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IIF COMPLEX RENAL CYSTS: COST IMPLICATIONS OF SURVEILLANCE IMAGING
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THE JOURNAL OF UROLOGY姞
Vol. 185, No. 4S, Supplement, Sunday, May 15, 2011
CONCLUSIONS: These data support payment policies that encourage the provision of outpatient urologic care in less resourceintensive settings.
Procedure Type Endoscopic bladder procedures
Median Total Payments in U.S. Dollars HOPD
799 (472, 1595)
(25th, 75th percentile) ASC
617 (412, 1373)
Pediatrics: Andrology-Cryptorchidism & Varicoceles Podium 6
PO
197 (146, 270)
Sunday, May 15, 2011
10:30 AM-12:30 PM
Prostate biopsy
1948 (490, 1254)
1347 (482, 960)
317 (164, 272)
321
Urodynamic procedures
1318 (843, 2187)
1158 (673, 1864)
351 (74, 244)
LONG TERM OUTCOMES OF LYMPHATIC SPARING LAPAROSCOPIC VARICOCELECTOMY
Endoscopic urethral procedures
1201 (816, 1747)
1086 (714, 1612)
335 (202, 462)
Endoscopic ureteral procedures
1884 (1194, 3513) 1843 (1072, 3577)
Emad Rizkala*, Andrew Fishman, Israel Franco, Valhalla, NY
Urethral dilation/catheter placement 683 (264, 1210)
255 (146, 480)
291 (200, 538)
77 (55, 125)
Shockwave lithotripsy
3940 (3010, 6960) 3178 (2863, 4038)
MIST for prostate enlargement
2912 (2414, 3602) 3094 (2479, 4179) 3549 (3138, 3999)
822 (721, 1682)
Source of Funding: Urologic Diseases in America Project (N01-DK-7-0003)
320 BOSNIAK II/IIF COMPLEX RENAL CYSTS: COST IMPLICATIONS OF SURVEILLANCE IMAGING Chandy Ellimoottil*, Sam Brancato, Michael Ross, David Kollhoff, Philip Shalhoub, Joseph Allen, Sujeet Acharya, Thomas Turk, Maywood, IL INTRODUCTION AND OBJECTIVES: Renal cysts classified as Bosniak II and IIF are generally considered to be relatively benign and active surveillance of these cysts is a well accepted practice. A surveillance protocol for these cysts, however, has not been uniformly defined. We chose to assess both the practice patterns and yearly cost of radiographic surveillance of Bosniak II/IIF complex renal cysts at our institution. METHODS: We retrospectively reviewed the records of patients with complex renal cysts categorized as a Bosniak II or IIF that were referred to our department between 1998 –2009. We excluded patients that did not have at least one follow up imaging study and those that were followed for less than a year. We obtained data on the imaging modality and the dates of all imaging studies that were performed for the purposes of surveillance. Hospital charge and physician fee data was obtained from our hospital billing department. RESULTS: A total of 229 patients met study inclusion criteria and were reviewed. The median follow up for this group was 24.5 months and the median number of imaging studies performed per patient was 2.1 per year. In general, the charge (including facility and physician interpretation fee) associated with radiographic surveillance of these cysts at our institution ranged from $1,015 per renal ultrasound to $7,027 per MRI with and without contrast. We found that the median yearly cost of surveillance of Bosniak II/IIF renal cysts was $3,199.82 per patient. CONCLUSIONS: Given the low likelihood of malignancy associated with Bosniak II/IIF complex renal cysts, the high cost of radiographic surveillance should be considered when developing a surveillance protocol. Large scale studies demonstrating the true yield of imaging surveillance and rates of malignancy are needed. Source of Funding: None
INTRODUCTION AND OBJECTIVES: Previous studies have shown that lymphatic sparing laparoscopic varicocelectomy (LSLV) has comparable results in terms of varicocele recurrence and hydrocele formation, to microscopic lymphatic sparing varicocelectomy in adolescents. However, to date, there has not been any long term follow-up data regarding this technique. The primary objective of our analysis was to assess the long-term occurrence of hydroceles and varicocele recurrence in patients receiving LSLV compared to those receiving plain laparoscopic varicocelectomy (PLV). The secondary objective of our analysis is to assess the growth of testicular volume post-operatively. METHODS: We employed a standard three-trocar configuration. The spermatic vessels were identified in the retroperitoneum above the internal inguinal ring. Dissection was kept to a minimum