CPT Code and Modifers Description 90 Day Global Period
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
What a Difference a Delay Makes! CT Urogram: a Pictorial Essay
Abdominal Radiology (2019) 44:3919–3934 https://doi.org/10.1007/s00261-019-02086-0 SPECIAL SECTION : UROTHELIAL DISEASE What a diference a delay makes! CT urogram: a pictorial essay Abraham Noorbakhsh1 · Lejla Aganovic1,2 · Noushin Vahdat1,2 · Soudabeh Fazeli1 · Romy Chung1 · Fiona Cassidy1,2 Published online: 18 June 2019 © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019 Abstract Purpose The aim of this pictorial essay is to demonstrate several cases where the diagnosis would have been difcult or impossible without the excretory phase image of CT urography. Methods A brief discussion of CT urography technique and dose reduction is followed by several cases illustrating the utility of CT urography. Results CT urography has become the primary imaging modality for evaluation of hematuria, as well as in the staging and surveillance of urinary tract malignancies. CT urography includes a non-contrast phase and contrast-enhanced nephrographic and excretory (delayed) phases. While the three phases add to the diagnostic ability of CT urography, it also adds potential patient radiation dose. Several techniques including automatic exposure control, iterative reconstruction algorithms, higher noise tolerance, and split-bolus have been successfully used to mitigate dose. The excretory phase is timed such that the excreted contrast opacifes the urinary collecting system and allows for greater detection of flling defects or other abnormali- ties. Sixteen cases illustrating the utility of excretory phase imaging are reviewed. Conclusions Excretory phase imaging of CT urography can be an essential tool for detecting and appropriately characterizing urinary tract malignancies, renal papillary and medullary abnormalities, CT radiolucent stones, congenital abnormalities, certain chronic infammatory conditions, and perinephric collections. -
Urology Services in the ASC
Urology Services in the ASC Brad D. Lerner, MD, FACS, CASC Medical Director Summit ASC President of Chesapeake Urology Associates Chief of Urology Union Memorial Hospital Urologic Consultant NFL Baltimore Ravens Learning Objectives: Describe the numerous basic and advanced urology cases/lines of service that can be provided in an ASC setting Discuss various opportunities regarding clinical, operational and financial aspects of urology lines of service in an ASC setting Why Offer Urology Services in Your ASC? Majority of urologic surgical services are already outpatient Many urologic procedures are high volume, short duration and low cost Increasing emphasis on movement of site of service for surgical cases from hospitals and insurance carriers to ASCs There are still some case types where patients are traditionally admitted or placed in extended recovery status that can be converted to strictly outpatient status and would be suitable for an ASC Potential core of fee-for-service case types (microsurgery, aesthetics, prosthetics, etc.) Increasing Population of Those Aged 65 and Over As of 2018, it was estimated that there were 51 million persons aged 65 and over (15.63% of total population) By 2030, it is expected that there will be 72.1 million persons aged 65 and over National ASC Statistics - 2017 Urology cases represented 6% of total case mix for ASCs Urology cases were 4th in median net revenue per case (approximately $2,400) – behind Orthopedics, ENT and Podiatry Urology comprised 3% of single specialty ASCs (5th behind -
Native Kidney Biopsy
Mohammed E, et al., J Nephrol Renal Ther 2020, 6: 034 DOI: 10.24966/NRT-7313/100034 HSOA Journal of Nephrology & Renal Therapy Review Article Native Kidney Biopsy: An Introduction The burden of non communicable diseases has been a worldwide Update and Best Practice public health challenge, as chronic diseases compose 61% of global deaths and 49% of the global burden of diseases. Currently, many Evidence countries are encountering a fast transformation in the disease pro- file from first generation diseases such as infectious diseases to the encumbrance of non communicable diseases. In addition, Chronic Ehab Mohammed1, Issa Al Salmi1 *, Shilpa Ramaiah1 and Suad Hannawi2 Kidney Disease (CKD) is increasingly recognized as a global public health challenge as 10% of the global population is affected [1,2]. 