Contemporary National Surgical Outcomes in the Treatment of Ureteropelvic Junction Obstruction

Oberlin, Daniel T.; McGuire, Barry B.; Pilecki, Matthew; Rambachan, Aksharananda; Kim, John Y.; Perry, Kent T.; Nadler, Robert B.

doi:10.1016/j.urology.2014.07.068

Cited by 11 publications

(6 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…MIP has grown increasingly common in the last 2 decades, accounting for 83% of adult cases in 2011. 16 However, patients without private insurance may be less likely to undergo MIP 17 and they are not represented in this study. Pediatric and redo pyeloplasties reflect this growing trend and the steady uptake of MIP during our study period mirrors that in prior publications.…”

Section: Discussionmentioning

confidence: 99%

National Trends in Secondary Procedures Following Pediatric Pyeloplasty

Hsi

Holt

et al. 2016

Journal of Urology

View full text Add to dashboard Cite

Purpose Although reported success rates after pediatric pyeloplasty to correct ureteropelvic junction are high, failure may require intervention. We sought to characterize the incidence and timing of secondary procedures after pediatric pyeloplasty using a national employer based insurance database. Materials and Methods Using the MarketScan® database we identified patients 0 to 18 years old who underwent pyeloplasty from 2007 to 2013 with greater than 3 months of postoperative enrollment. Secondary procedures following the index pyeloplasty were identified by CPT codes and classified as stent/drain, endoscopic, pyeloplasty, nephrectomy or transplant. The risk of undergoing a secondary procedure was ascertained using Cox proportional hazards models adjusting for demographic and clinical characteristics. Results We identified 1,976 patients with a mean ± SD followup of 23.9 ± 19.8 months. Overall 226 children (11.4%) had undergone at least 1 post-pyeloplasty procedure. The first procedure was done within 1 year in 87.2% of patients with a mean postoperative interval of 5.9 ± 11.1 months. Stents/drains, endoscopic procedures and pyeloplasties were noted in 116 (5.9%), 34 (1.7%) and 71 patients (3.1%), respectively. Length of stay was associated with undergoing a secondary procedure. Compared with 2 days or less the HR of 3 to 5 and 6 days or greater was 1.65 and 3.94 (p = 0.001 and <0.001, respectively). Conclusions Following pediatric pyeloplasty 1 of 9 patients undergoes at least 1 secondary procedure with the majority performed within the first year. One of 11 patients undergoes intervention more extensive than placement of a single stent or drain, requiring management strategies that generally signify recurrent or persistent obstruction. Estimates of pyeloplasty success in this national data set are lower than in other published series.

show abstract

Section: Discussionmentioning

confidence: 99%

National Trends in Secondary Procedures Following Pediatric Pyeloplasty

Hsi

Holt

et al. 2016

Journal of Urology

View full text Add to dashboard Cite

show abstract

“…One potential explanation for this finding is that the increasing costs associated with performing robot-assisted surgery were offset by quicker convalescence and decreased hospital length of stay. 5 Although these treatment costs only pertain to a 60-day window around the time of the procedure, we expect that the two approaches would continue to have similar long-term costs since they have comparable success and complication rates. 3,22 In calculating costs associated with treatments, we did not account for the up-front cost of the robotic platform (*$1.5 million) or the annual maintenance fees (*$150,000).…”

Section: Discussionmentioning

confidence: 99%

“…These treatments have varying success rates and associated morbidities, but they are all generally considered effective. 2,3 Although prior work has examined factors associated with their use 4 as well as their outcomes, 3,5 few studies have assessed the costs related to these procedures. On the one hand, minimally invasive pyeloplasties (i.e., laparoscopic or robotic approaches) may reduce costs due to decreased hospital length of stay, quicker convalescence, and increased productivity.…”

Section: Introductionmentioning

confidence: 99%

Cost Analysis of Treatments for Ureteropelvic Junction Obstruction

Jacobs

Seelam

Hanley

et al. 2017

Journal of Endourology

View full text Add to dashboard Cite

Among the three treatments, endopyelotomy was the least expensive in the immediate perioperative period. Open and minimally invasive pyeloplasties were similar in cost, but both more expensive than endopyelotomies. The similar cost between the two pyeloplasty approaches provides additional evidence that minimally invasive pyeloplasty should be considered the standard treatment for ureteropelvic junction obstruction.

show abstract

“…On the contrary, when ultrasonic waves propagate in the body, the acoustic energy will be attenuated, and its attenuation coefficient is approximately proportional to the frequency in the megahertz frequency range. The attenuation of sound energy in common human tissues from large to small is bone, scar, tendon, muscle, fat, blood, and cystic fluid [ 6 ]. The resolution of 10 MHz ultrasound can reach 0.075 nm, and the maximum penetration depth in human soft tissue is 4 cm.…”

Section: Introductionmentioning

confidence: 99%

Application of Intelligent Ultrasound in Real-Time Monitoring of Postoperative Analgesic Nerve Block

Zhao

Wang

Zheng

2021

Contrast Media & Molecular Imaging

View full text Add to dashboard Cite

In order to monitor the effect of nerve block in postoperative analgesia more accurately, this paper puts forward the application research of ultrasonic real-time intelligent monitoring of nerve block in postoperative analgesia. Ultrasonic real-time intelligent monitoring of nerve block in upper limb surgery, lower limb surgery, and abdominal surgery combined with the nerve stimulator. The experiments show that there are 5 cases of adverse reactions when the nerve stimulator is only used, but no adverse reactions occur when combined with ultrasound-guided block. Continuous subclavian brachial plexus block with the ultrasound-guided nerve stimulator can clearly see the subclavian brachial plexus and its surrounding tissue structure, the direction of needle insertion in the plane, and the diffusion of narcotic drugs. The average success rate of block was up to 95.2%, which was significantly higher than that of nerve stimulator alone, and the success rate of recatheterization after the first failure was also improved. The average postoperative analgesia satisfaction was 85.6%, the average operation time was only 20 min, and the subclavian artery and pleura were avoided effectively. No pneumothorax and other complications occurred. The average success rate of ultrasound-guided subclavicular brachial plexus block in 1-2-year-old children was 97%, which was much higher than the average success rate of nerve stimulator localization with 63%. Ultrasound-guided nerve block not only directly blocks nerves under visual conditions but also helps to observe the structures around nerves and dynamically observe the diffusion of local anesthetics, which can significantly improve the accuracy and success rate of nerve block and reduce the incidence of complications.

show abstract

Contemporary National Surgical Outcomes in the Treatment of Ureteropelvic Junction Obstruction

Cited by 11 publications

References 27 publications

National Trends in Secondary Procedures Following Pediatric Pyeloplasty

National Trends in Secondary Procedures Following Pediatric Pyeloplasty

Cost Analysis of Treatments for Ureteropelvic Junction Obstruction

Application of Intelligent Ultrasound in Real-Time Monitoring of Postoperative Analgesic Nerve Block

Contact Info

Product

Resources

About