Pub Date : 2023-05-31DOI: 10.32474/juns.2023.04.000189
Kopytek Weronika
{"title":"What do we know about Treatment of Post Circumcision Penile Ischemia. Case report and Review of Literature","authors":"Kopytek Weronika","doi":"10.32474/juns.2023.04.000189","DOIUrl":"https://doi.org/10.32474/juns.2023.04.000189","url":null,"abstract":"","PeriodicalId":17651,"journal":{"name":"Journal of Urology & Nephrology Studies","volume":"294 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135477885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-24DOI: 10.32474/juns.2023.04.000181
Ramnik V Patel
Our team has extensive experience of dealing with pelvic outlet triple colorectal, genital and urinary systems anatomical diseases and functional disorders, congenital and acquired involving anatomical and functional problems [1-12].
{"title":"Successful Conservative Management of Triple Pelvic Outlet Functional Obstruction Syndrome with Voiding, Menstrual and Bowel Dysfunctions in an Adolescent Girl with long term follow up","authors":"Ramnik V Patel","doi":"10.32474/juns.2023.04.000181","DOIUrl":"https://doi.org/10.32474/juns.2023.04.000181","url":null,"abstract":"Our team has extensive experience of dealing with pelvic outlet triple colorectal, genital and urinary systems anatomical diseases and functional disorders, congenital and acquired involving anatomical and functional problems [1-12].","PeriodicalId":17651,"journal":{"name":"Journal of Urology & Nephrology Studies","volume":"27 14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136251814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-02DOI: 10.32474/juns.2023.04.000177
Joao Antonio Pereira-Correia
{"title":"Concordance between Urodynamicists: Can We Still Trust the Classification of Urofluxometry Curves?","authors":"Joao Antonio Pereira-Correia","doi":"10.32474/juns.2023.04.000177","DOIUrl":"https://doi.org/10.32474/juns.2023.04.000177","url":null,"abstract":"","PeriodicalId":17651,"journal":{"name":"Journal of Urology & Nephrology Studies","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135799658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-18DOI: 10.32474/juns.2021.03.000158
Abdul Kareem Meera Mohaideen
Urinary tract Obstruction (UTO) an alarming but common clinical condition affecting more women than men at any age, though common in 20 to 60 years of age having an overall incidence of hydronephrosis in 3.1% of autopsy. Over time, UTO results in irreversible loss of numerous nephrons leading to obstructive nephropathy and end-stage renal failure. If the obstruction of the ureter is partial and brief and if intervention is done at correct time, after relief of obstruction. complete recovery of renal function is possible. One has to be aware that UTO lasting more than 24 hours may cause irreversible loss of renal function. Radiology investigations may show UTO without ureteric dilation and dilation of ureter without UTO creating potential pitfall in radiologic diagnosis of UTO. Most of the UTO due to calculi are readily identifiable whereas many cases of ureteric exterior encasement are frequently missed from early detection even by experienced clinicians and radiologists. Failure in recognition of the encasement of ureters and causes may lead to mistaken diagnosis with resultant inappropriate management [1]. The most common benign cause of encasement of ureters is retroperitoneal fibrosis and the most frequent malignant causes are extension from an adjacent primary tumour such as sarcoma, lymphoma, (E.g.: sarcomas and lymphomas of uterus, ovaries, urinary bladder and prostate). Among benign conditions of swathed ureters, Extrinsic benign tumours, Retroperitoneal lymphadenopathy, Retroperitoneal abscess, Retroperitoneal fibrosis, Inflammatory abdominal aortic aneurysm or iliac artery aneurysm, and Endometriosis are significant. Chronic fibrosing conditions of the abdomen may involve multiple systems by their proliferative deep fibromatoses which form pseudotumor which cannot be differentiated from neoplastic conditions at imaging. Peri-ureteral inflammation (E.g.: peritonitis, salpingitis, and diverticulitis), multifocal idiopathic fibrosclerosis and schistosomiasis are some other known causes. Encasement may also be associated with blocked ureter [2-4]. Besides the inherent features of the disease causing the encasement of the ureters, in general, clinical features include recurrent fever, pain abdomen, oliguria, frequency, dysuria, haematuria nocturia, and hypertension. Patients may also present with fatigue, anorexia, weight loss, fever, hydroceles, scrotal pain, lower extremity oedema, and pulmonary embolism. Since ureters may be affected, various degrees of ureteral obstruction, hydronephrosis, and renal failure are also considered early and common clinical manifestations. In this article, we will review the four important diseases that cause ureteric encasement with some key imaging features for the diagnosis [5,6].
