MP29-01 EVALUATING THE IMPACT OF INTRARENAL PRESSURE ON CLINICAL OUTCOMES DURING REAL-TIME MONITORED URETEROSCOPY

The Journal of Urology · 2025-04-08

IP06-29 A 10-YEAR EVALUATION OF TIMING OF INFECTIONS FOLLOWING URETEROSCOPY FOR STONE TREATMENT IN A SINGLE INSTITUTION

The Journal of Urology · 2025-04-08

MP21-01 THERMAL INSIGHTS: ASSESSING THERMAL EFFECTS IN UROLITHIASIS TREATMENT WITH THULIUM: YAG LASER USING AN ANATOMICAL 3D-KIDNEY MODEL

The Journal of Urology · 2025-04-08

MP26-06 TREATMENT OF URETERAL STENT-RELATED SYMPTOMS WITH A TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR

The Journal of Urology · 2024-04-15

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (MP26)1 May 2024MP26-06 TREATMENT OF URETERAL STENT-RELATED SYMPTOMS WITH A TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR Rohit Tejwani, Shaun Hager, Ryan Sun, Nishant Doctor, Sneha Mohile, Timothy Chang, and Simon Conti Rohit TejwaniRohit Tejwani , Shaun HagerShaun Hager , Ryan SunRyan Sun , Nishant DoctorNishant Doctor , Sneha MohileSneha Mohile , Timothy ChangTimothy Chang , and Simon ContiSimon Conti View All Author Informationhttps://doi.org/10.1097/01.JU.0001009408.66023.77.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral stent placement following ureteroscopy (URS) is prevalent despite current controversies. Nonpharmacologic methods to manage stent-related symptoms are needed in light of efforts to reduce opiate prescription and lack of efficacy of current regimens. Transcutaneous electrical nerve stimulation (TENS) therapy is an effective and safe form of patient-controlled analgesia for a range of conditions and a 2006 randomized trial suggested efficacy in reducing renal colic in the pre-hospital setting. We sought to evaluate the use of TENS for stent-related symptoms in patients undergoing URS for urolithiasis. METHODS: Participants undergoing unilateral URS with lithotripsy at a tertiary center were randomized to receive standard therapy consisting of multiagent pharmacotherapy (NSAID, acetaminophen, alpha blocker, and opioids if pain still not controlled) versus standard therapy with adjunctive TENS at home using an FDA-approved device. Daily symptom scores via 10-point scale assessments of common domains were completed through 2 days post-stent removal. The validated Ureteral Stent Symptom Questionnaire (USSQ) and open-ended experiential questions (EQ) were administered at the first postoperative visit. Mean daily and USSQ scores per domain were compared via two-tailed t-tests and descriptive statistics as appropriate. Experiential comments were qualitatively analyzed by thematic coding. RESULTS: A total of 28 patients participated with 17 randomized to receive TENS. Average age was 52.9 vs. 63.1 y. Differences in average abdominal pain scores (3.52±3.08 vs. 3.42±2.85; p=0.929), groin pain (4.33±2.59 vs. 4.02±2.44; p=0.758), pain frequency (4.70±2.33 vs. 5.22±2.28; p=0.564) or nausea intensity (1.18±1.63 vs. 1.98±2.01; p=0.259) did not vary significantly between groups. 23 patients completed the USSQ with no difference in total (30.23±6.48 vs. 29.3±11.02, p=0.802) nor sub-domain scores. 13 TENS patients completed the EQ; 12 (92.3%) noted positive experiences with 10 (76.9%) preferring TENS to medication partially or entirely and 9 (69.2%) attributing TENS to decreased pain symptoms. None reported decreased nausea or urinary symptoms. CONCLUSIONS: While patients who received a TENS device reported subjective improvement of their symptoms and decreased pain medication use, these differences were not evident when compared to a control group. There remains strong interest by patients in non-pharmacologic symptom management options, but in our study the use of a TENS device does not seem to decrease symptom scores and pain medication use. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e416 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Rohit Tejwani More articles by this author Shaun Hager More articles by this author Ryan Sun More articles by this author Nishant Doctor More articles by this author Sneha Mohile More articles by this author Timothy Chang More articles by this author Simon Conti More articles by this author Expand All Advertisement PDF downloadLoading ...

