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Urology

Volume 22, Number 2

Volume 22, Number 2

Table of Contents

Non–muscle-invasive Bladder Cancer: Overview and Contemporary Treatment Landscape of Neoadjuvant Chemoablative Therapies Treatment Update
Non–muscle-invasive bladder cancer (NMIBC) is a heterogeneous subclassification of urothelial carcinoma with significant variation in individual risk of recurrence and progression to muscle-invasive disease. Risk stratification by American Urological Association (AUA) and European Association of Urology (EAU) guidelines or by using nomograms/risk calculators developed from clinical trial data can help inform patient treatment decisions but may not accurately classify all patients. Risk-adapted adjuvant (post–transurethral resection of bladder tumor [TURBT]) treatment strategies using intravesical therapies are an important means of balancing disease control with potential adverse effects. Adjuvant intravesical instillation with various chemotherapy agents and bacillus Calmette-Guérin (BCG) is well studied and associated with excellent outcomes for most patients. However, upwards of 40% of patients recur within 2 years and roughly 10% progress to muscle-invasive bladder cancer. Novel approaches and agents that aim to reduce the treatment burden associated with NMIBC are increasingly needed. We review the current landscape of NMIBC as it pertains to the use of and rationale for emerging neoadjuvant chemoablative therapies. [Rev Urol. 2020;22(2):43–51] © 2020 MedReviews®, LLC
Management of Small, Non-obstructing Renal Stones in Adults With Recurrent Urinary Tract Infections Management Review
The management of small, non-obstructing renal stones in adults with recurrent lower urinary tract infections remains unclear. Whereas for larger or obstructing stones the decision to intervene becomes clearer, for stones smaller than 5 to 6 mm the decision to intervene requires consideration of multiple factors. This review describes these factors, including history, imaging, laboratory studies, as well as a comprehensive review of the literature. It remains of utmost importance that patients have additional possible etiologies appropriately evaluated and managed prior to intervention for their small renal stones. [Rev Urol. 2020;22(2):52–56] © 2020 MedReviews®, LLC
The Role of Multiparametric MRI and MRI-targeted Biopsy in Detecting Clinically Significant Prostate Cancer in the Community Setting: A Retrospective Study Original Research
Multiparametric MRI and the Prostate Imaging-Reporting and Data System (PI-RADS) have emerged as tools to reveal suspicious prostate lesions and MRI-targeted biopsy has shown potential to avoid repeat prostate biopsies and miss fewer significant cancers. This retrospective study sought to assess the differences in diagnostic yield and sampling efficiency between MRI-targeted and standard biopsies in a community urology practice. We concluded that MRI-targeted biopsy was more efficient than a standard biopsy, although neither technique achieved a superior diagnostic yield of clinically significant cancer in our community setting. We recommend that a standard biopsy be performed alongside targeted biopsy. [Rev Urol. 2020;22(2):57–66] © 2020 MedReviews®, LLC
Implementation of a Centralized, Cost-effective Call Center in a Large Urology Community Practice Original Research
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
After COVID-19, LUGPA More Important Than Ever
[Rev Urol. 2020;22(2):75–76] © 2020 MedReviews®, LLC
Adolescent Varicocele NYU Case of the Month, May 2020
[Rev Urol. 2020;22(2):77–79] © 2020 MedReviews®, LLC
Leptomeningeal Carcinomatosis of Prostate Cancer: A Case Report and Review of the Literature
Leptomeningeal carcinomatosis is a rare complication of prostate cancer. It is likely underdiagnosed as suggested by autopsy studies and is expected to become more prevalent with increasing survival of prostate cancer patients. Prostate cancer leptomeningeal carcinomatosis is associated with rapid functional decline and a median survival of approximately 1 month. Diagnosis is challenging because the clinical manifestations are varied, and no gold-standard diagnostic approach exists. Treatment of prostate cancer leptomeningeal carcinomatosis is not standardized and multiple approaches have been reported, mostly as case studies. Herein we report a case of a 73-year-old patient with metastatic castration-resistant prostate cancer who presented to our clinic with subacute cognitive decline, ataxia, and urinary incontinence, and was found to have leptomeningeal carcinomatosis. [Rev Urol. 2020;22(2):80–84] © 2020 MedReviews®, LLC
First Do No Harm: A Cautious, Risk-adapted Approach to Testicular Cancer Patients
Current guidelines regarding treatment for germ-cell tumors (GCTs) emphasizes cautious progression focusing on stage-specific treatments. Presented herein is the case of a 30-year-old man who, through monitoring of serum alpha-fetoprotein (AFP) levels and surveillance imaging, avoided excessive treatment. This case demonstrates how an experienced clinician, familiar with natural history of GCTs, can appropriately classify level of risk and allow a patient to preserve natural fertility. Furthermore, we highlight the potential for miRNA analysis in staging and management of GCTs. This case serves to underscore the importance of acting with caution in the pursuit of the best outcome for our patients. [Rev Urol. 2020;22(2):85–89] © 2020 MedReviews®, LLC