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Christopher S Saigal

Publications and source records attributed to Christopher S Saigal.

At least 19 recordsLinked to original sources
PubMed2006

Variations in reconstruction after radical cystectomy.

BACKGROUND: Most urologists specializing in the management of patients with bladder cancer consider continent urinary diversion the reconstructive technique that affords the best quality of life after radical cystectomy. The authors sought to evaluate factors that predict reconstructive technique after radical cystectomy. METHODS: Using linked data from Medicare and the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program, 3611 subjects were identified who underwent radical cystectomy for bladder cancer between 1992 and 2000. Multivariate logistic regression was used to identify factors independently associated with utilization of continent reconstruction after radical cystectomy, incorporating patient and provider variables. RESULTS: In multivariate analysis, the likelihood of continent diversion was inversely associated with older age (odds ratio [OR] < or = 0.68, P <.002), African American race (OR 0.43, P = .003), and higher comorbidity index (OR 0.71, P = .03), and directly associated with male sex (OR 1.45, P = .002), higher education level (OR 1.54, P = .03), and year of surgery (OR > or = 1.56, P < .001 for all year categories vs. 1992-1994). Treatment at academic (OR 1.43, P = .003) and NCI-designated cancer centers (OR 5.50, P <.001) and by high-volume providers (OR 1.49, P <.001) was independently associated with continent reconstruction. CONCLUSIONS: Disparities in the utilization of continent urinary diversion after radical cystectomy suggest that demographic, socioeconomic, provider-based, and clinical variables predict the likelihood that those undergoing radical cystectomy will receive continent reconstruction. Regionalization of bladder cancer care may ameliorate many of the disparities noted but must be balanced against the risk imposed by a delay in care.

Aged↗
PubMed2006

Patterns of care for men with prostate cancer after failure of primary treatment.

BACKGROUND: This study sought to determine trends in patterns of care after failure of primary prostate cancer treatment and to determine whether nonclinical factors influenced the receipt of secondary treatment. METHODS: The authors identified individuals treated for nonmetastatic prostate cancer in the years 1991-1999 from the linked databases of Medicare and the National Cancer Institute's Surveillance, Epidemiology, and End Results registry. The outcome of interest was receipt of secondary therapy. They performed Cox proportional hazard analyses to investigate the link between demographic and clinical characteristics and the likelihood of receiving secondary treatment after either surgery or radiation. RESULTS: Of 65,716 subjects who met our inclusion criteria, 10,200 (15%) received some form of secondary therapy. For men undergoing initial surgical or radiation therapy, tumor grade, year of diagnosis, and geographic region were associated with secondary therapy. No socioeconomic factors such as education, ethnicity, or income level were associated with secondary therapy. CONCLUSIONS: Patterns of care after primary prostate cancer therapy continue to vary regionally. Standardized clinical algorithms and utilization of prostate-specific antigen testing appear to have influenced secondary therapy rates.

Aged↗
PubMed2006

Predictors and prevalence of erectile dysfunction in a racially diverse population.

BACKGROUND: To our knowledge, the burden of disease attributed to erectile dysfunction (ED) has not been adequately quantified across a complete spectrum of age and race using a global disease definition, as recommended by the National Institutes of Health consensus statement. To obtain a better understanding of the national estimates of prevalence and risk factors for ED, we analyzed data from the 2001-2002 National Health and Nutrition Examination Survey. METHODS: The National Health and Nutrition Examination Survey collects data by household interview. The sample design is a stratified, multistage, probability sample of clusters of persons representing the civilian noninstitutionalized population. Data include medical histories in which specific queries are made regarding urological symptoms (including ED). These items were selected for analysis in 3566 men, 20 years and older. RESULTS: In men 20 years and older, ED affected almost 1 in 5 respondents. Hispanic men were more likely to report ED (odds ratio [OR], 1.89), after controlling for other factors. The prevalence of ED increased dramatically with advanced age; 77.5% of men 75 years and older were affected. In addition, there were several modifiable risk factors that were independently associated with ED, including diabetes mellitus (OR, 2.69), obesity (OR, 1.60), current smoking (OR, 1.74), and hypertension (OR, 1.56). CONCLUSIONS: The burden of ED on the US population is significant. Hispanic men had an elevated risk for ED, a finding that requires confirmation in prospective studies. Obesity, hypertension, smoking, and diabetes mellitus are significantly associated with ED risk. Mitigation of these risk factors may ameliorate the burden of ED.

