENT REGISTRY: INCIDENCE OF RETAINED URETERAL STENTS AND IMPLICATIONS FOR PREVENTION
- Author
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Vernon M. Pais and Robin Djang
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medicine.medical_specialty ,urogenital system ,business.industry ,Urology ,Incidence (epidemiology) ,medicine.medical_treatment ,Stent ,Ureteral stents ,urologic and male genital diseases ,equipment and supplies ,Surgery ,Never events ,surgical procedures, operative ,medicine ,cardiovascular diseases ,business ,Medicaid - Abstract
INTRODUCTION AND OBJECTIVES:Retained ureteral stents are classified as “never events” by the Centers of Medicare and Medicaid services. Stent registries have been implemented to prevent unintended ...
- Published
- 2019
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