You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety I (MP10)1 Apr 2019MP10-10 PATIENT-LEVEL VALIDATION OF PROSTATE CANCER DATA COLLECTED VIA AUTOMATED EXTRACTION FROM STRUCTURED AND UNSTRUCTURED ELECTRONIC HEALTH RECORD (EHR) RECORDS Matthew R. Cooperberg*, William Meeks, Ji Qi, Rodney L. Dunn, Sanyog Pendharkar, Daniel Pichardo, Anna Johnson, Susan Linsell, Raymond Fang, Steven Schlossberg, and James E. Montie Matthew R. Cooperberg*Matthew R. Cooperberg* More articles by this author , William MeeksWilliam Meeks More articles by this author , Ji QiJi Qi More articles by this author , Rodney L. DunnRodney L. Dunn More articles by this author , Sanyog PendharkarSanyog Pendharkar More articles by this author , Daniel PichardoDaniel Pichardo More articles by this author , Anna JohnsonAnna Johnson More articles by this author , Susan LinsellSusan Linsell More articles by this author , Raymond FangRaymond Fang More articles by this author , Steven SchlossbergSteven Schlossberg More articles by this author , and James E. MontieJames E. Montie More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555154.96959.37AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: The AUA Quality (AQUA) Registry now includes data on >4.3M patients managed by over 1500 urologists across the country. AQUAs databases are populated by automated extraction of data from a variety of EHR systems. Some data (e.g., billing codes and orders) usually exist as structured data in EHRs. Others (e.g., cancer grade) usually do not, and must be identified via regular expression or the use of natural language processing. As a test of data extraction quality, we performed a patient-level validation of prostate cancer data from two AQUA practices compared to the manually abstracted data available through their participation in the Michigan Urological Surgical Improvement Collaborative (MUSIC). METHODS: Data were collected from men newly diagnosed with prostate cancer between 2014 and 2017 at two urology practices in Michigan. AQUA data were extracted using EHR connector software (FIGMD Inc, San Diego, CA), and MUSIC data were manually abstracted by trained staff at each site with annual onsite quality audits. Date of diagnosis, Gleason score (primary and secondary), diagnostic PSA, number of biopsy cores (positive and total), clinical staging, and primary treatment were compared. Percent of cases with missing information on each variable was also evaluated for both registries. RESULTS: A total of 725 patients from the two practices were linked between AQUA and MUSIC registry. The rate of missing data in each registry as well as matching rates for values when identified are shown in Table 1. The most common mismatches for treatment were between brachytherapy and external- beam radiation, and between radiation and primary androgen deprivation. CONCLUSIONS: Automated extraction of both structured and unstructured data from EHRs is possible, and has the potential to substantially reduce the time and cost of disease registry population. Adjustments to algorithms will continually improve the quality of the automated abstraction. Source of Funding: American Urological Association and Blue Cross Blue Shield of Michigan San Francisco, CA; Linthicum, MD; Ann Arbor, MI; Pune, India; Linthicum, MD; Ann Arbor, MI; Linthicum, MD; Walnut Creek, CA; Ann Arbor, MI© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e121-e121 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew R. Cooperberg* More articles by this author William Meeks More articles by this author Ji Qi More articles by this author Rodney L. Dunn More articles by this author Sanyog Pendharkar More articles by this author Daniel Pichardo More articles by this author Anna Johnson More articles by this author Susan Linsell More articles by this author Raymond Fang More articles by this author Steven Schlossberg More articles by this author James E. Montie More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making II (MP39)1 Apr 2019MP39-07 CHARACTERISTICS OF ELECTRONIC HEALTH RECORD USE AMONG UROLOGISTS IN THE UNITED STATES Christopher D. Tessier*, Raymond Fang, William Meeks, Matthew E. Nielsen, Steven M. Schlossberg, and J. Stuart Wolf Christopher D. Tessier*Christopher D. Tessier* More articles by this author , Raymond FangRaymond Fang More articles by this author , William MeeksWilliam Meeks More articles by this author , Matthew E. NielsenMatthew E. Nielsen More articles by this author , Steven M. SchlossbergSteven M. Schlossberg More articles by this author , and J. Stuart WolfJ. Stuart Wolf More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556068.68234.2aAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Over the past decade, the adoption of electronic health record (EHR) technology has rapidly expanded among urologists in the United States. In response to a series of federal regulatory and payment incentive programs, EHR technology and provider use have evolved beyond traditional clinical documentation. Our objective was to assess general perceptions of EHR usability, and to characterize the use and interest in efficiency-enhancing strategies among U.S. urologists. METHODS: In the 2018 AUA Census, half of census participants were randomly surveyed about the experience of adopting and using EHR systems in their practice. We received a total of 1,181 completed questionnaires from urologists in the United States. Descriptive analysis was used to analyze each of six