PD04-04 ASSESSING FINANCIAL TOXICITY IN PEDIATRIC UROLOGY: VALIDATION OF A PATIENT-REPORTED OUTCOME MEASURE TOOL IN SPINA BIFIDA

The Journal of Urology · 2024-04-15

You have accessJournal of UrologyPediatrics I (PD04)1 May 2024PD04-04 ASSESSING FINANCIAL TOXICITY IN PEDIATRIC UROLOGY: VALIDATION OF A PATIENT-REPORTED OUTCOME MEASURE TOOL IN SPINA BIFIDA Diana A. Aponte-Colon, Rafael D. Tua Caraccia, Leonid Aksenov, Kevin Hobbs, Rohit Tejwani, Rebecca Fairchild, Dandan Chen, Bryce Reeve, John Wiener, and Jonathan Routh Diana A. Aponte-ColonDiana A. Aponte-Colon , Rafael D. Tua CaracciaRafael D. Tua Caraccia , Leonid AksenovLeonid Aksenov , Kevin HobbsKevin Hobbs , Rohit TejwaniRohit Tejwani , Rebecca FairchildRebecca Fairchild , Dandan ChenDandan Chen , Bryce ReeveBryce Reeve , John WienerJohn Wiener , and Jonathan RouthJonathan Routh View All Author Informationhttps://doi.org/10.1097/01.JU.0001008812.05762.7f.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The concept of "financial toxicity" explores the negative therapeutic side effect of healthcare-related expenditure on individuals undergoing medical treatment, including financial burden as well as emotional distress. Little is known regarding the impact of financial toxicity on patients with congenital conditions, including spina bifida. To that end, our group previously created a questionnaire based on semi-structured patient and caregiver interviews that identified themes related to the financial burden experienced by patients with spina bifida and their caregivers. Our current study aimed to validate the financial toxicity patient reported outcomes measure tool. METHODS: We partnered with the Spina Bifida Association to distribute the patient reported outcomes measure tool for patients with spina bifida and their caretakers through their listserv and social media platforms. The patient survey consisted of 19 questions and the parent/caretaker survey consisted of 20. Descriptive analyses of the survey questions were used to check data quality. Confirmatory factor analysis was used to examine the factor structure and assess the reliability of the surveys. RESULTS: 180 patients and their parents/caregivers were included in the study. Among those, 67% had a household income of less than $50,000. Of the 93 parents, 30% had a household income of less than $50,000. The results of confirmatory factor analyses found that a one-factor model fit the patient survey data well, with a comparative fit index (CFI)=0.96, root mean square error (RSMEA)=0.08, and standardized root mean square residual (SRMR)=0.05. A one-factor model represented the parent survey data well with a CFI=0.93, RSMEA=0.12, and SRMR=0.09 The factor structures were shown to be reliable with an internal consistency of 0.94 for the patient survey and 0.94 for the parent survey. CONCLUSIONS: This new instrument demonstrated significant internal consistency and validity among US individuals with spina bifida and their caregivers. The use of validated, internally consistent survey questions is crucial to guide clinicians in counseling families and may help identify those at risk of financial toxicity. Early identification of at-risk families could allow for early case management/social work intervention; further work to prove this hypothesis is ongoing. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e83 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Diana A. Aponte-Colon More articles by this author Rafael D. Tua Caraccia More articles by this author Leonid Aksenov More articles by this author Kevin Hobbs More articles by this author Rohit Tejwani More articles by this author Rebecca Fairchild More articles by this author Dandan Chen More articles by this author Bryce Reeve More articles by this author John Wiener More articles by this author Jonathan Routh More articles by this author Expand All Advertisement PDF downloadLoading ...

