URETEROSCOPIC LITHOTRIPSY: A DAY-SURGERY PROCEDURE

Size: px
Start display at page:

Download "URETEROSCOPIC LITHOTRIPSY: A DAY-SURGERY PROCEDURE"

Transcription

1 ISRA MEDICAL JOURNAL Volume Issue 2 Jun 2013 ORIGINAL ARTICLE URETEROSCOPIC LITHOTRIPSY: A DAY-SURGERY PROCEDURE Abdul Rasheed Shaikh, Mohamed Ali Sohail Memon, A Saboor Soomro, A. Hameed Bozdar ABSTRACT OBJECTIVE: To ascertain patient's safety and efficacy of ureterolithotripsy as a day-surgery procedure. STUDY DESIGN: An interventional study. PLACE AND DURATION: At Citi Medical Center Larkana, Ghulam Mohammed Mahar Medical College & Hospital Sukkur Peoples University of Medical & Health Sciences for Women Nawabshah between Dec: 2007 to Dec: METHODOLOGY: All the patients of either sex having ureteral stone less than 1. cm in diameter were selected on the basis of routine clinical examination, laboratory investigation like complete blood count and biochemistry, Ultra-sound and x-rays like intravenous urography (IVU) etc for ureteral lithotripsy. The Semi-rigid Ureteroscopic6.0 Fr with Swiss Lithoclast lithotripter was used. RESULTS: Our study comprises 320 selected patients. Male to female ratio was 1.6:1. Average age of patients was 30. year. The mean stone diameter was 1.2 cm. The stones were successfully disintegrated and completely pulverized in 9% (n=304) cases. In remaining %(n=16) cases, the procedure was deferred. Among them, ureteric catheter or JJ stent in 3% (n=9) and 2%(n=7) cases respectively had been left. Of them, former cases were due to failure of access to stone and ureteroscope did not negotiate at all and in later cases stone was presented in upper ureter and inadvertently floated up into the kidney (P< 0.0). The operative complications like simple mucosal injury occurred in 11%(n=3) and minor bleeding which did not cloud the field of vision occurred only in 13%(n=42) cases. The Mean operating time was 27(ranged from 22 to ) minutes. Postoperative complications like urinary tract infection (sepsis) with fever and persisting haematuria had occurs in.%(n=18) cases 9%(n=29) respectfully. The hospital stay was merely a day in all except 1% (n=47) cases who developed post-operative complications (P< 0.0). In 03 week follow-up, residual fragments were noted only in 6%(n=19) cases. These patients were managed conservatively except 2%(n=7) cases that underwent repeat ureteral catheterization for manipulation of fragments which were jammed together. remit CONCLUSION: Although, our study has documented high success rate and low morbidity with merely a day hospital stay but is dependent on many potentially modifiable and process-related factors KEY WORDS: Ureteral stone, Ureteroscope, Swiss Lithoclast INTRODUCTION With all the options of treatment, the method of choice should be minimal invasive and successful. The conservative Urolithiasis is known as the most common urological 1 method of treatment like expectant therapy with non-steroid ailment. A USA study reports that approximately 12% anti-inflammatory analgesic drugs and hydration or medicalperson of population will have stone disease at some point 2 expulsive therapy (MET) with an alpha 1-adrenoceptor in their lives. Primary stones have rarely formed in ureter. blocker (tamsulosin), has been used for facilitating They have formed in kidney and trapped during its spontaneous passage of smaller stones (04 to 08 mm passage through ureter where they produce more 3 diameter in size) has been recommended for certain group symptoms and complications. These, ureteral stones 6 of patients under restricted criteria. The open surgery account for 20% of urolithiasis, and 70% of them are (ureterolithotomy) or laparoscopic method of treatment are located in the lower third part of the ureter and are known 4 the popular options for very large impacted, and /or multiple as distal ureteral stones ureteral stones. These stones are difficult to manage with Various modalities of treatment for ureteral stone like 7 URS or ESWL alone. conservative, non-invasive extra-corporeal shock wave Among non-invasive and minimal invasive procedures like lithotripsy (ESWL), minimal invasive uretero-renoscopy ESWL and retrograde ureteroscopy (URS) with lithoclast are (URS), laparoscopic and surgical are being practiced. 7 the preferred methods. Undoubtedly, ESWL has become a most valuable asset to the urologist and greatly benefits patients who had renal stones. Its use for ureteral stone is 1 Professor GMC Sukkur 2 Associate Professor Nawab Shah 3 Assistant Professor GMC Sukkur 4 Senior Registrar GMC Sukkur Correspondence to: Dr. Abdul Saboor soomro Assistant Professor, GMC Sukkur soomrosaboor2007@yahoo.com 8-9 again limited. The endoscopic management for ureteral calculi with dormia basket is a rather challenging procedure but was popular in old days. From last 03 decades its use with or without fluoroscope had replaced with the advent of ureteroscope. Over the time, there have been many advances in ureteroscope design has taken place. These are modern up-dated small size caliber ureteroscope with better 130

2 10 optical visualization and have sufficient working channel ureteral orifice. Ureteroscopy has proceeded. Unless More over recently, another timely advance in progression difficulty was encountered in inserting the ureteroscope of endoscope with development of prototypes flexible through ureteral orifice then ureteral dilatation was ureteroscope has occurred. It lead to allow access to performed with balloon or ureteral catheter (-7 Fr) dilators. entire upper urinary tract and supposed to be a final Once ureteroscope was in the ureter, further it passed up to version which incorporated >3000 primary active stone carefully using a least amount of irrigation fluid ( deflection. Thus, today uretero-renoscopy continues to Glysine) consistent with good vision to prevent the float up of gain popularity with ever-increasing indication. Its use, the stone. For this purpose other precautions include intra- both for diagnostic as well as therapeutic purposes are venous frusamide infusion of 40mg with 00ml dextrose 6-10 well documented. Nowadays, worldwide trend has water and raising the operative table from cranial side was started to perform this procedure on an out-patient basis taken. The 0.8mm probe of Lithoclast was passed through and has been well suggested In our set-up, Majority of working channel of ureteroscope. The treatment procedure our patients comes either from rural or far-flung areas and was started and stone was pulverized under direct vision till they do not have access to advanced medical services. complete fragmentation has achieved. The fragments were T herefore, the objective of our study was to ascertain left in situ (smash & go).at the end of procedure, ureteral patient's safety and efficacy of ureterolithotripsy as a daycatheter was tied around the 18 or 16Fr Foley's catheter. catheter (4Fr) or JJ stent (4.7Fr) was left. The ureteral surgery procedure. These were removed after 18 hours where as JJ stent was METHODOLOGY kept for 06 week. The majority of patients were discharged on the following day after the procedure. All patients were This multicentral study was conducted at Citi Medical followed up routinely at weekly interval for 2-3 week. The Center Larkana, Ghulam Mohamed Mahar Medical KUB x-ray was advised to assess the outcome of the College & Hospital Sukkur and Peoples University of procedure. Medical & Health Sciences for Women Nawabshah The numerical data has analyzed, using a commercially between Dec: 2007 to Dec: All the patients, enrolled available SPSS version 11.. The analysis of variance from OPD of either sex having ureteral stone radiological (ANOVA) test, chi-square test or Fisher test when diameter less than 1. cm in size were selected prior to day appropriate was used to determine any statistical significant. of admission. Then, we evaluated and documented factors into 03 components: (1) Patient factors (e.g., RESULTS patient wellness); It based on complete history, clinical examination and investigation like urine analysis, Urine Our study comprises 320 selected patients. Among them culture, hemoglobin, complete blood count, bleeding 208(6%) were males and 112(3%) were female (Table - I). profile and Biochemistry like serum cretinine, Random Male to female ratio was 1.6:1. Their mean age was 30.year blood sugar, ultrasound, x-ray chest, ECG and (ranged from 16 to 8 years). The stone was presented in intravenous urography. The patients fulfilling our selection 19(61%) cases on right and 12(39%) cases on left side. requirement were admitted on the afternoon of the day of The further distribution of stone location at lower, Middle and procedure. Those patients, who were more than 40 year upper ureter was 183(7%), 102(32%) and 3(11%) age or found hypertensive, were further assessed by respectively (Figure - I). Mean stone diameter was 1.2 cm cardiologist and anesthetist. The patients, who were under Figure - 1: Distribution of stone location 12 years of age, having bleeding disorder or with major comorbidities included ischemic heart disease, un-controlled diabetic mellitus, chronic obstructive airway disease, obvious infection, pregnant women and those becomes unfit by cardiologist and anesthetist were postpone or excluded from the study. (2) Structural and process factors (e.g. Suitability in hospital bed and operating rooms schedule system); (3) evaluated the outcome and patient interviewed to confirmed the emotional and financial impact. The procedure was attempted under spinal or general anesthesia in modified lithotomic position. Preoperative broad spectrum Antibiotics coverage has given in all cases. A semi-rigid ureteroscope 6.0 Fr or 7.Fr (Karl Storz, Germany) and Swiss pneumonatic lithotripter (Lithoclast) were used. Preliminary check cystoscopy has done to assess the status of the lower urinary tract and (range 0.6 to1.6 cm). No significant difference was found in size between proximal and distal ureteral stones (P=NS). 131