relevant questions using IBM SPSS software. RESULTS: Of the 1,181 urologists surveyed, 1,137 (96.3%) reported using an EHR system in their practice. Among EHR users, 41% of urologists responded that EHRs improve the quality and accuracy of their work. More than half of EHR users (654; 57.5%) did not feel that productivity has been enhanced by their EHR system. Utilization of a medical scribe was noted by 218 (19.2%) EHR users. Benefits cited by medical scribe users included increased productivity (146; 67.0%), improved clinic workflow/efficiency (167; 76.6%), decreased documentation time (156; 71.6%), and improved provider quality of life (158; 72.5%). Of EHR users, 867 (76.2%) thought AUA-generated documentation templates would be valuable; however, 470 (54.2%) of these users doubted that templates could be incorporated into their current EHR systems. CONCLUSIONS: In 2018, practice-based EHR use among urologists is nearly universal, yet significant usability and productivity concerns remain apparent. This study demonstrates that clinical documentation facilitated by medical scribes and knowledge-based templates may optimize practice-based EHR systems used by urologists. More broadly, significant improvement is needed in the area of EHR usability to ensure that systems are used efficiently, effectively, and satisfactorily by clinical users. A limitation of this study is that the analysis was based on unweighted samples, which may not represent the full spectrum of EHR usability perceptions among all practicing urologists in the country. Source of Funding: None Portland, OR; Linthicum, MD; Chapel Hill, NC; Walnut Creek, CA; Austin, TX© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e546-e547 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher D. Tessier* More articles by this author Raymond Fang More articles by this author William Meeks More articles by this author Matthew E. Nielsen More articles by this author Steven M. Schlossberg More articles by this author J. Stuart Wolf More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life & Shared Decision Making II1 Apr 2018MP51-02 SLING REOPERATION RATES IN THE AUA QUALITY (AQUA) REGISTRY Jennifer Anger, J. Quentin Clemens, Steven Schlossberg, Raymond Fang, J. Stuart Wolf, and Matthew Cooperberg Jennifer AngerJennifer Anger More articles by this author , J. Quentin ClemensJ. Quentin Clemens More articles by this author , Steven SchlossbergSteven Schlossberg More articles by this author , Raymond FangRaymond Fang More articles by this author , J. Stuart WolfJ. Stuart Wolf More articles by this author , and Matthew CooperbergMatthew Cooperberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1633AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The midurethral synthetic sling has been considered the gold standard in the surgical management of stress urinary incontinence, despite controversies surrounding transvaginal mesh. Early (<1 year) failure rates reported range from less than 4% in clinical series to over 10% among older Medicare beneficiaries. We used the AUA Quality (AQUA) registry, a national Qualified Clinical Data Registry (QCDR) designed to measure, report, and improve healthcare quality and patient outcomes, to study real-world reoperation rates after surgery for stress urinary incontinence, provider volume and types of anti-incontinence procedures performed. METHODS The AQUA Registry provides physicians with essential infrastructure and information they need to improve clinical practice and patient outcomes. As of November 2017, the AQUA Registry covers over 400 practices in 48 US States/territories in private practices, large health systems and academic centers. We abstracted 2014-2016 AQUA registry data from the first 95 urology practices to join to determine re-operation rates after surgery for stress urinary incontinence within one year of initial surgery. The relationships between provider volume and re-operation rate were measured using descriptive statistics and Pearson's correlation. RESULTS There were 8,571 incontinence procedures performed by 61 AQUA practices in 2014-2016. Overall reoperation rate by CPT code was 4.1%. Most first operations (95.4%) were slings, with many fewer bladder neck suspensions (MMK/Burch/Peyrera). Repeat procedures were usually the same procedure type performed a second time, even in the case of bladder neck suspensions. Among those undergoing a sling for the first procedure, 0.22% underwent a urethrolysis, 1.2% underwent a sling revision or takedown, and 3.4% underwent a repeat sling operation. There was no correlation between provider volume and reoperation rates (r=0.0058, p=0.96). There was a wide range of reoperation rates between practices (0-77%). CONCLUSIONS The sling, even after the mesh controversy with its negative press, dominates as the most common anti-incontinence procedure. Overall, sling failure rates, revisions, and takedowns were acceptably low across various practice settings. These low reoperation rates indicate that both low and high-volume providers can attain good outcomes with the sling. