Neal D Shore, Deepak A Kapoor, Evan R Goldfischer, David C Chaikin, Earl L Walz, R Jonathan Henderson, Richard G Harris, Robert D Asinof, Gary M Kirsh
{"title":"Preserving Independent Urology: LUGPA's First Decade.","authors":"Neal D Shore, Deepak A Kapoor, Evan R Goldfischer, David C Chaikin, Earl L Walz, R Jonathan Henderson, Richard G Harris, Robert D Asinof, Gary M Kirsh","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94353,"journal":{"name":"Reviews in urology","volume":"21 2-3","pages":"102-108"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864914/pdf/RiU021002-3_0102.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49687110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Raoul S Concepcion, Edward M Schaeffer, Neal D Shore, Deepak A Kapoor, Jeffrey A Scott, Gary M Kirsh
Given the number of prostate biopsies performed annually in the United States and associated infectious events as a result, we sought to determine if implementation of a standardized biopsy protocol utilizing antibiotic prophylaxis based on locally derived antibiograms would result in a decrease, relative to a contemporary control population, in the incidence of infection-related complications among community-based practices. A total of nine member groups of LUGPA participated in both a retrospective review and a prospective study of infection-related complications following prostate biopsy. Historic infectious complications, defined as chills/rigor, temperature higher than 101 °F, or documented positive blood or urine cultures, were self-reported by a retrospective review of patients undergoing prostate biopsy under the practice's current protocol in the year prior to the study. The prospective phase of the study required each group to develop a locally derived augmented prophylaxis regimen (>2 antibiotics) based on local antibiograms. After implementation, the practices enrolled patients undergoing prostate biopsy over an 8-week period. Monitoring for infection-related complication took place over the ensuing 3 weeks post-biopsy. Seven hundred fifty-nine patients over nine practices were enrolled into the study utilizing the augmented locally determined prophylaxis protocol. There was a 53% reduction in the incidence of infection-related complication, relative to the historical rate. By developing a standardized biopsy protocol with specific emphasis on incorporating an augmented antibiotic prophylactic regimen based upon local antibiograms, we were able to demonstrate in a prospective trial across nine geographically distinct community practices a significant reduction in the incidence of infection-related complications.
{"title":"The Effect of Local Antibiogram-based Augmented Antibiotic Prophylaxis on Infection-related Complications Following Prostate Biopsy.","authors":"Raoul S Concepcion, Edward M Schaeffer, Neal D Shore, Deepak A Kapoor, Jeffrey A Scott, Gary M Kirsh","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Given the number of prostate biopsies performed annually in the United States and associated infectious events as a result, we sought to determine if implementation of a standardized biopsy protocol utilizing antibiotic prophylaxis based on locally derived antibiograms would result in a decrease, relative to a contemporary control population, in the incidence of infection-related complications among community-based practices. A total of nine member groups of LUGPA participated in both a retrospective review and a prospective study of infection-related complications following prostate biopsy. Historic infectious complications, defined as chills/rigor, temperature higher than 101 °F, or documented positive blood or urine cultures, were self-reported by a retrospective review of patients undergoing prostate biopsy under the practice's current protocol in the year prior to the study. The prospective phase of the study required each group to develop a locally derived augmented prophylaxis regimen (>2 antibiotics) based on local antibiograms. After implementation, the practices enrolled patients undergoing prostate biopsy over an 8-week period. Monitoring for infection-related complication took place over the ensuing 3 weeks post-biopsy. Seven hundred fifty-nine patients over nine practices were enrolled into the study utilizing the augmented locally determined prophylaxis protocol. There was a 53% reduction in the incidence of infection-related complication, relative to the historical rate. By developing a standardized biopsy protocol with specific emphasis on incorporating an augmented antibiotic prophylactic regimen based upon local antibiograms, we were able to demonstrate in a prospective trial across nine geographically distinct community practices a significant reduction in the incidence of infection-related complications.</p>","PeriodicalId":94353,"journal":{"name":"Reviews in urology","volume":"21 2-3","pages":"93-101"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864918/pdf/RiU021002-3_0093.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49687111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anand Sharma, Narin Suleyman, Oliver Jones, Nikhil Vasdev
The past decade has seen significant improvement in our understanding of tumor biological features, which has led to use of anti-programmed-death 1 (PD-1) and anti-PD-ligand-1 (PD-L1) agents and cytotoxic T lymphocytes antigen 4 (CTLA-4) inhibitors in a multitude of cancers. These immunotherapeutic agents have shown activity in melanoma, lung, head and neck, colorectal, urological, and other cancers. This article details the use of immunotherapy agents in urothelial, renal, prostate, and testicular tumors.