3 ISRA MEDICAL JOURNAL Volume Issue 2 Jun As a contribution to the growing data for all size of Radiological Grade 1 and Grade-2 hydronephrosis and dilated ureter were presented only in 121(38%) and in stone with minimal stay at hospital, it is the need of time to 80(2%) cases respectively. In remaining 119(37%) evaluate surgical procedures at lesser stay and eventually it cases, the hydronephrosis and dilated ureter were not reflects on cost of patient and burden on hospital beds. presented. The ureteral dilatation with balloon ureteric In our series a total of 320 selected ureteroscopies were dilator or with ureteric catheter no: and 6 Fr was needed attempted. The stones were successfully pulverized in only in 9(18.%) cases versus 261(81.%) cases that did 304(9%) cases and in remaining 16(%) cases, the not require so. The stones were successfully disintegrated procedure was deferred. Of them, the failure of access to and completely fragmented in 304(9%) cases (Table - 2). stone had occurred in 09(3%) cases due to constricted lower Remaining 16(%) cases, the procedure was deferred. ureter and ureteroscope did not negotiate at all means. These cases were simply managed by inserting 04Fr ureteric catheter and were successfully treated by second attempt after 03-0 day. In remaining 07(2%) cases, stone was presented in upper ureter and after partial disintegration incidentally floated up into the kidney even we have applied all traditional measures i-e keeping the proximal part of patient body tilts with head up of operating table at 30 to 4 degree and using intravenous frusamide 40mg infusion. Therefore, only in these cases JJ stent had been left. More or less similar positive results were reported from many wellknown centers all around the globe (Table -II) and had been 4, 7, 14, 16-, documented in the international literature We did not come across with any major operative complications like profuse bleeding or ureteral perforation. It may be because of our up-to-date replacement of 06Fr semirigid ureteroscope and achievement of perfection in skill. There or thereabouts, this sort of favorable outcome was 4-9, Among them, ureteric catheter or JJ stent in 9(3%) and reported from many distinguished centers of the world 07(2%) cases respectively had been left. Of them, former 7 but is almost similar to Mugiya et al in 2006, who also did not cases were due to failure of access to stone and stumble upon any complication. Nonetheless, more recent 16 ureteroscope did not negotiate at all and in later cases studies published from our country by Adeel etal, 2011 and stone was presented in upper ureter and were easily Ikramullah etal, 2011, who were bump into with major floated up into the kidney (P< 0.0).The operative operative complications namely ureteral perforation and complications like simple mucosal injury occurred in ureteric wall avulsion in 2% and 1% of their cases 3(11%) and slight bleeding which did not cloud the field of respectively. The former complication may be justified on the vision occurred in 42(13%) cases. The Mean operating basis that both scholars were still using 9.Fr ureteroscope in time was 27(ranged from 22 to ) minutes. Postoperative the era where 6Fr one are easily available. However, for later complications like urinary tract infection (sepsis) with fever complication, we could not find any good reason because and mild persisting haematuria had occurred in 18(.%) this is the known complication of dormia basket therapy. Our cases 29(9%) respectfully. The hospital stay was merely a 16 study also disagree with methodology of former author that day in all (Pie - I) except 47(1%) cases who developed they have inserted JJ 6Fr stent all even in successful cases. post-operative complications. These patients stayed in Because this requires another endoscopic procedure for its hospital for 03 day (Pie - 1).Mean hospital stay was 1.28 removal, therefore, we routinely keep ureteral catheter which day. Statistically significant difference (P=NS) was not has tied with Foley's catheter. Moreover, it could be removed found in regard to hospital stay. In 02 week follow-up, effortlessly. In this context, we do agree with later author residual fragments were noted only in 19(6%) cases. who recommended JJ stent only in difficult and adverse These patients were managed conservatively except situation. We do also encountered with some anticipated 7(2%) cases that underwent repeat ureteral minor and insignificant operative complications like simple catheterization for manipulation of fragments which were mucosal injury and bleeding which did not cloud the field of jammed together. vision that had occurred only in 3(11%) and 42(13%) cases respectively. These were not creating any difficulty to go DISCUSSION through the procedure. The factor responsible was, unexpected striking of lithoclast probe with mucosa of ureter. The advent of new urological armamentarium has made These minor operative complications in present series are ureteroscopy (URS) a safe, efficacious and more popular 4-9, comparable and nearer to other studies. In this context, 6-10 procedure and its application has followed very fast. In 1 Knispel et al has recommended that the constant direct this context, we also presented our early experience in 132