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e684-e685 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jennifer Anger More articles by this author J. Quentin Clemens More articles by this author Steven Schlossberg More articles by this author Raymond Fang More articles by this author J. Stuart Wolf More articles by this author Matthew Cooperberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyPlenary: Next Frontier1 Apr 2018LBA1 CHARACTERISTICS OF PARTICIPANTS IN THE AUA QUALITY (AQUA) REGISTRY AND EARLY IMPACT OF PARTICIPATION ON QUALITY OF CARE Jeremy Shelton, Daniel Pichardo, William Meeks, Ronald Suh, Kimberly Ross, J. Stuart Wolf Jr., Steven Schlossberg, Raymond Fang, and Matthew Cooperberg Jeremy SheltonJeremy Shelton More articles by this author , Daniel PichardoDaniel Pichardo More articles by this author , William MeeksWilliam Meeks More articles by this author , Ronald SuhRonald Suh More articles by this author , Kimberly RossKimberly Ross More articles by this author , J. Stuart Wolf Jr.J. Stuart Wolf Jr. More articles by this author , Steven SchlossbergSteven Schlossberg More articles by this author , Raymond FangRaymond Fang More articles by this author , and Matthew CooperbergMatthew Cooperberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.03.080AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES 21 years ago the Institute of Medicine articulated a vision of a learning healthcare system based on electronic health records (EHRs). Building on federal investment in EHRs and policy reform linking payment to quality, the American Urological Association invested in a platform to aggregate clinical data from EHRs for quality measurement and reporting. The resulting AQUA Registry is a Qualified Clinical Data Repository (QCDR) that can report quality measures to the Centers for Medicare and Medicaid Services (CMS). We describe AQUA participants and report early trends in quality scores reported to CMS through AQUA. METHODS This is a retrospective analysis of AQUA participation from 2014-2016. We compared characteristics of urologists and practices participating in AQUA to those of the broader urologist population as reported in the 2016 AUA Census. We assessed the impact of AQUA participation on quality of care by comparing measure pass rates pre and post participation. To ensure data validity we limited our analysis to measures reported to CMS, with a denominator ≥10, and from practices with ≥180 days of participation. To evaluate the trend before and after joining AQUA, we fit a univariate linear spline regression with a knot at time 0. RESULTS Participation in AQUA increased rapidly during the first full 3 years of operation and now includes over 125 practices and 1148 urologists (9.4%). 97.6% of AQUA participants are in private practice, 1.9% are in academic practice, and 0.5% are employed by private or public hospitals, compared with 59.1%, 25.5% and 11.2% respectively among urologists nationally. 95.9% of AQUA participants live in metropolitan areas compared with 89.9% of urologists nationally, and they are 4 years younger. Participation is distributed across regions and states. 17 quality measures were reported to CMS through AQUA, 4 of which were urology specific and 13 of which were cross-cutting measures. Figure 1 shows the mean pass rate on each of the 4 urologic measures before and after participation in AQUA. CONCLUSIONS Early participants in the AQUA registry were mostly community practitioners in metropolitan areas. 3 of 4 urologic measures examined showed improvement and 1 showed no change, suggesting that measuring care facilitated gains in measurement and possibly quality. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e576-e577 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jeremy Shelton More articles by this author Daniel Pichardo More articles by this author William Meeks More articles by this author Ronald Suh More articles by this author Kimberly Ross More articles by this author J. Stuart Wolf Jr. More articles by this author Steven Schlossberg More articles by this author Raymond Fang More articles by this author Matthew Cooperberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Physician burnout has been linked to decreased job performance, increased medical errors, interpersonal conflicts, and depression. Recent multispecialty studies suggest that urologists have higher rates (up to 63.6%) of burnout compared to physicians in other specialties; however, these reports were limited by low sample sizes.1 We aimed to evaluate the prevalence of urologist burnout, verify risk factors, and recommend preventative measures and solutions for colleagues at risk or suffering from burnout. Urologist burnout is a true entity that transcends level of training and nationality. Its roots appear to be deep-seated in our tireless efforts to strive for excellence in care for our patients, our growing academic and research pursuits, and surmounting administrative responsibilities; these virtues, which are regarded as the foundations of our career successes, are often obtained at the expense of personal health and wellbeing, as well as family sacrifice. Various other medical societies have become increasingly vocal about the issue of physician burnout and have actively initiated successful strategies to minimize its impact on their members. As an organization with a strong national presence, the Canadian Urological Association (CUA) should promote tools to prevent and interventions to assist those at risk for and suffering from burnout. Increased awareness in the general medical community has led to strategies and tools that can help prevent, identify, or assist physicians in their recovery from burnout. The CUA should develop and facilitate access to information and offer comprehensive support for urologists struggling with burnout.