Single-port hidden incision endoscopic (HIdES) pediatric nephrectomy via pfannenstiel incision

Journal of Pediatric Urology · 2023-01-20 · 4 citations

Combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity

BMC Medical Informatics and Decision Making · 2022-03-29 · 6 citations

BACKGROUND: Clinical decision support (CDS) tools built using adult data do not typically perform well for children. We explored how best to leverage adult data to improve the performance of such tools. This study assesses whether it is better to build CDS tools for children using data from children alone or to use combined data from both adults and children. METHODS: Retrospective cohort using data from 2017 to 2020. Participants include all individuals (adults and children) receiving an elective surgery at a large academic medical center that provides adult and pediatric services. We predicted need for mechanical ventilation or admission to the intensive care unit (ICU). Predictor variables included demographic, clinical, and service utilization factors known prior to surgery. We compared predictive models built using machine learning to regression-based methods that used a pediatric or combined adult-pediatric cohort. We compared model performance based on Area Under the Receiver Operator Characteristic. RESULTS: While we found that adults and children have different risk factors, machine learning methods are able to appropriately model the underlying heterogeneity of each population and produce equally accurate predictive models whether using data only from pediatric patients or combined data from both children and adults. Results from regression-based methods were improved by the use of pediatric-specific data. CONCLUSIONS: CDS tools for children can successfully use combined data from adults and children if the model accounts for underlying heterogeneity, as in machine learning models.

Financial toxicity among individuals with spina bifida and their families: A qualitative study and conceptual model

Journal of Pediatric Urology · 2022 · 21 citations

• Medicine
• Family medicine
• Pediatrics

PD02-07 FINANCIAL TOXICITY OF SPINA BIFIDA: INITIAL DEVELOPMENT OF A PATIENT-REPORTED OUTCOME MEASURE

The Journal of Urology · 2022-04-07

You have accessJournal of UrologyCME1 May 2022PD02-07 FINANCIAL TOXICITY OF SPINA BIFIDA: INITIAL DEVELOPMENT OF A PATIENT-REPORTED OUTCOME MEASURE Leonid Aksenov, Kevin Hobbs, Rebecca Fairchild, Rohit Tejwani, John Wiener, and Jonathan Routh Leonid AksenovLeonid Aksenov More articles by this author , Kevin HobbsKevin Hobbs More articles by this author , Rebecca FairchildRebecca Fairchild More articles by this author , Rohit TejwaniRohit Tejwani More articles by this author , John WienerJohn Wiener More articles by this author , and Jonathan RouthJonathan Routh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002517.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Financial toxicity, the material and emotional strain caused by financial distress from a medical condition and its treatment, has adverse effects on patient physical health, clinical outcomes, and overall well-being. This concept is widely studied in adult oncology, where the COmprehensive Score for financial Toxicity (COST) is an established patient-reported outcome measure (PROM) that assess financial toxicity in adults with cancer. Financial toxicity has not been assessed in congenital conditions, such as spina bifida (SB) – the most common permanently disabling birth defect in the United States. This is in part due to the absence of an instrument specific to this population. Thus, our aim was to develop a SB-specific financial toxicity PROM (SBFT-PROM) for individuals with SB and their caregivers. METHODS: We conducted semi-structured interviews with individuals affected by SB and/or their caregivers with the aim of identifying common themes related their financial distress. Interviews were transcribed and thematic analysis was performed to identify recurring themes. These insights were used to create a conceptual framework and guide the development of the SBFT-PROM. RESULTS: A total of 14 interviews were conducted. Average patient age was 17.9 years. Five dominant themes were identified: affect, direct costs, indirect costs, coping, and resources. These insights, along with prior studies of financial toxicity in oncology patients, were used to create a conceptual framework (figure). The themes identified were similar to themes identified during the development of the COST measure. Thus, we adapted the COST measure to create two versions of SBFT-PROM – one for individuals with SB and one for caregivers. CONCLUSIONS: We developed a conceptual framework of financial toxicity for individuals with SB and their caregivers. This framework and the previously established COST measure were leveraged and adapted specifically for SB, creating the SBFT-PROM. This work has allowed us to begin validation of SBFT-PROM in our clinic prior to employing it in a clinical or research setting. The ability to quantitatively measure financial distress from SB will enhance clinicians’ efforts to deliver patient-centered care and improve clinical outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e38 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leonid Aksenov More articles by this author Kevin Hobbs More articles by this author Rebecca Fairchild More articles by this author Rohit Tejwani More articles by this author John Wiener More articles by this author Jonathan Routh More articles by this author Expand All Advertisement PDF DownloadLoading ...

Correction to: Combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity

BMC Medical Informatics and Decision Making · 2022-05-12