Karen Stern

Factors Influencing Fluid Intake Behavior Among Kidney Stone Formers

PURPOSE We determined factors influencing the behavior of patients with kidney stones in the prevention of recurrent stones. MATERIALS AND METHODS Patients with stones from an academic and a community practice were recruited for key informant interviews and focus groups. Groups were guided based on the framework of the health belief model. Content analysis was done on transcriptions using qualitative data analysis software. RESULTS Key informant interviews were completed with 16 patients and with a total of 29 subjects in 5 focus groups. Content analysis revealed that patients were highly motivated to prevent stones. The minimum level of perceived benefit for adopting the behavior change varied among patients and the behaviors proposed. An important strategy to increase fluid intake was insuring availability with containers. Patients were more consistently confident in the ability to increase fluid, in contrast to ingesting medicine or changing the diet. While barriers to increasing fluid were multifactorial among individuals, the barriers aligned into 3 progressive stages that were associated with distinct patient characteristics. Stage 1 barriers included not knowing the benefits of fluid or not remembering to drink. Stage 2 barriers included disliking the taste of water, lack of thirst and lack of availability. Stage 3 barriers included the need to void frequently and related workplace disruptions. CONCLUSIONS Patients with kidney stones are highly motivated to prevent recurrence and were more amenable to fluid intake change than to another dietary or pharmaceutical intervention. Barriers preventing fluid intake success aligned into 3 progressive stages. Tailoring fluid intake counseling based on patient stage may improve fluid intake behavior.

Reviewing radiographic images with patients: results of a trial on patient preferences, understanding, and satisfaction.

PURPOSE To evaluate patient preferences, understanding, and satisfaction regarding visual review of radiographic images during counseling. PATIENTS AND METHODS 101 urologic patients who presented for counseling where images impacted decision making were randomized into group A, shown their images, and group B, shown a diagram. Both completed a satisfaction survey blinded to the studys purpose. A second unblinded survey evaluated patient comprehension of and preferences regarding images. Comparison of intervention and control groups for differences in satisfaction and analysis of patient self-reported preferences and understanding regarding radiographic images was performed. RESULTS Group A had higher satisfaction scores but did not reach statistical significance. Both groups reported comprehension of images (100%, 97.9%), improvement in understanding of their condition and treatment because of viewing images (98%, 95.8%), and felt images should be shown to all patients (92%, 89.6%). Multivariate analysis identified female sex to independently predict greater understanding of images and belief that all patients should be shown their images. CONCLUSIONS Almost all patients reported comprehension of images, improvement in understanding because of review of images, and preference for being shown images. Female patients expressed greater understanding and preference for all patients to be shown their images. Review of radiographic images represents a potentially useful additional modality for patient counseling whose usefulness for improving satisfaction will need to be confirmed in further studies.

Recent Advances and Emerging Technology in the Surgical Management of BPH-Related Voiding Dysfunction

As transurethral resection of the prostate (TURP) continues to be the standard of care to alleviate voiding dysfunction in men with benign prostatic hyperplasia (BPH), novel techniques are being addressed to promote operative efficacy and long-term results for improved voiding. This review addresses recent literature over the past year on various transurethral technologies and procedures as well as the developing practice of prostatic arterial embolization (PAE) to improve lower urinary tract symptoms in the setting of BPH. The transurethral technologies include bipolarity, which has come to the forefront in the resection of large prostates as it reduces the risk of TUR syndrome, and plasmakinetic enucleation and diode laser enucleation which have both recently been demonstrated to improve tissue resection for larger prostate glands. The Oyster Procedure, described below, is a specific method of adenoma resection which has been demonstrated to be effective in the treatment of large obstructing prostates. HoLEP, which has been established as an effective tool for large prostates, has now been described to be useful in patients requiring retreatment of LUTS secondary to BPH. Prostatic artery embolization (PAE) has recently come to the forefront of a minimally invasive alternative to TURP with a reduction of symptoms and recovery time in patients who have had unsuccessful or refractory treatments for LUTS. While TURP aids in improving voiding dysfunction, it is known to affect sexual function. New implants, such as those explained in the UroLift procedure below, can improve LUTS while preserving sexual function. Finally, The GreenLight laser prostatectomy has now been demonstrated to be safe and effective in an office setting with conscious sedation, thereby reducing surgical risk with anesthesia for those with comorbidities. The studies discussed in this review focus on improving procedures for treating larger prostates, prostates with prior surgical interventions or refractory BPH, patients who wish to maintain sexual function, and assessing interventions for the elderly and those with comorbidities. As new technologies continue to expand, their use among both novice and experienced surgeons will be vital to advancing the treatments for BPH.

COMPLIANCE WITH OVERACTIVE BLADDER MEDICATIONS IN A MANAGED HEALTHCARE ORGANIZATION

399 COMPLIANCE WITH OVERACTIVE BLADDER MEDICATIONS IN A MANAGED HEALTHCARE ORGANIZATION Jocelyn Rieder*, Viet Tran, Karen Stern, Ashok Chopra, Sherif Aboseif. Los Angeles, CA. INTRODUCTION AND OBJECTIVE: Currently the main treatment of overactive bladder is anticholinergic medications. This treatment is limited by patients’ willingness to continue taking the medications. The purpose of this study is to evaluate the level of compliance with anticholinergic medication prescribed to treat overactive bladder disease in a managed healthcare population. METHODS: During a 12 month period in 2005 and 2006, 10,321 patients were newly prescribed an anticholiergic medication in the Southern California Kaiser Permanente Region. Medications included Tolteridine (Detrol), Tolteridine Extended Release (Detrol LA), Oxybutynin Immediate Release (IR), Oxybutynin Extended Release (ER), and Oxybutynin Patch (Oxytrol). Patients were followed for one year after