You have accessJournal of UrologyPlenary: Next Frontier1 Apr 2017PNFBA-07 THE CURRENT MANAGEMENT OF PROSTATE CANCER IN THE UNITED STATES: DATA FROM THE AQUA REGISTRY Matthew Cooperberg, Raymond Fang, J. Stuart Wolf, Jr, Heddy Hubbard, Sanyog Pendharkar, Sunil Gupte, Kimberly Ross, Mary Nolin, Steven Schlossberg, and J. Quentin Clemens Matthew CooperbergMatthew Cooperberg , Raymond FangRaymond Fang , J. Stuart Wolf, JrJ. Stuart Wolf, Jr , Heddy HubbardHeddy Hubbard , Sanyog PendharkarSanyog Pendharkar , Sunil GupteSunil Gupte , Kimberly RossKimberly Ross , Mary NolinMary Nolin , Steven SchlossbergSteven Schlossberg , and J. Quentin ClemensJ. Quentin Clemens View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3236AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer management trends have been described previously using a variety of data sources, but none has captured actual national data across a broad range of practice types and locations. We explored management trends in the new AUA Quality (AQUA) Registry. METHODS The AQUA Registry collects data from participating practices via automated data extraction from local electronic health record systems. Data are collected from both structured (e.g., billing codes, prescriptions) and unstructured (e.g., pathology reports, physician notes) chart elements. We identified newly diagnosed prostate cancer cases using a series of data rules and algorithms. RESULTS From Jan. 2014 to Jun. 2016, the AQUA Registry collected data on 35,437 men with prostate cancer from 64 practices. Localized prostate cancer disease was found in 22,861. The median number of localized cases per site was 112 (range 1-2768, IQR 36-315). A total of 16,485 (72%) had sufficient data to calculate risk; the missing data rate fell from 33% in 2014 to 23% in 2016. Of men with sufficient data, 42%, 35%, and 23% had low, intermediate, and high-risk disease, respectively. The proportion of low-risk cases fell from 45% in 2014 to 40% in 2016, the differences are reflected in rising rates of high-risk disease (p<0.001). The Figure below illustrates treatment trends over time for 15,825 men with identified primary treatment. The rate of active surveillance for low-risk disease rose from 41% in 2014 to 54% in 2016. Medication data were available for 5154 men receiving advanced disease medications; 32.5% of these received more than one medication. In total, 2089 men received abiraterone, 2289 enzalutamide, 320 docetaxesl, 81 cabazitaxel, 334 sipuleucel-T, 108 radium-223, and 2290 denosumab. Among 738 men receiving both abiraterone and enzalutamide, 66% received abiraterone first; the median time starting these two medications was 232 days. CONCLUSIONS We confirmed prior reports from less representative registries in terms of shifting prostate cancer risk distribution and high and rising rates of active surveillance for low-risk disease. The AQUA Registry provides unique data on patterns of use for advanced prostate cancer medications. Many more urology practices have recently joined the registry and therefore, the numbers of men represented will grow rapidly. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e911-e912 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Matthew Cooperberg More articles by this author Raymond Fang More articles by this author J. Stuart Wolf, Jr More articles by this author Heddy Hubbard More articles by this author Sanyog Pendharkar More articles by this author Sunil Gupte More articles by this author Kimberly Ross More articles by this author Mary Nolin More articles by this author Steven Schlossberg More articles by this author J. Quentin Clemens More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

INTRODUCTION:Determining the most effective treatments for complex medical conditions requires robust clinical data. Clinical registries comprise real-world observational data, which allow rapid assessment of the effectiveness of treatments and care processes. In 2014 the AUA (American Urological Association) launched the AQUA (AUA Quality) Registry, a national urological disease registry intended to measure and report health care quality and patient outcomes, and support health services and comparative effectiveness research. The initial focus of the registry is newly diagnosed prostate cancer. In July 2014 the AUA convened a Stakeholder Forum with more than 20 organizations interested in improving the quality of care provided to patients with prostate cancer.METHODS:We discuss the rationale and need for the AQUA Registry, define quality of care for prostate cancer, prioritize data and information needs, and identify potential future uses for AQUA data beyond quality improvement.RESULTS:AQUA data will provide high quality data on effective treatments. Good quality of care for prostate cancer focuses on patient centered outcomes based on current evidence. The highest priority data collection needs are patient characteristics, evaluation and intervention utilization data, clinical and patient reported outcomes, and cost and resource use. In the future the registry data may be used to fulfill urologist quality reporting requirements. The AQUA Registry will also allow for a range of local and national quality improvement, and health services research efforts driven by urologists.CONCLUSION:The AQUA Registry will provide an essential platform to improve health care quality and support the next generation of clinical urology research and policy initiatives.