Adult↗
PubMed2006

The prevalence of urinary incontinence among community dwelling men: results from the National Health and Nutrition Examination survey.

PURPOSE: To measure the prevalence of urinary incontinence in community dwelling men in the United States, we analyzed data from respondents to the National Health and Nutrition Examination Survey. MATERIALS AND METHODS: From 1999 to 2000 the National Health and Nutrition Examination Survey asked a national sample of community dwelling men, "In the past 12 months, have you had difficulty controlling your bladder, including leaking small amounts of urine when you cough or sneeze?" Questionnaire results were recorded and analyzed with respect to demographic data, and compared to the National Health and Nutrition Examination Survey data in women. RESULTS: The overall prevalence of urinary incontinence in men was 17%. Prevalence increased with age from 11% in men 60 to 64 years old to 31% in men 85 years old or older. Of the men reporting any incontinence 42% reported daily incontinence and 24% reported it weekly. Black men had the highest prevalence of male incontinence (21%) and black women had the lowest prevalence of female incontinence (20%). While the prevalence of incontinence in black women was virtually the same as that in black men, the prevalence of incontinence in white and Mexican-American women was at least 2.5 times that of men of the same ethnicity. CONCLUSIONS: The National Health and Nutrition Examination Survey draws a nationally representative sample of subjects from the community and, thus, provides prevalence data for urinary incontinence for all men in the United States. Ethnicity appears to be a contributing risk factor for incontinence, although racial patterns clearly differ between men and women.

Aged↗
PubMed2006

True prevalence of urinary incontinence among female nursing home residents.

OBJECTIVES: Urinary incontinence is a significant problem in nursing home residents in the United States. Estimates of its prevalence have often been based on data from medical records obtained at nursing home admission. To measure the sensitivity of this method of defining the prevalence of urinary incontinence among female nursing home residents, we examined data from a clinical survey. METHODS: We analyzed data from the National Nursing Home Survey, which collected information from nursing homes for each resident concerning admission diagnoses, presence of an indwelling Foley catheter or ostomy, need for assistance from equipment or personnel in using the toilet, and difficulty controlling urination. RESULTS: Residents' medical records revealed a very low rate of admission diagnoses of incontinence. However, clinical queries revealed a high prevalence of bladder dysfunction. More than one half of all female nursing home residents were reported to have "difficulty controlling urination," and more than one half needed assistance in using the toilet. CONCLUSIONS: Although only 1% to 2% of nursing home residents have a diagnosis of urinary incontinence, the true prevalence of bladder dysfunction in this group is much greater. The sharp divergence of National Nursing Home Survey data from published studies on the prevalence of incontinence in nursing homes highlights the limitations of using administrative data to study the epidemiology of bladder dysfunction.

Aged↗
PubMed2006

The prevalence of urinary incontinence among community dwelling adult women: results from the National Health and Nutrition Examination Survey.

PURPOSE: Population based studies estimate that a large proportion of adult women report urinary incontinence. However, there is a wide range of estimates of the burden posed by UI. To measure the prevalence of incontinence in women in the community we analyzed data from women responding to the National Health and Nutrition Examination Survey. MATERIALS AND METHODS: NHANES is a series of health and nutrition surveys performed by the National Center for Health Statistics. From 1999 to 2000 NHANES asked a national sample of community dwelling women, "In the past 12 months, have you had difficulty controlling your bladder, including leaking small amounts of urine when you cough or sneeze (exclusive of pregnancy or recovery from childbirth)?" Questionnaire results were recorded and analyzed with respect to demographic data including age, race and level of education. RESULTS: The overall prevalence of urinary incontinence in women was 38%. The prevalence of daily incontinence increased with age, ranging from 12.2% in women 60 to 64 years old to 20.9% in women 85 years old or older. Of women reporting any incontinence, 13.7% reported daily incontinence, and an additional 10.3% reported weekly incontinence. Prevalence was higher in non-Hispanic white women (41%) than in non-Hispanic black (20%) or Mexican-American women (36%). Women with less than a high school education were less likely to report incontinence than were those with at least a high school education. CONCLUSIONS: Unlike many other studies the NHANES draws a nationally representative sample of subjects in the community and, thus, provides prevalence data for urinary incontinence for all women in the United States. Prevalence is high, and varies with age, race/ethnicity and socioeconomic variables.

