Eric O. Kwon

The Poppy Seed Test for Colovesical Fistula: Big Bang, Little Bucks!

PURPOSE Diagnosis of a colovesical fistula is often challenging, and usually involves numerous invasive and expensive tests and procedures. The poppy seed test stands out as an exception to this rule. We evaluated the accuracy and cost-effectiveness of various established diagnostic tests used to evaluate a suspected colovesical fistula. MATERIALS AND METHODS We identified 20 prospectively entered patients with surgically confirmed colovesical fistulas between 2000 and 2006. Each patient was evaluated preoperatively with a (51)chromium nuclear study, computerized tomography of the abdomen and pelvis with oral and intravenous contrast medium, and the poppy seed test. Costs were calculated using institutional charges, 2006 Medicare limiting approved charges and the market price, respectively. The z test was used to compare the proportion of patients who tested positive for a fistula with each of these modalities. RESULTS The chromium study was positive in 16 of 20 patients (80%) at a cost of

Rapid implementation of a robot-assisted prostatectomy program in a large health maintenance organization setting.

490.83 per study. Computerized tomography was positive in 14 of 20 patients (70%) at a cost of

THE POPPY SEED TEST FOR COLOVESICAL FISTULAS

652.92 per study. The poppy seed test was positive in 20 of 20 patients (100%) at a cost of

THE “NO-TOUCH” TECHNIQUE: A NOVEL TECHNIQUE FOR REDUCING POST-OPERATIVE INFECTIONS IN PATIENTS RECEIVING MULTI-COMPONENT INFLATABLE PENILE PROSTHESES

5.37 per study. The difference in the proportion of patients who tested positive for a fistula on computerized tomography and the poppy seed test was statistically significant (p = 0.03). There was no difference between the chromium group and the computerized tomography or poppy seed group (p = 0.72 and 0.12, respectively). CONCLUSIONS The poppy seed test is an accurate, convenient and inexpensive diagnostic test. It is an ideal initial consideration for evaluating a suspected colovesical fistula.

Cavernous hemangioma of tunica albuginea testis manifesting as testicular pain

PURPOSE We present the rapid implementation of a robot-assisted surgery program by one of the largest health maintenance organizations (HMOs) in the United States. MATERIALS AND METHODS A core group of 10 urologists were offered access to a new da Vinci S surgical system. A core group of five ancillary staff was assembled and trained at an Intuitive Surgical-designated training site. An experienced robotic surgeon acted as a proctor. Data regarding patient demographics, preoperative parameters, operative times, pathologic outcomes, and EPIC-26 quality-of-life questionnaires were collected prospectively and reviewed. All procedures were recorded on digital video disc as part of a quality assurance protocol. The core group reviewed complications monthly and received feedback on surgical techniques and pathologic outcomes. RESULTS A total of 100 robot-assisted laparoscopic radical prostatectomies were performed from August to October 2008. The patient demographics, preoperative parameters, operative times, and pathologic outcomes of these first 100 procedures are outlined. CONCLUSIONS We demonstrate the rapid implementation of an efficient multisurgeon HMO-based robot-assisted prostatectomy program with promising initial outcomes.

1125: Impact of Positive Surgical Margins in Patients Undergoing Partial Nephrectomy for Renal Cortical Tumors

Each patient was evaluated preoperatively with 3 main tests,the Chromium-51 nuclear study, computed tomography (CT) of the abdomen and pelvis with oral and intravenous contrast and the poppy seed test. Several others were evaluated by colonoscopy, cystoscopy, barium enema or cystogram. The costs of these tests were calculated using institutional charges for the Chromium study, the market price for poppy seeds and 2006 Medicare-limiting approved charges for the remaining