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The impact and burden on patient and health system of nephrostomy urinary diversion for upper tract obstruction in Canterbury

A 2018/2019 Summer Studentship research project

This study may validate our current practice or may suggest there is merit in exploring alternatives (such as Memokath stents, Resonance stents or more aggressive surgical reconstruction in non-malignant obstruction), both in terms of quality of life or cost to the health system.

Student: Claire Whitehead
Supervisors: Mr Giovanni Losco (Consultant Urologist), Mr Peter Davidson (Consultant Urologist), Dr Andrew Laing (Consultant Inverventinal Radiologist)
Sponsor: Canterbury Urological Research Foundation

Project brief

Introduction

  • The Urology Department at Canterbury DHB currently uses nephrostomy tubes as a standard way of managing upper tract urinary obstruction, in both short and long-term obstruction.
  • We typically have little ongoing contact with these patients.
  • There are a number of alternative options to nephrostomy that could be investigated depending on the cost-benefit and quality of life outcomes of this study.

Aim

  • To understand the number of patients in our community with nephrostomy tubes.
  • To assess the impact these patients place on the health system with respect to Emergency Department (ED), After Hours, District Nursing and primary care attendances.
  • To assess quality of life (QOL) in these individuals.
  • To quantify the cost to the health system of nephrostomy urinary diversion.

Method

  • Radiology booking records to be obtained to identify group of patients over a 24-month period.
  • Patients to be approached for consent and to respond to questionnaire: demographics, diagnosis, date of first nephrostomy, time between changes, need for urgent changes, unexpected attendances due to tube problems, admissions, urinary tract infections and QOL will be collected.
  • Health Connect South (HCS) would be accessed to quantify number of tube changes (planned and emergency) as well as ED attendances and admissions.
  • Cost analysis would performed by quantifying all nephrostomy-related interventions for the patients.

Student researcher’s component of the study

The student will be involved in all components of the study. Initially the cohort of patients will be obtained from Radiology. Consent and questionnaires will be posted to patients and the results collated by the student when the questionnaires have been returned. Patients may be phoned where necessary. HCS will be accessed for each patient. Costings will be obtained and data tabulated by the student. A draft manuscript with methodology, results and discussion will be written up prior to the conclusion of the studentship with the intention of publication in an internationally peer-reviewed journal. This will allow the student to be a part of every step of the project, from study design, data collection, analysis and publication. Due to small patient numbers, the project is considered achievable within the timeframe.