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making IV1 Apr 2017MP76-10 BURNOUT IN UROLOGY: RESULTS FROM THE 2016 AUA CENSUS Amanda C. North, Patrick H. McKenna, Raymond Fang, Alp Sener, Brian K. McNeil, Julie Franc-Guimond, William Meeks, Steven Schlossberg, Chris M. Gonzalez, and James Q. Clemens Amanda C. NorthAmanda C. North , Patrick H. McKennaPatrick H. McKenna , Raymond FangRaymond Fang , Alp SenerAlp Sener , Brian K. McNeilBrian K. McNeil , Julie Franc-GuimondJulie Franc-Guimond , William MeeksWilliam Meeks , Steven SchlossbergSteven Schlossberg , Chris M. GonzalezChris M. Gonzalez , and James Q. ClemensJames Q. Clemens View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2138AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Physician burnout is linked to decreased job performance as well as increased medical errors, interpersonal conflicts and depression. Two recent multi-specialty studies showed that compared to other physicians in the 29-65 age group, urologists had the highest rate of burnout (54.4% vs. 63.6%); however, these reports were limited by a low sample size for urologists (n=119). We aimed to establish the prevalence of urologist burnout and to determine factors associated with burnout more comprehensively. METHODS In the 2016 AUA Census, Maslach Burnout Inventory (MBI) questions were randomly assigned to half of the respondents. Using matrix sampling, the 1,126 practicing urologists who received and answered the MBI questions represent the entire 2,301 who completed the Census with a sampling weight of 2.04. Burnout was defined as scoring high in either the emotional exhaustion (score≥27) or depersonalization (score≥10) categories. Demographic and practice variables were assessed through both univariate descriptive analysis and multivariate logistic analysis to establish correlating factors to burnout. RESULTS Overall, 38.8% of urologists met the criteria for burnout, of whom 17.2% scored high for emotional exhaustion and 37.1% scored high for depersonalization. Multivariate analysis revealed that urologist burnout is associated with a variety of factors as follows (ranked from most important): greater number of patient visits in a typical week; younger age group; in sub-specialty area other than pediatric or oncology; in either solo or multi-specialty practices; practice size of more than 2; and greater number of work hours in a typical week. (See table.) CONCLUSIONS These results suggest that the burnout rate for urologists, 38.8% overall or 41.3% in urologists ages 29-65, is lower than previously reported and is consistent with rates reported in other medical and surgical specialties. Burnout continues to be an important issue for urologists. Higher workload correlated with increased burnout while other practice patterns, such as being a solo owner of a practice or working in an academic center, appear to be protective. Understanding the causes of burnout in urology will help guide future intervention. It is important to keep all urologists in the workforce to help lessen projected shortages. © 2017FiguresReferencesRelatedDetailsCited byChouhan J, Anwar T, Jones A and Murray K (2020) Burnout in the Urology Workforce: Voluntary Survey Results in the United StatesUrology Practice, VOL. 7, NO. 6, (566-570), Online publication date: 1-Nov-2020. Volume 197Issue 4SApril 2017Page: e1016-e1017 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Amanda C. North More articles by this author Patrick H. McKenna More articles by this author Raymond Fang More articles by this author Alp Sener More articles by this author Brian K. McNeil More articles by this author Julie Franc-Guimond More articles by this author William Meeks More articles by this author Steven Schlossberg More articles by this author Chris M. Gonzalez More articles by this author James Q. Clemens More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

An optimal prostate biopsy in clinical practice is based on a balance between adequate detection of clinically significant prostate cancers (sensitivity), assuredness regarding the accuracy of negative sampling (negative predictive value or NPV), limited detection of clinically insignificant cancers, and good concordance with whole-gland surgical pathology results to allow accurate risk stratification for treatment selection. A variety of biopsy techniques have emerged for optimizing these attributes, including computerized and image-guided techniques, but systematic sampling with variable core numbers remains the standard in practice.

