Examining the impact of postoperative opioid use on length of hospital stay following radical cystectomy.

INTRODUCTION: Radical cystectomy (RC) is associated with high rates of morbidity, prolonged hospital stay, and increased opioid use for postoperative pain management; however, the relationship between postoperative opioid use and length of stay (LOS ) remains uncharacterized. This study serves to investigate the association between postoperative opioid use and length of hospital stay after RC. The relationship between patient and surgical factors on LOS was also characterized. METHODS: We retrospectively reviewed all patients between 2009 and 2019 who underwent RC at our institution. Patient and perioperative variables were analyzed to determine the relationship between postoperative opioid use and LOS using multivariable linear regression analysis. RESULTS: We identified 240 patients for study inclusion with a median age of 70.0 years. Median LOS was 10.0 days, with median daily mg morphine equivalent use of 57.5 for patients. Daily mg morphine equivalent use was significantly associated with an increased LOS, as were previous pelvic radiation, postoperative ileus, and higher Clavien-Dindo grade complication during admission (all p<0.05). Median LOS increased by one day for each increase of 13.2 daily mg morphine equivalents received. CONCLUSIONS: Increased daily opioid use was associated with increased length of hospital stay after RC. Non-opioid-based pain management approaches may be effective in reducing LOS after RC.

Spontaneous, atraumatic hydrocele rupture: A case report.

There is little information in the literature on the management and prognosis of ruptured hydroceles. We present a case report of spontaneous, atraumatic left hydrocele rupture in a 64-year-old male. His hydrocele was initially diagnosed as non-complex and appeared to have ruptured spontaneously three years after initial onset. On follow-up in clinic, mild re-accumulation of fluid was observed, and no pain was reported by the patient. Post-rupture fluid re-accumulation was minimal in our patient but there is potential for significant fluid re-accumulation based on other reports of ruptured hydroceles.

Ultrasound Correlates Highly With Cross Sectional Imaging for Small Renal Masses in a Contemporary Cohort.

OBJECTIVE: To determine the correlation between ultrasound (US), cross-sectional imaging, and pathological renal mass sizes. METHODS: Between January 2011 and January 2021, a cohort of patients from 14 academic institutions who had an US and cross-sectional imaging within 8 weeks of each other and within 6 months of surgery were identified. A second cohort of patients with small renal masses (≤4 cm) who had US and cross-sectional imaging within 8 weeks of each other were also examined, regardless of their treatment modality. Correlation coefficients, Bland-Altman plots, and sensitivity tables were generated. RESULTS: A total of 1464 patients were included in the surgical cohort and 1582 patients (1921 imaging pairs) were included in the small renal mass (SRM) cohort. Pearson correlation coefficients between computed tomography (CT)/magnetic resonance imaging (MRI) and pathologic size was 0.93 (P <.0001) and between US and pathological size was 0.90 (P <.0001). The correlation between US and CT/MRI was 0.93 (P <.0001). Bland-Altman plots demonstrated a greater agreement for smaller renal masses. For the SRM cohort when comparing US to CT/MRI, 1441 (75%) SRM measurements were within 0.5 cm and only 149 (7.8%) were greater than 1 cm in difference. Subgroup analysis demonstrated that correlation between US and CT/MRI for SRMs were higher in patients with lower body mass index. CONCLUSION: There is a strong correlation between US and cross-sectional imaging in 75% of patients at baseline imaging. Our study provides support for utilization of US for active surveillance.

Evaluation of Optimal Timing of Expert Feedback in a Simulated Flexible Ureteroscopy Course.

Introduction: Simulation-based training (SBT) has become an increasingly popular modality to train novice surgical residents in the face of rapidly increasing innovative surgical techniques across all surgical disciplines. Recent studies have already demonstrated SBT to be effective in helping overcome the learning curve associated with new surgical techniques, especially in junior residents and endoscopic procedures. In addition, it is known that trainees benefit significantly from expert feedback; however, there is a paucity of data looking into the optimal timing of this feedback during SBT. To address this knowledge deficit, an SBT curriculum was developed for junior urology residents to assess optimal timing of feedback during SBT for flexible ureteroscopy (fURS). Materials and Methods: The SBT course consisted of a pretraining assessment, three independent practice sessions, and a post-training assessment, with residents receiving expert feedback right after their pretraining assessment (early feedback [EF]) or after their final independent training session (late feedback [LF]). Results: Fifteen trainees with similar baseline fURS experience and precourse fURS task performance score participated in the study. There was a significant difference between the pre- and post-task completion times overall (15.2 minutes vs 9.1 minutes, p < 0.001), with no difference between the early or LF groups (p = 0.884). The mean performance scores improved for both groups (18.2 vs 24.2, p < 0.001) with the EF group having a more statistically significant improvement in performance scores than the LF group (p = 0.05), and most (73%) of residents preferred EF. Conclusions: This study demonstrates that an SBT curriculum for fURS is effective for technical skills development among junior trainees, and that EF resulted in marginally better overall scores and was preferred by residents.