{"title":"Immunotherapy in Urological Tumors.","authors":"Anand Sharma, Narin Suleyman, Oliver Jones, Nikhil Vasdev","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The past decade has seen significant improvement in our understanding of tumor biological features, which has led to use of anti-programmed-death 1 (PD-1) and anti-PD-ligand-1 (PD-L1) agents and cytotoxic T lymphocytes antigen 4 (CTLA-4) inhibitors in a multitude of cancers. These immunotherapeutic agents have shown activity in melanoma, lung, head and neck, colorectal, urological, and other cancers. This article details the use of immunotherapy agents in urothelial, renal, prostate, and testicular tumors.</p>","PeriodicalId":94353,"journal":{"name":"Reviews in urology","volume":"21 1","pages":"15-20"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585187/pdf/RiU021001_0015.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Best of the 2019 AUA Annual Meeting: Highlights From the 2019 American Urological Association Annual Meeting, May 3-6, 2019, Chicago, IL.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94353,"journal":{"name":"Reviews in urology","volume":"21 2-3","pages":"109-117"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864905/pdf/RiU021002-3_0109.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49687108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew J Ziegelmann, M Ryan Farrell, Laurence A Levine
Chronic scrotal content pain (CSCP) refers to bothersome pain localized to structures within the scrotum that has been present for ≥ 3 months. Etiologies include infection, trauma, and referred pain from the spine, abdomen, and retroperitoneum. However, in many patients there is no obvious identifiable cause. The initial evaluation should include a thorough history and physical examination with adjunctive imaging and laboratory tests as indicated. Treatments vary based on the underlying etiology and include both nonsurgical and surgical options with high levels of success when selectively utilized. The spermatic cord block with local anesthetic is an important tool that helps identify those patients who may benefit from surgery such as microscopic denervation of the spermatic cord. Other treatments including pelvic floor physical therapy may also be indicated in specific circumstances. Using a thoughtful and thorough approach to evaluation and treatment of CSCP, urologists can work with patients to achieve significant improvements in quality of life.
{"title":"Evaluation and Management of Chronic Scrotal Content Pain-A Common Yet Poorly Understood Condition.","authors":"Matthew J Ziegelmann, M Ryan Farrell, Laurence A Levine","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Chronic scrotal content pain (CSCP) refers to bothersome pain localized to structures within the scrotum that has been present for ≥ 3 months. Etiologies include infection, trauma, and referred pain from the spine, abdomen, and retroperitoneum. However, in many patients there is no obvious identifiable cause. The initial evaluation should include a thorough history and physical examination with adjunctive imaging and laboratory tests as indicated. Treatments vary based on the underlying etiology and include both nonsurgical and surgical options with high levels of success when selectively utilized. The spermatic cord block with local anesthetic is an important tool that helps identify those patients who may benefit from surgery such as microscopic denervation of the spermatic cord. Other treatments including pelvic floor physical therapy may also be indicated in specific circumstances. Using a thoughtful and thorough approach to evaluation and treatment of CSCP, urologists can work with patients to achieve significant improvements in quality of life.</p>","PeriodicalId":94353,"journal":{"name":"Reviews in urology","volume":"21 2-3","pages":"74-84"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864917/pdf/RiU021002-3_0074.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49687109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Duplications of the lower urinary tract are rare congenital anomalies that are usually accompanied by concomitant nonurologic anomalies; they are typically diagnosed in early childhood. In more rare cases these are isolated, leading to diagnosis later. We describe a 50-year-old man who remained asymptomatic and therefore undiagnosed for five decades. His is one of fewer than 20 cases in the literature describing urethral duplication in the coronal (collateral) plane, the more common variant being sagittal (dorsal-ventral) duplication. He is one of only four cases reported without concomitant midline anomaly. Furthermore, he is the sole case associated with adult polycystic kidney disease.
