David C Miller

..Despite this promise, however, the currently available measures have several limitations that should be considered during their implementation in prostate cancer quality assessment and improvement activities...

..We describe the establishment of the Urological Surgery Quality Collaborative including our pilot project to improve radiographic staging for men with prostate cancer...

..To clarify the contemporary clinical epidemiology of renal cell carcinoma we present trends in clinical presentation and treatment in patients enrolled in a population based case-control study...

..Therefore, we evaluated trends in prostate cancer severity in an ethnically diverse cohort of low income, uninsured men served by a state funded public health program in California...

..To achieve this aim, we compared procedure assignments based on Medicare claims with the type of surgery specified in SEER registry data and clinical operative reports...

..We describe findings from a Urological Surgery Quality Collaborative project focused on improving the use of radiographic staging in men with newly diagnosed prostate cancer...

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..To better delineate which factors influence the decision to undergo active surveillance of small renal masses...

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..The authors assessed adherence with the College of American Pathologists (CAP) radical prostatectomy (RP) practice protocol in a national sample of men who underwent RP for early-stage prostate cancer...

..This study compared oncologic and health-related quality-of-life outcomes among patients undergoing intraperitoneal or extraperitoneal robotic prostatectomy...

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..Restaging bladder tumor resection improves staging accuracy and the response to intravesical therapy. However, its use outside of a tertiary care setting, and its subsequent clinical implications, are unknown...

..To clarify the benefits of nephron-sparing surgery among patients with early-stage kidney cancer, the authors compared the frequency of renal and cardiovascular morbidity after partial or radical nephrectomy...

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..Characterization of these factors could enhance preoperative patient counseling and facilitate perioperative management, thereby improving the quality of patient care...

..To evaluate the potential association between sexual motivation and patterns of erectile dysfunction (ED) therapy among a large cohort of localized prostate cancer treatment survivors...

..We sought to characterize hospice use by men dying of prostate cancer and to compare the use of high-intensity care between those who did or did not enroll in hospice...

..To evaluate patient and tumor characteristics associated with percutaneous renal mass biopsy (RMB) among patients with small renal masses (SRMs) and assessed the impact on clinical decision-making...

..During this period short-term outcomes following cystectomy improved, while the use of subacute care facilities and home health services increased dramatically, underscoring a shift in the burden of care in this patient population...

..Thus, Medicare's transplant experience allows us to examine the role of payer leverage in motivating hospital benchmark compliance...

..Perioperative outcomes and complications were compared...

..CONCLUSIONS: These data quantify a target population for whom greater use of expectant approaches may reduce overtreatment and improve the quality of localized prostate cancer care...

..Variations in patterns of care and treatment outcomes suggest differences in the quality of care for men treated for localized prostate cancer...

..Despite their potential benefits to patients, the adoption of partial nephrectomy and laparoscopic kidney cancer surgery has been both gradual and concentrated in select hospitals...

..We describe longitudinal trends in surgeon adoption of laparoscopic radical nephrectomy. We assessed whether this technique is associated with specific surgeon and/or practice setting characteristics...

..The implications of stage divergence on survival are ill defined in the context of those treated by surgery alone and would facilitate patient counseling and enhance prognostication...

..We evaluated the impact of the specialized medical and ancillary services available at low vs. high volume prostatectomy centers on prolonged length of stay (LOS) outcomes after radical prostatectomy...

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..Practice guidelines for nonmuscle invasive (ie, early stage) bladder cancer are ambiguous, resulting in substantial practice variation without a clear patient benefit...

..Risk adjustment tools should be used to identify patients (young and old) who would be better served by less aggressive management...

..To evaluate longitudinal changes in disease-specific health-related quality of life (HRQOL) among a cohort of low-income men treated for prostate cancer...

..For this reason, we undertook a study to better understand the relationships between large prostate size and robotic prostatectomy outcomes with respect to intraoperative and pathologic factors...

..Mounting evidence suggests a relationship between hospital volume and outcomes after major cancer surgery; however, the absolute benefits of volume-based referral on a national basis are unclear...

..We explored this hypothesis by evaluating national trends in the use of intraoperative pathological consultation during radical or partial nephrectomy with time, across regions, and by patient and provider characteristics...

..Although screening currently is not recommended, better medical care of patients who are at risk (ie, those with hematuria) has the potential to improve outcomes...

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..Additional study using detailed clinical data is necessary to identify the underlying causes of these differences...

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..Accordingly, the Urological Surgery Quality Collaborative implemented a project aimed at understanding and improving the use of immediate intravesical chemotherapy...

..We assessed the relationship between postoperative complications and long-term survival among patients treated surgically for kidney cancer...

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..We sought to elicit the influence of local pressures (in the form of the technologic imperative exerted by laparoscopy) on discharge physician practice style as measured by LOS...

..This article details major initial findings from the Urologic Diseases in America project with respect to the demographic impact of the most common benign, malignant, and pediatric urologic conditions...

