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Directory of Authors from the Journal and their last article.

Duk-Yoon KimView Articles
Dunia Taufiq KhaledView Articles

Volume 18, Number 4Case Review

Collateral Urethral Duplication in an Adult With Adult Polycystic Kidney Disease

Dunia Taufiq KhaledAmanda Feige SaltzmanLester Joesph Prats

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. [Rev Urol. 2016;18(4):242-245 doi: 10.3909/riu0705] © 2016 MedReviews®, LLC

Collateral duplicationCoronal duplicationDuplicate urethraUrethral anomalyDuplication of lower urinary tract

Dustin WhitakerView Articles

Volume 20, Number 3Original Research

Accuracy in 24-hour Urine Collection at a Tertiary Center

Dean G AssimosKyle WoodCarter BoydDustin WhitakerOmotola AshorobiRobert OsterLisa HarveyRoss P Holmes

There is a paucity of studies addressing the accuracy of 24-hour urine collection for assessing stone risk parameters. Collection accuracy is thought to be essential for assigning optimal therapy for stone prevention. The objective of this study was to determine factors associated with accurate and inaccurate collections. During a 2-year period (2015-2016), 241 stone formers completed 24-hour urine collections. They were divided into accurate collectors (AC), defined as at least one accurate urine collection, and inaccurate collectors (IC). Accuracy was assessed by 24-hour urine creatinine (Cr) excretion indexed to body weight (normal: males, 20-25 mg Cr/kg; females, 15-20 mg Cr/kg). Demographic data analyzed included age, gender, race, insurance status, partner status, income, and education. Statistical analysis methods included the chi-square test, Fisher’s exact test, and the two-group t-test. Average age was 50.7 years at the time of collection; 50.2% were men, 86% were white, and 14% were black. Overall, 51.0% of collections were inaccurate. There was no statistical significance between AC and IC for gender (P = 0.85), race (P = 0.90), insurance status (P = 0.85), recurrence (P = 0.87), stone type (P = 0.57), education (P = 0.35), income (P = 0.42), or poverty (P = 0.35). Older age (P = 0.017) and having a partner (P = 0.022) were significantly associated with AC. The high rate of inaccurate 24-hour urine collections is a concern. The only factors we identified as influencing collection accuracy were age and partner status. These results underscore the importance of developing methods to improve the accuracy of collecting 24-hour urine samples. [Rev Urol. 2018;20(3):119–124 doi: 10.3909/riu0807] © 2018 MedReviews®, LLC

Kidney stonesMetabolic evaluation24-hour urine collectionaccuracyDemographicsSocioeconomic factors

Dylan StoyView Articles

Volume 18, Number 3Original Research

Health Economic Impact and Prospective Clinical Utility of Oncotype DX® Genomic Prostate Score

Michael J KemeterPhillip G FebboDavid AlbalaRuixiao LuVincy JohnDylan StoyBela DenesMarybeth McCallAlan W ShindelFrank Dubeck

Prostate cancer (CaP) will be diagnosed in approximately 181,000 American men in 2016. Despite the high number of deaths from CaP in the United States, the disease has a protracted natural history and many men diagnosed with CaP will not die of the disease regardless of treatment. Unfortunately, identification of men with truly indolent/nonaggressive CaP is challenging; limitations of conventional diagnostic modalities diminish the ability of physicians to accurately stage every case of CaP based on biopsy results alone. The resulting uncertainty in prognosis may prompt men with low-risk CaP to proceed to morbid and expensive treatments for an unclear survival benefit. Incorporation of the Genomic Prostate Score (GPS) as part of the decision algorithm for patients with National Comprehensive Cancer Network very low-risk and low-risk cancer led to a substantial increase in uptake of active surveillance and substantial cost savings. GPS provides physicians and patients with an additional tool in assessing personalized risk and helps guide individual decision making. [Rev Urol. 2016;18(3):123-132 doi: 10.3909/riu0725] © 2016 MedReviews®, LLC

Prostate cancerOncotype DX® GPSGenomic testingHealth economicsClinical utility

E Darracott VaughanView Articles
E David CrawfordView Articles
Earl L WalzView Articles
Earl WalzView Articles

Volume 22, Number 2Review Articles

Implementation of a Centralized, Cost-effective Call Center in a Large Urology Community Practice

Original Research

Gary M KirshStephen F KappaChris McClainKrista WallacePaul CinquinaDon LawsonMary M SmithEarl WalzBrooke Edwards

Call centers provide front-line care and service to patients. This study compared call-answering efficiency and costs between the implementation of an internal, centralized call center (January to July 2019) and previously outsourced call-center services (January to July 2018) for a large urology community practice. Retrospective review of call metrics and cost data was performed. Internal call-center leadership, training, and culture was examined through survey of staff and management. A total of 299,028 calls with an average of 5751 calls per week were answered during the study periods. The Average Speed of Answer (ASA) was 1:42 (min:s) for the outsourced call center and 0:14 for the internal call center (P < 0.001), with 70% of outsourced calls answered under 2 minutes compared with 99% of calls for the internal call center (P < 0.001). The Average Handle Time (AHT) for each outsourced call was 5:32 versus 3:41 for the internal call center (P < 0.001). The total operating expenses were 7.7% lower for the internal call center. Surveys revealed the importance of engaged leadership and staff training with feedback, simplified work algorithms, and expanded clinical roles. We found that internal, centralized call centers may provide a call-answering solution with greater efficiency and lower total operating expense versus an outsourced call center for large surgical practices. A culture that emphasizes continuous improvement and empowers call-center staff with expanded clinical roles may ultimately enhance patient communication and service. [Rev Urol. 2020;22(2):67–74] © 2020 MedReviews®, LLC

