Introduction Diagnostic pressure on endoscopy suite can lead to delay in flexible cystoscopic stent removal. We compare the cost and organizational impact of reusable flexible cystoscope versus single-use, flexible cystoscope with a built-in stent grasper (Isiris ® ). Material and methods Data for the reusable cystoscopic stent removal performed in endoscopy room, group A (period 1) were compared to Isiris disposable stent removal performed in outpatient clinic, group B (period 2). We chose the same calendar months in successive years for these two different groups (9 months each). A micro cost analysis was performed evaluating the impact on costs, complications and organizational benefit. Results A total of 72 patients (37, group A; 35, group B) were included with no significant differences in age and gender ratio. The mean procedure time was 14.4 and 2.2 minutes, and the mean stent dwell time was 26.8 and 15.4 days in groups A and B respectively (p <0.001). In group A, 5 patients (14%) developed stent encrustation, of which 3 needed a ureteroscopic removal subsequently. No complication occurred in group B. More staff on average were needed for procedures done in group A, than group B (p <0.001). The number of patients who had cancer diagnostic wait of >2 weeks for flexible cystoscopy and the mean number of days they waited, reduced from 16 to 3, and 21 days to 3 days respectively between period 1 to period 2. The cost per procedure between group A and group B was £267.2 and £252.62 (p <0.05) if the cost of managing complications was not considered, and £365.40 and £252.62 (p <0.001) if the cost of managing complications was also considered. Conclusions Isiris significantly reduced stent dwell time, procedural time and staff needed to carry out the stent removals. It also allowed the procedures to be done in the outpatient setting thereby reducing the organizational pressure on endoscopy related diagnostic procedures.
Introduction: We introduced a nurse-led telephone-based virtual stone clinic (VSC) follow-up for the surveillance of patients with asymptomatic renal calculi or those at a high risk of recurrent kidney stone disease (KSD). The aim of this study was to look at the outcomes of VSC and its role in the post-COVID era. Methods: Prospective outcomes audit was done for all patients referred to the VSC for a 6-year period (March 2014-April 2020). VSC is led by specialist stone nurses for ongoing surveillance of KSD patients. Results: A total of 290 patients were seen (468 individual appointments; 1.6-1.0 per patient), with a mean age of 57.0-15.8 years (range: 17-92) and a men-women ratio of 3:2. The referral was for surveillance of asymptomatic small renal stones (230, 79.3%); history of recurrent stone disease (45, 15.5%); solitary kidneys (5, 1.7%); cystine stones; young age; and other conditions (10, 3.4%). The mean stone size was 5.0-2.7 mm, followed up with kidney, ureter, and bladder radiograph (225, 77.6%) and ultrasound scan (USS) (65, 22.4%), for median duration of 12 months (range: 3-24 months). At the end, 132 patients (45.6%) remained in VSC, 106 (36.6%) were discharged, 47 (16.2%) returned to face-to-face clinic or treatment, and 5 (1.7%) had emergency admissions. Of 47 patients who returned, 23 (48.9%) developed new symptoms, 21 (44.6%) had stone growth, and 3 defaulted to face-to-face appointment. Thirty-five patients needed surgical intervention (URS-21, SWL-13, and PCNL-1) and 10 were managed conservatively. VSC reduced the cost per clinic appointment from £27.9 to £2 per patient (93% reduction), equating to a total saving of £12,006 for the study period. Conclusion: Nurse-led VSC not only provided a safe follow-up but also allowed to substantially reduce the cost of treatment by allowing patients to be either discharged or return to a face-to-face clinic or surgical intervention if needed. Post-COVID, this model using telemedicine will have a much wider uptake and further help to optimize health care resources.
Introduction Shock wave lithotripsy (SWL) is a well-established treatment for kidney stone disease (KSD) and despite its decreased popularity in the past, it has now gained renewed interest due to its minimally invasive nature and good outcomes, especially in the face of COVID-19 pandemic. The aim of our study was to perform a service evaluation to analyse and identify quality of life (QoL) changes [using Urinary Stones and Intervention Quality of Life (USIQoL) questionnaire] after repeat SWL treatments. This would enable a greater understanding of SWL treatment and reduce the current gap of knowledge regarding patient specific outcomes in the field. Material and methods Patients affected by urolithiasias underwent SWL treatment between September 2021 and February 2022 (6 months), were included in the study. A questionnaire was given to the patients in each SWL session and consisted of three main topic areas: a domain on Pain and Physical Health, on Psycho-social Health and on Work (see appendix below). Patients also completed a Visual Analogue Scale (VAS) in relation to the pain related to the treatment. Data from the questionnaires were collected and analysed. Results A total of 31 patients filled in two or more surveys, with a mean age of 55.8 years. On repeat treatments, pain and physical health domain was significantly better (p = 0.0046), psycho-social health domain was significantly better (p <0.001), work domain was significantly better (p = 0.009) and a correlation [on Visual Analog Scale (VAS)] was observed between pain decreasing in subsequent SWL procedures. Conclusions Our study found that the choice of SWL to treat KSD does improve a patient’s QoL. This could be related to improvement of physical health, psychological and social wellbeing, and ability to work. Higher QoL and low pain scores are observed in relation to repeat SWL treatment and are not directly associated to stone-free status.
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