..As a result, survivors have a protracted course, harboring considerable clinical and economic implications. Thus, we investigated the extent to which health service use and expenditures vary during continuing prostate cancer care...

..From a quality-of-care perspective, the underuse of partial nephrectomy may represent suboptimal delivery of healthcare...

..Although postprostatectomy HRQOL remains relatively stable during this interval, disease-specific HRQOL continues to evolve among men treated with BT and 3-D CRT...

..The fact that increased detection and treatment of small tumors is not reducing mortality argues for a reassessment of the current treatment paradigm...

..Using a population-based cohort, a competing risk analysis was performed to estimate patient survival after surgery for kidney cancer, as a function of patient age and tumor size at diagnosis...

..The histologic classification of kidney cancer has been revised to reflect this new paradigm...

..Therefore, we compared the use of laparoscopy by procedure indication (kidney donor, and benign and malignant kidney disease) to examine potential specialty specific associations with the slow uptake of this technology...

..We assessed the influence of tumor size and surgical approach on the use of lymphadenectomy and adrenalectomy with radical nephrectomy...

..To determine the proportion of physician practices in the United States that currently meets medical home criteria...

..When considered in the context of the well established benefits of laparoscopy, our findings lend additional support in favor of laparoscopy as the standard of care...

..Growth in prostate cancer spending continues to outpace that for overall health expenditures, garnering nearly $7 billion annually...

..The management of renal cell carcinoma (RCC) is evolving toward less extirpative surgery and the use of targeted therapy. The authors set out to provide a benchmark against which emerging therapies should be measured...

..The greater satisfaction and confidence among Hispanic men are explained by modifiable variables that suggest avenues for improvement...

..Demonstration of such variation, even within a single institution, suggests that the indicators are sufficiently sensitive to detect differences in practice patterns...

..To quantify the degree to which overall urologic oncology volume either reduces or enhances the effect of single procedure volume on short-term outcomes after urologic oncology surgery...

..However, the mediators of the volume effect remain unclear. We assessed whether differences among hospitals could explain some or all of the volume effect on short-term outcomes after cystectomy for bladder cancer...

..To better understand care coordination in the context of prostate cancer we examined how the delivery of prostate cancer care is partitioned across primary care providers and specialists...

..We determined the extent to which the regionalization of nephrectomy has occurred and describe the potential causes and implications of any observed regionalization...

..As a result, urologists should maintain a leading role in efforts to further define of quality of care as it relates to prostate cancer and radical prostatectomy...

..These findings provide compelling evidence that hospital volume and patient characteristics have important effects on surgical outcome specific to renal neoplasms...

..We clarify the natural history of contralateral vesicoureteral reflux (VUR) in children with multicystic dysplastic kidney (MCDK), including its impact on long-term renal growth...

..We describe a robot-assisted retroperitoneal approach for the management of posterior renal masses. Our early results suggest reduced perioperative morbidity with the ability to manage more complex tumors...

..The authors compared the types of treatments prostate cancer patients received from county hospitals and private providers as part of a statewide public assistance program...

..These findings suggest that oncologic, rather than technologic, concerns were determining our practice patterns...

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..Therefore, despite its limitations, the NSQIP may provide a better foundation for urologic quality improvement endeavors...

..The NCDB remains a unique and rich source of novel patient care information and serves as a national point of reference for prostate carcinoma presentation, diagnosis, and staging...

..The administration of local anesthesia both topical and injectable before transrectal ultrasound-guided prostate biopsy is safe and efficacious. We describe our technique and review the relevant published data on this topic...

..Initial results with the lockout valve reservoir in preventing autoinflation are encouraging though additional study is warranted to justify their routine use...

..02). Taken together, our results provide some additional support for the hypothesis that selected, rare MSR1 mutations are associated with increased prostate cancer susceptibility among African-American men...

..This easily reversible diversion allows aggressive, sequential external sphincter dilation and produces substantial improvements in bladder storage properties...

..While the techniques described are neither comprehensive nor feasible for every program, they nevertheless provide an important starting point for a meaningful exchange of ideas in the urological graduate medical education community...

..This finding underscores the value of assessing overall health before recommending and proceeding with surgery. Moreover, our results emphasize the need to adjust for co-morbidity when comparing outcomes following radical cystectomy...

..In patients with augmented bladders, application of this technique may minimize the risk of residual fragments and obviate the need for adjuvant lithotripsy...

..Emerging data suggest that, in select cases, cryoablation may have a role in focal ablation of prostate. The current state of the art of cryoablation in these applications is reviewed...

..CONCLUSIONS: We describe recent trends in urological graduate medical education. The observations reported suggest that our specialty has maintained its focus on training a consistent number of high quality urological surgeons...

..To evaluate this concern we used the SEER registry to characterize national practice patterns for the surgical management of small renal masses...

..In our model, the ability of S. pneumoniae to regulate, via CpsD phosphorylation, CPS production was required for its transition from the lung to the bloodstream...

..If cause-specific therapy has failed, alternatives to IUI should be considered for couples when the PTMS count is less than 10 million...