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Call centerView 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

Calyceal diverticulaView Articles

Volume 16, Number 1Review Articles

Calyceal Diverticula: A Comprehensive Review

Disease State Review

Zeph OkekeNikhil WaingankarSamih HayekArthur D Smith

Calyceal diverticula are rare outpouchings of the upper collecting system that likely have a congenital origin. Stones can be found in up to 50% of calyceal diverticula, although, over the combined reported series, 96% of patients presented with stones. Diagnosis is best made by intravenous urography or computed tomography urogram. Shock wave lithotripsy (SWL) is an option for first-line therapy in patients with stone-bearing diverticula that have radiologically patent necks in mid- to upper-pole diverticula and small stone burdens. Stone-free rates are the lowest with SWL, although patients report being asymptomatic following therapy in up to 75% of cases with extended follow-up. Ureteroscopy (URS) is best suited for management of anteriorly located mid- to upper-pole diverticular stones. Drawbacks to URS include difficulty in identifying the ostium and low rate of obliteration. Percutaneous management is best used in posteriorly located mid- to lower-pole stones, and offers the ability to directly ablate the diverticulum. Percutaneous nephrolithotomy remains effective in the management of upper-pole diverticula, but carries the risk of pulmonary complications unless subcostal access strategies such as triangulation or renal displacement are used. Laparoscopic surgery provides definitive management, but should be reserved for cases with large stones in anteriorly located diverticula with thin overlying parenchyma, and cases that are refractory to other treatment. This article reviews the current theories on the pathogenesis of calyceal diverticula. The current classification is examined in addition to the current diagnostic methods. Here we summarize an extensive review of the literature on the outcomes of the different treatment approaches. [ Rev Urol. 2014;16(1):29-43 doi: 10.3909/riu0581] © 2014 MedReviews®, LLC

UreterorenoscopyCalyceal diverticulaPercutaneous nephrostolithotomyLaparoscopic surgeryShock wave lithotripsy

Calyceal diverticulumView Articles

Volume 12, Number 1Case Review

Transitional Cell Carcinoma Within a Calyceal Diverticulum Associated With Stone Disease

Case Review

Dean G AssimosJack M ZuckermanCorey Passman

We report a case of transitional cell carcinoma (TCC) discovered within a calyceal diverticulum at the time of percutaneous nephrolithotomy. The stones and tumor were endoscopically removed and the diverticular cavity fulgurated. Pathologic analysis demonstrated low-grade TCC. A subsequent laparoscopic radical nephroureterectomy was performed and high-grade TCC invading the parenchyma was found. This case demonstrates the potential for TCC to develop in stone-containing calyceal diverticula and also the potential for coexistence of different grades of TCC within the involved renal unit.[Rev Urol. 2010;12(1):52-55 doi: 10.3909/riu0446]

Percutaneous nephrolithotomyUrinary tract infectionTransitional cell carcinomaUrolithiasisCalyceal diverticulumStone

CancerView Articles
Cancer mortality ratesView Articles
Cancer screeningView Articles
Cancer surveillanceView Articles

Volume 18, Number 4Prostate Cancer Academy

Prostate Cancer Survivorship: Implementation of Survivorship Care Plans to Meet the Mandate and Enhance Urologic Practice Through Collaborative Care

Alison M RasperRyan P Terlecki

Prostate cancer is the most common malignancy among the male survivorship population in the United States, representing 44% of approximately 7 million survivors. In the era of modern medicine and value-based care, successfully treating only the cancer is not sufficient. The cancer survivor represents an individual in need of restoration and protection against future events. A well-designed and well-supported survivorship program not only meets a mandate for accreditation, it logically translates into better patient care. This review summarizes the history of the survivorship movement, outlines some key elements of a survivorship program, and highlights the opportunity to apply these principles to improve cancer-related care, develop relationships with colleagues that may allow increased identification of men at risk, and expand both the experience and outcomes of individual specialists within men’s health. [Rev Urol. 2016;18(4):214-220 doi: 10.3909/riu0733] © 2016 MedReviews®, LLC

Cancer, prostateSurvivorship care planCancer surveillance

Cancer survivorshipView Articles

Volume 18, Number 2Review Articles

Challenges and Opportunities in Radiation-induced Hemorrhagic Cystitis

Therapeutic Strategy Update

Michael B ChancellorBernadette MM ZwaansHeinz G NicolaiLaura E Lamb

As diagnosis and treatment of cancer is improving, medical and social issues related to cancer survivorship are becoming more prevalent. Hemorrhagic cystitis (HC), a rare but serious disease that may affect patients after pelvic radiation or systemic chemotherapy, has significant unmet medical needs. Although no definitive treatment is currently available, various interventions are employed for HC. Effects of nonsurgical treatments for HC are of modest success and studies aiming to control radiation-induced bladder symptoms are lacking. In this review, we present current and advanced therapeutic strategies for HC to help cancer survivors deal with long-term urologic health issues. [Rev Urol. 2016;18(2):57-65 doi: 10.3909/riu0700] © 2016 MedReviews®, LLC

Hemorrhagic cystitisRadiation-induced cystitisHematuriaCancer survivorship

Cancer treatmentView Articles
Cancer, bladderView Articles
Cancer, prostateView Articles
Cancer, renalView Articles
Cancer, renal cellView Articles
Cancer, stagingView Articles
Candida albicansView Articles

Volume 16, Number 2Case Review

Solitary Candida albicans Infection Causing Fournier Gangrene and Review of Fungal Etiologies