4 effect on patient emotional satisfaction, as well as on perception of quality of care. Moreover, it confirms the financial impact. More recently, worldwide current trend is to perform the procedure on an out-patient basis has in progressed. Many studies justify its feasibility on the basis that the same day planned and unplanned re-admission rate was reported only as low as in 1.% and 3.6% cases respectively These authors concluded that successfully out-patient ureterolithotripsy may be performed only at well established medical institution having backup with developed infrastructure. The complications may be minimized by using flexible ureteroscope and Holmium Laser lithotripter. In our set-up, Majority of our patients comes either from rural or farflung areas and they do not have access to nearby advanced medical services. Hence, we do not perform this procedure on out-patient basis. We also have a belief that, this practice may only be suitable for local resident because of unappropriate infrastructure in our country which supposed to be the key for a successful out-patient service. Although, we recommend it as a primary first-line treatment modality for ureteral calculi but requires fully established equipped medical care centre with experts and trained staff for such a short stay surgery. CONCLUSION Although, our study has documented high success and low complication rates with merely a day indoor stay but is consistent with many potentially modifiable and process- related factors. It has not only positive effect on patient satisfaction but also reflects the cost-effectiveness vision must be maintained and no energy is applied until and unless there is contact between stone and probe to avoid the mucosal injury and bleeding during the procedure. The post operative recovery was uneventful in majority of our 273(8%) cases except 47(1%) cases who developed febrile urinary tract infection or persisting but self-remitting haematuria. These were resolved within 72 hours of conservative treatment. The hospital stay was merely a day in all except who developed sepsis and haematuria. The mean hospital stay was 03 day in these patients. In this context, our study contradicts with Ikramullah et al 2011, who reported 06 day mean hospital stay in their cases that developed complications. It may be reasonable on the basis that their patient went through major operative complications. This study dominated our former study presented in 2007 (Rasheed et al ) consisting with our early experience of ureteroscopy. In that series, we had achieved an 88% success rate with major operative complications. It was due to our initial learning phase and using rather larger diameter 7.Fr (Karl Storz, Germany) and 8. (Wolf, Germany) ureteroscope. Then, we replaced it with new up-to-date 6.0 Fr (Karl Storz, Germany) one. Furthermore improvement in our judgment and surgical skill led to even better results with insignificant operative complications. This has given us courage to deal our cases on day care basis. The initial results are not only very much encouraging and authenticate but also prove the positive REFERENCES 1. Ramello A, Vitale C, Marangella M. Epidemiology of nephrolithiasis. J Nephrol 2000;13: Rasheed SA, Nisar SA and Saiyal AR. Extra-corporeal Shock Wave Lithotripsy; Early Experience with Chinese Lithotriptor at Larkana. The Prof: 47 Medical J: 08 (01) 2001; Naqvi SA. Khalique M, Zafar MN and Rizvi SAH. Treatment of ureteric stones. Comparison of laser and pneumatic lithotripsy. BJU , Meng-yuan Z, Sen-tai D, jia-ju L, Yan-he L, Hui Z and Qing-hua X. Comparison of tamsulosin with extracorporeal shock wave lithotripsy in treating distal ureteral stones. Chin Med J 2009;122 (7): Rasheed SA, Qurban A, Fatah A, Iqbal M, Nisar A and Altaf H. Uretero lithotripsy with semi-rigid ureteroscope: An early experience with 100 cases. JSP (int:) 2007;12 (3) Bierkens AF, Handrikx AJ, De La, Rossete JJ, Stultiens GN, Beerlage GN, et al. Treatment of mid and lower ureteric calculi: Extracorporeal Shockwave Lithotripsy vs laser ureteroscopy. A comparison of cost, morbidity 133

5 ISRA MEDICAL JOURNAL Volume Issue 2 Jun 2013 and effectiveness. Br J Urol. 1998;81:31-. of mini ureteroscope: results in 143 patients. J Urol, 7. Mugiya S, Ozono S, Nagata M, Takayama T, Nagai H. 1996; 12(6): 13-. Retrograde endoscopic management of ureteral 16. Adeel A khan, Syed AH, Khan N, Syed Majeed MK and stones more than 2cm in size. Urology. 2006; 67: Sulaiman M. Safety and efficacy of ureteroscopic lithotripsy. JCPSP 2011, 21(10) Denstedt JD, Eberwein PM, Singh RR. The Swiss. Ikramullah, Wazir BG, Alam K, Islam M, Shah F and Lithoclast: a new device for intracorporeal lithotripsy. J Khan SA. Evaluation of safety and efficacy of Urol. 1992;148; ureteroscopic lithotripsy in management of ureteral 9. Turk TM, Jenkins AD. A comparison of ureteroscopy to calculi. Ann. Pak. Inst. Med. Sci Vol. 7(3) in situ extracorporeal shock wave lithotripsy for the 18. Ali A, Saleem M, Jamil M and Tabassum SA. Our treatment of distal ureteral calculi. J Urol 1999; experience with 100 cases of ureteric stones. The 161:4-6. Professional. 2000; 7(3) Luis Osorio, Estevao Lima, Jose Soares and et al. 19. Ather MH, Paryani J, Memon A and Suleman MN. A 10 Emergency ureteroscopic Management of ureteral years experience of managing ureteric calculi. Changing stones: Why not? Urology. 2007; 69: trends towards endourological intervention- Is there a 11. Wills TE, Burns JR. Ureteroscopy: an outpatient procedure? J Urol1994;11: Cheung MC, Lee F, Leung YL, Wong BB, Chu SM, Tam PC. Outpatient Ureteroscopy: predictive factors for postoperative events. Urology 2001;8: role for open surgery. Br J Urol Int: 2001; 88, AL-Busaidy S S, Prem A R, Medhat M and Bulushi AL Y H K. Ureteric calculi in children; Preliminary experience with holmium: YAG Laser lithotripsy. BJU (int:) 2004; 93(9) Fasihuddin Q, Hasan AT. Ureteroscopy (URS): an 21. Ghalayini IF, AL-Ghazo MA, Khader YS. Extracorporeal effective interventional and diagnostic modality. J Pak Shockwave lithotripsy versus ureteroscopy for distal Med Assoc. 2002; 2: ureter calculi: efficacy and patient satisfaction. Int Braz J 14. Park H, Park M, Park T. Two years experience with Urol ; 32(6): ureteral stones: extracorporial shock wave lithotripsy 22. Subhani GM, Javed SH, Iqbal Z and etal. Outcome of v ureterorenoscopic manipulation. J Endourol. 1998; Retrograde ureteroscopy for the Management of 13: Ureteric Calculi: Four Years Experience. A.P.M.C. 2009; 1. Knispel HH, Klan R, Heicappell R, Miller K. Pneumatic 3(1) lithotripsy applied through deflected working channel 134

URETEROSCOPY (AND TREATMENT OF KIDNEY STONES)

URETEROSCOPY (AND TREATMENT OF KIDNEY STONES) URETEROSCOPY (AND TREATMENT OF KIDNEY STONES) AN INFORMATION LEAFLET Written by: Department of Urology May 2011 Stockport: 0161 419 5698 Website: w w w. s t o c k p o r t. n h s. u k Tameside: 0161 922

More information

surg urin Surgery: Urinary System 1

surg urin Surgery: Urinary System 1 Surgery: Urinary System 1 This section contains information to assist providers in billing for surgical procedures related to the urinary system. Extracorporeal Shock Wave Lithotripsy Medi-Cal covers Extracorporeal

More information

Ureteroscopy with Laser Lithotripsy

Ureteroscopy with Laser Lithotripsy Ureteroscopy with Laser Lithotripsy Introduction Kidney stones are fairly common. Although kidney stones can be very painful, they are treatable, and in many cases preventable. Your doctor may recommend

More information

Medical Malpractice in Endourology: Analysis of Closed Cases From the State of New York

