Journal of Urology

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ISSN / EISSN : 0022-5347 / 1527-3792
Total articles ≅ 143,752
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Christopher S. Elliott, Kai Dallas, Kazuko Shem, James Crew
Abstract:
Introduction: In April 2008, Medicare amended their policy for clean intermittent catheter (CIC), increasing coverage from 4 re-used catheters per month to up to 200 single-use catheters. The primary reason for the policy change was an assumed decrease in risk of urinary tract infection (UTI) with single-use catheters. Given its economic/environmental impact (∼50-fold increase in cost and plastic waste) and a paucity of supporting evidence, we retrospectively evaluate the policies’effect in a prospective spinal cord injury (SCI) registry. Methods: We accessed data for the years 1995 to 2020 from The National Spinal Cord Injury Database focusing on 1-year follow-up in those unable to volitionally void after injury. We asked two questions: 1) Did hospitalizations for genitourinary reasons decrease after the CIC policy change; and 2) Did CIC adoption and adherence increase after the CIC policy change? Results: During the study period, 2657 of the 6843 (38.8%) participants unable to volitionally void after SCI were hospitalized during their first follow-up year. Of the cohort performing CIC, fewer individuals were hospitalized for genitourinary reasons prior to the CIC policy change compared to after (10.6% versus 14.6%, p <0.001), a finding that persisted on multivariate logistic regression (OR=0.67, p <0.001). In addition, the number of individuals performing CIC at 1-year follow-up was less after the policy change compared to prior (57.0% vs 59.1%, p=0.044). Conclusion: Our findings suggest the 2008 policy change shifting CIC coverage from catheter reuse to single-use did not decrease hospitalizations for UTI or increase CIC uptake in individuals with SCI.
Matvey Tsivian, Daniel D. Joyce, Vignesh T. Packiam, Christine M. Lohse, Stephen A. Boorjian, Theodora A. Potretzke, George K. Chow, Bradley C. Leibovich, Vidit Sharma, R Houston Thompson
Abstract:
Purpose: Conversions from partial (PN) to radical nephrectomy (RN) are uncommon and reports on this topic are rare. In this study we present a detailed analysis of conversions from PN to RN in a single institutional contemporary experience and provide an analysis of preoperative risk factors. Materials and Methods: Patients who underwent converted (cases) and completed (controls) PN from 2000 to 2015 were matched 1:1 for analysis. Perioperative imaging was reviewed and RENAL nephrometry scores (RENAL-NS) were calculated. Reasons for conversions were abstracted from operative reports. Multivariable conditional logistic regression analyses were used to assess preoperative risk factors for conversion. Results: A total of 168 cases (6.1% of all PNs) were identified and matched on tumor size, year of surgery, and surgical approach to 168 controls. Conversion rates decreased from 13% in 2000-2003 to 4% in 2012-2015. Oncologic considerations, such as concern for upstaging and positive margins, were the most cited (56%) reasons for conversion. On multivariable analyses, male sex (OR 2.34; p=0.03), Charlson score (OR per 1-unit increase:1.28; p=0.03), posterior and middle (on anteroposterior axis) location (ref: anterior, OR 2.83, p=0.02 and OR 6.38, p<0.001, respectively) and hilar location (ref: peripheral/central, OR 5.61; p<0.001) were associated with increased odds of conversion. Conclusions: Rates of conversion from PN to RN in our experience were low and decreased over time. Preoperative characteristics such as hilar, posterior, and middle locations were significantly associated with conversions after controlling for tumor size and offer guidance for operative planning and patient counseling.
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