Aged↗
PubMed2006

Increasing costs of urinary incontinence among female Medicare beneficiaries.

PURPOSE: We measured the financial burden of urinary incontinence in the United States from 1992 to 1998 among women 65 years old or older. MATERIALS AND METHODS: We analyzed Medicare claims for 1992, 1995 and 1998 and estimated spending on the treatment of urinary incontinence. Total costs were stratified by type of service (inpatient, outpatient and emergency department). RESULTS: Costs of urinary incontinence among older women nearly doubled between 1992 and 1998 in nominal dollars, from $128 million to $234 million, primarily due to increases in physician office visits and ambulatory surgery. The cost of inpatient services increased only slightly during the period. The increase in total spending was due almost exclusively to the increase in the number of women treated for incontinence. After adjusting for inflation, per capita treatment costs decreased about 15% during the study. CONCLUSIONS: This shift from inpatient to outpatient care likely reflects the general shift of surgical procedures to the outpatient setting, as well as the advent of new minimally invasive incontinence procedures. In addition, increased awareness of incontinence and the marketing of new drugs for its treatment, specifically anticholinergic medication for overactive bladder symptoms, may have increased the number of office visits. While claims based Medicare expenditures are substantial, they do not include the costs of pads or medications and, therefore, underestimate the true financial burden of incontinence on the aging community.

Aged↗
PubMed2005

Marriage and mortality in bladder carcinoma.

BACKGROUND: Being married confers significant benefits in survival for patients with a variety of chronic conditions including breast and prostate carcinoma. The authors attempted to determine whether marital status is associated with survival in patients undergoing radical cystectomy for bladder carcinoma. METHODS: The authors identified 7262 subjects from the Surveillance, Epidemiology, and End Results public-use database who underwent radical cystectomy for transitional cell carcinoma of the bladder. They performed survival analyses using Kaplan-Meier estimates and Cox proportional hazards models. The authors created multivariate models to evaluate the independent association between marital status and survival, controlling for pathologic stage, lymph node status, age, race/ethnicity, and gender. RESULTS: Married subjects were older and more often male, white, and had earlier disease stage at diagnosis. Married subjects had significantly better survival than did single or widowed subjects (P < 0.001), and married subjects revealed a trend toward better survival than separated/divorced subjects (P = 0.20). Multivariate modeling revealed that compared with single subjects, those who were married had better survival, independent of age at the time of diagnosis, gender, race/ethnicity, disease stage, and lymph node status (P < 0.001). CONCLUSIONS: Marriage was associated with improved survival in patients with bladder carcinoma, independent of other factors known to influence mortality in this population. Although the mechanisms underlying this survival advantage are unknown, possibilities include differences in cancer screening, risk behaviors, and access to medical care. The interaction between psychosocial factors and the body's immune function may further explain the differential survival in this cohort.

Adult↗
PubMed2005

Predictors of fatigue after treatment for prostate cancer.

