TY - JOUR
T1 - Impact of Implementing Contrast-Enhanced Ultrasound for Antegrade Nephrostogram After Percutaneous Nephrolithotomy
AU - Fetzer, David T.
AU - Flanagan, Jennifer
AU - Nabhan, Ali
AU - Pongsatianwong, Kim
AU - Antonelli, Jodi
AU - Pearle, Margaret
AU - Vijay, Kanupriya
AU - Watumull, Lori
N1 - Publisher Copyright:
© 2020 American Institute of Ultrasound in Medicine
PY - 2021/1
Y1 - 2021/1
N2 - Objectives: To report results from a quality improvement (QI) project evaluating diagnostic performance, hospital resource use, and patient response data for postoperative contrast-enhanced ultrasound (CEUS) antegrade nephrostogram after percutaneous nephrolithotomy. Methods: For this Health Insurance Portability and Accountability Act–compliant, Institutional Review Board–approved study, QI data were deidentified and analyzed. On the first postoperative day after percutaneous nephrolithotomy, patients underwent both CEUS and fluoroscopic antegrade nephrostogram. For CEUS, 1.0 mL of Lumason (sulfur hexafluoride lipid type A microspheres; Bracco Diagnostics, Inc, Monroe Township, NJ) was injected via an indwelling nephrostomy tube, with ureteral patency confirmed by identifying intravesical ultrasound (US) contrast. Diagnostic performance for ureteral patency and contrast extravasation was calculated (with fluoroscopy as the reference standard). The examination time, room time, physician time, hospital costs, and patient response data were compared. The mean, standard deviation, 95% confidence interval, differences in mean, and 95% confidence interval of differences were calculated. Results: Eighty-one examinations were performed in 73 patients during the QI period. The sensitivity and specificity of CEUS for ureteral patency were 96% and 57%, respectively. There was no significant difference in time metrics between modalities, and the cost analysis showed lower direct and indirect costs for CEUS. Patient responses revealed lower levels of comfort for CEUS relative to fluoroscopy, without significant differences in reported pain or effort levels. Conclusions: Contrast-enhanced US showed very high sensitivity for ureteral patency; the relatively low specificity may have resulted from false-negative results in fluoroscopy. The hospital costs and resource use of CEUS compared favorably to fluoroscopy. Contrast-enhanced US also offers inherent advantages, including portability and lack of ionizing radiation.
AB - Objectives: To report results from a quality improvement (QI) project evaluating diagnostic performance, hospital resource use, and patient response data for postoperative contrast-enhanced ultrasound (CEUS) antegrade nephrostogram after percutaneous nephrolithotomy. Methods: For this Health Insurance Portability and Accountability Act–compliant, Institutional Review Board–approved study, QI data were deidentified and analyzed. On the first postoperative day after percutaneous nephrolithotomy, patients underwent both CEUS and fluoroscopic antegrade nephrostogram. For CEUS, 1.0 mL of Lumason (sulfur hexafluoride lipid type A microspheres; Bracco Diagnostics, Inc, Monroe Township, NJ) was injected via an indwelling nephrostomy tube, with ureteral patency confirmed by identifying intravesical ultrasound (US) contrast. Diagnostic performance for ureteral patency and contrast extravasation was calculated (with fluoroscopy as the reference standard). The examination time, room time, physician time, hospital costs, and patient response data were compared. The mean, standard deviation, 95% confidence interval, differences in mean, and 95% confidence interval of differences were calculated. Results: Eighty-one examinations were performed in 73 patients during the QI period. The sensitivity and specificity of CEUS for ureteral patency were 96% and 57%, respectively. There was no significant difference in time metrics between modalities, and the cost analysis showed lower direct and indirect costs for CEUS. Patient responses revealed lower levels of comfort for CEUS relative to fluoroscopy, without significant differences in reported pain or effort levels. Conclusions: Contrast-enhanced US showed very high sensitivity for ureteral patency; the relatively low specificity may have resulted from false-negative results in fluoroscopy. The hospital costs and resource use of CEUS compared favorably to fluoroscopy. Contrast-enhanced US also offers inherent advantages, including portability and lack of ionizing radiation.
KW - contrast-enhanced ultrasound
KW - fluoroscopy
KW - nephrolithiasis
KW - nephrostogram
KW - pyelography
KW - urolithiasis
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U2 - 10.1002/jum.15380
DO - 10.1002/jum.15380
M3 - Article
C2 - 32639063
AN - SCOPUS:85097875451
SN - 0278-4297
VL - 40
SP - 101
EP - 111
JO - Journal of Ultrasound in Medicine
JF - Journal of Ultrasound in Medicine
IS - 1
ER -