Neil Baum

2001 American Urological Association Gallup Survey: changes in physician practice patterns, satisfaction with urology, and treatment of prostate cancer and erectile dysfunction.

PURPOSEnThe Health Policy Survey and Research Committee of the American Urological Association and the Gallup organization have performed 9 surveys of American urologists since 1992 for the purpose of assessing demographics and practice patterns. The results of the 2001 survey are presented.nnnMATERIALS AND METHODSnA random sample of 507 urologists was interviewed in February and March 2001. Major content areas were physician practice patterns, cryosurgery/brachytherapy, prostate specific antigen, erectile dysfunction, Medicare and the Internet.nnnRESULTSnMembership in the American Urological Association continues to increase among American urologists. The number of patients seen weekly in the office also continues to increase. While age at retirement has not changed significantly, most urologists are satisfied with the specialty and increasing numbers are using the Internet.nnnCONCLUSIONSnMinimally invasive procedures such as brachytherapy for prostate cancer continue to proliferate and there is evidence that the specialty of urology is continuing to become more office based. The demand for urological services appears to be continuing to increase.

The Adjustable Continence Therapy System for Recurrent Female Stress Urinary Incontinence: 1-Year Results of the North America Clinical Study Group

PURPOSEnWe determined the efficacy, safety, adjustability and technical feasibility of the adjustable continence therapy device (Uromedica, Plymouth, Minnesota) for the treatment of recurrent female stress urinary incontinence.nnnMATERIALS AND METHODSnFemale patients with recurrent stress urinary incontinence were enrolled in the study and a defined set of exclusionary criteria were followed. Baseline and regular followup tests to determine eligibility, and to measure subjective and objective improvement were performed. A trocar was passed fluoroscopically and with digital vaginal guidance to the urethrovesical junction through small incisions between the labia majora and minora. The adjustable continence therapy device was delivered and the balloons were filled with isotonic contrast. The injection ports for balloon inflation were placed in a subcutaneous pocket in each labia majora. Device adjustments were performed percutaneously in the clinic postoperatively. An approved investigational device exemption Food and Drug Administration protocol was followed to record all adverse events.nnnRESULTSnA total of 162 subjects underwent implantation with 1 year of data available on 140. Mean Stamey score improved by 1 grade or more in 76.4% (107 of 140) of subjects. Improvement in the mean incontinence quality of life questionnaire score was noted at 36.5 to 70.7 (p <0.001). Reductions in mean Urogenital Distress Inventory (60.3 to 33.4) and Incontinence Impact Questionnaire (54.4 to 23.4) scores also occurred (p <0.001). Mean provocative pad weight decreased from 49.6 to 11.2 gm (p <0.001). Of the patients 52% (67 of 130) were dry at 1 year (less than 2 gm on provocative pad weight testing) and 80% (102 of 126) were improved (greater than 50% reduction on provocative pad weight testing). Complications occurred in 24.4% (38 of 156) of patients. Explantation was required in 18.3% (28 of 153) of the patients during 1 year. In terms of the complications 96.0% were considered to be mild or moderate.nnnCONCLUSIONSnThe Uromedica adjustable continence therapy device is an effective, simple, safe and minimally invasive treatment for recurrent female stress urinary incontinence. It can be easily adjusted percutaneously to enhance efficacy and complications are usually easily manageable. Explantation does not preclude later repeat implantation.

Xanthogranulomatous Epididymitis: A Case Report

We report a case of bilateral scrotal masses in a diabetic man with bilateral epididymitis and abscess formation.

Treatment of moderate to severe female stress urinary incontinence with the adjustable continence therapy (ACT) device after failed surgical repair.

IntroductionTreatment of recurrent stress incontinence after a failed surgical procedure is more complicated, and repeat surgeries have higher rates of complications and limited efficacy. We determined the technical feasibility, efficacy, adjustability, and safety of adjustable continence therapy device for treatment of moderate to severe recurrent urinary incontinence after failed surgical procedure.Materials and methodsFemale patients with moderate to severe recurrent stress urinary incontinence who had at least one prior surgical procedure for incontinence were enrolled. All patients underwent percutaneous placement of adjustable continence therapy (ACT) device (Uromedica, Plymouth, Minnesota). Baseline and regular follow-up tests to determine subjective and objective improvement were performed.ResultsA total of 89 patients have undergone implantation with 1–3xa0years of follow-up. Data are available on 77 patients at 1xa0year. Of the patients, 47% were dry at 1xa0year and 92% improved after 1-year follow-up. Stamey score improved from 2.25 to 0.94 at 1xa0year (Pxa0<xa00.001). IQOL questionnaire scores improved from 33.9 to 71.6 at 1xa0year (Pxa0<xa00.001). UDI scores reduced from 60.7 to 33.3 (Pxa0<xa00.001) at 1xa0year. IIQ scores reduced from 57.0 to 21.6 (Pxa0<xa00.001) at 1xa0year. Diary incontinence episodes per day improved from 8.1 to 3.9 (Pxa0<xa00.001) at 1xa0year. Diary pads used per day improved from 4.3 to 1.9 (Pxa0<xa00.001). Explantation was required in 21.7% of patients.ConclusionThe ACT device is an effective, simple, safe, and minimally invasive treatment for moderate to severe recurrent female stress urinary incontinence after failed surgical treatment.

The Basics of the Business of Medicine

Our purpose is to provide the graduating and practicing physician with an understanding of the business of a medical practice. All doctors leave medical school and their postgraduate training with excellent skills for diagnosing and treating medical illnesses. However, nearly every new doctor leaves his or her training with little to no skills to become successful businessmen and businesswomen. In fact, most physicians are now stereotyped as poor business people. Doctors have a reputation for being good at caring for their patients, but poor at managing the business aspect of their practices.

Business of UrologyThe 4 Questions to Ask and Answer Regarding ICD-10: Second of a 2-Part Series

Introduction: On October 1, 2015 the International Classification of Diseases and Related Health Problems, 9th revision (ICD‐9) will be replaced by the 10th revision (ICD‐10) for coding medical encounters in the United States. This transition will fundamentally change how medical care is documented, how health care is delivered and how delivery systems operate. We will shed light on the ICD‐10 transition and answer 4 questions we believe to be important to this transition. We first wanted to know 1) how ICD‐10 differs from ICD‐9 and 2) why we need to do this/what frustrations we might expect. Methods: A search was undertaken regarding the transition from ICD‐9 to ICD‐10, and included input and expertise from coding experts as well as personal experience. Results: ICD‐10 differs from ICD‐9 in a number of ways, not just in the extreme expansion in the number of codes and specificity. ICD‐10 has a new structure and rules that must be understood. The proposed advantages of transitioning to ICD‐10 include a better analysis of disease patterns, improved treatment outcomes, streamlined claims submissions and reduced overall health care costs. These “advantages” have been debated and not yet proved. The transition could be very expensive and very frustrating. Conclusions: The transition to ICD‐10 presents a significant implementation challenge for every health care provider and practice, and could be financially devastating to those who are unprepared. There is a significant cost to implementation, much of which is seemingly placed directly on health care providers. We must be prepared.