Casey A. Seideman

What is evaluation of hematuria by primary care physicians? Use of electronic medical records to assess practice patterns with intermediate follow-up

BACKGROUND To determine whether patients found to have hematuria by their primary care physicians are evaluated according to best practice policy. MATERIALS AND METHODS The University of Texas Southwestern Medical Center maintains institutional outpatient electronic medical records (EMR) that are used by all providers in all specialties. We conducted an Institutional Review Board approved observational study of patients found to have more than 5 red blood cells/high power field between March 2009 and February 2010. RESULTS There were 449 patients of whom the majority were female (82%), Caucasian (39%), with microscopic hematuria (MH) (85%). Almost 58% of patients were initially symptomatic with urinary symptoms or pain. Evaluation for the source of hematuria was limited and included imaging (35.6%), cystoscopy (9%, and cytology (7.3%). Only 36% of men and 8% of women were referred to a urologist. No abnormality was found in 32% and 51% of patients with gross hematuria and MH, respectively (P = 0.004). There were 4 bladder tumors and 1 renal mass detected. Male gender, ethnicity and gross (vs. microscopic) hematuria were associated with higher rate of urological referral. Advanced age, smoking, provider practice type, and the presence of urinary symptoms were not associated with an increase rate of urological referral. No additional cancers were diagnosed with 29-month follow-up. CONCLUSIONS While urinalysis remains a common diagnostic tool, most cases of both microscopic and gross hematuria are not fully evaluated according to guidelines. Use of cystoscopy, cytology, and upper tract imaging is limited. Further studies will be needed to determine the extent of the problem and impact on morbidity and survival.

Self-retaining barbed suture for parenchymal repair during laparoscopic partial nephrectomy; Initial clinical experience

Study Type – Therapy (case series)

Cost-Effectiveness of Fluorescence In Situ Hybridization in Patients with Atypical Cytology for the Detection of Urothelial Carcinoma

PURPOSE Patients with atypical cytology and equivocal or negative cystoscopy pose a challenge due to uncertainty about the presence of cancer. We determined the cost-effectiveness of using fluorescence in situ hybridization assays to determine the need for biopsy in patients with atypical cytology and equivocal or negative cystoscopy. MATERIALS AND METHODS Data from 2 large prospective studies evaluating the usefulness of fluorescence in situ hybridization in the setting of atypical cytology to detect urothelial carcinoma were combined. The data were used to calculate sensitivity and specificity for the UroVysion fluorescence in situ hybridization assay in various clinical scenarios. Cost data were obtained from our institution and Medicare reimbursement rates. Evaluations with or without bladder biopsy and with or without upper tract evaluation were considered. RESULTS The study included 263 patients with atypical cytology and equivocal (62) or negative (201) cystoscopy. In patients with equivocal cystoscopy (assuming biopsy was performed in the operating room) biopsy based on fluorescence in situ hybridization results saved

The Performance of a Modified RENAL Nephrometry Score in Predicting Renal Mass Radiofrequency Ablation Success

1,740 per patient (

Renal tumour nephrometry score does not correlate with the risk of radiofrequency ablation complications.

3,267 vs

Malleable Penile Prosthesis Is a Cost-Effective Treatment for Refractory Ischemic Priapism

1,527 per patient) and avoided 42 biopsies compared to biopsy in all patients. If office based biopsies were used then cost savings using fluorescence in situ hybridization results were

Robot-assisted laparoendoscopic single-site pyeloplasty: technique using the da Vinci Si robotic platform.

95 per patient. Among patients with negative cystoscopy biopsy based on fluorescence in situ hybridization resulted in costs savings of

Cost Comparison of Robot-Assisted and Laparoscopic Pyeloplasty

2,241 per patient, avoiding 167 biopsies, compared to biopsy in all patients. Assuming office based biopsy, the cost savings were

A Surprisingly Low Prevalence of Demonstrable Stress Urinary Incontinence and Pelvic Organ Prolapse in Women with Multiple Sclerosis Followed at a Tertiary Neurogenic Bladder Clinic

216 per patient. CONCLUSIONS The decision to perform biopsy based on fluorescence in situ hybridization assay in patients with atypical cytology and equivocal or negative cystoscopy was associated with a significant decrease in bladder cancer associated costs.

DNA Copy Number Variations in Patients with Persistent Cloaca

OBJECTIVE To assess the predictive performance of a modified RENAL nephrometry score for renal tumors undergoing radiofrequency ablation (RFA). METHODS Patients who underwent RFA were identified from 2002 to 2011, and RENAL nephrometry scoring was performed for each. A modified RENAL (m-RENAL) nephrometry score was created to account for the small sizes of tumors ablated for which the size variable, R, was adjusted. A size of 3 cm was calculated as the optimal cutoff for the R component of the m-RENAL nephrometry score, and tumors were given an R score of 1 if <3 cm, 2 if 3-4 cm, or 3 if >4 cm. Other RENAL variables were unchanged. Oncologic outcomes were stratified by complexity tertiles defined as low (4-6), medium (7-9), and high (10-12). Outcomes were reported as initial ablation success (IAS), recurrence-free survival (RFS), and metastatic-free survival (MFS). The Kaplan-Meir method was used to estimate survival based on complexity tertile. RESULTS Two hundred forty patients were identified who underwent RFA, of which 192 patients were eligible for analysis. Median follow-up was 32.2 months, and median tumor size was 2.4 cm. IAS was achieved in 185 of 192 patients (96.4%). Overall, the estimated 3-year RFS was 95.1% and MFS was 97.3%. There was no statistical difference between complexity tertiles using the standard RENAL nephrometry score; however, the m-RENAL nephrometry score was significantly associated with IAS and RFS (P = .027 and P = .003, respectively). There were too few events (n = 3) to perform statistical analysis for MFS. CONCLUSION A modification to the size variable increases the performance of the RENAL nephrometry score when used to stratify RFA ablation success.