Medical Malpractice in Endourology: Analysis of Closed Cases From the State of New York Medical Malpractice in Endourology: Analysis of Closed Cases From the State of New York Brian Duty,* Zhamshid Okhunov, Zeph Okeke and Arthur Smith From the Department of Urology, North Shore-Long Island

More information

Effectiveness of Day-case Surgery in Urology: Single Surgeon Experience

Effectiveness of Day-case Surgery in Urology: Single Surgeon Experience Bahrain Medical Bulletin 29, No. 3, September 2007 Effectiveness of Day-case Surgery in Urology: Single Surgeon Experience Mohamed H. Durazi, FRCS ED, FRCSI* Reem Al-Bareeq, MRCSI, CAB(Urol)** Mohamed

More information

Urolithiasis/Endourology

Urolithiasis/Endourology Urolithiasis/Endourology Use of Ureteral Stent in Extracorporeal Shock Wave Lithotripsy for Upper Urinary Calculi: A Systematic Review and Meta-Analysis Shen Pengfei, Jiang Min, Yang Jie, Li Xiong, Li

More information

Kidney Stones removal Without surgery

Kidney Stones removal Without surgery Patient Education Service Lithotripsy - The world s latest treatment for Kidney Stones removal Without surgery With COMPUTERISED high tech DIREX LITHOTRIPTER Experience counts PIONEERS in North INDIA -

More information

X-Plain Kidney Stones Reference Summary

X-Plain Kidney Stones Reference Summary X-Plain Kidney Stones Reference Summary Introduction Kidney stones are fairly common. Although they can be very painful, they are treatable, and in many cases preventable. This reference summary will help

More information

The University of Hong Kong Department of Surgery Division of Esophageal and Upper Gastrointestinal Surgery

The University of Hong Kong Department of Surgery Division of Esophageal and Upper Gastrointestinal Surgery Program Overview The University of Hong Kong Department of Surgery Division of Esophageal and Upper Gastrointestinal Surgery Weight Control and Metabolic Surgery Program The Weight Control and Metabolic

More information

Kidney Stones. This reference summary will help you understand kidney stones and how to treat and prevent them. Kidney

Kidney Stones. This reference summary will help you understand kidney stones and how to treat and prevent them. Kidney Introduction A kidney stone is a solid piece of material that forms in the kidney from substances in the urine. Kidney stones are fairly common. Although kidney stones can be painful, they are treatable.

More information

Open the Flood Gates Urinary Obstruction and Kidney Stones. Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke

Open the Flood Gates Urinary Obstruction and Kidney Stones. Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke Open the Flood Gates Urinary Obstruction and Kidney Stones Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke Nephrology vs. Urology Nephrologist a physician who has been trained in the diagnosis

More information

University College Hospital at Westmoreland Street. Lithotripsy. Urology Directorate

University College Hospital at Westmoreland Street. Lithotripsy. Urology Directorate University College Hospital at Westmoreland Street Lithotripsy Urology Directorate 2 3 If you require a large print, audio or translated version of this leaflet, please contact us on 020 3447 9179. We

More information

ECG may be indicated for patients with cardiovascular risk factors

ECG may be indicated for patients with cardiovascular risk factors eappendix A. Summary for Preoperative ECG American College of Cardiology/ American Heart Association, 2007 A1 2002 A2 European Society of Cardiology and European Society of Anaesthesiology, 2009 A3 Improvement,

More information

Prevention and Recognition of Obstetric Fistula Training Package. Module 8: Pre-repair Care and Referral for Women with Obstetric Fistula

Prevention and Recognition of Obstetric Fistula Training Package. Module 8: Pre-repair Care and Referral for Women with Obstetric Fistula Prevention and Recognition of Obstetric Fistula Training Package Module 8: Pre-repair Care and Referral for Women with Obstetric Fistula Early detection and treatment If a woman has recently survived a

More information

NEPHROLITHIASIS Diagnosis & Treatment

NEPHROLITHIASIS Diagnosis & Treatment Learning Objectives NEPHROLITHIASIS Diagnosis & Treatment Jai Radhakrishnan, MD, MS Professor of Clinical Medicine Columbia University Management of the first episode of renal colic: Optimal Imaging Treatment

More information

Ch. 138 CARDIAC CATHETERIZATION SERVICES 28 138.1 CHAPTER 138. CARDIAC CATHETERIZATION SERVICES GENERAL PROVISIONS

Ch. 138 CARDIAC CATHETERIZATION SERVICES 28 138.1 CHAPTER 138. CARDIAC CATHETERIZATION SERVICES GENERAL PROVISIONS Ch. 138 CARDIAC CATHETERIZATION SERVICES 28 138.1 CHAPTER 138. CARDIAC CATHETERIZATION SERVICES Sec. 138.1 Principle. 138.2. Definitions. GENERAL PROVISIONS PROGRAM, SERVICE, PERSONNEL AND AGREEMENT REQUIREMENTS

More information

Transurethral Resection of Bladder Tumour (T.U.R.B.T)

Transurethral Resection of Bladder Tumour (T.U.R.B.T) Transurethral Resection of Bladder Tumour (T.U.R.B.T) Patient Information Introduction This booklet has been written to help you understand the surgery you are about to undergo. It will give you information

More information

Retrograde Intrarenal Surgery (RIRS) - Ureterorenoscopic Lithotripsy for Renal Stones

Retrograde Intrarenal Surgery (RIRS) - Ureterorenoscopic Lithotripsy for Renal Stones Retrograde Intrarenal Surgery (RIRS) - Ureterorenoscopic Lithotripsy for Renal Stones Dr. Wing-hang AU MBBS(HK), FRCS(Edin), FCSHK, FRCSEd(Urol), FHKAM(Surgery) Associate Consultant Urologist Division

More information

GENTLY DOES IT. Stonemanagement

GENTLY DOES IT. Stonemanagement GENTLY DOES IT Kidney and ureteral stone retrieval by Sur-catch NT Basket from Olympus Stonemanagement content Content... 2 Introduction... 3 The Disease... 4-5 Causes... 5 Prevention... 6 Symptoms...

More information

Ureteral Stenting and Nephrostomy

Ureteral Stenting and Nephrostomy Scan for mobile link. Ureteral Stenting and Nephrostomy Ureteral stenting and nephrostomy help restore urine flow through blocked ureters and return the kidney to normal function. Ureters are long, narrow

More information

Long-term result of Memokath urethral sphincter stent in. spinal cord injury patients

Long-term result of Memokath urethral sphincter stent in. spinal cord injury patients 1 Long-term result of Memokath urethral sphincter stent in spinal cord injury patients Subramanian Vaidyanathan 1 E-mail: vaidyanathansiu@hotmail.com Bakul M Soni 1 E-mail: Bakul.Soni@mail.soh-tr.nwest.nhs.uk

More information

PROCEDURE- SPECIFIC INFORMATION FOR PATIENTS

PROCEDURE- SPECIFIC INFORMATION FOR PATIENTS The British Association of Urological Surgeons 35-43 Lincoln s Inn Fields London WC2A 3PE Phone: Fax: Website: E- mail: +44 (0)20 7869 6950 +44 (0)20 7404 5048 www.baus.org.uk admin@baus.org.uk PROCEDURE-