to avoid disruption of lymphatics. Lymphatics were dissected free from the spermatic artery and veins based on laparoscopic appearance. The spermatic artery and veins were divided between plastic locking clips. We performed a retrospective chart review of all pediatric patients who underwent laparoscopic varicocelectomy between June 2003 and January 2009. We noted the post-operative change in testicular volume, incidence of varicocele recurrence, and hydrocele formation. RESULTS: A total of 97 patients were included in our analysis. Sixty-seven patients underwent LSLV with a mean follow-up of 45.8 ⫾ 20.7 months and 30 patients underwent PLV with mean follow-up of 40.8 ⫾ 25.3 months (p ⫽15). There was a 4.5% hydrocele rate in the LSLV group compared to 43.3% in the PLV group. Of the patients who underwent a PLV and subsequently developed a hydrocele, 31% (n⫽4) required a hydrocelectomy, versus none in those patients who developed a hydrocele after LSLV. Varicocele rate was 6% in the LSLV group versus 3.3% in the PLV group. However, when the artery was not preserved, the probability of recurrence in the LSLV group was 1.3%. Time to hydrocele formation was 16 months in the LSLV group versus 37 months in the PLV group. There was catch-up testicular growth in both groups. CONCLUSIONS: There appears to be an increased risk of having to undergo hydrocelectomy after a PLV as compared to LSLV. Preservation of the artery has a high recurrence rate during LSLV. Performing a lymphatic sparing, non-artery preserving laparoscopic varicocelectomy has success and complication rates comparable with those of sub inguinal microsurgical varicocelectomy. There appears to be excellent catch-up testicular growth with either laparoscopic varicocelectomy technique. Source of Funding: None
322 IS VARICOCELE A COMPONENT OF PELVIC OR SYSTEMIC VENOUS DISEASE? Hakan Koyuncu, Anar Ismayilov, Vugar Hasanov, Nail Ersoz, Yusuf KIBAR*, Hasan Cem IRKILATA, Murat DAYANC, Ankara, Turkey INTRODUCTION AND OBJECTIVES: The aim of this study was to evaluate the possible relationship between varicocele and hemorrhoids and sapheno-femoral insuficiency, which are the clinicial signs of venous insufficiency, in patients diagnosed with primary varicocele.
THE JOURNAL OF UROLOGY姞
Vol. 185, No. 4S, Supplement, Sunday, May 15, 2011
CONCLUSIONS: These data support payment policies that encourage the provision of outpatient urologic care in less resourceintensive settings.
Procedure Type Endoscopic bladder procedures
Median Total Payments in U.S. Dollars HOPD
799 (472, 1595)
(25th, 75th percentile) ASC
617 (412, 1373)
Pediatrics: Andrology-Cryptorchidism & Varicoceles Podium 6
PO
197 (146, 270)
Sunday, May 15, 2011
10:30 AM-12:30 PM
Prostate biopsy
1948 (490, 1254)
1347 (482, 960)
317 (164, 272)
321
Urodynamic procedures
1318 (843, 2187)
1158 (673, 1864)
351 (74, 244)
LONG TERM OUTCOMES OF LYMPHATIC SPARING LAPAROSCOPIC VARICOCELECTOMY
Endoscopic urethral procedures
1201 (816, 1747)
1086 (714, 1612)
335 (202, 462)
Endoscopic ureteral procedures
1884 (1194, 3513) 1843 (1072, 3577)
Emad Rizkala*, Andrew Fishman, Israel Franco, Valhalla, NY
Urethral dilation/catheter placement 683 (264, 1210)
255 (146, 480)
291 (200, 538)
77 (55, 125)
Shockwave lithotripsy
3940 (3010, 6960) 3178 (2863, 4038)
MIST for prostate enlargement
2912 (2414, 3602) 3094 (2479, 4179) 3549 (3138, 3999)
822 (721, 1682)
Source of Funding: Urologic Diseases in America Project (N01-DK-7-0003)
320 BOSNIAK II/IIF COMPLEX RENAL CYSTS: COST IMPLICATIONS OF SURVEILLANCE IMAGING Chandy Ellimoottil*, Sam Brancato, Michael Ross, David Kollhoff, Philip Shalhoub, Joseph Allen, Sujeet Acharya, Thomas Turk, Maywood, IL INTRODUCTION AND OBJECTIVES: Renal cysts classified as Bosniak II and IIF are generally considered to be relatively benign and active surveillance of these cysts is a well accepted practice. A surveillance protocol for these cysts, however, has not been uniformly defined. We chose to assess both the practice patterns and yearly cost of radiographic surveillance of Bosniak II/IIF complex renal cysts at our institution. METHODS: We retrospectively reviewed the records of patients with complex renal cysts categorized as a Bosniak II or IIF that were referred to our department between 1998 –2009. We excluded patients that did not