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Gyn: Green Journal-cystoscopyFrom: D. Ashley Hill, M.D. (dahmd@mpinet.net)Fri Oct 29 15:46:01 1999
Jeff- Thanks for inviting discussion by posting a summary of recent Green Journal topics. I perform cystoscopy after every urogynecology procedure and complicated laparoscopic procedures or hysterectomies, but not after routine surgery. Here are some thoughts: 1. Lack of perceived benefit. A former partner of mine once told me, after an uncomplicated Burch, that he finds routine cystoscopy "a waste of time." I noted a nonpatent right ureter that opened after deligation of a stitch (his side, which made the educational value so much better)! Many folks see cysto after urogyn procedures as helpful, but not after all major gyn cases. This would make a nice study. 2. Cost considerations. Most HMOs in our area not longer compensate for intraoperative cystoscopy, saying it's an intrinsic part of the procedure. Since the tubing and saline cost money to the hospital, which is not reimbursed by the HMO, I assume hospitals would want to see a clear benefit before supplying cysto equipment for all gynecologists. 3. Credentialing issues. The first time I did a cystoscopy at my hospital the building was leaning to one side because so many urologists were looking in the OR window! Apparently some urology departments frown on gynecologists doing intraoperative cystoscopy, although it's generally an easy procedure that adds a lot to the surgical arsenal of gynecologists. Thanks again, Jeff. Ashley
-- David Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL http://home.mpinet.net/dahmd
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