More information

Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop

Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop Urinary Diversion: Ileovesicostomy/Ileal Loop/Colon Loop Why do I need this surgery? A urinary diversion is a surgical procedure that is performed to allow urine to safely pass from the kidneys into a

More information

PROCEDURE- SPECIFIC INFORMATION FOR PATIENTS

PROCEDURE- SPECIFIC INFORMATION FOR PATIENTS The British Association of Urological Surgeons 35-43 Lincoln s Inn Fields London WC2A 3PE Phone: Fax: Website: E- mail: +44 (0)20 7869 6950 +44 (0)20 7404 5048 www.baus.org.uk admin@baus.org.uk PROCEDURE-

More information

Urinary Tract Infection in Stone Patients and in Patients with Indwelling Urethral Catheters

Urinary Tract Infection in Stone Patients and in Patients with Indwelling Urethral Catheters Urinary Tract Infection in Stone Patients and in Patients with Indwelling Urethral Catheters Pages with reference to book, From 254 To 258 Farakh A. Khan, Salman H. Siddiqui, Nasreen Akhtar ( Department

More information

YALE UNIVERSITY SCHOOL OF MEDICINE: SECTION OF OTOLARYNGOLOGY PATIENT INFORMATION FUNCTIONAL ENDOSCOPIC SINUS SURGERY

YALE UNIVERSITY SCHOOL OF MEDICINE: SECTION OF OTOLARYNGOLOGY PATIENT INFORMATION FUNCTIONAL ENDOSCOPIC SINUS SURGERY YALE UNIVERSITY SCHOOL OF MEDICINE: SECTION OF OTOLARYNGOLOGY PATIENT INFORMATION FUNCTIONAL ENDOSCOPIC SINUS SURGERY What is functional endoscopic sinus surgery (FESS)? Functional endoscopic sinus surgery

More information

POAC CLINICAL GUIDELINE

POAC CLINICAL GUIDELINE POAC CLINICAL GUIDELINE Acute Pylonephritis DIAGNOSIS COMPLICATED PYELONEPHRITIS EXCLUSION CRITERIA: Male Known or suspected renal impairment (egfr < 60) Abnormality of renal tract Known or suspected renal

More information

Peripherally Inserted Central Catheter (PICC) for Outpatient

Peripherally Inserted Central Catheter (PICC) for Outpatient Peripherally Inserted Central Catheter (PICC) for Outpatient Introduction A Peripherally Inserted Central Catheter, or PICC line, is a thin, long, soft plastic tube inserted into a vein of the arm. It

More information

150640_Brochure_B 4/12/07 2:58 PM Page 2. Patient Information. Freedom From an Enlarged Prostate

150640_Brochure_B 4/12/07 2:58 PM Page 2. Patient Information. Freedom From an Enlarged Prostate 150640_Brochure_B 4/12/07 2:58 PM Page 2 Patient Information Freedom From an Enlarged Prostate 150640_Brochure_B 4/12/07 2:58 PM Page 3 GreenLight Laser Therapy 1 150640_Brochure_B 4/12/07 2:58 PM Page

More information

Laparoscopic Nephrectomy

Laparoscopic Nephrectomy Laparoscopic Nephrectomy Information for Patients This leaflet explains: What is a Nephrectomy?... 2 Why do I need a nephrectomy?... 3 What are the risks and side effects of laparoscopic nephrectomy?...

More information

VARIO ULTRASOUND HANDPIECE

VARIO ULTRASOUND HANDPIECE VARIO ULTRASOUND HANDPIECE SWISS LithoClast MASTER State of the art State of the art ORIGINAL Swiss Lithoclast MASTER Combined ultrasound and pneumatic lithotripsy taken to its best by the inventor of

More information

Percutaneous Abscess Drainage

Percutaneous Abscess Drainage Scan for mobile link. Percutaneous Abscess Drainage An abscess is an infected fluid collection within the body. Percutaneous abscess drainage uses imaging guidance to place a thin needle through the skin

More information

PREVENTION OF CATHETER ASSOCIATED URINARY TRACT INFECTIONS. (CAUTIs)

PREVENTION OF CATHETER ASSOCIATED URINARY TRACT INFECTIONS. (CAUTIs) PREVENTION OF CATHETER ASSOCIATED URINARY TRACT INFECTIONS (CAUTIs) CAUTIs A UTI where an indwelling urinary catheter was in place for >2 calendar days on the date of event. OR If an indwelling urinary

More information

HELPFUL STEP-BY-STEP ILLUSTRATIONS ARE LOCATED IN THIS BOOKLET

HELPFUL STEP-BY-STEP ILLUSTRATIONS ARE LOCATED IN THIS BOOKLET HELPFUL STEP-BY-STEP ILLUSTRATIONS ARE LOCATED IN THIS BOOKLET DESCRIPTION The Vet Sent Ureter comes as a sterile stent system comprised of two components: 1) the radioopaque, double pigtail multi-fenestrated

More information

MANAGEMENT OF PROSTATE ENLARGEMENT/BPH

MANAGEMENT OF PROSTATE ENLARGEMENT/BPH MANAGEMENT OF PROSTATE ENLARGEMENT/BPH J E S S I C A E. P A O N E S S A, M. D. A S S I S T A N T P R O F E S S O R D E P A R T M E N T O F U R O L O G Y S U N Y U P S T A T E M E D I C A L U N I V E R

More information

Perioperative Cardiac Evaluation

Perioperative Cardiac Evaluation Perioperative Cardiac Evaluation Caroline McKillop Advisor: Dr. Tam Psenka 10-3-2007 Importance of Cardiac Guidelines -Used multiple times every day -Patient Safety -Part of Surgical Care Improvement Project

More information

Normal bladder function requires a coordinated effort between the brain, spinal cord, and the bladder.

Normal bladder function requires a coordinated effort between the brain, spinal cord, and the bladder. .. Urinary Incontinence Urinary incontinence is not an inevitable part of aging, and it is not a disease. The loss of bladder control - called urinary incontinence - affects between 13 and 17 million adult

More information

Coding Education Newsletter

Coding Education Newsletter Coding Education Newsletter Issue 7, October 2013 Inside this issue Coding queries & audit discussion cases ACCD 3M Codefinder tip Coding tip lithotripsy of urinary tract Back to basics dagger and asterisk

More information

What is Balloon Sinuplasty?