Cost effectivenessCall centerTelehealthOrganizational efficiency

Edith Canby-HaginoView Articles
Edmund S SabaneghView Articles

Volume 11, Number 2Case Review

Genitourinary Sarcoidosis

Edmund S SabaneghPravin K Rao

Genitourinary involvement of sarcoidosis can mimic many common urologic conditions. Although sarcoidosis is a benign inflammatory condition, it can present much like malignant or infectious conditions; thus, failed diagnosis can lead to unnecessary medications or surgical procedures. In addition, management choices for patients with scrotal findings have important implications for future fertility. Thus, this uncommon condition should be on the differential diagnosis for any urologic patient. The authors report on a patient with a scrotal mass as his presenting symptom of sarcoidosis and review the diagnosis, implications, and management of sarcoidosis involving all potential sites in the urinary tract.[Rev Urol. 2009;11(2):108-113]

UrologySarcoidosisGenitourinaryScrotal mass

Edmund Y KoView Articles

Volume 15, Number 4Case Review

47,XYY Syndrome and Male Infertility

Edmund S SabaneghIna W KimArjun C KhadilkarEdmund Y Ko

Men with 47,XYY syndrome present with varying physical attributes and degrees of infertility. A retrospective chart review was performed on a male infertility and genetic anomaly database. Three patients with 47,XYY were found. Each presented with . 2 years of infertility. All were tall with elevated body mass indices. Scrotal findings ranged from normal to atrophic testicles. Semen analyses demonstrated oligospermia and varying endocrine profiles. Because of the diverse phenotype and potential lack of symptoms, identification and diagnosis of men with 47,XYY syndrome may be difficult. We recommend careful screening of 47,XYY patients and referral to primary physicians for long-term follow-up for increased incidence of health-related comorbidities. [Rev Urol. 2013;15(4):188-196 doi: 10.3909/riu0580] © 2014 MedReviews®, LLC

XYY syndromeInfertility syndromes

Eduard J GamitoView Articles
Eduardo I CantoView Articles
Edward F IkeguchiView Articles
Edward J McGuireView Articles
Edward KimView Articles
Edward LoizidesView Articles
Edward M SchaefferView Articles

Volume 12, Number 1Review Articles

Complications of Pelvic Lymphadenectomy: Do the Risks Outweigh the Benefits?

Treatment Review

Alan W PartinEdward M SchaefferStacy Loeb

The American Urological Association Best Practice Policy states that although pelvic lymph node dissection (PLND) is commonly done with radical prostatectomy, its morbidity must be considered, particularly in cases in which it offers little additional information. The benefits of PLND include more accurate staging and reassurance for the patient. In addition, PLND may be therapeutic for men with lymph node metastases and may result in long-term biochemical cure for selected node-positive patients. However, the incidence of node positivity is declining, and accordingly a greater number of lymphadenectomies must be performed to benefit 1 patient. In addition to the associated cost, PLND has the potential for morbidity, including lymphoceles, thromboembolic events, ureteral injury, and neurovascular injury. Patients and physicians should therefore assess the risk/benefit ratio associated with PLND on an individual basis to permit informed treatment decisions.[Rev Urol. 2010;12(1):20-24 doi:10.3909/riu0422]

Prostate cancerRadical prostatectomyPelvic lymph node dissectionUreteral injuryLymph node metastasesRisk to benefit ratioLymphoceleThromboembolic eventsVascular injuryNerve injury

Edward N RampersaudView Articles

Volume 14, Number 3Review Articles

Systemic Therapy for Metastatic Renal Cell Carcinoma: A Review and Update

Management Update

Karim ChamieJoshua E LoganEdward N RampersaudGeoffrey A SonnDennis J SlamonFairooz F KabbinavarArie S BelldegrunAllan J Pantuck

An in-depth understanding of metastatic renal cell carcinoma (mRCC) is important so that practitioners can make informed evidenced-based decisions with patients to optimize not only quantity of life but quality of life as well. Therefore, this review focuses on the biology of mRCC as it relates to targets for therapy, as well as on the small molecules rationally designed with these targets in mind. In addition, anticipated emerging therapies are highlighted, including the new tyrosine kinase inhibitors axitinib and tivozanib, as well as new immune-based therapies such as dendritic cell-based vaccines and antibodies. We also briefly review recent reports from the emerging field of predicting drug response based on molecular markers. And finally, management of metastatic non-clear cell RCC histologies are discussed focusing on available evidence to direct decision making when assessing therapeutic options. [Rev Urol. 2012;14(3/4):65-78 doi: 10.3909/riu0562] © 2013 MedReviews®, LLC

Metastatic renal cell carcinomaTyrosine kinase inhibitorsDendritic cell-based vaccines

Edward ZoltanView Articles

Volume 9, Number 4Review Articles

Anticholinergics and Central Nervous System Effects: Are We Confused?

Treatment Update

David R StaskinEdward Zoltan

The central nervous system (CNS) effects of anticholinergic agents have been documented in various patient populations and to varying degrees in case reports, brain-activity surrogates, and computerized cognitive testing. The older patient population with overactive bladder represents a group at increased risk of cognitive impairment and other CNS side effects associated with antimuscarinic agents. The complexity of the effect of anticholinergic agents on CNS function requires an increased level of careful investigation. Studies need to be performed in the at-risk population with multiple, validated tests at clinically prescribed doses in acute and chronic situations. These studies need to take into account the effect of commonly prescribed dosing regimens, with doses selected to represent with equivalent bladder potency. The alterations in the serum levels and parent/metabolite effects contributed by metabolic issues or drug delivery systems require special attention. [Rev Urol. 2007;9(4):191-196]

Overactive bladderElderlyAntimuscarinic drugsCNS adverse eventsCognitive impairment