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Using Templates to Enhance Efficiency and Productivity in Your Urology Practice

Posted by | Oct 2021

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, presenting on behalf of his colleagues James E. Gottesman, MD, and Evan R. Goldfischer, MD, MBA, reviews tools for improving efficiency in a urology practice. He explains that efficiency is important for practices because revenues are decreasing, overhead is increasing, and incomes are being squeezed. Dr. Baum’s first recommendation for improving efficiency is to use scribes, since they improve patient flow, increase productivity, and improve both patient and physician satisfaction. He then highlights the benefits of voice recognition software, which significantly reduces time needed for documentation, as well as the utility of telemedicine, which has been adopted by the majority of urologists since the start of the COVID-19 pandemic. Dr. Baum notes that new software for prior authorization approval also increases efficiency. He then goes in depth about the effectiveness of using urology electronic medical record (EMR) templates, explaining that most urologic conditions can be managed with 10 to 15 templates, and that EMR templates enhance efficiency, enhance documentation, improve the learning curve of scribes and medical assistants, and may assist in coding and billing. Dr. Baum concludes by inviting interested viewers to contact either himself, Dr. Goldberg, or Dr. Gottesman for more information on the templates.

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High Intensity Focused Ultrasound for Prostate Cancer: Guidelines, Complications, and Outcomes

High Intensity Focused Ultrasound for Prostate Cancer: Guidelines, Complications, and Outcomes

Posted by | Sep 2021

Arvin George, MD, Assistant Professor of Urology at the University of Michigan in Midland, Michigan, reviews high intensity ultrasound (HIFU) for prostate cancer and outlines guidelines, patient selection, complications, and outcomes for the treatment. The NCCN guidelines state that HIFU is included as a salvage option after prior treatment failure, specifically radiation failure, but is not recommended as routine primary therapy due to lack of long-term comparative data. The EAU guidelines say to only offer HIFU within clinical trials or well-designed prospective cohorts. Dr. George describes the ideal HIFU patient as having unifocal, clinically-significant, and MRI-visible disease that has an absence of high-risk features. He then goes over a list of common complications and their rates of occurrence: retention (7-27%), hematoma (0-1.6%), sloughing (3-8%), urinary tract infection (5-18%), orchitis (2-8%), abscess (1-2%), fistula (.3-3%), pain (.5-3%), erectile dysfunction (12-30%), incontinence (0-5%), and stricture (2-4%). Dr. George says that to prevent complications one should not retreat the posterior zone, and should plan above the capsule while avoiding near field heat. He then reviews a study on focal therapy compared to radical prostatectomy for non-metastatic prostate cancer that found mostly HIFU focal therapy to have a failure free survival (FFS) rate comparable to that of radical prostatectomy, never exceeding a difference of 13%. Dr. George also discusses another study of medium-term oncological outcomes in a large cohort of men treated with either focal or hemi-ablation using high-intensity focused ultrasonography for primary localized prostate cancer which showed FFS rates of 86% at 24 months, 64% at 60 months, and 54% at 96 months. He concludes with a final study which consolidated and compared HIFU’s outcomes to those of active monitoring, radiotherapy, and radical prostatectomy, showing that HIFU produces consistently better quality of life outcomes.

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Role of PARP Inhibitors in Prostate Cancer

Posted by | Sep 2021

Daniel P. Petrylak, MD, Director of Genitourinary Oncology, Professor of Medicine and Urology, Co-Leader of Cancer Signaling Networks, and Co-Director of the Signal Transduction Program at Yale University Cancer Center in New Haven, Connecticut, discusses PARP inhibitors for castrate-resistant prostate cancer (CRPC). He begins by considering the relevant pathogenic germline mutations, outlining how PARP inhibitors function and presenting studies demonstrating their effectiveness. He notes that the 2015 TOPARP study was the first to suggest that PARP inhibitors could be used to treat metastatic CRPC (mCRPC). Dr. Petrylak then discusses phase III of the PROfound study which found that BRCA 1 and 2 mutations responded best to PARP. In describing the clinical implications, Dr. Petrylak reviews recently FDA-approved PARP inhibitors including olaparib and rucaparib. Olaparib was approved for treatment of homologous recombination repair (HRR) gene-mutated or deleterious germline mCRPC in patients who have progressed following prior treatment with enzalutamide or abiraterone. Rucaparib received accelerated approval for BRCA-mutated mCRPC in patients who have been treated with androgen receptor directed therapy and a taxane-based chemotherapy. Lastly, Dr. Petrylak comments on PARP inhibitor toxicities which include anemia, thrombocytopenia, and neutropenia and may necessitate infusions to help the patient’s blood count. He concludes that PARP inhibition is effective in patients with some DNA repair mutations but may be less effective on ATM mutations.

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