OBJECTIVES: To investigate whether post-treatment fatigue among men treated for prostate cancer varies by treatment, demographics, or pretreatment general and disease-specific health-related quality of life. We also sought to describe the baseline characteristics of men who were fatigued at follow-up to allow for interventions in those at greatest risk. METHODS: We conducted a secondary analysis on data gathered from men with prostate cancer at biopsy and after treatment by examining factors that predicted for post-treatment fatigue. RESULTS: Univariate and multivariate analysis results demonstrated that post-treatment fatigue was associated with baseline fatigue, role limitations due to emotional problems, treatment type, and treatment location. RESULTS: Univariate analysis showed that those who were fatigued at follow-up were more likely to have been treated at a public facility (P = 0.0017), be nonwhite (Latino, African American, or Asian Pacific-Islander; P = 0.0362), be married (P = 0.0413), be not employed at least part-time (P = 0.0327), to have one or more comorbidities (P = 0.0005), and to have scored lower in all domains of the RAND 36-Item Health Survey and UCLA Prostate Cancer Index at baseline (all P < or = 0.05) than those not fatigued at follow-up. Those who declined from baseline energy levels were more likely to have had lower baseline energy scores (P < 0.0001), to have been treated in a public facility (P = 0.0578), and to have had a baseline prostate-specific antigen level of 10 ng/mL or greater (P = 0.059) than those who remained at their baseline energy level. Lower baseline role-emotional scores were associated with both fatigue at follow-up and a decline from baseline at follow-up. CONCLUSIONS: Men with lower pretreatment quality-of-life measures may be at increased risk of fatigue after prostate cancer treatment.

Adenocarcinoma↗
PubMed2005

Obesity does not adversely affect health-related quality-of-life outcomes after anatomic retropubic radical prostatectomy.

OBJECTIVES: To study the impact of obesity on the health-related quality-of-life (HRQOL) outcomes after radical prostatectomy (RP). METHODS: Patient-reported sexual and urinary HRQOL was assessed at baseline and 3, 6, 12, and 24 months after anatomic retropubic RP using the University of California, Los Angeles, Prostate Cancer Index among a cohort of 340 men. Linear regression analysis was used to compare the longitudinal HRQOL scores by body mass index (BMI) adjusting for age, baseline HRQOL, and nerve-sparing status (non-nerve sparing versus unilateral versus bilateral). RESULTS: At baseline, the sexual and urinary function and bother scores were similar between normal-weight (BMI less than 25 kg/m2), overweight (BMI 25.0 to 29.9 kg/m2), and obese (BMI 30 kg/m2 or greater) men. Obese men were as likely to undergo bilateral nerve-sparing surgery as men with a lower BMI. After adjustment for age, baseline HRQOL, and nerve-sparing status, no statistically significant differences were found in any HRQOL score at any point among the BMI groups, except for a lower urinary function score at 24 months among overweight men (P = 0.02). CONCLUSIONS: In a select group of men undergoing RP at a tertiary care referral center, BMI was, in general, unrelated to the baseline and longitudinal postoperative HRQOL scores. Obese men (BMI 30 to 35 kg/m2) should not be selectively discouraged against RP because of concerns about HRQOL. Additional studies are needed to assess the HRQOL outcomes among men with very high BMI values (greater than 35 kg/m2).

Body Mass Index↗
PubMed2005

Health-related quality-of-life outcomes after anatomic retropubic radical prostatectomy in the phosphodiesterase type 5 ERA: impact of neurovascular bundle preservation.

OBJECTIVES: To examine the impact of neurovascular bundle preservation on longitudinal health-related quality-of-life (HRQOL) outcomes after anatomic radical retropubic prostatectomy (RP) using a validated questionnaire. METHODS: We examined patient-reported sexual and urinary HRQOL at baseline and at 3, 6, 12, and 24 months after RP using the University of California, Los Angeles, Prostate Cancer Index among 342 patients treated between 2001 and 2004 by a single surgeon. The time to return to baseline urinary and sexual function and bother were compared between men who underwent unilateral versus bilateral nerve-sparing RP using a Cox proportional hazards regression model. RESULTS: Of the 342 patients, 15 (5%), 69 (20%), and 258 (75%) had no, one, or both neurovascular bundles preserved, respectively. After adjustment for age and baseline sexual function, bilateral nerve sparing was associated with greater sexual function scores than unilateral nerve sparing at all points, although the differences only approached or reached significance at 3 (P = 0.06) and 6 (P = 0.04) months after RP. After adjustment for age and baseline sexual function, a trend was noted for an earlier return to baseline sexual function among men who underwent bilateral nerve-sparing RP (hazard ratio 1.67, 95% confidence interval 0.88 to 3.17, P = 0.12), although this did not reach significance. More than 90% of the men returned to their baseline urinary function and bother, regardless of nerve-sparing status. CONCLUSIONS: In the current study, bilateral nerve-sparing RP was associated with better postoperative sexual HRQOL scores than unilateral nerve-sparing RP, although in general the differences were slight.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2005

Economic costs of benign prostatic hyperplasia in the private sector.