{"title":"Swathed Ureter, an Enigma in Diagnosis- A Pictorial Essay","authors":"Abdul Kareem Meera Mohaideen","doi":"10.32474/juns.2021.03.000158","DOIUrl":"https://doi.org/10.32474/juns.2021.03.000158","url":null,"abstract":"Urinary tract Obstruction (UTO) an alarming but common clinical condition affecting more women than men at any age, though common in 20 to 60 years of age having an overall incidence of hydronephrosis in 3.1% of autopsy. Over time, UTO results in irreversible loss of numerous nephrons leading to obstructive nephropathy and end-stage renal failure. If the obstruction of the ureter is partial and brief and if intervention is done at correct time, after relief of obstruction. complete recovery of renal function is possible. One has to be aware that UTO lasting more than 24 hours may cause irreversible loss of renal function. Radiology investigations may show UTO without ureteric dilation and dilation of ureter without UTO creating potential pitfall in radiologic diagnosis of UTO. Most of the UTO due to calculi are readily identifiable whereas many cases of ureteric exterior encasement are frequently missed from early detection even by experienced clinicians and radiologists. Failure in recognition of the encasement of ureters and causes may lead to mistaken diagnosis with resultant inappropriate management [1]. The most common benign cause of encasement of ureters is retroperitoneal fibrosis and the most frequent malignant causes are extension from an adjacent primary tumour such as sarcoma, lymphoma, (E.g.: sarcomas and lymphomas of uterus, ovaries, urinary bladder and prostate). Among benign conditions of swathed ureters, Extrinsic benign tumours, Retroperitoneal lymphadenopathy, Retroperitoneal abscess, Retroperitoneal fibrosis, Inflammatory abdominal aortic aneurysm or iliac artery aneurysm, and Endometriosis are significant. Chronic fibrosing conditions of the abdomen may involve multiple systems by their proliferative deep fibromatoses which form pseudotumor which cannot be differentiated from neoplastic conditions at imaging. Peri-ureteral inflammation (E.g.: peritonitis, salpingitis, and diverticulitis), multifocal idiopathic fibrosclerosis and schistosomiasis are some other known causes. Encasement may also be associated with blocked ureter [2-4]. Besides the inherent features of the disease causing the encasement of the ureters, in general, clinical features include recurrent fever, pain abdomen, oliguria, frequency, dysuria, haematuria nocturia, and hypertension. Patients may also present with fatigue, anorexia, weight loss, fever, hydroceles, scrotal pain, lower extremity oedema, and pulmonary embolism. Since ureters may be affected, various degrees of ureteral obstruction, hydronephrosis, and renal failure are also considered early and common clinical manifestations. In this article, we will review the four important diseases that cause ureteric encasement with some key imaging features for the diagnosis [5,6].","PeriodicalId":17651,"journal":{"name":"Journal of Urology & Nephrology Studies","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90058309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.13188/2380-0585.1000031
R. Lombardo, Destefanis, Varvello, Oriti, Tuccio, Ruggera, D. Rienzo, C. DeNunzio
Objective: To evaluate the efficacy of highly bioavailable curcumin complex on postoperative lower urinary symptoms in patients treated with photoselective vaporization of the prostate (PVP) for lower urinary tract symptoms and benign prostatic enlargement (LUTS/BPE) in a multicentre randomized controlled study. Materials and Methods: A consecutive series of patients with LUTS-BPE undergoing PVP were enrolled. Patients were randomized in a 2:1 ratio to oral highly bioavailable curcumin complex (Qurmin®, Naturneed, Italy), twice a day for 10 days then once daily for 20 days postoperatively or no treatment. Clinical and demographic characteristics of all patients were collected. Patients were evaluated preoperatively, on day 1 (after catheter removal), on day 15 and on day 30 using the International Prostate Symptom Score (IPSS), National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and Pain Urgency Frequency (PUF) questionnaires to assess the efficacy of the treatment. Results: Overall 106 patients were randomized to curcumin complex treatment (71/106:67%) or no treatment (35/106:33%). Preoperatively no significant differences in terms of age, PV, IPSS; Qmax, NIH-CPSI and PUF were recorded. Patients in both groups presented improvements in terms of IPSS, NIH-CPSI and PUF scores on day 15 and on day 30 when compared to day 1 (p<0,01). On day 15 patients on active treatment group presented a better improvement in terms of urinary symptoms (Δ15-1 IPSS score: 6,0 ± 7,6 vs 3,1 ± 4,6, p=0,001) and pain (Δ15-1 PUF pain : 1,7 ± 4,2 vs -0,8 ± 4,1, p=0,001). As well on day 30 patients on active treatment group presented a better improvement in terms of urinary symptoms (Δ30-1 IPSS score: 9,0 ± 7,6 vs 6,2 ± 6,4, p=0,001) and pain (Δ30-1 PUF pain: 3,3 ± 5,3 vs 1,6 ± 4,5, p=0,001). No significant differences in terms of NIH-CPS improvements were recorded between groups. No adverse events or side effects have been recorded in the treated group. Conclusions: Patients treated with highly bioavailable curcumin complex after PVP reported a significantly better improvement in symptoms and pain when compared to no treatment. Further studies should confirm our results.
