Urology Office Research Articles

Pharmacotherapy in the Management of Voiding and Storage Disorders, Including Enuresis and Encopresis

Child and adolescent psychiatrists are uniquely positioned to manage disorders of bladder and rectum, including enuresis and encopresis. Such disorders-whether primary complaints or comorbid with other disorders-typically account for about 40% of all pediatric urology office visits, with reported prevalence rates of 2% to 7% in school-age children for daytime incontinence.1 These disorders are amenable to therapeutic interventions. Still, confusion about etiology as well as about clinical semantics and terminology tends to obfuscate rational clinical decision making.

Missed Diagnoses by Urologists Resulting in Malpractice Payment

Missed diagnoses are a patient safety concern and they can result in malpractice allegation. The specialist physician may be liable for missed or delayed diagnoses even if an abnormality in the physician area of expertise is ruled out. We approached this largely unstudied area of medical malpractice in an effort to increase physician awareness and identify opportunities for prevention. Working with the Medical Liability Mutual Insurance Company of New York State, we evaluated malpractice claims in urology that were closed with indemnity payment between 1985 and 2004. We identified all such claims resulting from alleged missed or delayed diagnoses by urologists. Claims were divided into 2 main categories based on whether the missed diagnosis was primarily urological, ie testis torsion, or not urological, ie appendicitis. A total of 75 missed diagnosis claims were identified, representing 15% of claims overall. The total indemnity payment for missed diagnosis claims was $32,591,013, which represented 27% of all indemnity payments for the study period. They were divided into 58 missed urological diagnoses and 17 missed nonurological diagnoses. Cancer represented 71% of missed urological diagnoses and 41% of missed nonurological diagnoses. Urological cancer missed diagnosis claims were associated with the highest average indemnity payment of $526,460. The average indemnity payment for missed diagnosis claims was 92% greater than the average indemnity payment for all other claims ($434,546 vs $226,133). An increase in the frequency of missed diagnosis claims closed with indemnity payment and in the amount of payment for missed diagnosis claims were observed during the 20-year study period. Indemnity payments resulting from missed diagnosis claims represent a disproportionately high percent of total indemnity payments (27%) due to a high average payment for such claims. Liability for the urologist resulted from missed diagnoses not only of urological conditions, but also of nonurological conditions.

Multiplex Polymerase Chain Reaction for Microsatellite Analysis of Urine Sediment Cells: A Rapid and Inexpensive Method for Diagnosing and Monitoring Superficial Transitional Bladder Cell Carcinoma

Several urinary markers have been recently introduced in clinical practice for improving the noninvasive diagnosis of transitional cell carcinoma. Although microsatellite analysis must be considered the best method in terms of results, its cost and method time are unacceptable for daily use. We validated a more rapid and inexpensive method of determination using rapid DNA extraction and automatic multiplex polymerase chain reaction amplification. A total of 120 patients who presented consecutively to a urological office, including 73 with transitional cell carcinoma and 43 who served as controls, were selected for study. Microsatellite analysis was performed in the blood/urine pair using 3 multiplex polymerase chain reactions per patient. Urine sediment inflammatory cells were assessed by urine dipstick test. Ten microsatellite loci were investigated. Numerical data collected during electrophoresis of the amplified segment in an ABI Prism 310 Genetic Analyzer were used to calculate the cutoff for allelic imbalance. Method sensitivity, specificity, and positive and negative predictive values were calculated. A total of 66 patients had microsatellite analysis alterations in urine sediment, of whom 59 had transitional cell carcinoma, while 7 had other urological diseases. Test sensitivity and specificity were 80.8% and 85.1%, respectively. Statistical analysis did not indicate any significant influence of inflammatory status on microsatellite analysis diagnostic performance. In the control group the allelic imbalance on chromosome 9 was significantly lower than on other chromosomes (p = 0.0143). This could confirm that chromosome 9 has a specific role in transitional cell carcinoma. The multiplex microsatellite analysis method was low cost and not time-consuming. Multiplex microsatellite analysis is a noninvasive, rapid, inexpensive and reproducible method for screening for and monitoring superficial transitional cell carcinoma. It should be considered an alternative method to urinary cytology and it should also be considered in the presence of urine sediment inflammatory cells.

