Standard v mini percutaneous nephrolithotomy in the supine modified lithotomy position: a randomized pilot study on 10-25 mm stones.

Background: Percutaneous nephrolithotomy (PCNL) is the recommended treatment for stones >2 cm in size. The majority of PCNL are still conducted with larger telescopes using tracts up to 30F in size. We have conducted a randomized pilot study comparing mini PCNL with our standard 22F PCNL for renal stones between 10 and 25 mm in diameter.

Accuracy of surgical death information: comparison of data held by Victorian Audit of Surgical Mortality and Victorian Agency for Health Information.

Background: The Victorian Audit of Surgical Mortality (VASM) investigates all surgically related deaths in Victoria. The Victorian Admitted Episodes Database (VAED) is an administrative dataset maintained by the Health Department's Victorian Agency of Health Information (VAHI). We have reviewed clinical records to assess the correlation between deaths reported to the databases.

Multi-parametric magnetic resonance imaging of the prostate in Victoria, Australia; unintended consequences of changing Medicare Benefits Schedule access.

ObjectiveTo assess whether prostate biopsy rates have altered with the July 2018 change in Australian Medicare Benefits Schedule (MBS) rebates supporting multiparametric magnetic resonance imaging (mpMRI) for diagnosing prostate cancer.MethodsBiopsy data (both trans-rectal and trans-perineal) were obtained from the Victorian Agency for Health Information from July 2016 to June 2022. The data were stratified by financial year, age group and hospital type (public vs private).

Death after endoscopic prostate surgery in Australia and New Zealand: a review of clinical management issues.

Background: Endoscopic prostate surgery is an established treatment for male lower urinary tract symptoms (LUTS) and is recognized to have low mortality rates. We aimed to describe factors that may have contributed to death following endoscopic prostate surgery using data from the Australia and New Zealand Audits of Surgical Mortality (ANZASM).

Methods: All urological related deaths reported to ANZASM from January 1 2012 to December 31 2019 were reviewed.

Modified Supine Percutaneous Nephrolithotomy in the Elderly: Outcomes and Safety.

With increases in the aging population, conditions affecting older people and relevant surgical techniques are becoming more pertinent. Modified supine percutaneous nephrolithotomy (PCNL) is increasingly being adopted. There are limited data on the safety of this position in the elderly patient population.

The burden of radiation exposure in children requiring percutaneous nephrolithotomy.

Background: Children undergoing investigation and management for complex upper tract urolithiasis often require multimodal imaging. The significance of related radiation exposure in stone care pathways has received little attention in the published literature.

Study Design: Medical records of paediatric patients undergoing percutaneous nephrolithotomy were retrospectively analysed to ascertain the modalities used and determine extent of radiation exposure occurring during each care pathway.

Ureterorenoscopic stone procedures have low success rates and poor post-operative follow-up: results from an Australian tertiary health service.

Background: To assess the results of ureterorenoscopy (URS) for upper tract urolithiasis in a contemporary Australian tertiary healthcare setting.

Methods: Hospital records of all URS stone procedures performed between January 2017 and December 2018 in a metropolitan service were retrospectively reviewed. Outcome measures including stone free rates, adherence to postoperative follow-up and complications rates were recorded.

Analysis of potential clinical management issues in unreported mortality data from an Australian health service.

Background: We have previously reported incomplete data submission to the Victorian Audit of Surgical Mortality (VASM) by a large health service. We have further examined the source health service clinical data to assess whether any clinical management issues (CMI) occurred and should have been reported.

Methods: The previous study identified 46 deaths that should have been reported to VASM.

Contributions to expenditure in endoscopic stone management: a costly process.

No comprehensive cost estimates exist for performing ureteropyeloscopy (URS), which is increasingly utilised as a treatment of upper tract urolithiasis in Australia. To estimate expenditure associated with URS in an Australian public hospital setting and determine factors contributing to increased cost. Patients who underwent flexible URS for urolithiasis over a 2-year period at a Victorian public health site were included.

Urinary tract stone deaths: data from the Australian and New Zealand Audits of Surgical Mortality.

Objectives: To analyse all mortalities related to surgery for urinary tract calculi in Australia from 1 January 2009 to 31 December 2018, and identify common causes, clinical management issues (CMIs), and areas for improvement.

Patients And Methods: All urological-related deaths reported to the Australian and New Zealand Audit of Surgical Mortality (ANZASM) from 2009 to 2017 were analysed. The Bi-National Audit of Surgical Mortality (BAS) database was interrogated for any involvement with renal, ureteric or bladder stones and all relevant associated data analysed.

Risk-adjusted hospital clinical management issue rates using data from the Victorian Audit of Surgical Mortality.