目的:在一项多中心随机对照研究中，评价高生物利用度姜黄素复合物对下尿路症状和良性前列腺增大(LUTS/BPE)患者行前列腺光选择性汽化(PVP)治疗后下尿路症状的疗效。材料与方法:纳入了一系列连续的LUTS-BPE患者进行PVP治疗。患者以2:1的比例随机分配到口服高生物利用度姜黄素复合物(Qurmin®，Naturneed，意大利)，每天两次，持续10天，然后每天一次，持续20天，术后或未治疗。收集所有患者的临床和人口学特征。术前、拔管后第1天、第15天和第30天分别采用国际前列腺症状评分(IPSS)、美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)和疼痛急迫频率(PUF)问卷对患者进行评估，以评估治疗效果。结果:106例患者随机分为姜黄素复合治疗组(71/106:67%)和不治疗组(35/106:33%)。术前年龄、PV、IPSS差异无统计学意义;记录Qmax、NIH-CPSI、PUF。与第1天相比，两组患者在第15天和第30天的IPSS、NIH-CPSI和PUF评分均有改善(p< 0.01)。第15天，积极治疗组患者在泌尿系统症状(Δ15-1 IPSS评分:6,0±7,6 vs 3,1±4,6,p= 0.001)和疼痛(Δ15-1 PUF疼痛:1,7±4,2 vs -0,8±4,1,p= 0.001)方面有较好的改善。同时，在第30天，积极治疗组患者在泌尿系统症状(Δ30-1 IPSS评分:9,0±7,6比6,2±6,4,p= 0.001)和疼痛(Δ30-1 PUF疼痛:3,3±5,3比1,6±4,5,p= 0.001)方面均有较好的改善。在NIH-CPS改善方面，两组间无显著差异。治疗组无不良事件或副作用记录。结论:PVP后接受高生物利用度姜黄素复合物治疗的患者与未接受治疗的患者相比，症状和疼痛的改善明显更好。进一步的研究将证实我们的结果。
{"title":"Efficacy of Qurmin on Post-Operative Lower Urinary Tract Symptoms After Photoselective Vaporization of the Prostate: A Multicentre Case-Control Study","authors":"R. Lombardo, Destefanis, Varvello, Oriti, Tuccio, Ruggera, D. Rienzo, C. DeNunzio","doi":"10.13188/2380-0585.1000031","DOIUrl":"https://doi.org/10.13188/2380-0585.1000031","url":null,"abstract":"Objective: To evaluate the efficacy of highly bioavailable curcumin complex on postoperative lower urinary symptoms in patients treated with photoselective vaporization of the prostate (PVP) for lower urinary tract symptoms and benign prostatic enlargement (LUTS/BPE) in a multicentre randomized controlled study. Materials and Methods: A consecutive series of patients with LUTS-BPE undergoing PVP were enrolled. Patients were randomized in a 2:1 ratio to oral highly bioavailable curcumin complex (Qurmin®, Naturneed, Italy), twice a day for 10 days then once daily for 20 days postoperatively or no treatment. Clinical and demographic characteristics of all patients were collected. Patients were evaluated preoperatively, on day 1 (after catheter removal), on day 15 and on day 30 using the International Prostate Symptom Score (IPSS), National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and Pain Urgency Frequency (PUF) questionnaires to assess the efficacy of the treatment. Results: Overall 106 patients were randomized to curcumin complex treatment (71/106:67%) or no treatment (35/106:33%). Preoperatively no significant differences in terms of age, PV, IPSS; Qmax, NIH-CPSI and PUF were recorded. Patients in both groups presented improvements in terms of IPSS, NIH-CPSI and PUF scores on day 15 and on day 30 when compared to day 1 (p<0,01). On day 15 patients on active treatment group presented a better improvement in terms of urinary symptoms (Δ15-1 IPSS score: 6,0 ± 7,6 vs 3,1 ± 4,6, p=0,001) and pain (Δ15-1 PUF pain : 1,7 ± 4,2 vs -0,8 ± 4,1, p=0,001). As well on day 30 patients on active treatment group presented a better improvement in terms of urinary symptoms (Δ30-1 IPSS score: 9,0 ± 7,6 vs 6,2 ± 6,4, p=0,001) and pain (Δ30-1 PUF pain: 3,3 ± 5,3 vs 1,6 ± 4,5, p=0,001). No significant differences in terms of NIH-CPS improvements were recorded between groups. No adverse events or side effects have been recorded in the treated group. Conclusions: Patients treated with highly bioavailable curcumin complex after PVP reported a significantly better improvement in symptoms and pain when compared to no treatment. Further studies should confirm our results.","PeriodicalId":17651,"journal":{"name":"Journal of Urology & Nephrology Studies","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79634525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.13188/2380-0585.1000032
V. Daniels-Hepnar
{"title":"The Therapeutic Ladder - A Clinician and a Patient Perspective","authors":"V. Daniels-Hepnar","doi":"10.13188/2380-0585.1000032","DOIUrl":"https://doi.org/10.13188/2380-0585.1000032","url":null,"abstract":"","PeriodicalId":17651,"journal":{"name":"Journal of Urology & Nephrology Studies","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84532874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-12-30DOI: 10.13188/2380-0585.1000029
