Volume 23, Number 3Business of UrologyThe Business of Independent Urologic Medicine: Caring for Patients While Operating a Business in a Post–COVID-19 Era of Private PracticeNathan P. DillerMara HoltonPrimum non nocere—“First, do no harm.” Independent medicine is challenged not only to achieve outcomes that patients value but also not to intentionally harm their business in the process. The COVID-19 pandemic and postpandemic regulatory environment have added new limitations on and restrictions to independent practices’ ability to innovate, grow, and provide stable access to meet their communities’ urologic needs. In the face of these challenges, independent medicine is at its strongest when it continues to press toward meeting its social contract with its community. Conversely, but just as importantly, society needs to be mindful of its social contract with the health care workforce.UrologyPrivate practiceCOVID-19
Volume 23, Number 2Bladder CancerManagement of Adverse Events From Checkpoint Inhibitors in Urologic Practice: Where Are We Today?Caroline BranchDaniel CanterGautam JayramUrologic oncology has seen a tremendous impact from the emergence of checkpoint inhibitors in the management of malignant conditions of the urinary tract. These therapies are now in the nonmetastatic setting, and there is ample opportunity to integrate them into urologic practice. The most common barrier to starting a checkpoint inhibitor therapy program is concern about immune-related adverse event management. The evaluation and management of immune-related adverse events can be part of the treatment protocol and centralized to promote safety and success. The key components of implementing an in-office infusion program that includes checkpoint inhibitors are the use of a team-based approach, with a champion physician; appropriate patient education before and during treatment; and timely evaluation and treatment of all adverse events, with subspecialty consultation, if needed.ImmunotherapyUrologyurinary bladder neoplasms
Volume 23, Number 2Bladder CancerIntegrating JELMYTO (Mitomycin) for Pyelocalyceal Solution Into Community Practice: Practical Tips for the UrologistMichael J. ShannonSandip M. PrasadTreatment options for upper-tract urothelial carcinoma are based on whether the patient has high-risk or low-risk disease. Low-grade tumors can be managed with nephron-sparing approaches, including ureteroscopic resection and ablation, although most patients undergoing endoscopic treatment of upper-tract urothelial cancers face a risk of recurrence. Mitomycin gel for pyelocalyceal solution provides an effective alternative therapy. In OLYMPUS, a phase 3, single-arm, open-label study, 58% of patients with low-grade disease experienced a complete response to induction therapy at 3 months. Kaplan-Meier analysis revealed an estimated 12-month durable response rate of 82%. The most common treatment-emergent adverse events were ureteric stenosis, urinary tract infection, hematuria, and flank pain (grade <3). Mitomycin gel offers a novel, kidney-sparing, nonoperative approach to managing low-grade upper-tract urothelial carcinoma.MitomycinUrologyDrug therapyUrinary tractCarcinomaUrologic neoplasmsurinary bladder neoplasms
Volume 23, Number 1Treatment ReviewConsistency in Care Opportunities for Prostate CancerWanda WiltNicole SmithKatie GrantJayme NalleyJody PinkertonThrough 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
Volume 23, Number 1Meet The ExpertMeet the Expert: Erika Ferrozzo, MHADavid M. AlbalaErika FerrozzoIn-office dispensaries (IODs) are frequently discussed but rarely implemented in urology private group practices. In this interview, Erika Ferrozzo, MHA, CEO of the Idaho Urologic Institute and a member of the LUGPA Executive Leadership Program’s class of 2023, explains how the Idaho Urologic Institute identified an opportunity that helped its patients experience improved adherence and ease of access to treatment and that earned the practice a year-over-year $250 000 increase in net revenue.UrologyGroup practiceequipment and supplies
Volume 2, Number 4Review ArticlesInternet Information on UrologyWeb UpdateCynthia L ShamelUrologyContinuing medical educationHealth care dataInformationInternet
Volume 11, Number 2Case ReviewGenitourinary SarcoidosisEdmund S SabaneghPravin K RaoGenitourinary 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
Volume 17, Number 2Book ReviewsA Review of Transplantation Practice of the Urologic Organs: Is It Only Achievable for the Kidney?Treatment UpdateJack Donati-BourneHarry W RobertsYaseen RajjoubRobert A ColemanTransplantation is a viable treatment option for failure of most major organs. Within urology, transplantation of the kidney and ureter are well documented; however, evidence supporting transplantation of other urologic organs is limited. Failure of these organs carries significant morbidity, and transplantation may have a role in management. This article reviews the knowledge, research, and literature surrounding transplantation of each of the urologic organs. Transplantation of the penis, testicle, urethra, vas deferens, and bladder is discussed. Transplantation attempts have been made individually with each of these organs. Penile transplantation has only been performed once in a human. Testicular transplantation research was intertwined with unethical lucrative pursuits. Interest in urethra, bladder, and vas deferens transplantation has decreased as a result of successful surgical reconstructive techniques. Despite years of effort, transplantations of the penis, testicle, urethra, vas deferens, and bladder are not established in current practice. Recent research has shifted toward techniques of reconstruction, tissue engineering, and regenerative medicine. [Rev Urol. 2015;17(2):69–77 doi: 10.3909/riu0659] © 2015 MedReviews®, LLCUrologyTransplantationReconstructionTissue engineering