What is Balloon Sinuplasty? What is Balloon Sinuplasty? The painful symptoms associated with chronic sinusitis can be overwhelming. If symptoms are difficult to control with medications alone, your primary doctor may refer you to

More information

PATIENT CARE MANUAL PROCEDURE

PATIENT CARE MANUAL PROCEDURE PATIENT CARE MANUAL PROCEDURE NUMBER VII-E-5 PAGE 1 OF 7 APPROVED BY: CATEGORY: Tri-site Nursing Policy and Procedures Review Committee Body Systems; Genitourinary 1.0 GOALS To influence patient care providers

More information

SUPRAPUBIC CATHETER INSERTION INFORMATION FOR PATIENTS

SUPRAPUBIC CATHETER INSERTION INFORMATION FOR PATIENTS The British Association of Urological Surgeons 35-43 Lincoln s Inn Fields London WC2A 3PE Phone: Fax: Website: E-mail: +44 (0)20 7869 6950 +44 (0)20 7404 5048 www.baus.org.uk admin@baus.org.uk INFORMATION

More information

Perioperative Management of Patients with Obstructive Sleep Apnea. Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine

Perioperative Management of Patients with Obstructive Sleep Apnea. Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine Perioperative Management of Patients with Obstructive Sleep Apnea Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine Disclosures. This activity is supported by an education grant from Trivalley

More information

KIDNEY FUNCTION RELATION TO SIZE OF THE TUMOR IN RENAL CELL CANCINOMA

KIDNEY FUNCTION RELATION TO SIZE OF THE TUMOR IN RENAL CELL CANCINOMA KIDNEY FUNCTION RELATION TO SIZE OF THE TUMOR IN RENAL CELL CANCINOMA O.E. Stakhvoskyi, E.O. Stakhovsky, Y.V. Vitruk, O.A. Voylenko, P.S. Vukalovich, V.A. Kotov, O.M. Gavriluk National Canсer Institute,

More information

Study Design Of Medical Research

Study Design Of Medical Research Study Design Of Medical Research By Ahmed A.Shokeir, MD,PHD, FEBU Prof. Urology, Urology & Nephrology Center, Mansoura, Egypt Study Designs In Medical Research Topics Classification Case series studies

More information

Refer to Coaptite Injectable Implant Instructions for Use provided with product for complete instructions for use.

Refer to Coaptite Injectable Implant Instructions for Use provided with product for complete instructions for use. Questions for my Doctor Refer to Coaptite Injectable Implant Instructions for Use provided with product for complete instructions for use. INDICATIONS: Coaptite Injectable Implant is indicated for soft

More information

Renal Cysts What should I do now?

Renal Cysts What should I do now? Renal Cysts What should I do now? Dr Edmund Chiong Asst. Professor & Consultant Department of Urology National University Hospital What are renal cysts? Fluid-filled structures in the kidney that are not

More information

Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI)

Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) The American Society for Gastrointestinal Endoscopy PIVI on Endoscopic Bariatric Procedures (short form) Please see related White

More information

Lectures Hands On Simula on Roundtable Discussions Panel Discussion August 14, 2015

Lectures Hands On Simula on Roundtable Discussions Panel Discussion August 14, 2015 presents Kidney Stones: Medical, Surgical and Dietary Approaches Lectures Hands On Simula on Roundtable Discussions Panel Discussion August 14, 2015 This ac vity has been approved for AMA PRA Category

More information

Abnormal Uterine Bleeding FAQ Sheet

Abnormal Uterine Bleeding FAQ Sheet Abnormal Uterine Bleeding FAQ Sheet What is abnormal uterine bleeding? Under normal circumstances, a woman's uterus sheds a limited amount of blood during each menstrual period. Bleeding that occurs between

More information

Laparoscopic Gallbladder Removal (Cholecystectomy) Patient Information from SAGES

Laparoscopic Gallbladder Removal (Cholecystectomy) Patient Information from SAGES Laparoscopic Gallbladder Removal (Cholecystectomy) Patient Information from SAGES Gallbladder removal is one of the most commonly performed surgical procedures. Gallbladder removal surgery is usually performed

More information

Trans Urethral Resection of the Prostate (TURP) Trans Urethral Incision of the Prostate (TUIP) Department of Urology

Trans Urethral Resection of the Prostate (TURP) Trans Urethral Incision of the Prostate (TUIP) Department of Urology Trans Urethral Resection of the Prostate (TURP) Trans Urethral Incision of the Prostate (TUIP) Department of Urology Where is the Prostate Gland? The prostate gland sits below the bladder which lies behind

More information

INFORMED CONSENT FOR SLEEVE GASTRECTOMY

INFORMED CONSENT FOR SLEEVE GASTRECTOMY INFORMED CONSENT FOR SLEEVE GASTRECTOMY This informed-consent document has been prepared to help inform you about your Sleeve Gastrectomy including the risks and benefits, as well as alternative treatments.

More information

Heart Center Packages

Heart Center Packages Heart Center Packages For more information and appointments, Please contact The Heart Center of Excellence at the American Hospital Dubai Tel: +971-4-377-6571 Email: heartcenter@ahdubai.com www.ahdubai.com

More information

Trauma/Reconstruction/Diversion. Assessing the Impact of Ureteral Stent Design on Patient Comfort

Trauma/Reconstruction/Diversion. Assessing the Impact of Ureteral Stent Design on Patient Comfort Trauma/Reconstruction/Diversion Assessing the Impact of Ureteral Stent Design on Patient Comfort James E. Lingeman,*, Glenn M. Preminger, Evan R. Goldfischer and Amy E. Krambeck (The Comfort Study Team)

More information

By Anne C. Travis, M.D., M.Sc. and John R. Saltzman, M.D., FACG Brigham and Women's Hospital Harvard Medical School Boston, MA

By Anne C. Travis, M.D., M.Sc. and John R. Saltzman, M.D., FACG Brigham and Women's Hospital Harvard Medical School Boston, MA SMALL BOWEL BLEEDING: CAUSES, DIAGNOSIS AND TREATMENT By Anne C. Travis, M.D., M.Sc. and John R. Saltzman, M.D., FACG Brigham and Women's Hospital Harvard Medical School Boston, MA 1. What is the small

More information

Evaluation and Follow-up of Fetal Hydronephrosis

Evaluation and Follow-up of Fetal Hydronephrosis Evaluation and Follow-up of Fetal Hydronephrosis Deborah M. Feldman, MD, Marvalyn DeCambre, MD, Erin Kong, Adam Borgida, MD, Mujgan Jamil, MBBS, Patrick McKenna, MD, James F. X. Egan, MD Objective. To

More information

Nursing college, Second stage Microbiology Dr.Nada Khazal K. Hendi L14: Hospital acquired infection, nosocomial infection

Nursing college, Second stage Microbiology Dr.Nada Khazal K. Hendi L14: Hospital acquired infection, nosocomial infection L14: Hospital acquired infection, nosocomial infection Definition A hospital acquired infection, also called a nosocomial infection, is an infection that first appears between 48 hours and four days after

More information

SECTION 5 HOSPITAL SERVICES. Free-Standing Ambulatory Surgical Center

SECTION 5 HOSPITAL SERVICES. Free-Standing Ambulatory Surgical Center SECTION 5 HOSPITAL SERVICES Table of Contents 1 GENERAL POLICY... 2 1-1 Clients Enrolled in a Managed Care Plan... 3 1-2 Clients NOT Enrolled in a Managed Care Plan (Fee-for-Service Clients)..................