{"title":"Collateral urethral duplication in an adult with adult polycystic kidney disease.","authors":"Dunia T Khaled, A. Saltzman, L. J. Prats","doi":"10.3909/riu0705","DOIUrl":"https://doi.org/10.3909/riu0705","url":null,"abstract":"Duplications of the lower urinary tract are rare congenital anomalies that are usually accompanied by concomitant nonurologic anomalies; they are typically diagnosed in early childhood. In more rare cases these are isolated, leading to diagnosis later. We describe a 50-year-old man who remained asymptomatic and therefore undiagnosed for five decades. His is one of fewer than 20 cases in the literature describing urethral duplication in the coronal (collateral) plane, the more common variant being sagittal (dorsal-ventral) duplication. He is one of only four cases reported without concomitant midline anomaly. Furthermore, he is the sole case associated with adult polycystic kidney disease.","PeriodicalId":94353,"journal":{"name":"Reviews in urology","volume":"71 9 1","pages":"242-245"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72679197","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}
Although the open (incisional) approach to cystectomy (simple or radical) is regarded as a standard approach to the surgical removal of the bladder for benign and malignant conditions, laparoscopic and robot-assisted approaches are becoming more popular. Laparoscopic and robotic cystectomy procedures can be safely performed with acceptably low risk of blood loss, transfusion, and intraoperative complications.1,2 However, because no specific Current Procedural Terminology (CPT® [American Medical Association, Chicago, IL]) codes exist for the performance of these procedures, and due to the significantly varied procedures (eg, completing the procedure only partially or completely laparoscopic or robotic, whether it is for cancer or benign conditions, the type of urinary diversion that is performed, whether a lymph node dissection is performed, if a prostatectomy or hysterectomy is also performed, and so on), choosing the correct CPT code to submit has been a matter of debate. Codes that are often used for cystectomy procedures are listed in Table 1. Traditional teaching for coding laparoscopic procedures is to choose the laparoscopic code when the procedure is performed laparoscopically, and the open code when it is performed using an incisional technique. CPT codes typically have a vignette that describes the basics of the procedure and typical work that is included in the procedure as a basis for valuing the code. For example, when choosing CPT codes for nephrectomy, CPT 50545 should be chosen for laparoscopic radical nephrectomy and CPT 50230 for open radical nephrectomy (or CPT 50225 if the nephrectomy is complicated due to prior surgery in the area). For simple nephrectomy (noncancerous conditions), the codes are CPT 50546 and CPT 50220 for the laparoscopic and open procedures, respectively. However, this is not as simple when approaching cystectomy. We are taught that an unlisted procedure code should be used when no specific CPT code exists for the procedure being performed. When submitting for reimbursement, we are taught to choose a procedure with comparable work as a reference for reimbursement. In the case of cystectomy, the code to submit is CPT 51999 Unlisted laparoscopic procedure bladder, and the work submitted should be compared with the open cystectomy code. Because CPT 51999 is an unspecified code, other components of the procedure are not bundled or described; therefore, CPT codes for other aspects of the procedure that are performed, with their corresponding work, should also be submitted. For example, CPT 55866 for laparoscopic prostatectomy, CPT 58543 and CPT 58541 for laparoscopic hysterectomy (. 250 g or , 250 g, respectively),
{"title":"Laparoscopic Cystectomy Coding.","authors":"J. Rubenstein","doi":"10.3909/RIU0728","DOIUrl":"https://doi.org/10.3909/RIU0728","url":null,"abstract":"Although the open (incisional) approach to cystectomy (simple or radical) is regarded as a standard approach to the surgical removal of the bladder for benign and malignant conditions, laparoscopic and robot-assisted approaches are becoming more popular. Laparoscopic and robotic cystectomy procedures can be safely performed with acceptably low risk of blood loss, transfusion, and intraoperative complications.1,2 However, because no specific Current Procedural Terminology (CPT® [American Medical Association, Chicago, IL]) codes exist for the performance of these procedures, and due to the significantly varied procedures (eg, completing the procedure only partially or completely laparoscopic or robotic, whether it is for cancer or benign conditions, the type of urinary diversion that is performed, whether a lymph node dissection is performed, if a prostatectomy or hysterectomy is also performed, and so on), choosing the correct CPT code to submit has been a matter of debate. Codes that are often used for cystectomy procedures are listed in Table 1. Traditional teaching for coding laparoscopic procedures is to choose the laparoscopic code when the procedure is performed laparoscopically, and the open code when it is performed using an incisional technique. CPT codes typically have a vignette that describes the basics of the procedure and typical work that is included in the procedure as a basis for valuing the code. For example, when choosing CPT codes for nephrectomy, CPT 50545 should be chosen for laparoscopic radical nephrectomy and CPT 50230 for open radical nephrectomy (or CPT 50225 if the nephrectomy is complicated due to prior surgery in the area). For simple nephrectomy (noncancerous conditions), the codes are CPT 50546 and CPT 50220 for the laparoscopic and open procedures, respectively. However, this is not as simple when approaching cystectomy. We are taught that an unlisted procedure code should be used when no specific CPT code exists for the procedure being performed. When submitting for reimbursement, we are taught to choose a procedure with comparable work as a reference for reimbursement. In the case of cystectomy, the code to submit is CPT 51999 Unlisted laparoscopic procedure bladder, and the work submitted should be compared with the open cystectomy code. Because CPT 51999 is an unspecified code, other components of the procedure are not bundled or described; therefore, CPT codes for other aspects of the procedure that are performed, with their corresponding work, should also be submitted. For example, CPT 55866 for laparoscopic prostatectomy, CPT 58543 and CPT 58541 for laparoscopic hysterectomy (. 