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The Minimally Invasive Urology Institute (MIUI) at The Miriam Hospital had a strong presence at the recent annual meeting of The New England Section of the American Urological Association. Ten scholarly works were presented by experts at the MIUI, an integral part of The Miriam’s urology program which was recently ranked 27th best in the nation by U.S. News & World Report.
Among the presentations were the following:
• Laboratory Testing Following Robotic Assisted Laparoscopic Radical Prostatectomy Does Not Change Clinical Management
Ohad Kott, MD1, Osama Al-Alao, MD1, Jorge Pereira, MD2, Steven Reinert, PhD3, Christopher Tucci, RN1, Boris Gershman, MD1, Joseph Renzulli, Sr., MD4, Dragan Golijanin, MD1, Gyan Pareek, MD1
In our retrospective observational study, we found no evidence of a clinical need to perform routine laboratory tests post-operatively in uncomplicated patients undergoing robotic assisted laparoscopic radical prostatectomy although there may still be a need to perform tests in patients that complicated intraoperatively or that have co-morbidities. Such unnecessary tests increase the chances of infection, increase costs and pose a burden on the healthcare system.
• Active Surveillance Stone Protocol Reduces Endourologic Interventions
Alejandra Balen, MD1, Ohad Kott, MD1, Osama Al-Alao, MD1, Eric Jung, MD1, Timothy O'Rourke, MD1, Meredith Wasserman, MD1, Christopher Tucci, RN1, Jie Tang, MD2, Gyan Pareek, MD1
Our institution applies an active surveillance multidisciplinary approach to provide a close follow-up and treatment plan for high-risk kidney stone formers. We sought to compare the incidence of surgical intervention within the multidisciplinary kidney stone center to the incidence of surgical intervention in a urology practice that uses a non-multidisciplinary approach. This study demonstrates that multidisciplinary kidney stone center patients treated with an active surveillance multidisciplinary approach had a statistically significant lower incidence of surgical interventions compared to urology practice patients, despite being high-risk stone formers and prone to higher rate of surgical interventions.
• Dusting is Efficacious and Safe with a 30-Watt Laser
Eric Jung, MD, Ohad Kott, MD, Osama Al-Alao, MD, Alejandra Balen, MD, Timothy O'Rourke, MD, Meredith Wasserman, MD, Christopher Tucci, RN, Gyan Pareek, MD
We identified 246 adult patients who underwent ureteroscopic laser lithotripsy for kidney stones at our institution between March 1, 2017 to September 1, 2017. Of those, 101 patients met the inclusion criteria and were stone free post ureteroscopic laser lithotripsy. In this study, ureteroscopic stone treatment using 30-Watt laser was efficacious and did not prolong operating time compared to dusting with a 100-Watt laser.
• Endourology Survey on Radiation Exposure Reveals A Need for Clear Guidelines for Post Ureteroscopy Imaging
Ohad Kott, MD1, Osama Al-Alao, MD1, Jorge Pereira, MD2, Christopher Tucci, RN1, Gyan Pareek, MD1
This survey, among active members of the Endourological Society, evaluated knowledge and perception of best practice and patient radiation exposure in post URSL imaging. Our data reveals that urologists worldwide need better education on radiation exposure from diagnostic studies. Additionally, there appears to be a knowledge deficit with the timing and utilization of low dose CT. This deficit appears larger outside than within USA. Current guidelines appear to be discretionary, not supported with enough evidence and do not take into account the utilization of low-dose CT.
• Economic Trends of Endourologic Surgery Reimbursement Demonstrates Increased Profitability for Healthcare Systems
Ohad Kott, MD, Christopher Tucci, RN, Gyan Pareek, MD
Nephrolithiasis afflicts 11% of the United States population. The utilization of endourological procedures for nephrolithiasis has increased in the past decade. Our data demonstrates that approximately $6 million in reimbursement per year is being generated from endourological care alone at our institution.
• Preparing the Patient for Success: Pre-Op, Post-Op and Beyond
Ashlee Viveiros, DNP; Lauren Pillsbury, NP
Enhanced recovery involves preparing patients pre-operatively so they succeed post-operatively. Developing evidence-based care pathways provides direction to ensure low complication and readmission rates while maintaining a decreased length of stay.
• Understanding the Methodology: Improving Care and Becoming a National Leader on U.S. News & World Report Best Hospital list
Christopher Tucci, Ashlee Viveiros, Gyan Pareek, Dragan Golijanin
Annually, U.S. News & World Report publishes a ranking of Best Hospitals and specialties based on objective outcomes, volume, specialty specific services and technologies, expert opinion and patient satisfaction. The methodology of urology ranking and process discussed.
• Optimizing Care Transitions for Minimally Invasive Radical Cystectomy Patients to Reduce Readmissions and Enhance Recovery Success
Ashlee Viveiros, DNP; Christopher T. Tucci, MS, RN-BC, CURN, NE-BC
Transitions of care between settings can place patients with complex care needs at risk for poor outcomes due to lack of communication and coordination between organizations and caregivers. Care coordination and patient navigation efforts at our institution have demonstrated a reduction in fragmented care across settings for this patient population resulting in decreased avoidable readmissions, reduced emergency room visits, fewer complications, and improved communication and continuity of care
• Pelvic Floor Rehab: How to do it and What does it Treat
Christy Ciesla DPT
Pelvic floor rehabilitation serves a number of roles including improving urinary control problems related to defecation, sexual dysfunction, pelvic pain and prenatal/postpartum issues.
• AUA/ SUNA White Paper: Optimizing Outcomes in Urological Surgery: Pre-Op, Intraop, Post-Op
Christopher T. Tucci, MS, RN-BC, CURN, NE-BC
As co-author of the AUA/ SUNA joint white paper, Christopher T. Tucci, MS, RN-BC, CURN, NE-BC discussed strategies to optimize care for pre-operative, intra-operative and post-operative phases of care.