PURPOSE:An optimal prostate biopsy in clinical practice is based on a balance among adequate detection of clinically significant prostate cancers (sensitivity), assuredness regarding the accuracy of negative sampling (negative predictive value), limited detection of clinically insignificant cancers and good concordance with whole gland surgical pathology results to allow accurate risk stratification and disease localization for treatment selection. Inherent within this optimization is variation of the core number, location, labeling and processing for pathological evaluation. To date, there is no consensus in this regard. The purpose of this review is to 1) define the optimal number and location of biopsy cores during primary prostate biopsy among men with suspected prostate cancer, 2) define the optimal method of labeling prostate biopsy cores for pathological processing which will provide relevant and necessary clinical information for all potential clinical scenarios, and 3) determine the maximal number of prostate biopsy cores allowable within a specimen jar which would not preclude accurate histological evaluation of the tissue. MATERIALS AND METHODS:A bibliographic search using PubMed® covering the period up to July 2012 yielded approximately 550 articles. Articles were reviewed and categorized based on which of the 3 objectives of this review was addressed. Data were extracted, analyzed and summarized. Recommendations are provided based on this literature review and our clinical experience. RESULTS:The use of 10 to 12-core extended sampling protocols increases cancer detection rates compared to traditional sextant sampling methods and reduces the likelihood of repeat biopsy by increasing negative predictive value, ultimately allowing more accurate risk stratification without increasing the likelihood of detecting insignificant cancers. As the number of cores increases above 12, the increase in diagnostic yield becomes marginal. Only limited evidence supports the use of initial biopsy schemes involving more than 12 cores or saturation. Apical and laterally directed sampling of the peripheral zone increases cancer detection rate, reduces the need for repeat biopsies and predicts pathological features on prostatectomy while transition zone biopsies do not. There are little data to suggest that knowing the exact site of an individual positive biopsy core provides meaningful clinical information. However, determining laterality of cancer on biopsy may be helpful for predicting sites of extracapsular extension and therapeutic planning. Placement of multiple biopsy cores in a single container (greater than 2) appears to compromise pathological evaluation, which can reduce cancer detection rate and increase the likelihood of equivocal diagnoses. CONCLUSIONS:A 12-core systematic biopsy that incorporates apical and far-lateral cores in the template distribution allows maximal cancer detection, avoids repeat biopsy, and provides information adequate for identifying men who need therapy and planning that therapy while minimizing the detection of occult, indolent prostate cancers. This literature review does not provide compelling evidence that individual site specific labeling of cores benefits clinical decision making regarding the management of prostate cancer. Based on the available literature, we recommend packaging no more than 2 cores in each jar to avoid reduction of the cancer detection rate through inadequate tissue sampling.

With the changing environment for medical practice, physician practice models will continue to evolve. These “supergoups'' create economies of scale, but their advantage is not only in the traditional economic sense. Practices with enough size are able to better meet the challenges of medical practice with increasing regulatory demands, explosion of clinical knowledge, quality and information technology initiatives, and an increasingly tight labor market. Smaller practices can adapt some of these strategies selectively. Depending on the topic, smaller practices should think differently about how to approach the challenges of practice.

