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Directory of Authors from the Journal and their last article.

Douglas ChinnView Articles
Dov KadmonView Articles
Driss TouitiView 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

Drogo K MontagueView Articles
Duane R HicklingView Articles

Volume 15, Number 2Review Articles

Management of Recurrent Urinary Tract Infections in Healthy Adult Women

Management Update

Victor W NittiDuane R Hickling

Recurrence after urinary tract infection (rUTI) is common in adult women. The majority of recurrences are believed to be reinfection from extraurinary sources such as the rectum or vagina. However, uropathogenic Escherichia coli are now known to invade urothelial cells and form quiescent intracellular bacterial reservoirs. Management of women with frequent symptomatic rUTI can be particularly vexing for both patients and their treating physicians. This review addresses available and promising management strategies for rUTI in healthy adult women. [Rev Urol. 2013;15(2):41-48 doi: 10.3909/riu0566] © 2013 MedReviews®, LLC

Recurrent urinary tract infectionUropathogenic Escherichia coliProphylaxis

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