have at least one follow up imaging study and those that were followed for less than a year. We obtained data on the imaging modality and the dates of all imaging studies that were performed for the purposes of surveillance. Hospital charge and physician fee data was obtained from our hospital billing department. RESULTS: A total of 229 patients met study inclusion criteria and were reviewed. The median follow up for this group was 24.5 months and the median number of imaging studies performed per patient was 2.1 per year. In general, the charge (including facility and physician interpretation fee) associated with radiographic surveillance of these cysts at our institution ranged from $1,015 per renal ultrasound to $7,027 per MRI with and without contrast. We found that the median yearly cost of surveillance of Bosniak II/IIF renal cysts was $3,199.82 per patient. CONCLUSIONS: Given the low likelihood of malignancy associated with Bosniak II/IIF complex renal cysts, the high cost of radiographic surveillance should be considered when developing a surveillance protocol. Large scale studies demonstrating the true yield of imaging surveillance and rates of malignancy are needed. Source of Funding: None
INTRODUCTION AND OBJECTIVES: Previous studies have shown that lymphatic sparing laparoscopic varicocelectomy (LSLV) has comparable results in terms of varicocele recurrence and hydrocele formation, to microscopic lymphatic sparing varicocelectomy in adolescents. However, to date, there has not been any long term follow-up data regarding this technique. The primary objective of our analysis was to assess the long-term occurrence of hydroceles and varicocele recurrence in patients receiving LSLV compared to those receiving plain laparoscopic varicocelectomy (PLV). The secondary objective of our analysis is to assess the growth of testicular volume post-operatively. METHODS: We employed a standard three-trocar configuration. The spermatic vessels were identified in the retroperitoneum above the internal inguinal ring. Dissection was kept to a minimum to avoid disruption of lymphatics. Lymphatics were dissected free from the spermatic artery and veins based on laparoscopic appearance. The spermatic artery and veins were divided between plastic locking clips. We performed a retrospective chart review of all pediatric patients who underwent laparoscopic varicocelectomy between June 2003 and January 2009. We noted the post-operative change in testicular volume, incidence of varicocele recurrence, and hydrocele formation. RESULTS: A total of 97 patients were included in our analysis. Sixty-seven patients underwent LSLV with a mean follow-up of 45.8 ⫾ 20.7 months and 30 patients underwent PLV with mean follow-up of 40.8 ⫾ 25.3 months (p ⫽15). There was a 4.5% hydrocele rate in the LSLV group compared to 43.3% in the PLV group. Of the patients who underwent a PLV and subsequently developed a hydrocele, 31% (n⫽4) required a hydrocelectomy, versus none in those patients who developed a hydrocele after LSLV. Varicocele rate was 6% in the LSLV group versus 3.3% in the PLV group. However, when the artery was not preserved, the probability of recurrence in the LSLV group was 1.3%. Time to hydrocele formation was 16 months in the LSLV group versus 37 months in the PLV group. There was catch-up testicular growth in both groups. CONCLUSIONS: There appears to be an increased risk of having to undergo hydrocelectomy after a PLV as compared to LSLV. Preservation of the artery has a high recurrence rate during LSLV. Performing a lymphatic sparing, non-artery preserving laparoscopic varicocelectomy has success and complication rates comparable with those of sub inguinal microsurgical varicocelectomy. There appears to be excellent catch-up testicular growth with either laparoscopic varicocelectomy technique. Source of Funding: None
322 IS VARICOCELE A COMPONENT OF PELVIC OR SYSTEMIC VENOUS DISEASE? Hakan Koyuncu, Anar Ismayilov, Vugar Hasanov, Nail Ersoz, Yusuf KIBAR*, Hasan Cem IRKILATA, Murat DAYANC, Ankara, Turkey INTRODUCTION AND OBJECTIVES: The aim of this study was to evaluate the possible relationship between varicocele and hemorrhoids and sapheno-femoral insuficiency, which are the clinicial signs of venous insufficiency, in patients diagnosed with primary varicocele.