Mubarika, Haryana
Prostate Cancer (PCa) isthe fifth leading cause of death worldwide and the second most common cancer in men. Worldwide, it was estimated that around 1,276,106 newly diagnosed PCa were reported in 2018 [1]. The diagnosis of suspected PCa is made when the abnormality from the Digital Rectal Examination (DRE) and elevated Prostate Specific Antigen (PSA) present [2]. PSA value of morethan 4 ng/mlisan indication for prostate biopsy examination and this border line value hasa positive predictive value of only 37%, and a negative predictive value of 91% [2]. Therefore, rigorous studies searching for new biomarkers with non-invasive methods that have higher specificity than PSA and can be used as an early detectors as well as prognostic predictors of PCa, have emerged [3].
{"title":"MicroRNA and messenger RNA As Potential Urinary Biomarkers in Prostate Cancer","authors":"Mubarika, Haryana","doi":"10.13188/2380-0585.1000029","DOIUrl":"https://doi.org/10.13188/2380-0585.1000029","url":null,"abstract":"Prostate Cancer (PCa) isthe fifth leading cause of death worldwide and the second most common cancer in men. Worldwide, it was estimated that around 1,276,106 newly diagnosed PCa were reported in 2018 [1]. The diagnosis of suspected PCa is made when the abnormality from the Digital Rectal Examination (DRE) and elevated Prostate Specific Antigen (PSA) present [2]. PSA value of morethan 4 ng/mlisan indication for prostate biopsy examination and this border line value hasa positive predictive value of only 37%, and a negative predictive value of 91% [2]. Therefore, rigorous studies searching for new biomarkers with non-invasive methods that have higher specificity than PSA and can be used as an early detectors as well as prognostic predictors of PCa, have emerged [3].","PeriodicalId":17651,"journal":{"name":"Journal of Urology & Nephrology Studies","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75474239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-30DOI: 10.13188/2380-0585.1000026
{"title":"Renal Failure from CastNephropathy: Role of Plasmapheresis","authors":"","doi":"10.13188/2380-0585.1000026","DOIUrl":"https://doi.org/10.13188/2380-0585.1000026","url":null,"abstract":"","PeriodicalId":17651,"journal":{"name":"Journal of Urology & Nephrology Studies","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72672804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-11DOI: 10.32474/JUNS.2019.01.000119
J. Sullivan
End Stage Renal Disease impacts the lives of over 725,000 Americans and their families. In 1972, despite the cost of supporting a rapidly growing chronic condition at the time, the United States initiated a system whereby everyone would be treated that qualifies for social security benefits, after a waiting period of three years (Medicare Secondary Payer was slowly extended over the years to 36 months after diagnosis as it currently stands), regardless of age, providing the platform for the debate of a potential nationalized health care system that currently seems to be in a period of uncertainty. However, over three decades through significant consolidation, the treatment of dialysis via two large provider chains (one fully integrated) have directed patients to hemodialysis in the out-patient setting without considering the technological or clinical benefits of home hemodialysis or peritoneal dialysis [1,2]. This may have occurred as a result of medical training although the overall system is structured more on a corporate basis today with new nephrologists joining practices that are already contracted with a large chain through medical directorships. That said, patients seem to be directed towards outpatient hemo-dialysis over other options such as home hemo-dialysis and peritoneal dialysis. The result has created an economic and medical system that has shifted toward what is perceived as the