Latest Videos

Bottom Line Shrinking? Check Your EOBs

Posted by | Mar 2022

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses the importance of reviewing explanations of benefits (EOBs) in a medical practice to ensure the practice is receiving appropriate compensation. He defines EOBs as feedback on the effectiveness of a practice’s billing/coding, and argues that failing to review EOBs will result in a decrease in cash flow. Dr. Baum claims that reviewing EOBs strengthens management of the billing team and helps practices know why they are or are not successful, since “what gets measured gets managed.” He gives the example of an overwhelmed biller who failed to submit 10% of claims for 12 years and rarely appealed denials. By reviewing EOBs, Dr. Baum explains, the managing partner can identify the problem and gather proof that billing needs improvement. He discusses several other benefits of reviewing EOBs, noting that EOBs show deficiencies and how to correct them, as well as provide tracker data on a practice’s payor mix and frequency of highly paid procedures. Dr. Baum recommends that practices review EOBs approximately every three months, using an exception report to track any deviation in compensation. He says that doing so will take little more than an hour per month and help practices ensure they are paid what they deserve in an era of decreasing reimbursements and increasing overhead expenses.

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When is Radical Cystectomy Indicated for NMIBC?

Posted by | Mar 2022

Guilherme Godoy, MD, MPH, Assistant Professor of Urology at Baylor College of Medicine, in Houston, Texas, discusses the role of cystectomy in non-muscle invasive bladder cancer (NMIBC). He begins by describing the management options for NMIBC, including transurethral resection of the bladder tumor (TURBT), intravesical treatment, systemic therapy, and radical cystectomy. Dr. Godoy then explains the importance of re-TURBT, stating that it is one of the most critical steps in management for reducing understaging and improving intravesical therapy response in patients. He summarizes the indicators for cystectomy, including failure to resect, adverse pathology, and treatment failures. Dr. Godoy reviews data from a large single-institution retrospective study showing a significant difference in recurrence-free survival, cancer-specific survival, and overall survival in favor of the primary muscle invasion at presentation group vs. the progressive MIBC group. He then discusses data from a systematic review and meta-analysis of 14 studies on oncological outcomes of primary and secondary MIBC, finding worse outcomes overall for secondary muscle invasive cystectomy. Dr. Godoy looks at the European and AUA risk stratification tables, focusing on how both support aggressive management of high risk disease. He shows data from a study of the impact of variant histology on outcomes with intravesical immunotherapy, finding 40% progression-free survival compared to 17.5% in conventional bladder cancer. He states that all of this data supports cystectomy as an important and integral tool in the management of NMIBC due to its excellent oncological outcomes and potential benefit of abbreviated management and follow-up for aggressive NMIBC despite its morbidity, though the treatment may not be appropriate for everyone.

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Prostate Imaging Elevated By Deep Learning

Posted by | Mar 2022

Mukesh Harisinghani, MD, Director of Abdominal MRI at Massachusetts General Hospital and Professor of Radiology at Harvard Medical School in Boston, Massachusetts, discusses how deep learning algorithms can improve the efficiency and accuracy of prostate cancer imaging. He highlights the importance of widespread prostate cancer screening, observing that every 3 minutes, a man is diagnosed with prostate cancer, and every 17 minutes, a man dies of prostate cancer. Dr. Harisinghani notes that patients want to get a multiparametric (mp)MRI if there is a clinical suspicion of prostate cancer and, if negative, avoid a biopsy in order to prevent unnecessary intervention and avoid cost. Because this is such a widespread need and mpMRIs are relatively time-consuming, he argues there is a need to figure out how to reduce scan time and not lose accuracy. Dr. Harisinghani explains that the two main time sinks in prostate mpMRI are T2-weighted imaging and diffusion-weighted imaging (DWI). He then demonstrates how deep learning reconstruction using software like AIR Recon DL in all 3 planes leads to significant time gain for T2-weighted imaging. Dr. Harisinghani says that many might be hesitant to ‘skimp’ on DWI, since higher b value (which takes a longer time to attain) leads to better image quality. However, he argues that deep learning can reduce scan time without reducing scan quality in DWI, and presents images comparing standard DWI and Air Recon DL to show the improved quality of the latter. Dr. Harisinghani concludes that a scan time of less than 10 minutes is not necessarily just a dream if you can apply Air Recon DL to both T2 and DWI.

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Innovations in Urologic Residency Education

Posted by | Mar 2022

Wesley A. Mayer, MD, Associate Professor of Medicine, Assistant Dean of Graduate Education, and Vice Chair of Education in the Scott Department of Urology at Baylor College of Medicine in Houston, Texas, discusses innovations in urologic residency education in the face of changing technology and COVID-19. He begins with a brief history of medical training, explaining that the apprenticeship model was standard until around the start of the 20th century, when William Halstead began to develop the traditional surgical education experience featuring intense and repetitive experiences with surgical patients. Dr. Mayer then lists new challenges in modern surgical training, including work-hour restrictions, influence from other high-stakes fields, an increasingly litigious environment, rising expectations from the public, a progressive physician shortfall, and generational changes in learning style and needs. He argues that to meet these challenges, modern surgical training should: leverage simulators as well as inanimate and animate models; deconstruct complex surgeries into component skills; incorporate structured objective assessment tools; utilize concise, constructive, real-time feedback; address broader stressors impacting trainees, such as wellness and burnout; develop non-surgical skills; and innovate through servant leadership. Dr. Mayer then discusses recent innovations in open surgical training, highlighting the benefits of using cost-effective models based on cheaper materials and 3D printing rather than expensive traditional benchtop models and cadaveric simulations. He moves on to look at innovations in endoscopic surgical training and innovations in laparoscopic/robotic surgical training, emphasizing the benefits of virtual reality training models and video-based coaching. Dr. Mayer summarizes the recent experience of resident education in the Scott Department, particularly focusing on the department’s participation in a trial of SIMPL, a smartphone-based surgical skills assessment tool. He then briefly expands upon innovative feedback models and ways to manage trainee wellness and burnout. Dr. Mayer also considers the effect of COVID-19 on surgical training, observing that while the pandemic led to reduced resident work hours and increased concern that residents would not be able to meet minimum case requirements, the rise of videoconferencing allowed for the positive development of nationwide urology didactics. He closes the presentation by discussing innovative educational uses of social media and the importance of non-technical skills training.

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Mini PCNL versus Standard PCNL

Posted by | Mar 2022

Manoj J. Monga, MD, FACS, Professor and Chair of Urology at the University of California, San Diego, compares mini percutaneous nephrolithotomy (mini PCNL) for renal stone removal to standard percutaneous nephrolithotomy (PCNL). He begins by looking at who needs a PCNL, explaining that he typically performs them on patients with a stone larger than 15mm, but that he also sometimes performs PCNL on stones when there are anatomical considerations that would make it difficult to get to the stone ureteroscopically. Dr. Monga notes that PCNL has the best outcomes and results in the best quality of life of any stone removal technique. He then poses the question: Why not treat every stone with PCNL? The answer, of course, he says, is because 4/1000 patients die from PCNL due to sepsis. Dr. Monga then moves on to discuss mini PCNL, noting that it was originally assumed to potentially be safer than PCNL, but that a 2001 study showed there was no advantage. He also observes that the smaller sheath used in mini PCNL actually increases the risk of infectious complications, and that outcomes are worse and operating room time is longer with mini PCNL compared to standard. However, Dr. Monga notes, there does appear to be a lower risk for bleeding and fewer transfusions, which might result in less kidney volume loss.

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