You have accessJournal of Urology1 Apr 2008SINGLE STAGE URETHRAL RECONSTRUCTION FOLLOWING UROLUME® FAILURE Edward R Houser, Lydia T Laboccetta, Jeffrey D Brady, Kurt A McCammon, Steven M Schlossberg, and Gerald H Jordan Edward R HouserEdward R Houser More articles by this author , Lydia T LaboccettaLydia T Laboccetta More articles by this author , Jeffrey D BradyJeffrey D Brady More articles by this author , Kurt A McCammonKurt A McCammon More articles by this author , Steven M SchlossbergSteven M Schlossberg More articles by this author , and Gerald H JordanGerald H Jordan More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)60071-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "SINGLE STAGE URETHRAL RECONSTRUCTION FOLLOWING UROLUME® FAILURE." The Journal of Urology, 179(4S), p. 22 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 22 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetrics Author Information Edward R Houser More articles by this author Lydia T Laboccetta More articles by this author Jeffrey D Brady More articles by this author Kurt A McCammon More articles by this author Steven M Schlossberg More articles by this author Gerald H Jordan More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of Urology1 Apr 2008RECONSTRUCTION FOR CONGENITAL CURVATURE OF THE PENIS Timothy O Davies, Uri Gur, Steven M Schlossberg, and Gerald H Jordan Timothy O DaviesTimothy O Davies More articles by this author , Uri GurUri Gur More articles by this author , Steven M SchlossbergSteven M Schlossberg More articles by this author , and Gerald H JordanGerald H Jordan More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61185-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "RECONSTRUCTION FOR CONGENITAL CURVATURE OF THE PENIS." The Journal of Urology, 179(4S), p. 405 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 405 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Timothy O Davies More articles by this author Uri Gur More articles by this author Steven M Schlossberg More articles by this author Gerald H Jordan More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVETo present our experience with the management of recurrent and resistant anastomotic stenosis following radical prostatectomy (RP) using transurethral laser incision of the stenotic area and injection of steroids.PATIENTS AND METHODSBetween January 1999 and April 2006, we evaluated 24 patients with anastomotic stenosis that would not allow the passage of the flexible cystoscope (17 F). Using the paediatric 7.5 F Olympus scope and a 550‐µm fibre holmium laser, deep incisions were cut at the 3 and 9 o’clock positions at the bladder neck, and then triamcinolone was injected at the incision sites. Another session was then scheduled for office cystoscopy 6 weeks later, and if that showed evidence of annularity, another incision was made, as described above.RESULTSAll 24 patients had RP for localized disease, 21 were retropubic and two were perineal, and one laparoscopic. Five patients had adjuvant radiotherapy. The mean patient age was 64 years. Nineteen (79%) patients had previous attempts to open the bladder neck: eight patients had dilatation, eight patients had internal urethrotomy, five patients underwent transurethral resection of the bladder neck, and six patients had open surgical intervention. The procedure was done once in 17 patients, and twice in seven patients. After a mean (range) follow up of 24 (6–72) months, 19 patients (83%) had a well‐healed and widely patent bladder neck. Of the 24 patients, 17 had urinary incontinence (UI) associated with the bladder neck contracture. An artificial urinary sphincter was implanted in 11 patients, three of which had to be explanted for malfunction in two, and erosion in one.CONCLUSIONHolmium laser bladder neck incision and steroid injection for anastomotic stenosis after RP had a success rate of 83% in this small series. It can be used safely as a primary treatment, or in some cases, for resistant and recurrent stenosis. It appears that insertion of an artificial sphincter can be done in patients with UI when the bladder neck remains patent for at least 8 weeks.

You have accessJournal of Urology1 Apr 2008BURIED PENIS IN ADULTS Timothy O Davies, Uri Gur, Kurt A McCammon, Steven M Schlossberg, David R Gilbert, and Gerald H Jordan Timothy O DaviesTimothy O Davies More articles by this author , Uri GurUri Gur More articles by this author , Kurt A McCammonKurt A McCammon More articles by this author , Steven M SchlossbergSteven M Schlossberg More articles by this author , David R GilbertDavid R Gilbert More articles by this author , and Gerald H JordanGerald H Jordan More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)60033-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "BURIED PENIS IN ADULTS." The Journal of Urology, 179(4S), p. 10 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 10 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Timothy O Davies More articles by this author Uri Gur More articles by this author Kurt A McCammon More articles by this author Steven M Schlossberg More articles by this author David R Gilbert More articles by this author Gerald H Jordan More articles by this author Expand All Advertisement PDF downloadLoading ...