Tiffany A PerkinsJared M BieniekJoel M Sumfest

Polymicrobial bacterial infections are commonly found in cases of Fournier gangrene (FG), although fungal growth may occur occasionally. Solitary fungal organisms causing FG have rarely been reported. The authors describe a case of an elderly man with a history of diabetes who presented with a necrotizing scrotal and perineal soft tissue infection. He underwent emergent surgical debridement with findings of diffuse urethral stricture disease and urinary extravasation requiring suprapubic tube placement. Candida albicans was found to be the single causative organism on culture, and the patient recovered well following antifungal treatment. Fungal infections should be considered as rare causes of necrotizing fasciitis and antifungal treatment considered in at-risk immunodeficient individuals. [Rev Urol. 2014;16(2):95-98 doi: 10.3909/riu0595] © 2014 MedReviews®, LLC

Fournier gangreneFournier’s Gangrene Severity IndexCandida albicans

CaP CUREView Articles
Capromab pendetideView Articles

Volume 8, Supplement 1Review Articles

The Emergence of Radioimmunoscintigraphy for Prostate Cancer

Prostate Cancer Imaging

David G McLeodThomas E KeaneInger L RosnerM Scott Wingo

The ability to label tissue-specific antibodies has long been of interest for improving detection and guidance for therapeutic applications. The most studied target for prostate cancer is the prostate-specific membrane antigen, which is upregulated in prostate cancer, hormone-refractive disease, and prostate cancer metastases. Investigations using radioimmunoscintigraphy with the radiolabeled 7E11 antibody capromab pendetide have significantly improved sensitivity for prostate cancer detection compared with standard cross-sectional imaging, based on tissue confirmation of pathologic results. Over the past 5 years, significantly greater image resolution from improved camera technology and the use of co-registration to fuse functional and anatomic (computerized tomography and magnetic resonance imaging) images have dramatically enhanced prostate cancer localization. Outcomes data from several sources have spurred a resurgence in interest in this imaging modality. [Rev Urol. 2006;8(suppl 1):S20-S28]

Prostate cancerProstaScintProstate-specific membrane antigenRadioimmunoscintigraphyCapromab pendetideImage co-registrationLymph node metastasis

CapsaicinView Articles
Carbonic anhydrase inhibitorsView Articles
CarcinogenesisView Articles
Carcinoid tumorView Articles
CarcinomaView Articles

Volume 23, Number 4Kidney Cancer

Imaging Techniques in the Diagnosis of Renal Cell Carcinoma: Contemporary Trends and Future Directions

Gautam Jayram

Increasing radiographic detection of incidental small renal masses has led to a growing concern regarding overtreatment of these lesions. Given the limitations of computed tomography and magnetic resonance imaging, there is an unmet need for improved kidney imaging techniques that can provide more accurate assessments of renal lesions. This review provides a summary of established kidney imaging modalities and also those likely to be meaningful in the near future. Kidney imaging has evolved, with several modalities contributing to the overall diagnostic landscape. There is great optimism that a new era of molecular imaging in renal cell carcinoma can vastly improve diagnostic capabilities and limit unnecessary invasive procedures.

Carcinoma, renal cellCarcinomaKidney neoplasmsmolecular imagingpositron-emission tomography

Carcinoma in situView Articles
Carcinoma, renalView Articles
Carcinoma, renal cellView Articles

Volume 23, Number 4Kidney Cancer

Imaging Techniques in the Diagnosis of Renal Cell Carcinoma: Contemporary Trends and Future Directions

Gautam Jayram

Increasing radiographic detection of incidental small renal masses has led to a growing concern regarding overtreatment of these lesions. Given the limitations of computed tomography and magnetic resonance imaging, there is an unmet need for improved kidney imaging techniques that can provide more accurate assessments of renal lesions. This review provides a summary of established kidney imaging modalities and also those likely to be meaningful in the near future. Kidney imaging has evolved, with several modalities contributing to the overall diagnostic landscape. There is great optimism that a new era of molecular imaging in renal cell carcinoma can vastly improve diagnostic capabilities and limit unnecessary invasive procedures.

Carcinoma, renal cellCarcinomaKidney neoplasmsmolecular imagingpositron-emission tomography

Carcinoma, transitional cellView Articles
Carcinoma, transitionalcellView Articles
carcinoma, tubularView Articles

Volume 23, Number 3Kidney Cancer

Response to Targeted Therapy and Checkpoint Inhibition in a Patient With Mucinous Tubular and Spindle Cell Carcinoma: A Case Report and Literature Review

Ruchi AgarwalDaniela V. CastroYu Jun LiJaya GoudSalvador Jaime-Casas

Mucinous tubular and spindle cell carcinoma (MTSCC) is a form of renal cell carcinoma characterized by its tubular structure, mucinous stroma, and spindle-shaped cells. It makes up less than 1% of all renal cell carcinoma cases and has been classically described as indolent, although the disease course varies. Here we analyze the case of a 67-year-old woman with metastatic MTSCC with a sarcomatoid component. The course of treatment was extensive and included targeted therapy and immunotherapy. Thus, this case review offers insight into the heterogeneous clinical course of MTSCC and potential therapeutic options for these patients.

Immunotherapyimmune checkpoint inhibitorsCarcinoma, renal cellCarcinomaneoplasms, squamous, mucinous, and serouscarcinoma, tubular

Carcinoma,transitional cellView Articles
Cardiovascular diseaseView Articles