Background: In recent years, there has been a concerted drive for an increase in public reporting of hospital-level outcomes as a means of identifying strategies to improve patient safety. Surgical care, as a high-risk area of medical practice, has come under sharp scrutiny. This study uses data from the Victorian Audit of Surgical Mortality (VASM) in conjunction with data from the Victorian Admitted Episode Dataset to compare hospital rates of clinically identified serious clinical management issues that were definitely or probably preventable and caused or contributed to the death of the patient who would otherwise be expected to survive.

Assessment of accuracy of Australian health service death data: implications for the audits of surgical mortality.

Background: The Victorian Audit of Surgical Mortality (VASM) investigates all surgically related deaths in Victoria, Australia, as a surgical educational activity aimed to make surgery safer. Whilst data collected within the audit are regularly reviewed for accuracy, there has never been a review of the data provided from health services.

Methods: Two-year death data provided by one Victorian health service were reviewed.

Stakeholder's perceived value of surgical audit data provided by the Victorian Audit of Surgical Mortality.

Background: Clinical audits can vary in their effectiveness depending on how the information is provided and the relationship between those giving and receiving feedback. In the Australian state of Victoria, the Victorian Audit of Surgical Mortality (VASM) is a state-wide mortality audit that, prior to this study, did not have a bidirectional feedback mechanism in place to gauge perception of the audit held by its stakeholders.

Objective: We aimed to investigate the perceived quality of the audit's information and the effectiveness of the audit's communication strategies from the stakeholder population.

Impact of modern media on analgesic requirements during extracorporeal shockwave lithotripsy.

Background: In Australia, shockwave lithotripsy (SWL) to treat urinary tract stones is routinely performed with general anaesthesia (GA). We have established a SWL service avoiding GA based outside operating theatres and wish to assess the effectiveness of utilizing modern media on patient satisfaction and analgesic requirements during treatment.

Methods: A randomized three-arm trial was performed.

Implementing error rate checks to improve the data quality in the Victorian Audit of Surgical Mortality.

Objective: The Victorian Audit of Surgical Mortality (VASM) is part of the Australian and New Zealand Audit of Surgical Mortality, aiming to identify factors associated with surgical mortality. A quality assurance method was utilised to rectify system issues through error rate checks of VASM data points. This method ensured data collected and entered in the audit database were accurate.

Introduction of a new imaging guideline for suspected renal colic in the ED reduces CT urography utilisation.

Background: Patients presenting to the ED with suspected renal colic are frequently imaged with CT urography (CTU), which rarely alters diagnosis or management. To reduce use of CTU in this population, we instigated a new imaging and management guideline in our ED.

Methods: This was a quasi-experimental prospective study, whereby a new guideline was commenced at the intervention site (Monash Medical Centre) and the existing guideline continued at the control site (Dandenong Hospital).

Modified supine versus prone percutaneous nephrolithotomy: Surgical outcomes from a tertiary teaching hospital.

Purpose: The traditional prone positioning of percutaneous nephrolithotomy (PCNL) is associated with various anesthetic and logistic difficulties. We aimed to compare the surgical outcomes of PCNLs performed using our modified supine position with those performed in the standard prone position.

Materials And Methods: A prospective group of 236 renal units (224 patients) undergoing PCNL were included in this 2 site study: 160 were performed in the modified supine position were compared with 76 undergoing PCNL in the prone position.

Predictors for urologic intervention and alternate diagnoses in people having computed tomography urography for suspected renal colic.

Objective: The majority of ureteric calculi pass spontaneously and are uncomplicated, yet use of computed tomography urography (CTU) has increased in recent years. This study describes a cohort of ED patients undergoing CTU for renal colic and assesses the predictors of urologic intervention.

Methods: A retrospective cohort study enrolled patients who underwent CTU at three Melbourne EDs.

Complete stone clearance using a modified supine position: initial experience and comparison with prone percutaneous nephrolithotomy.

Background And Purpose: The recently described Galdakao-modified supine Valdivia position for percutaneous nephrolithotomy (PCNL) has become increasingly popular. We have made further modifications to this and describe our recent experience compared with our previous prone cases.

Patients And Methods: From April 2011, all patients undergoing PCNL have been placed in the modified supine position.

Patient knowledge about prostate-specific antigen (PSA) and prostate cancer in Australia.

Objective: To assess whether men undergoing prostate biopsies for raised prostate-specific antigen (PSA) concentrations were adequately counselled before their first PSA test.

Patients And Methods: Men were given a PSA information sheet and interviewed immediately before undergoing transrectal ultrasonography (TRUS)/prostate biopsy. Information collected included whether they had been informed of the test, whether they were aware of TRUS/biopsy and whether possible treatments for prostate cancer had been discussed.

Repeated radiological radiation exposure in patients undergoing surgery for urinary tract stone disease in Victoria, Australia.

Unlabelled: What's known on the subject? and What does the study add? Radiation exposure is a cause of cancer. Increasing use of CT scans has increased patient exposure to ionizing radiation which may increase long-term risk of cancer. Not all scans performed may be medically necessary.