More information

Initial results of treatment with Linear Shockwave Therapy (LSWT) by Renova in patients with Erectile Dysfunction A pilot clinical study

Initial results of treatment with Linear Shockwave Therapy (LSWT) by Renova in patients with Erectile Dysfunction A pilot clinical study Initial results of treatment with Linear Shockwave Therapy (LSWT) by Renova in patients with Erectile Dysfunction A pilot clinical study Investigators Dr. Ahmed Hind, MD Consultant to Pr.Catanzaro Milano

More information

Preoperative Laboratory and Diagnostic Studies

Preoperative Laboratory and Diagnostic Studies Preoperative Laboratory and Diagnostic Studies Preoperative Labratorey and Diagnostic Studies The concept of standardized testing in all presurgical patients regardless of age or medical condition is no

More information

CLINICAL PRIVILEGES- NURSE ANESTHETIST

CLINICAL PRIVILEGES- NURSE ANESTHETIST Name: Page 1 Initial Appointment Reappointment All new applicants must meet the following requirements as approved by the governing body effective: 8/5/2015. Applicant: Check off the Requested box for

More information

Correct Coding to Maximize Reimbursements: Common Urological Coding and Billing Errors. Michael A. Ferragamo, MD, FACS

Correct Coding to Maximize Reimbursements: Common Urological Coding and Billing Errors. Michael A. Ferragamo, MD, FACS Correct Coding to Maximize Reimbursements: Common Urological Coding and Billing Errors Michael A. Ferragamo, MD, FACS Coding and Reimbursement Consultant; Assistant Clinical Professor of Urology, University

More information

Laparoscopic Colectomy. What do I need to know about my laparoscopic colorectal surgery?

Laparoscopic Colectomy. What do I need to know about my laparoscopic colorectal surgery? Laparoscopic Colectomy What do I need to know about my laparoscopic colorectal surgery? Traditionally, colon & rectal surgery requires a large, abdominal and/or pelvic incision, which often requires a

More information

Femoral artery bypass graft (Including femoral crossover graft)

Femoral artery bypass graft (Including femoral crossover graft) Femoral artery bypass graft (Including femoral crossover graft) Why do I need the operation? You have a blockage or narrowing of the arteries supplying blood to your leg. This reduces the blood flow to

More information

Treatment for bladder tumours - transurethral resection of a bladder tumour (TURBT)

Treatment for bladder tumours - transurethral resection of a bladder tumour (TURBT) Treatment for bladder tumours - transurethral resection of a bladder tumour (TURBT) You have had a cystoscopy or other examination that has shown that you have an abnormal area (tumour) in your bladder.

More information

Treatment Strategies of Ureteral Stones

Treatment Strategies of Ureteral Stones eau-ebu update series 4 (2006) 184 190 available at www.sciencedirect.com journal homepage: www.europeanurology.com Treatment Strategies of Ureteral Stones Stefanos Papadoukakis a, Jens-Uwe Stolzenburg

More information

PATIENT CONSENT TO PROCEDURE - ROUX-EN-Y GASTRIC BYPASS

PATIENT CONSENT TO PROCEDURE - ROUX-EN-Y GASTRIC BYPASS As a patient you must be adequately informed about your condition and the recommended surgical procedure. Please read this document carefully and ask about anything you do not understand. Please initial

More information

Considering a Hysterectomy?

Considering a Hysterectomy? Considering a Hysterectomy? Learn more about virtually scarless surgery using da Vinci Single-Site technology { {Symptoms & Conditions: Chronic Pain, Heavy Bleeding, Fibroids, Endometriosis, Adenomyosis,

More information

Oxford Eye Hospital. Vitrectomy. Information for patients

Oxford Eye Hospital. Vitrectomy. Information for patients Oxford Eye Hospital Vitrectomy Information for patients What is a Vitrectomy The vitreous humour is normally a clear, transparent jelly-like substance inside the eye. It lies behind the iris (the coloured

More information

THE BENEFITS OF LIVING DONOR KIDNEY TRANSPLANTATION. feel better knowing

THE BENEFITS OF LIVING DONOR KIDNEY TRANSPLANTATION. feel better knowing THE BENEFITS OF LIVING DONOR KIDNEY TRANSPLANTATION feel better knowing your choice will help create more memories. Methods of Kidney Donation Kidneys for transplantation are made available through deceased

More information

Learning Resource Guide. Understanding Incontinence. 2000 Prism Innovations, Inc. All Rights Reserved

Learning Resource Guide. Understanding Incontinence. 2000 Prism Innovations, Inc. All Rights Reserved Learning Resource Guide Understanding Incontinence 2000 Prism Innovations, Inc. All Rights Reserved ElderCare Online s Learning Resource Guide Understanding Incontinence Table of Contents Introduction

More information

Blood in the urine (hematuria)

Blood in the urine (hematuria) Blood in the urine (hematuria) Hematuria refers to the presence of blood in the urine. It is important to investigate the cause of hematuria because rarely, it is caused by a serious condition, such as

More information

CARE PROCESS STEP EXPECTATIONS RATIONALE

CARE PROCESS STEP EXPECTATIONS RATIONALE URINARY INCONTINENCE CARE PROCESS STEP EXPECTATIONS RATIONALE ASSESSMENT/PROBLEM RECOGNITION 1. Did the staff and physician seek and document risk factors for urinary incontinence and any history of urinary

More information

Preparing for your laparoscopic pyeloplasty

Preparing for your laparoscopic pyeloplasty Preparing for your laparoscopic pyeloplasty Welcome We look forward to welcoming you to The Royal London Hospital. You have been referred to us for a laparoscopic pyeloplasty, which is an operation using

More information

What You Should Know About Cerebral Aneurysms

What You Should Know About Cerebral Aneurysms What You Should Know About Cerebral Aneurysms From the Cerebrovascular Imaging and Interventions Committee of the American Heart Association Cardiovascular Radiology Council Randall T. Higashida, M.D.,

More information

Laparoscopic Adrenal Gland Removal (Adrenalectomy) Patient Information from SAGES

Laparoscopic Adrenal Gland Removal (Adrenalectomy) Patient Information from SAGES Laparoscopic Adrenal Gland Removal (Adrenalectomy) Patient Information from SAGES What are the Adrenal Glands? The adrenal glands are two small organs, one located above each kidney. They are triangular

More information

Case Based Urology Learning Program

Case Based Urology Learning Program Case Based Urology Learning Program Resident s Corner: UROLOGY Case Number 21 CBULP 2011 068 Case Based Urology Learning Program Editor: Associate Editors: Manager: Case Contributors: Steven C. Campbell,

More information

Appendix. Costing Case Samples for OOHCA

Appendix. Costing Case Samples for OOHCA Appendix Costing Case Samples for OOHCA The patient (ICD-1) Treatment Codes (OPCS 4) Patient 27 Admitted to ICU following percutaneous cardiac intervention (PCI) with 2 drugeluting stents following a VF

More information

A Very Rare Indication in Urology: Ablation of all the Urinary Organs: About A Case

A Very Rare Indication in Urology: Ablation of all the Urinary Organs: About A Case Article ID: WMC002102 ISSN 2046-1690 A Very Rare Indication in Urology: Ablation of all the Urinary Organs: About A Case Author(s):Dr. Hatim El Karni, Dr. Bezzaz Aicha, Dr. El Ghanmi Jihad, Dr. Koutani

More information

100.1 - Payment for Physician Services in Teaching Settings Under the MPFS. 100.1.1 - Evaluation and Management (E/M) Services

100.1 - Payment for Physician Services in Teaching Settings Under the MPFS. 100.1.1 - Evaluation and Management (E/M) Services MEDICARE CLAIMS PROCESSING MANUAL Accessed September 25, 2005 100.1 - Payment for Physician Services in Teaching Settings Under the MPFS Payment is made for physician services furnished in teaching settings

More information

Beaumont Hospital. Varicose Veins. and their TREATMENT. Professor Austin Leahy, MCh, FRCS, FRCSI WWW.VEINCLINICSOFIRELAND.COM

