Trends and Patterns of Urodynamic Studies in U.S. Males, 2000–2012

ObjectiveTo evaluate trends in urodynamic procedures in the U.S. males from 2000–2012 and determine if a 2010 decline in reimbursement was associated with decreased utilization.Subjects and methodsWe analyzed 2000–2012 administrative healthcare claims from Truven Health’s Marketscan Database and evaluated males ≥18 years of age. We identified cystometrograms and any concurrent procedures using procedure billing codes. Covariates included age, year of cystometrogram, region and associated diagnosis codes. We estimated standardized cystometrogram utilization rates per 10,000 person-years (PY). We used age, region, and calendar year adjusted Poisson regression models to estimate the independent effect of calendar year and region.ResultsDuring 127,558,186 PY of observation, we identified 153,168 cystometrograms for an overall utilization rate of 12.0 per 10,000 PY (95% CI 11.9–12.1). Cystometrogram utilization increased with age, peaking at age 85 with a rate of 77.7 per 10,000 PY (95% CI 74.7–80.7). Adjusted cystometrogram utilization rate ratios show that compared to a referent of 2000–2004, utilization was significantly higher in each year 2005 to 2011 among all patients and in 2012 among patients ≥ 65. Standardized utilization rates peaked in 2008 at 12.4 per 10,000 PY (95% CI 12.2–12.6), remained elevated until 2010, then decreased slightly in 2011 and substantially in 2012 to 8.5 per 10,000 PY (95% CI 8.4–8.7).ConclusionsUtilization of urodynamic procedures increased until 2010 and decreased thereafter. Utilization was greatest among men older than 65

Levels of evidence in the urological literature.

PURPOSE: The concept of levels of evidence is one of the guiding principles of evidence based clinical practice. It is based on the understanding that certain study designs are more likely to be affected by bias than others. We provide an assessment of the type and levels of evidence found in the urological literature. MATERIALS AND METHODS: Three reviewers rated a random sample of 600 articles published in 4 major urology journals, including 300 each in 2000 and 2005. The level of evidence rating system was adapted from the Center of Evidence Based Medicine. Sample size was estimated to detect a relative increase in the proportion of studies that provided a high level of evidence (I and II combined) from 0.2 to 0.3 with 80% power. RESULTS: Of the 600 studies reviewed 60.3% addressed questions of therapy or prevention, 11.5% addressed etiology/harm, 11.3% addressed prognosis and 9.2% addressed diagnosis. The levels of evidence provided by these studies from I to IV were 5.3%, 10.3%, 9.8% and 74.5%, respectively. A high level of evidence was provided by 16.0% of studies in 2000 and by 15.3% in 2005 (p = 0.911). CONCLUSIONS: This study suggests that a majority of studies in the urological literature provide low levels of evidence that may not be well suited to guide clinical decision making. We propose that editors of leading urology journals should promote awareness for this guiding principle of evidence based clinical practice by providing a level of evidence designation with each published study

Observed person-time and cystometrogram (CMG) procedure frequencies by age, calendar year, and region of service, for U.S. males, 2000–2012.

<p>Observed person-time and cystometrogram (CMG) procedure frequencies by age, calendar year, and region of service, for U.S. males, 2000–2012.</p

Proportion of cystometrograms (CMG) accompanied by voiding pressure (VP) studies, urethral pressure profiles (UPP), electromyography (EMG), and fluoroscopy procedures by calendar year, U.S. males 2000–2012.

<p>Proportion of cystometrograms (CMG) accompanied by voiding pressure (VP) studies, urethral pressure profiles (UPP), electromyography (EMG), and fluoroscopy procedures by calendar year, U.S. males 2000–2012.</p

Standardized cystometrogram (CMG) utilization rates and adjusted utilization rate ratios by calendar year and region, for U.S. males 2000–2012.