lowest cost of care without a consideration for other treatment modalities that promote a better quality of life for the patient as well as greater monetary benefits for the United States Federal Government. From a pure economic standpoint, profitability for providers is in the out-patient clinics despite the initial investment of $1-2 million to build out a clinic via fixed asset utilization and the variable cost of peritoneal dialysis as well as the supply costs needed for home hemodialysis. In other words, for these two treatment modalities, the margin, if any, is built purely into the treatment. Margins can be enhanced through high utilization of in-center facilities via leveraging the staff and fixed costs while using economies of scale to reduce variable costs such as dialyzers and lines combined with a favorable commercial patient base. With the focus on this modality, there are economic impacts based on decisions that increase the overall expenditures to the entire system that can easily be avoided or reduced.
{"title":"Employment Status of Patients with ESRD and the Subsequent treatment modalities in the United State","authors":"J. Sullivan","doi":"10.32474/JUNS.2019.01.000119","DOIUrl":"https://doi.org/10.32474/JUNS.2019.01.000119","url":null,"abstract":"End Stage Renal Disease impacts the lives of over 725,000 Americans and their families. In 1972, despite the cost of supporting a rapidly growing chronic condition at the time, the United States initiated a system whereby everyone would be treated that qualifies for social security benefits, after a waiting period of three years (Medicare Secondary Payer was slowly extended over the years to 36 months after diagnosis as it currently stands), regardless of age, providing the platform for the debate of a potential nationalized health care system that currently seems to be in a period of uncertainty. However, over three decades through significant consolidation, the treatment of dialysis via two large provider chains (one fully integrated) have directed patients to hemodialysis in the out-patient setting without considering the technological or clinical benefits of home hemodialysis or peritoneal dialysis [1,2]. This may have occurred as a result of medical training although the overall system is structured more on a corporate basis today with new nephrologists joining practices that are already contracted with a large chain through medical directorships. That said, patients seem to be directed towards outpatient hemo-dialysis over other options such as home hemo-dialysis and peritoneal dialysis. The result has created an economic and medical system that has shifted toward what is perceived as the lowest cost of care without a consideration for other treatment modalities that promote a better quality of life for the patient as well as greater monetary benefits for the United States Federal Government. From a pure economic standpoint, profitability for providers is in the out-patient clinics despite the initial investment of $1-2 million to build out a clinic via fixed asset utilization and the variable cost of peritoneal dialysis as well as the supply costs needed for home hemodialysis. In other words, for these two treatment modalities, the margin, if any, is built purely into the treatment. Margins can be enhanced through high utilization of in-center facilities via leveraging the staff and fixed costs while using economies of scale to reduce variable costs such as dialyzers and lines combined with a favorable commercial patient base. With the focus on this modality, there are economic impacts based on decisions that increase the overall expenditures to the entire system that can easily be avoided or reduced.","PeriodicalId":17651,"journal":{"name":"Journal of Urology & Nephrology Studies","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87074146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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