Beaumont Hospital. Varicose Veins. and their TREATMENT. Professor Austin Leahy, MCh, FRCS, FRCSI WWW.VEINCLINICSOFIRELAND.COM Beaumont Hospital Varicose Veins and their TREATMENT Professor Austin Leahy, MCh, FRCS, FRCSI WWW.VEINCLINICSOFIRELAND.COM Department of Surgery Beaumont Hospital and Royal College of Surgeons in Ireland

More information

The Cardiac Society of Australia and New Zealand

The Cardiac Society of Australia and New Zealand The Cardiac Society of Australia and New Zealand Guidelines on Support Facilities for Coronary Angiography and Percutaneous Coronary Intervention (PCI) including Guidelines on the Performance of Procedures

More information

LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER - SHREVEPORT MEDICAL RECORDS CONTENT/DOCUMENTATION

LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER - SHREVEPORT MEDICAL RECORDS CONTENT/DOCUMENTATION LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER - SHREVEPORT MEDICAL RECORDS CONTENT/DOCUMENTATION Hospital Policy Manual Purpose: To define the components of the paper and electronic medical record

More information

Peripherally Inserted Central Catheter

Peripherally Inserted Central Catheter Peripherally Inserted Central Catheter (PICC) by Patricia Griffin Kellicker, BSN En Español (Spanish Version) Definition A peripherally inserted central catheter is a long, thin tube that is inserted through

More information

length of stay in hospital, sex, marital status, discharge status and diagnostic categories. Mean age and mean length of stay were compared for the

length of stay in hospital, sex, marital status, discharge status and diagnostic categories. Mean age and mean length of stay were compared for the Clinical and Demographic Characteristics of Psychiatric Inpatients admitted via Emergency and Non-Emergency routes at a University Hospital in Pakistan E.U. Syed,R. Atiq ( Departments of Psychiatry, Aga

More information

X-Plain Subclavian Inserted Central Catheter (SICC Line) Reference Summary

X-Plain Subclavian Inserted Central Catheter (SICC Line) Reference Summary X-Plain Subclavian Inserted Central Catheter (SICC Line) Reference Summary Introduction A Subclavian Inserted Central Catheter, or subclavian line, is a long thin hollow tube inserted in a vein under the

More information

Transvaginal Endoscopy TVE GYN 18 7.0 02/2015-E

Transvaginal Endoscopy TVE GYN 18 7.0 02/2015-E Transvaginal Endoscopy TVE GYN 18 7.0 02/2015-E TRANSVAGINAL ENDOSCOPY Leuven Institute for Fertility and Embryology Prof. Dr. S. Gordts, Dr. R. Campo, Dr. P. Puttemans, Prof. Em. Dr. I. Brosens 2 Transvaginal

More information

Surgeon and Radiological Services Billing for Laparoscopic Adjustable Gastric Band Procedures

Surgeon and Radiological Services Billing for Laparoscopic Adjustable Gastric Band Procedures Surgeon and Radiological Services Billing for Laparoscopic Adjustable Gastric Band Procedures Table 1: Surgeon Billing for Laparoscopic Adjustable Gastric Band Procedures 2012 Medicare Payment 2 43770

More information

Critical Care Billing and Coding. Date: February 2015 Presented by: Part B Provider Outreach & Education (POE)

Critical Care Billing and Coding. Date: February 2015 Presented by: Part B Provider Outreach & Education (POE) Critical Care Billing and Coding Date: February 2015 Presented by: Part B Provider Outreach & Education (POE) Workshop Protocol Cannot register with WebEx using mobile device Must use desktop or laptop

More information

MINIMALLY INVASIVE MANAGEMENT OF FELINE LOWER URINARY TRACT DISEASE:

MINIMALLY INVASIVE MANAGEMENT OF FELINE LOWER URINARY TRACT DISEASE: MINIMALLY INVASIVE MANAGEMENT OF FELINE LOWER URINARY TRACT DISEASE: LASERS, STENTS AND BALLOONS Dr. Allyson Berent, DVM, DACVIM The Animal Medical Center, New York, NY Feline lower urinary tract disease

More information

Recurrent Kidney Stones

Recurrent Kidney Stones Recurrent Kidney Stones Sean A. Pierre, MD; and Darren T. Beiko, MD, FRCSC As presented at the College of Canadian Family Physicians Annual Family Medicine Forum, Toronto, Ontario. Family physicians are

More information

Saint Francis Kidney Transplant Program Issue Date: 6/9/15

Saint Francis Kidney Transplant Program Issue Date: 6/9/15 Kidney Transplant Candidate Informed Consent Education Here are educational materials about Kidney Transplant. Please review and read these before your evaluation visit. The RN Transplant Coordinator will

More information

Surgery for oesophageal cancer

Surgery for oesophageal cancer Surgery for oesophageal cancer This information is an extract from the booklet Understanding oesophageal cancer (cancer of the gullet). You may find the full booklet helpful. We can send you a free copy

More information

This document contains three General Surgery placement descriptions:

This document contains three General Surgery placement descriptions: This document contains three General Surgery descriptions: North Central Thames Foundation School (NCTFS) Individual Description - Basildon and Thurrock University Hospitals NHS Foundation Trust type of

More information

Documentation Guidelines for Physicians Interventional Pain Services

Documentation Guidelines for Physicians Interventional Pain Services Documentation Guidelines for Physicians Interventional Pain Services Pamela Gibson, CPC Assistant Director, VMG Coding Anesthesia and Surgical Divisions 343.8791 1 General Principles of Medical Record

More information

Article ID: WMC001893 2046-1690

Article ID: WMC001893 2046-1690 Article ID: WMC001893 2046-1690 Hyperkalaemia, Renal Failure, and Right-Sided Hydro-Uretero-Nephrosis a Sequel of Intravesical Debris in the Presence of an Indwelling Long-Term Urethral Catheter: Case

More information

UW MEDICINE PATIENT EDUCATION. Aortic Stenosis. What is heart valve disease? What is aortic stenosis?

UW MEDICINE PATIENT EDUCATION. Aortic Stenosis. What is heart valve disease? What is aortic stenosis? UW MEDICINE PATIENT EDUCATION Aortic Stenosis Causes, symptoms, diagnosis, and treatment This handout describes aortic stenosis, a narrowing of the aortic valve in your heart. It also explains how this

More information

FAQ About Prostate Cancer Treatment and SpaceOAR System

FAQ About Prostate Cancer Treatment and SpaceOAR System FAQ About Prostate Cancer Treatment and SpaceOAR System P. 4 Prostate Cancer Background SpaceOAR Frequently Asked Questions (FAQ) 1. What is prostate cancer? The vast majority of prostate cancers develop

More information

Allium Ureteral Stent (URS)

Allium Ureteral Stent (URS) Allium Ureteral Stent (URS) Instructions For Use Manufactured by Allium Ltd. DEVICE NAME: ALLIUM Ureteral Stent (URS) is intended to be inserted into the lower ureter to allow free flow of urine from the

More information

Heart transplantation

Heart transplantation Heart transplantation A patient s guide 1 Heart transplantation Heart transplantation has the potential to significantly improve the length and quality of life for patients with severe heart failure.

More information