Diagnosis of enterovesical fistula using poppy seeds

Colorectal DiseaseVolume 8, Issue 1 p. 71-72 Diagnosis of enterovesical fistula using poppy seeds H. Wensky, H. Wensky Urological Office, Prüner GangSearch for more papers by this authorJ. Jongen, J. Jongen Colorectal surgeon (EBSQ), Proctological Office, Beselerallee 67, 24105 Kiel, Germany E-mail: jjongen@proktologie-kiel.deSearch for more papers by this author H. Wensky, H. Wensky Urological Office, Prüner GangSearch for more papers by this authorJ. Jongen, J. Jongen Colorectal surgeon (EBSQ), Proctological Office, Beselerallee 67, 24105 Kiel, Germany E-mail: jjongen@proktologie-kiel.deSearch for more papers by this author First published: 09 December 2005 https://doi.org/10.1111/j.1463-1318.2005.00902.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume8, Issue1January 2006Pages 71-72 RelatedInformation

Current status of dynamic lymphoscintigraphy and sentinel lymph‐node biopsy in urological malignancies

BJU InternationalVolume 96, Issue 9 p. 1235-1239 Current status of dynamic lymphoscintigraphy and sentinel lymph-node biopsy in urological malignancies Paul Hadway, Paul Hadway Urology, St George's Hospital, London, UKSearch for more papers by this authorMark Lynch, Mark Lynch Urology, St George's Hospital, London, UKSearch for more papers by this authorSusan Heenan, Susan Heenan Urology, St George's Hospital, London, UKSearch for more papers by this authorNicholas A. Watkin, Corresponding Author Nicholas A. Watkin Urology, St George's Hospital, London, UKNicholas Watkin, Urology office, St James's Wing, St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, UK. e-mail: [email protected]Search for more papers by this author Paul Hadway, Paul Hadway Urology, St George's Hospital, London, UKSearch for more papers by this authorMark Lynch, Mark Lynch Urology, St George's Hospital, London, UKSearch for more papers by this authorSusan Heenan, Susan Heenan Urology, St George's Hospital, London, UKSearch for more papers by this authorNicholas A. Watkin, Corresponding Author Nicholas A. Watkin Urology, St George's Hospital, London, UKNicholas Watkin, Urology office, St James's Wing, St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, UK. e-mail: [email protected]Search for more papers by this author First published: 15 November 2005 https://doi.org/10.1111/j.1464-410X.2005.05738.xCitations: 12Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume96, Issue9December 2005Pages 1235-1239 RelatedInformation

Access to urologic care for children in California: Medicaid versus private insurance

Objectives To compare the access to urologic care for a child with cryptorchidism insured by Medi-Cal versus one insured by private insurance. Medi-Cal (California State Medicaid) is a joint state and federal health insurance program that plays a significant role in providing healthcare coverage to low-income children. Methods A total of 54 randomly chosen urology offices throughout California were surveyed by telephone to determine whether the office accepted pediatric patients, accepted Medi-Cal, and when the earliest appointment date would be for a patient with Medi-Cal versus one with private insurance. Results Of the 46 practices that accepted pediatric patients, 96% offered a new patient appointment to a child with private insurance, but only 41% were willing to offer an appointment to a child with Medi-Cal ( P <0.0001). Of the offices that would not see a child with Medi-Cal, 75% were unable to recommend a urology office that might accept Medi-Cal. Conclusions Children insured by Medi-Cal have significantly less access to necessary urologic care compared with children with private insurance.

Degree of bother caused by nocturia in women.

The prevalence of nocturia in women has been studied, but its severity has not been categorized based on degree of bother. The number of nighttime voids that defines clinically significant nocturia has not been established. The objective of this study was to establish how bothersome nocturia is in women and to determine whether number of nighttime voids correlates with the degree of bother. We also sought to determine if this correlation was affected by age or continence status. The charts of 1,214 neurologically healthy women that presented to a female urology office were reviewed. All women completed the American Urological Association Symptom Index (AUASI) and the symptom problem index (SPI). Question no. 7 of the AUASI assesses the number of voids per night and question no. 3 of the SPI assesses the bother of nighttime voiding. The correlation of these two variables was evaluated using a proportional odds model. Mean age was 54.6 years (18-93). 87.3% complained of waking at least one time per night to void. Bother score increased as the number of nightly voids increased, irrespective of age or continence status. The proportional odds model showed that as the number of voids increases 1 value on AUASI, the odds of having an increase in bother increases 2.7 times (P<0.0001). As the number of nighttime voiding episodes increases, the bother increases, independent of age or continent status. Based on the degree of bother, we propose that clinically significant nocturia in women be classified as two or more episodes per night.

Office pediatric urologic procedures from a parental perspective

I commend the authors for increasing our awareness of the issues of pediatric pain management during urologic office procedures. Certainly, one of our goals as pediatric practitioners is to reduce the trauma of medical procedures whenever possible. The use of EMLA is a convenient, economical, painless method to minimize pain during minor procedures. The safety and effectiveness of EMLA is well documented in published reports of nonurologic procedures. In this article, the authors have shown its utility in urologic procedures. Use of this topical anesthetic poses minimal risks compared with the use of a general anesthetic. In my experience, when EMLA is used along with distraction techniques, many children will be unaware that the lysis or meatotomy has been performed.

EFFECTIVE OFFICE MANAGEMENT OF CHRONIC PROSTATITIS

Chronic prostatitis does not have to be a frustrating urologic office encounter. The empathetic urologist who is equally committed to all patients (including those with prostatitis), can achieve realistic improvement in symptoms with a simple and straightforward diagnostic and therapeutic strategy.