250 g or , 250 g, respectively),","PeriodicalId":94353,"journal":{"name":"Reviews in urology","volume":"82 1","pages":"157-158"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76979308","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}
{"title":"Staghorn calculi in a woman with recurrent urinary tract infections: NYU Case of the Month, December 2016.","authors":"Philip T. Zhao","doi":"10.3909/riu0734c","DOIUrl":"https://doi.org/10.3909/riu0734c","url":null,"abstract":"","PeriodicalId":94353,"journal":{"name":"Reviews in urology","volume":"12 1","pages":"237-238"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78345430","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}
Changes involving the health care economic landscape have affected physicians' workflow, productivity, compensation structures, and culture. Ongoing Federal legislation regarding regulatory documentation and imminent payment-changing methodologies have encouraged physician consolidation into larger practices, creating affiliations with hospitals, multidisciplinary medical specialties, and integrated delivery networks. As subspecialization and evolution of care models have accelerated, independent medical groups have broadened ancillary service lines by investing in enterprises that compete with hospital-based (academic and nonacademic) entities, as well as non-physician- owned multispecialty enterprises, for both outpatient and inpatient services. The looming and dramatic shift from volume- to value-based health care compensation will assuredly affect urology group compensation arrangements and productivity formulae. For groups that can implement change rapidly, efficiently, and harmoniously, there will be opportunities to achieve the Triple Aim goals of the Patient Protection and Affordable Care Act, while maintaining a successful medical-financial practice. In summary, implementing new payment algorithms alongside comprehensive care coordination will assist urology groups in addressing the health economic cost and quality challenges that have been historically encountered with fee-for-service systems. Urology group leadership and stakeholders will need to adjust internal processes, methods of care coordination, cultural dependency, and organizational structures in order to create better systems of care and management. In response, ancillary services and patient throughput will need to evolve in order to adequately align quality measurement and reporting systems across provider footprints and patient populations.
{"title":"Urology Group Compensation and Ancillary Service Models in an Era of Value-based Care.","authors":"N. Shore, Dana L. Jacoby","doi":"10.3909/RIU0726","DOIUrl":"https://doi.org/10.3909/RIU0726","url":null,"abstract":"Changes involving the health care economic landscape have affected physicians' workflow, productivity, compensation structures, and culture. Ongoing Federal legislation regarding regulatory documentation and imminent payment-changing methodologies have encouraged physician consolidation into larger practices, creating affiliations with hospitals, multidisciplinary medical specialties, and integrated delivery networks. As subspecialization and evolution of care models have accelerated, independent medical groups have broadened ancillary service lines by investing in enterprises that compete with hospital-based (academic and nonacademic) entities, as well as non-physician- owned multispecialty enterprises, for both outpatient and inpatient services. The looming and dramatic shift from volume- to value-based health care compensation will assuredly affect urology group compensation arrangements and productivity formulae. For groups that can implement change rapidly, efficiently, and harmoniously, there will be opportunities to achieve the Triple Aim goals of the Patient Protection and Affordable Care Act, while maintaining a successful medical-financial practice. In summary, implementing new payment algorithms alongside comprehensive care coordination will assist urology groups in addressing the health economic cost and quality challenges that have been historically encountered with fee-for-service systems. Urology group leadership and stakeholders will need to adjust internal processes, methods of care coordination, cultural dependency, and organizational structures in order to create better systems of care and management. In response, ancillary services and patient throughput will need to evolve in order to adequately align quality measurement and reporting systems across provider footprints and patient populations.","PeriodicalId":94353,"journal":{"name":"Reviews in urology","volume":"65 1","pages":"143-150"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89633802","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}
{"title":"2014-2016: How far has LUGPA come?","authors":"Gary M. Kirsh","doi":"10.3909/riu0735","DOIUrl":"https://doi.org/10.3909/riu0735","url":null,"abstract":"","PeriodicalId":94353,"journal":{"name":"Reviews in urology","volume":"114 4","pages":"221-224"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72575212","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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