<p>^a We estimated standardized utilization rates by year and region by reweighting the age distribution in the data to resemble a standard population of U.S. males with employer-provided health plans (under age 65) and U.S. males with employer-supplemented Medicare plans (above age 65), as estimated by the 2010 Current Population Survey. Calendar year rates are standardized by age and region while regional rates are standardized by age and calendar year (weighting each year of data equally).</p><p>^b Within each stratum of age (< 65 and ≥ 65), we estimated utilization rate ratios by calendar year using age and region adjusted Poisson models, and by region using age and calendar year adjusted models. We used a referent of 2000–2004 for rate ratios by calendar year and the Northeast for rate ratios by region.</p><p>Standardized cystometrogram (CMG) utilization rates and adjusted utilization rate ratios by calendar year and region, for U.S. males 2000–2012.</p

Trends and Patterns of Urodynamic Studies in U.S. Males, 2000–2012

To evaluate trends in urodynamic procedures in the U.S. males from 2000-2012 and determine if a 2010 decline in reimbursement was associated with decreased utilization.We analyzed 2000-2012 administrative healthcare claims from Truven Health's Marketscan Database and evaluated males ≥18 years of age. We identified cystometrograms and any concurrent procedures using procedure billing codes. Covariates included age, year of cystometrogram, region and associated diagnosis codes. We estimated standardized cystometrogram utilization rates per 10,000 person-years (PY). We used age, region, and calendar year adjusted Poisson regression models to estimate the independent effect of calendar year and region.During 127,558,186 PY of observation, we identified 153,168 cystometrograms for an overall utilization rate of 12.0 per 10,000 PY (95% CI 11.9-12.1). Cystometrogram utilization increased with age, peaking at age 85 with a rate of 77.7 per 10,000 PY (95% CI 74.7-80.7). Adjusted cystometrogram utilization rate ratios show that compared to a referent of 2000-2004, utilization was significantly higher in each year 2005 to 2011 among all patients and in 2012 among patients ≥ 65. Standardized utilization rates peaked in 2008 at 12.4 per 10,000 PY (95% CI 12.2-12.6), remained elevated until 2010, then decreased slightly in 2011 and substantially in 2012 to 8.5 per 10,000 PY (95% CI 8.4-8.7).Utilization of urodynamic procedures increased until 2010 and decreased thereafter. Utilization was greatest among men older than 65

An American Association for the Surgery of Trauma (AAST) prospective multi-center research protocol: outcomes of urethral realignment versus suprapubic cystostomy after pelvic fracture urethral injury.

BackgroundPelvic fracture urethral injuries (PFUI) occur in up to 10% of pelvic fractures. It remains controversial whether initial primary urethral realignment (PR) after PFUI decreases the incidence of urethral obstruction and the need for subsequent urethral procedures. We present methodology for a prospective cohort study analyzing the outcomes of PR versus suprapubic cystostomy tube (SPT) after PFUI.MethodsA prospective cohort trial was designed to compare outcomes between PR (group 1) and SPT placement (group 2). Centers are assigned to a group upon entry into the study. All patients will undergo retrograde attempted catheter placement; if this fails a cystoscopy exam is done to confirm a complete urethral disruption and attempt at gentle retrograde catheter placement. If catheter placement fails, group 1 will undergo urethral realignment and group 2 will undergo SPT. The primary outcome measure will be the rate of urethral obstruction preventing atraumatic passage of a flexible cystoscope. Secondary outcome measures include: subsequent urethral interventions, post-injury complications, urethroplasty complexity, erectile dysfunction (ED) and urinary incontinence rates.ResultsPrior studies demonstrate PR is associated with a 15% to 50% reduction in urethral obstruction. Ninety-six men (48 per treatment group) are required to detect a 15% treatment effect (80% power, 0.05 significance level, 20% loss to follow up/death rate). Busy trauma centers treat complete PFUI approximately 1-6 times per year, thus our goal is to recruit 25 trauma centers and enroll patients for 3 years with a goal of 100 or more total patients with complete urethral disruption.ConclusionsThe proposed prospective multi-institutional cohort study should determine the utility of acute urethral realignment after PFUI