An analysis of benign prostatic hyperplasia surgical treatment reimbursement trends across Canada: Examining provincial changes over the recent decade with comparison to cost of living changes.

INTRODUCTION: A variety of procedures for the endoscopic surgical treatment of symptomatic benign prostatic hyperplasia (BPH) refractory to medical therapy have existed for decades. The present study examines trends in surgeon compensation for these treatments within Canada. METHODS: The physician fee schedule for BPH surgery across 10 Canadian provinces for the years 2010 and 2023 were obtained. A descriptive study examining first, the provincial reimbursement for transurethral resection of prostate (TURP) and laser ablative/enucleation surgery; second, the difference in TURP reimbursement between 2010 and 2023; and third, the annual change in TURP reimbursement juxtaposed with the annual change in the provincial Consumer Price Index (CPI) and annual salary for the working population aged 35-44. RESULTS: Seven of 10 Canadian provinces reimburse laser BPH surgery equally to TURP. The average provincial TURP reimbursement is $545, ranging from $451 in Ontario to $688 in Saskatchewan. Since 2010, TURP reimbursement has varied by province from a 0% net change in Ontario to an increase of 21% in Nova Scotia. Reimbursement for TURP has increased at a slower pace than the local CPI, and for half of the provinces at a slower pace than the annual salary for people aged 35-44. CONCLUSIONS: The compensation model for endoscopic BPH surgery does not have a unified structure in Canada that is consistent across provinces, nor does it keep up with inflation, possibly impacting future recruitment, increasing geographic disparities, and most importantly, limiting the adoption of new BPH therapies.

Malignant hypertension due to renal artery stenosis after open partial nephrectomy in a solitary kidney.

Laparoscopic and open partial nephrectomy is now routinely performed on small renal masses. Complications of clamping the renal artery during nephron-sparing surgery can include atheroembolic events and dissection of the renal artery. We report a case involving renal artery stenosis after open partial nephrectomy on a solitary kidney.

Safe and novel technique for peritoneal access in urologic laparoscopy without prior insufflation.

BACKGROUND AND PURPOSE: Access to the peritoneum for transperitoneal laparoscopic surgery can be achieved using a variety of techniques, each of which has advantages and disadvantages as well as risks of complications. The endoscopic threaded imaging port (EndoTIP) is a metal, reusable, threaded visual-access cannula that is inserted by rotational rather than axial force. When the technique was described initially, capnoperitoneum was obtained prior to trocar insertion. We describe the results of our series using the EndoTIP port without prior capnoperitoneum. PATIENTS AND METHODS: All 165 patients who underwent urologic transperitoneal laparoscopic procedures using the EndoTIP performed by a single surgeon from October 2001 through June 2005 were reviewed. Twentyfive patients were morbidly obese, and 32 had had previous abdominal surgical procedures. All data regarding patient demographics, details of the procedures, and outcomes were obtained from a database developed for prospective data collection at our institution. RESULTS: There were no complications associated with peritoneal access or trocar insertion. The average time required to obtain capnoperitoneum was <1 minute. CONCLUSIONS: Insertion of the EndoTIP port without prior capnoperitoneum is a safe, quick, and reliable method for peritoneal access in laparoscopic surgery. By avoiding blind punctures of the abdominal cavity, the risk of complications during access is minimized. We believe this technique should be considered in preference to techniques where trocars are inserted blindly.

Late ureteral conduit urinary leak as a presentation of urothelial carcinoma of the ureter.

Urinary leakage at the ureteroenteric anastomosis in patients with urinary diversion is a rare complication that usually occurs in the early postoperative period, regardless of the indication for surgery. To our knowledge, ureteroenteric urinary leaks that occur late in the postoperative period have not been described. We present a unique case of a late ureteroenteric anastomotic leak within an ileal conduit that occurred as a result of recurrent urothelial carcinoma of the ureter at the site of anastomosis.