INTRODUCTION AND OBJECTIVES: We previously reported the incidence of urologic-induced Clavien grade III complications of Prophylactic Ureteral Localization Stents (PULSe) is estimated at 2%. Conclusions of this study raised the possibility of mandatory guidewire utilization prior to all PULSe placement, as this was not obligatory in the initial series. As a quality improvement project, we sought to compare a modification of technique, mandatory use of guidewire, prior to PULSe placement to reduce urologic-induced complications in this patient cohort. Moreover, we performed a systematic review of the literature to determine the overall incidence of urologic-induced complications in patients undergoing PULSe placement.METHODS: We performed a retrospective review of all patients who underwent cystoscopy and PULSe placement at the time of General Surgical Procedure over a 12-month period. We compared this patient cohort to our prior cohort from July 2013 to June 2014 with the following variables: age, BMI, ASA score, pre-operative creatinine, post-operative creatinine, pre/post-operative creatinine difference, and Clavien III urologic-induced complications. We then performed a literature review from 1985-2018 using the following search terms: 'prophylactic ureteral stent' and 'localization stent'. Of the 145 studies reviewed, 14 publications met our inclusion criteria of PULSe prior to surgical procedure for the purpose of ureteral localization.RESULTS: In a current institutional series, 132 patients with a mean age and BMI of 55.78 (18-89) and 27.02, respectively, underwent bilateral PULSe placement with mandatory use of guidewire. No Clavien III complications were encountered in the contemporary cohort, compared to the prior incidence of 2% (p<0.001) Moreover, postoperative creatinine and pre/post-procedural creatinine difference also favored the contemporary cohort (p<0.022 and p<0.003, respectively). Review of literature and complication profile can be seen in Table 1. Overall urologic-induced complication rate in the literature is 2.47%.CONCLUSIONS: Mandatory use of guidewire prior to PULSe placement reduced our incidence of urologic-induced Clavien III complications to zero. The literature varies with respect to use of guidewire or fluoroscopy during PULSe placement
1000 beneficiaries accounting for age and race. Utilization rates were examined nationally and by hospital referral region (HRR).RESULTS: The national adjusted rate of penile prosthesis utilization significantly declined from 5.41 per 1000 beneficiaries in 2006 to 3.74 per 1000 beneficiaries in 2014. The number of beneficiaries diagnosed with ED significantly outpaced the number undergoing surgery. Significant regional variation was observed in penile prosthesis utilization over the study period; as high as a 27-fold difference in 2009 (1.7/1000 in Kansas City, MO to 45.4/1000 in Miami, FL) and 12-fold difference more recently in 2014 (1.9/1000 in Norfolk, VA to 24.2/ 1000 in Miami, FL, See Figure 1). Looking at the year 2014, 1,083,176 beneficiaries carried a diagnosis of ED, while only 4,050 underwent surgery. In 2014, over 65% of HRRs performed zero or < 11 penile prosthesis surgeries and were censored from the analysis.CONCLUSIONS: Significant regional variation exists in the utilization of penile prostheses among Medicare beneficiaries in the U.S.; up to a 27-fold difference was observed over the study period. This variance may be explained by a combination of demand, urologist availability, and patient-specific factors. In addition, over twothirds of U.S. hospital referral regions performed few to zero implants per year. Penile prosthesis placement for the treatment of ED in Medicare beneficiaries is likely dependent on where these patients seek urologic care.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.