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IncisionView Articles
IncontinenceView Articles
Incontinence episode frequencyView Articles
Incontinence Quality of LifescaleView Articles
Incontinence, stressView Articles
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Independent practiceView Articles

Volume 18, Number 3Review Articles

Urology Group Compensation and Ancillary Service Models in an Era of Value-based Care

Health Care Economics

Neal D ShoreDana Jacoby

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. [Rev Urol. 2016;18(3):143-150 doi: 10.3909/riu0726] © 2016 MedReviews®, LLC

Independent practiceCollaborationValue-based careSpecializationCompensation

IndicationsView Articles
indigo carmineView Articles

Volume 23, Number 1Literature Reviews

Comparison of Methods for Ureteral Patency Visualization

Michelle BoytimMatthew J. JonesAlex S. BartPavel Svintozelskiy

The most common cause of ureteral trauma occurs during open, laparoscopic, or endoscopic procedures across multiple specialties. Ureteral injuries are often unrecognized or mismanaged. Early recognition of ureteral injuries by cystoscopy allows for prompt intervention. Visualization can be enhanced using agents that color or improve the contrast of ureteral flow.

Cystoscopydiagnostic imagingindigo carminemethylene bluefluorescein

Indigo® Optima LaserView Articles
IndinavirView Articles
Inferior vena cavaView Articles
InfertilityView Articles
Infertility syndromesView 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

Infertility treatments, cost/benefitView Articles
InflammationView Articles

Volume 11, Number 2Meeting Reviews

Best of the 2009 AUA Annual Meeting

Highlights From the 2009 Annual Meeting of the American Urological Association, April 25-30, 2009, Chicago, IL

Dean G AssimosEllen ShapiroAlan W PartinMichael B ChancellorStacy LoebJ Curtis NickelClaus G RoehrbornMichael K BrawerNaoki YoshimuraArie S BelldegrunB ShuchF Pouliot

Prostate cancer screeningObesityBenign prostatic hyperplasiaLower urinary tract symptomsVesicoureteral refluxNephrolithiasisStress urinary incontinenceInflammationSilodosinHormonal therapyTumor markersTMPRSS2ERG4-Kallikrein panelBotulinum toxin type AMale voiding dysfunctionBenign prostatic specific antigenRoux-en-Y gastric bypass surgeryGenitourinary pain indexUPOINT clinical phenotype systemNephron-sparing surgeryWatchful waitingLaparoscopy for adrenal cortical carcinomaPartial adrenalectomyUrethral traumaPediatric urethral strictureEnteric urologic surgery

Inflatable penile prosthesisView Articles

Volume 19, Number 1Case Review

Penile Ossification: A Reconstructive Challenge

Nirmish SinglaArthi SatyanarayanAllen F Morey

Penile ossification is a rare condition that occurs most commonly in acquired cases of penile deformity. We report the case of a 43-year-old man with Peyronie disease who was incidentally found to have significant ossified tissue in his penile corpora during complex placement of an inflatable penile prosthesis (IPP). His clinical course was later complicated by impending distal extrusion of his IPP laterally, necessitating corporoplasty. Penile ossification remains a poorly understood, unusual entity that may pose a reconstructive challenge for urologists. We discuss evaluation and management of this condition, focusing on important considerations for preoperative counseling and intraoperative pearls. [Rev Urol. 2017;19(1):64-67 doi: 10.3909/riu0722] © 2017 MedReviews®, LLC

Peyronie’s diseasePenile ossificationInflatable penile prosthesisCorporoplasty

InformationView Articles
Infrequent voiders syndromeView Articles

Volume 16, Number 3Review Articles

Taxi Cab Syndrome: A Review of the Extensive Genitourinary Pathology Experienced by Taxi Cab Drivers and What We Can Do to Help

Disease State Review

Alon Y MassDavid S GoldfarbOjas D Shah

This review consolidates knowledge regarding the extensive genitourinary pathology experienced by taxi cab drivers. Taxi cab, livery, truck, and other drivers all objectively and subjectively may have more voiding dysfunction, infertility, urolithiasis, bladder cancer, and urinary infections as compared with nonprofessional drivers; this is called taxi cab syndrome. Together with governmental and medical assistance, simple interventions—such as education, the addition of taxi relief stations, and possibly the use of sanitary urinary collection devices—to curb the progression of genitourinary disease in taxi drivers should be prospectively studied. It is postulated that many of these interventions may also benefit other groups of occupationally related infrequent voiders. [Rev Urol. 2014;16(3):99-104 doi: 10.3909/riu0627] This article is a US Government work, and, as such, is in the public domain in the United States of America. Published by MedReviews®, LLC

InfertilityUrolithiasisTaxi cab syndromeInfrequent voiders syndromeOccupational hazardVoiding dysfunctionProstodynia