PURPOSE: Several studies document the impact of benign prostatic hyperplasia (BPH) in working, aged men. Direct medical costs related to BPH treatment are largely borne by employees through higher premiums. However, indirect costs related to lost work are primarily borne by the employer. In this study we used claims data and absentee records from large employers to estimate the costs associated with BPH in working age males. MATERIALS AND METHODS: We used 2 data sources to examine direct and indirect costs associated with BPH in a privately insured, nonelderly population. Multivariate regression models were used to predict spending for persons with and without a medical claim for BPH, controlling for relevant covariates. Data on work loss were linked to medical claims to estimate work loss related to treatment for BPH. RESULTS: Mean annual expenditures were 4,193 dollars for men without a medical claim for BPH. In contrast, annual spending was 5,729 dollars for men with a claim for BPH. Thus, the incremental cost associated with a diagnosis of BPH was 1,536 dollars yearly. Overall the average employee with the condition missed 7.3 hours of work yearly related to BPH with approximately 10% reporting some work loss related to a health care encounter for BPH. CONCLUSIONS: Treatment of men with BPH places a significant burden on employees and their employers through direct medical costs as well as through lost work time. Direct and indirect costs to the private sector related to BPH treatment are estimated to be 3.9 billion dollars.

Absenteeism↗
PubMed2005

Urologic diseases in America Project: analytical methods and principal findings.

PURPOSE: The burden of urological diseases on the American public is immense in human and financial terms but it has been under studied. We undertook a project, Urologic Diseases in America, to quantify the burden of urological diseases on the American public. MATERIALS AND METHODS: We identified public and private data sources that contain population based data on resource utilization by patients with benign and malignant urological conditions. Sources included the Centers for Medicare and Medicaid Services, National Center for Health Statistics, Medical Expenditure Panel Survey, National Health and Nutrition Examination Survey, Department of Veterans Affairs, National Association of Children's Hospitals and Related Institutions, and private data sets maintained by MarketScan Health and Productivity Management (MarketScan, Chichester, United Kingdom), Ingenix (Ingenix, Salt Lake City, Utah) and Center for Health Care Policy and Evaluation. Using diagnosis and procedure codes we described trends in the utilization of urological services. RESULTS: In 2000 urinary tract infections accounted for more than 6.8 million office visits and 1.3 million emergency room visits, and 245,000 hospitalizations in women with an annual cost of more than 2.4 billion dollars. Urinary tract infections accounted for more than 1.4 million office visits, 424,000 emergency room visits and 121,000 hospitalizations in men with an annual cost of more than 1 billion dollars. Benign prostatic hyperplasia was the primary diagnosis in more than 4.4 million office visits, 117,000 emergency room visits and 105,000 hospitalizations, accounting for 1.1 billion dollars in expenditures that year. Urolithiasis was the primary diagnosis for almost 2 million office visits, more than 600,000 emergency room visits, and more than 177,000 hospitalizations, totaling more than 2 billion dollars in annual expenditures. Urinary incontinence in women was the primary cause for more than 1.1 million office visits in 2000 and 452 million dollars in aggregate primary cause for more than 1.1 million office visits in 2000 and 452 million dollars in aggregate annual expenditures. Other manuscripts in this series present further detail for specific urologic conditions. CONCLUSIONS: Recent trends in epidemiology, practice patterns, resource utilization and costs for urological diseases have broad implications for quality of health care, access to care and the equitable allocation of scarce resources for clinical care and research.

Cost of Illness↗
PubMed2005

Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management?

