Consistency in Care Opportunities for Prostate Cancer

Wanda WiltNicole SmithKatie GrantJayme NalleyJody Pinkerton

Through data analysis and multiple interviews and insights, this study attempted to address the inconsistency in care for patients with prostate cancer who shared similar journey time points, demographics, and care center expertise. The Consistency of Care Project aimed to evaluate the impact of efforts to improve targeted metrics surrounding crucial clinical interventions of prostate-specific antigen monitoring, surveillance scanning, and pharmacologic interventions over a 9-month period. For comparison, 15 private urology practices of like size, patient population, and demographics were monitored. Ten of the practices benefitted from reviewed workflow training on the PPS Analytics data platform; access to a PPS Analytics Clinical Analyst, who supported education for identification of actionable patients; consistent data analysis; workflow support; and regular check-in meetings to monitor progress. The 5 control sites were monitored without additional, purposeful intervention. Outcomes support the hypothesis that inconsistency in care can begin to be addressed through focused workflows, strong navigation, and attention to key performance indicators. Attrition rate differences of 32% vs 6% improvements (reengaging patients for care who had no next appointment scheduled). On average, the experimental group increased the metastatic castration-sensitive prostate cancer diagnosis rate by 10%. However, the treatment rates measured a relative increase of 35% but an average of 11% absolute improvement at the supported sites vs 6% at the control sites. Patients with metastatic castration-resistant prostate cancer at the supported sites improved by 20%, compared with those in the control group, who improved by 4%. Care teams with strong workflows, supportive resources, and consistent care pathways—when combined with data analytics—can influence care and drive increased, measurable differences.

Prostate cancerProstatic neoplasmsUrologyNeoplasmpatient navigation

Contemporary Management of Bulbar Urethral Strictures

Management Review

Andrew J CohenRoss S LiaoErica SternJames E Wright

Urethral stricture disease (USD) is a progressive scar-forming disease commonly encountered by urologists and is challenging to manage. USD most frequently occurs in the bulbar urethra. Patients typically present with chronic obstructive voiding symptoms but may develop recurrent urinary tract infections, detrusor failure, or renal disease. The authors review the pathophysiology, diagnostic workup, and evidence-based management of bulbar urethral strictures (BUS). There are multiple surgical options to treat BUS. Endoscopic techniques (eg, dilation and urethrotomy) are suitable for the initial management of short strictures but new evidence-based guidelines recommend against repeated endoscopic treatment. Urethroplasty is the gold standard treatment for BUS of all lengths, with anastomotic techniques appropriate for strictures <2 cm and tissue substitution performed for longer strictures. New techniques, such as non-transecting urethroplasty, lack long-term data but may represent a paradigm shift in the field. Future treatments may utilize tissue-engineered grafts and agents that inhibit inflammation and scar formation. [Rev Urol. 2020;22(4):139–151] © 2021 MedReviews®, LLC

UrethroplastyBulbar urethral strictureUrethrotomyUrethral dilationBuccal graft non-transecting

Failing to Prepare Is Preparing to Fail

Deepak A KapoorKathleen A Latino

[Rev Urol. 2020;22(3):91-92] © 2020 MedReviews®, LLC