Inguinal herniaView Articles

Volume 15, Number 1Case Review

Inguinal Bladder Hernia: Four Case Analyses

Kamal MoufidDriss TouitiLezrek Mohamed

A study of four cases presenting as inguinal bladder hernia was performed based on a review of the clinical presentation, circumstances of diagnostics, and surgical management. The mean age of patients was 66.5 years. Presenting symptoms included lower urinary tract symptoms (LUTS; three cases) and decrease in scrotal size after voiding (one case). The diagnostic circumstances were incidental finding during investigation for urethral stricture (one case), preoperative discovery on the basis of decrease in scrotal size after voiding (one case), perioperative discovery during standard herniorrhaphy (one case), and peritoneal effusion secondary to bladder injury in the early postoperative period. All patients were managed successfully by replacement of the bladder in its original position and inguinal herniorrhaphy, the Lichtenstein technique (two cases), Shouldice repair (one case), or modified Bassini repair (one case) through the same inguinal incision. For one patient, bladder injury was diagnosed at the time of inguinal herniorrhaphy and repair was promptly made. For another, bladder injury was discovered only at surgical abdominal exploration. Surgical repair led to the resolution of signs and urologic symptoms in all but one patient who needed medical therapy for residual LUTS. An awareness of this possibility on the part of general surgeons should guide preoperative evaluation and therapy appropriately. Even if the preoperative diagnosis is missed, a perioperative diagnosis is crucial to avoid bladder injury during surgery. [Rev Urol. 2013;15(1):32-36 doi: 10.3909/riu0560] © 2013 MedReviews®, LLC

ComplicationsBladderInguinal herniaCystographyHerniorrhaphy

InjectablesView Articles
InjectionView Articles

Volume 20, Number 2Review Articles

Botulinum Toxin Use in Neurourology

Systematic Review

Benjamin M BruckerGregory VurtureBenoit PeyronnetXavier GaméVictor W Nitti

The use of botulinum toxin A (BTX-A) has revolutionized the treatment of neurogenic lower urinary tract dysfunction (NLUTD) over the past three decades. Initially, it was used as a sphincteric injection for detrusor sphincter dyssynergia but now is used mostly as intradetrusor injection to treat neurogenic detrusor overactivity (NDO). Its use is supported by high-level-of-evidence studies and it has become the gold-standard treatment for patients with NDO refractory to anticholinergics. Several novelties have emerged in the use of BTX-A in neurourology over the past few years. Although onabotulinumtoxinA (BOTOX®, Allergan, Inc., Irvine, CA) remains the only BTX-A for which use is supported by large, multicenter, randomized, controlled trials (RCT), and is therefore the only one to be licensed in the United States and Europe, a second BTX-A, abobotulinumtoxinA (Dysport®, Ipsen Biopharmaceuticals, Basking Ridge, NJ), is also supported by high-level-of-evidence studies. Other innovations in the use of BTX-A in neurourology during the past few years include the BTX switch (from abobotulinumtoxinA to onabotulinumtoxinA or the opposite) as a rescue option for primary or secondary failures of intradetrusor BTX-A injection and refinements in intradetrusor injection techniques (number of injection sites, injection into the trigone). There is also a growing interest in long-term failure of BTX-A for NDO and their management, and a possible new indication for urethral sphincter injections. [Rev Urol. 2018;20(2):84–93 doi: 10.3909/riu0792] © 2018 MedReviews®, LLC

Botulinum toxinNeurogenic detrusor overactivitySphincterInjection

InstabilityView Articles
Insulin resistanceView Articles

Volume 12, Number 4Review Articles

Metabolic Syndrome and Urologic Diseases

Mangement Review

Haluk AkpinarIlya Gorbachinsky

Metabolic syndrome (MetS) is a complex entity consisting of multiple interrelated factors including insulin resistance, central adiposity, dyslipidemia, endothelial dysfunction and atherosclerotic disease, low-grade inflammation, and in males, low testosterone levels. MetS has been linked to a number of urologic diseases including nephrolithiasis, benign prostatic hyperplasia and lower urinary tract symptoms, erectile dysfunction, male infertility, female incontinence, and prostate cancer. This article reviews the relationships between MetS and these entities. Urologists need to be cognizant of the impact that MetS has on urologic diseases as well as on overall patient health.[Rev Urol. 2010;12(4):e157-e180 doi: 10.3909/riu0487]© 2010 MedReviews®, LLC

ObesityMetabolic syndromeBenign prostatic hyperplasiaNephrolithiasisHypogonadismCardiovascular diseaseInsulin resistanceEndothelial dysfunction

Insulin-like growth factorView Articles
insurance, healthView Articles

Volume 23, Number 4Editorial

2024 LUGPA Advocacy Year in Review: Confronting Challenges, Advancing Progress

Matthew Glans

In 2024, independent practices nationwide faced new and mounting challenges, including increasing and expanding regulatory obligations and growing patient demands against a background of rising input costs and financial pressures. Amid a shifting health care landscape, urologists were tasked with the pressing challenge of doing more with less.

Telemedicinehealth care costsinsurance, healthhealth services accessibility

IntensityView Articles

Volume 16, Number 2Review Articles

Proton Beam Therapy for Localized Prostate Cancer 101: Basics, Controversies, and Facts

Treatment Update

Eric S WisenbaughPaul E AndrewsRobert G FerrigniSteven E SchildSameer R KeoleWilliam W WongSujay A Vora

Proton beam therapy for prostate cancer has become a source of controversy in the urologic community, and the rapid dissemination and marketing of this technology has led to many patients inquiring about this therapy. Yet the complexity of the technology, the cost, and the conflicting messages in the literature have left many urologists ill equipped to counsel their patients regarding this option. This article reviews the basic science of the proton beam, examines the reasons for both the hype and the controversy surrounding this therapy, and, most importantly, examines the literature so that every urologist is able to comfortably discuss this option with inquiring patients. [Rev Urol. 2014;16(2):67-75 doi: 10.3909/riu0601] © 2014 MedReviews®, LLC

Prostate cancerProton beam therapyExternal beam radiation therapyIntensity

Intensity-modulated radiation therapyView Articles
Interferon-View Articles