PURPOSE:We report our experience and long-term followup of patients undergoing excision and primary anastomotic reconstruction for anterior urethral strictures. MATERIALS AND METHODS:From July 1986 to May 2006 the charts of 260 patients who underwent excision with primary anastomosis at our center for bulbar urethral stricture were reviewed. Patient age ranged from 14 to 78 years (mean 38.4), stricture length ranged 0.5 to 4.5 cm (mean 1.9). Patients who had surgery within the last 5 years were contacted by telephone if their 6-month postoperative cystoscopic evaluation was patent and they had not visited the clinic afterward. RESULTS:After a mean followup of 50.2 months 257 patients (98.8%) were symptom-free and required no further procedures. Recurrent stricture occurred early in 2 patients and late in 1 patient. Two patients opted for intermittent dilations, and a single direct visual internal urethrotomy was performed in 1 patient 4 years postoperatively. One of the patients who elected dilation subsequently elected urethral reconstruction, which was done successfully. Complications encountered were position related neuropraxia in 9 (3.4%), early urinary tract infection in 13 (5%), chest related in 5 (1.9%), scrotalgia in 4 (1.5%) and wound related in 4 (1.5%). All resolved within the early postoperative period. Erectile dysfunction was encountered in 6 (2.3%) patients, of whom 4 had a history of significant straddle trauma, 4 responded well to oral pharmacotherapy and 1 elected to not have the erectile dysfunction treated. CONCLUSIONS:Excision with primary anastomosis for anterior urethral stricture has a high success rate of 98.8% with durable long-term results in most patients. Complications are few, of short duration and self-limited. Where applicable, we believe that the procedure clearly is the choice for short anterior urethral strictures.

We present our experience with management of recurrent and resistant vesicourethral stenosis following radical prostatectomy using transurethral laser incision of the stenotic area and injection of steroids.

You have accessJournal of UrologyPodium, Monday, May 22, 2006, 3:30 - 5:30 pm1 Apr 2006996: Management of Peyronie's Disease Using Dermal or Porcine Small Intestinal Submucosa (SIS) Grafts Ehab A. Eltahawy, Ramon Virasoro, Kurt A. McCammon, Steven M. Schlossberg, and Gerald H. Jordan Ehab A. EltahawyEhab A. Eltahawy More articles by this author , Ramon VirasoroRamon Virasoro More articles by this author , Kurt A. McCammonKurt A. McCammon More articles by this author , Steven M. SchlossbergSteven M. Schlossberg More articles by this author , and Gerald H. JordanGerald H. Jordan More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33221-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "996: Management of Peyronie's Disease Using Dermal or Porcine Small Intestinal Submucosa (SIS) Grafts." The Journal of Urology, 175(4S), p. 321 © 2016 by American Urological AssociationFiguresReferencesRelatedDetailsCited ByKnoll L (2018) Use of Small Intestinal Submucosa Graft for the Surgical Management of Peyronie’s DiseaseJournal of Urology, VOL. 178, NO. 6, (2474-2478), Online publication date: 1-Dec-2007. Volume 175Issue 4SApril 2006Page: 321 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Ehab A. Eltahawy More articles by this author Ramon Virasoro More articles by this author Kurt A. McCammon More articles by this author Steven M. Schlossberg More articles by this author Gerald H. Jordan More articles by this author Expand All Advertisement Loading ...

You have accessJournal of UrologyPodium, Saturday, May 20, 2006, 3:30 - 5:30 pm1 Apr 2006113: Long Term Follow-Up in Fossa Navicularis Reconstruction Ramon Virasoro, Ehab A. Eltahawy, Kurt A. McCammon, Steven M. Schlossberg, and Gerald H. Jordan Ramon VirasoroRamon Virasoro More articles by this author , Ehab A. EltahawyEhab A. Eltahawy More articles by this author , Kurt A. McCammonKurt A. McCammon More articles by this author , Steven M. SchlossbergSteven M. Schlossberg More articles by this author , and Gerald H. JordanGerald H. Jordan More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)32380-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "113: Long Term Follow-Up in Fossa Navicularis Reconstruction." The Journal of Urology, 175(4S), pp. 36–37 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 36-37 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Ramon Virasoro More articles by this author Ehab A. Eltahawy More articles by this author Kurt A. McCammon More articles by this author Steven M. Schlossberg More articles by this author Gerald H. Jordan More articles by this author Expand All Advertisement PDF downloadLoading ...