(UroToday.com) The 2025 World Congress of Endourology and Uro-Technology included a session on diversity, equity, and inclusion featuring work from Linda Dayan Rahmani and colleagues at Mount Sinai who presented their study titled “Impact of Language Barriers and Interpreter Services on Outcomes of Ambulatory Percutaneous Nephrolithotomy (PCNL)”. As PCNL continues to evolve from an inpatient procedure to an ambulatory one, patient comprehension of discharge and follow-up instructions becomes increasingly important. Language barriers may pose a significant challenge, potentially leading to disparities in care and postoperative outcomes. This study investigated whether non-English speakers experience different outcomes compared to English speakers after ambulatory PCNL.
The team conducted a retrospective analysis of 250 patients who underwent supine PCNL at their institution between March 2023 and December 2024. Patients were categorized as English or non-English speakers depending on their need for interpretation services. Demographics, stone characteristics, and intraoperative variables were compared between the two groups. Postoperative outcomes of interest included pain scores, non-same-day discharge rate, length of hospital stay, 30-day emergency department (ED) visits, and the interval from surgery to follow-up imaging.
Figure 1: Comparison of instruction-related outcomes between English and non-English speaking patients. (a) non-same-day discharge and 30-day ED visits, (b) pain scores in the recovery room and time interval from surgery to imaging.
Among the cohort, 213 patients were English speakers and 37 were non-English speakers. No significant differences were seen in demographics, stone size, or intraoperative characteristics. Postoperative outcomes, including non-same-day discharge rate, ED visits within 30 days, and recovery room pain scores, were also comparable between the two groups. However, non-English speakers experienced a significantly longer delay between surgery and follow-up imaging, averaging 66 days compared to 43 days for English speakers.
Dr. Linda Rahmani concluded that interpretation services may help reduce disparities in most postoperative outcomes. However, language barriers may still contribute to delays in follow-up care. They emphasized the need for urologists to ensure that postoperative instructions are delivered clearly and, in the patient’s, preferred language, to minimize gaps in care and loss to follow-up.
During the discussion, one audience member shared that his institution employs wheel-around interpreter devices, providing nearly automatic, on-the-spot translation for patients. He questioned whether these services extend across all levels of the care pathway—for example, whether radiology departments use interpreters when conveying imaging results. The presenter responded that Spanish-speaking patients often have easier access to radiology interpretation, but for less common languages, delays may occur depending on interpreter availability and scheduling.
Another audience member suggested that future work should incorporate a qualitative approach to better capture patient perspectives and experiences. Dr. Semins, serving as moderator, noted that her institution schedules postoperative follow-ups on the day of surgery to ensure interpreter availability, reducing the risk of missed communication. Dr. Santiago-Lastra emphasized the importance of listening directly to patients within this pipeline to understand their lived experiences. She also highlighted the role of insurance coverage in creating disparities: patients with HMOs or Medicaid may face greater structural barriers in arranging timely follow-up compared to those with PPO coverage. While interpreter services may be strong, systemic issues such as capitated care groups can still contribute to longer delays.
The moderators concluded that a deeper dive into community-level barriers, including insurance, access, and care coordination, would provide valuable insights to complement the current findings.
Presented By: Linda Dayan Rahmani, MD, Resident at Icahn School of Medicine at Mount Sinai
Written by: Kriselle Madamba, Department of Urology, University of California, Irvine, during the 2025 WCET Annual Meeting, September 8-12, 2025, Phoenix, Arizona, USA
References:- Adam D. Geffner, Ziv Savin, Linda Dayan Rahmani, Eve Frangopoulos, Vinay Durbhakula, Asher Mandel, Esther Kim, Aubrey DiBello, Blair Gallante, William M. Atallah, Mantu Gupta. Impact of Language Barriers and Interpreter Services on Outcomes of Ambulatory Percutaneous Nephrolithotomy [abstract]. In: World Congress of Endourology and Uro-Technology Annual Meeting, September 8-12, 2025, Phoenix, Arizona