BACKGROUND: More than 5% of the United States population has been diagnosed with nephrolithiasis and about one half of (first-time) stone formers will have a recurrence within 5 years. The prevalence of nephrolithiasis is concentrated among working age adults, yet little prior work has examined the economic burden of the disease on employers and their employees. We sought to estimate the direct and indirect costs of nephrolithiasis for working age adults (18-64) with employer-provided insurance. METHODS: This was an observational study using retrospective claims data. Detailed medical and pharmacy claims from 25 large employers and absentee data from a subset of firms were used to estimate the direct and indirect costs associated with nephrolithiasis in a privately insured, non-elderly population. Multivariate regression models were used to predict health care expenditures for persons with and without the condition, controlling for differences in patient (health status) and plan characteristics. RESULTS: More than 1% of working-age adults were treated for nephrolithiasis in 2000. Prevalence was considerably higher among men and employees age 55 to 64. About one third of employees treated for nephrolithiasis in 2000 missed work due to the condition, with an average work loss for the entire treated population of 19 hours per person. Conditional on receiving treatment, the incremental costs of nephrolithiasis were 3,494 US dollars per person in 2000. CONCLUSION: The direct and indirect costs of nephrolithiaisis are substantial among working-age adults. Interventions that prevent recurrence among known stone formers may be a cost-effective component of disease management programs.

Adolescent↗
PubMed2003

Regret in men treated for localized prostate cancer.

PURPOSE: We identify the predictors of medical regret in men treated for localized prostate cancer. MATERIALS AND METHODS: Patients previously treated for early stage prostate cancer were assessed for treatment regret using validated items. Univariate and multivariate analyses identified associations between regret and demographic characteristics, clinical outcomes, medical knowledge, and general and disease specific health related quality of life as measured by the general health perceptions domain of the RAND 36-Item Health Survey and a validated short form of the University of California, Los Angeles Prostate Cancer Index. RESULTS: Of 96 respondents (mean age 64 years, mean followup 2.8 years) 16% expressed regret with treatment decisions. Regretful men were almost twice as likely as nonregretful men to have less than a college education (60% versus 33%, p = 0.05) and worse current health related quality of life (p <0.05). In addition, regretful men tended to be unable to recall the most recent prostate specific antigen accurately (p = 0.06). Men with and without regret did not differ in other demographic characteristics, treatment choice or clinical outcomes. Regretful men were more likely to say they would choose a different treatment if they could. In multivariate analyses worse quality of life predicted regret but decline in quality of life with time was not associated with regret. CONCLUSIONS: Men expressing regret over treatment choice for localized prostate cancer have poorer health related quality of life. Further study is needed to identify factors that predict posttreatment regret. Such information will allow patients and physicians to individualize treatment decisions, optimize quality of life and avoid medical regret.

Aged↗
PubMed2003

Variation in continence and potency by definition.

PURPOSE: The reporting of quality of life outcomes after prostate cancer treatment has improved with the use of validated instruments and third party data collection, and yet widely disparate continence and potency rates persist among providers. We assessed how well various definitions of these outcomes correspond with each other in the same patients. MATERIALS AND METHODS: A longitudinal cohort of 269 men undergoing radical prostatectomy for early stage prostate cancer completed quality of life questionnaires, including the University of California-Los Angeles Prostate Cancer Index. Six definitions of urinary continence and 6 definitions of potency represented by individual or aggregated items in the survey were analyzed. Using 2,506 questionnaires patients meeting the criteria for continence or potency by each definition were compared. RESULTS: Correspondence among continence definitions varied widely. Of the men who reported using no pads only 42% leaked urine not at all. Other definitions had higher rates of concordance with 98% of patients who reported total control also claiming no pads. Correspondence among potency definitions was even more disparate. Only 5% of men with erections firm enough for intercourse reported having morning erection very often, while 61% rated their ability to function sexually as good or very good. CONCLUSIONS: Variations in outcomes from items intended to measure the same domain reflect the idiosyncrasy of patient definitions of urinary and erectile function. Disease targeted, health related quality of life outcomes vary greatly depending on the specific definition used.

Erectile Dysfunction↗