2021 Archives

Endoscopic Challenges in the Renal Transplant Patient

Posted by Wesley A. Mayer, MD | Apr 2021

Wesley A. Mayer, MD, outlines common urologic complications of renal transplant patients and discusses surgical options and endoscopic strategies to build confidence in managing these patients. Some of the urologic complications for renal transplant patients include ureteral strictures and urolithiasis. Dr. Mayer discusses using endourologic treatment, ureteroscopy, and PCNL to treat these complications. He discusses that there are more kidney donors accepted with stones and how to select patients for these transplants. He explains that ex vivo ureteroscopy is a safe, quick, and relatively straightforward and effective management option for donor kidneys with stones. He suggests working with an endourologist in complex cases.

Using the Level 2 Next Generation Sequencing Report for Recurrent UTI Patients

Posted by Ryan J. Malone, MD | Apr 2021

Mark N. Painter, CPMA, managing partner of PRS Consulting LLC, the CEO of PRS Urology Service Corporation, the Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc., and CEO of Relative Value Studies, Inc., discusses changes to Medicare billing in 2021, covering HIFU (high intensity-focused ultrasound) and detailing how the procedure is reimbursed. He details how the new CPT code for 2021, code 55880, is used for ablation of malignant prostate tissue, transretally approached, using high intensity-focused ultrasound (HIFU) and ultrasound guidance. Mr. Painter details how Medicare has set up facility payments: HIFU can only be billed once per date of service, and many Medicare carriers still consider HIFU as a non-covered service. Also, if the HIFU is done at a non-participating facility, it becomes patient responsibility. The new code does not allow for co-surgeons or assistant surgeons. He points out that there is an established fee schedule for facilities and appropriate values for the code, and advises to look at coverage rules and to keep an eye on individual carriers to see whether they will follow NGS moving forward or not. Mr. Painter also advises to check with each payer before providing this service to find where coverage is, where patient responsibilities lie, and to juggle that with your charges and reimbursement activity.

One-Page Marketing Plan for a Urology Practice (Part 1 of 3)

Posted by Neil H. Baum, MD | Apr 2021

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, presents a one-page marketing plan for urology practices in part one of a three-part series. Most doctors and office managers are untrained in the marketing skills necessary to develop and execute a successful plan, and consultants are not always worth the hype. Dr. Baum discusses the first three components that are key to creating a marketing plan: identifying the target market, messaging to that target market, and utilizing relevant social media tools. He advises doctors to clarify their unique service proposition, focus on what they enjoy doing, and assess the potential profitability of their proposed target market. Next, he offers tips for developing a brand, such as building on positive online reviews and distinguishing the practice through effective messaging. Ultimately, a compelling marketing plan tells a potential patient why they will prefer one practice over a competitor before they arrive for their first appointment. Finally, Dr. Baum looks at using social media and analytics to both reach the target market and measure the success of the campaign.

Enfortumab Vedotin for Previously Treated Advanced Urothelial Carcinoma

Posted by Daniel P. Petrylak, MD | Apr 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, summarizes his article on the EV-301 study of enfortumab vedotin and its role in making the drug a standard treatment option for patients with urothelial cancer. In 2012, Dr. Petrylak began working on a phase 1 trial of enfortumab which found that the drug had about a 40% response rate in patients with or without checkpoint surgery. He then worked on the EV-201 phase 2 trial, which found about a 40% response rate in patients previously treated with either a platinum-based chemotherapy or checkpoint inhibitor. Dr. Petrylak also worked on the phase 3 study (EV-301), which randomized patients to receive either enfortumab vedotin or standard chemotherapy and found significant overall survival benefits as well as a response rate of about 40% in the enfortumab arm. By confirming phase 1 and phase 2 data, this study earned enfortumab vedotin accelerated FDA approval. Dr. Petrylak does note that the drug has some side effects, including neuropathy and rashes. The video ends with a question and answer session conducted by E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology. Drs. Petrylak and Crawford discuss plans to use enfortumab vedotin earlier in the treatment process, and Dr. Petrylak observes that many studies are working on exactly that, including one looking at using enfortumab with pembrolizumab as a first-line treatment.

Overview of Image-Guided, Minimally-Invasive Focal Treatment

Posted by Jim C. Hu, MD, MPH | Apr 2021

Jim C. Hu, MD, MPH, Director of the LeFrak Center for Robotic Surgery and the Ronald P. Lynch Chair in Urologic Oncology at Weill Cornell Medical College, reviews emerging data on patient selection and outcomes of focal therapy. He discusses results of recent studies examining high-intensity focused ultrasound (HIFU) and comparing it with cryoablation, and looks at cancer recurrence rates after focal therapy. Dr. Hu describes an exploratory study of in-office partial gland cryoablation, then discusses a current project, PC CONCEPT, which is evaluating focal therapy at a population level. He emphasizes that a significant number of men do not get a prostate biopsy during follow-up. Since 30-60% of men who do receive a follow-up biopsy are shown to have biopsy-proven cancer, there is concern that men who do not receive a biopsy at some point following treatment may have recurrent cancer and have missed a window of curability. Dr. Hu concludes by noting that functional outcome preservation is better with focal therapy than radical prostatectomy, with only a 1-2% risk of significant deterioration of urinary and sexual functioning. He also adds that volume and orientation changes after focal therapy can create significant challenges for accurate biopsy and surveillance.