Liquid sterilization versus high level disinfection in the urologic office

Systems are available for liquid sterilization (LS) and high level disinfection (HLD) of flexible cystoscopes. Guidelines from the Association of Operating Room Nurses and the Association for Professionals in Infection Control and Epidemiology recommend HLD for urologic endoscopic equipment. We examine these methods emphasizing costs, performance of procedure, and maintenance. The process of LS using the Steris System 1 Processor (SSP1) was studied from June 1993 to June 1994. The Voluntary Hospital Association (VHA) Plus Glutaraldehyde HLD system was evaluated from July 1994 to July 1995. Costs are those incurred by the Ochsner Department of Urology over these same periods. Purchase of the SSP1 system proved costly: $16,200 for purchase; $8645 for accessories, service contract, and training seminars; and $5800 for unit installation. Two gallons of glutaraldehyde including the disinfection container cost $15.60. Since government regulation requires less than 0.2 ppm airborne glutaraldehyde concentration, some facilities may need to install ventilation systems. There were no clinical differences between the two systems. Yearly operating expenses in our department for SSP1 was $6037 compared to $445 for HLD. Mean length of time to process was 35 minutes per use for SSP1 and 20 minutes for HLD. Repair of seven cystoscopes during the SSP1 period cost $11,500. No repairs were required for the cystoscopes used during the HLD period. Outpatient flexible cystoscopy was performed an average of 988 times per year during the study period. Major cost savings were incurred with institution of the HLD system and no endoscope repairs were necessary. There were no clinical differences between the two systems.

Patient noncompliance after vasectomy

Objective: To determine the postoperative instruction compliance rate in men undergoing bilateral vasectomy. Design: Retrospective chart review. Setting: Private practice urological office. Patient(s): The records of all patients undergoing vasectomy were reviewed to determine the rate of compliance with postvasectomy follow-up instructions. It is our policy to have the patient continue to use some form of birth control until he achieves two consecutive negative semen analyses 1 month apart. In addition, we recommend a yearly semen analysis after achieving sterility to screen for the rare patient who recanalizes. Postvasectomy follow-up instructions are given to the patient both verbally and in writing. Intervention(s): None. Main Outcome Measure(s): The records of 1,892 consecutive patients undergoing vasectomy were reviewed, and the results of semen analyses were noted to determine the rate of compliance with postvasectomy follow-up instructions. Result(s): Six hundred forty-four men (34%) never returned after vasectomy and, therefore, no semen analyses were available for examination. Six hundred nineteen men (33%) returned for a single semen analysis. Six hundred twenty-nine men (33%) returned for a second negative semen analysis. Only 60 men (3%) completed postvasectomy follow-up instructions and returned for a yearly semen analysis. Conclusion(s): The rate of compliance with postvasectomy follow-up instructions for determining sterility is poor.

Rapid detection methods for bacteriol identification in urologic office laboratory

A regulatory era is taking shape under the Health Care Financeing Administration (HCFA) which eventually will be implemented under the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88). Sweeping changes are planned for all alaboratories, including physician's office and group practice offices. Both of these groups have previously been exempt from federal controls. Though many urologists have been doing uring cultures and colony counts in their offices for a long time, it is important that precise bacterial identification also be done for good patient care, to control quality and cost, and for more rapid results. Herein, we review many commercial kits now available for precise bacterial identification in the office laboratory. These are largely unknown to most practicing ueologists but have been available to microbiologists They easily can be learned and used in an ofice or group practice laboratory. Urologists are competent to perform these tests, especially with a review course or with assistance from thei local hospital microbiology laboratory

New Sterilizing Apparatus for Flexible Cystoscope

A new set-up for sterilization of flexible cystoscopes has been designed that is safe, efficient and practical in a urology office.

The Urologic Office Laboratory

For a variety of reasons, urologists are considering and reconsidering their needs in beginning an office laboratory. Advances in technology have made many instruments available for in-office analysis of blood and urine for various purposes. Moreover, changes in microbiologic analysis have made bacteriuria screening and culture and sensitivity testing of urine possible at different levels of sophistication. The authors consider some of the available modalities, their advantages and disadvantages, and the requirements for quality assurance and quality control.

Computerization of the Urologic Office: Billing, Record Keeping, and Education

Careful initial evaluation of the options is vital to successful medical office automation. The many available software programs should be scrutinized to be certain the one chosen satisfies all one's listed needs. In addition to the usual functions expected of computers, the data gathered can be used to market the urologic practice. Word processing, spreadsheet, and database programs can enhance relations among the urologist's office, referring physicians, and patients.

The Modern Urology Office

In the rapid change of urology practice, a modern office, carefully planned, can enhance the transition to high-technology urology and improve the doctor-patient relationship.

An Office Method for Calibrating a Uroflowmeter

We describe a method to calibrate a uroflowmeter without the use of specialized equipment. The technique requires a tap, a graduated measuring cylinder and a stopwatch, and it can be done easily in a urology office or clinic.