1Nephrologist, The Renal Medicine Department, The Royal Hospital, Muscat, Oman The scarcity of well-trained renal pathologists, even in high-in- come countries, is a major obstacle to use of biopsy samples. The ISN 2Medicine Department, Ministry of Health and Prevention, Dubai, UAE is working worldwide to enhance development of local renal patholo- gy expertise. Levin et al stated that analysis of kidney biopsy samples can be used to stratify CKD into distinct subgroups of diseases based Abstract on specific histological patterns, when combined with the clinical pre- sentation [3]. Diabetes mellitus and hypertensive nephropathy are the Objectives: To Provide up-to-date guidelines for medical and nurs- commonly identified causes of End-Stage Kidney Disease (ESKD). ing staffs on the pre, during, and post care of a patient undergoing a Also, many patients with glomerulonephritis, systemic lupus erythe- percutaneous-kidney-biopsy-PKB. -
Guidelines on Paediatric Urology S
Guidelines on Paediatric Urology S. Tekgül (Chair), H.S. Dogan, E. Erdem (Guidelines Associate), P. Hoebeke, R. Ko˘cvara, J.M. Nijman (Vice-chair), C. Radmayr, M.S. Silay (Guidelines Associate), R. Stein, S. Undre (Guidelines Associate) European Society for Paediatric Urology © European Association of Urology 2015 TABLE OF CONTENTS PAGE 1. INTRODUCTION 7 1.1 Aim 7 1.2 Publication history 7 2. METHODS 8 3. THE GUIDELINE 8 3A PHIMOSIS 8 3A.1 Epidemiology, aetiology and pathophysiology 8 3A.2 Classification systems 8 3A.3 Diagnostic evaluation 8 3A.4 Disease management 8 3A.5 Follow-up 9 3A.6 Conclusions and recommendations on phimosis 9 3B CRYPTORCHIDISM 9 3B.1 Epidemiology, aetiology and pathophysiology 9 3B.2 Classification systems 9 3B.3 Diagnostic evaluation 10 3B.4 Disease management 10 3B.4.1 Medical therapy 10 3B.4.2 Surgery 10 3B.5 Follow-up 11 3B.6 Recommendations for cryptorchidism 11 3C HYDROCELE 12 3C.1 Epidemiology, aetiology and pathophysiology 12 3C.2 Diagnostic evaluation 12 3C.3 Disease management 12 3C.4 Recommendations for the management of hydrocele 12 3D ACUTE SCROTUM IN CHILDREN 13 3D.1 Epidemiology, aetiology and pathophysiology 13 3D.2 Diagnostic evaluation 13 3D.3 Disease management 14 3D.3.1 Epididymitis 14 3D.3.2 Testicular torsion 14 3D.3.3 Surgical treatment 14 3D.4 Follow-up 14 3D.4.1 Fertility 14 3D.4.2 Subfertility 14 3D.4.3 Androgen levels 15 3D.4.4 Testicular cancer 15 3D.5 Recommendations for the treatment of acute scrotum in children 15 3E HYPOSPADIAS 15 3E.1 Epidemiology, aetiology and pathophysiology -
Quality of Life Outcomes After Brachytherapy for Early Prostate Cancer
Prostate Cancer and Prostatic Diseases (1999) 2 Suppl 3, S19±S20 ß 1999 Stockton Press All rights reserved 1365±7852/99 $15.00 http://www.stockton-press.co.uk/pcan Quality of life outcomes after brachytherapy for early prostate cancer MS Litwin1, JM Brandeis1, CM Burnison1 and E Reiter1 1UCLA Departments of Urology, Health Services, and Radiation Oncology, UCLA, California, USA Despite the absence of empirical evidence, there is a XRT. Sildena®l appeared to have little effect in the radical popular perception that brachytherapy results in less prostatectomy patients. However, brachytherapy patients impairment of health-related quality of life. This study not receiving hormonal ablation or XRT who took silde- compared general and disease-speci®c health-related na®l had better sexual function and bother scores than quality of life in men who had undergone either brachy- those patients who did not. therapy (with and without pre-treatment XRT) or radical prostatectomy, and in healthy age-matched controls. Method Conclusion We surveyed all patients with clinical T2 or less prostate General health-related quality of life did not differ greatly cancer who had undergone interstitial seed brachyther- between the three groups, but there were variations in apy at UCLA during the previous 3±17 months. Each was disease-speci®c (urinary, bowel and sexual) health-related paired with two randomly selected, temporally matched quality of life. Radical prostatectomy patients had the radical prostatectomy patients. Healthy, age-matched worst urinary function (leakage), but brachytherapy controls were drawn from the literature. Surgery and patients were also signi®cantly worse than the controls. -
Prostate Biopsy in the Staging of Prostate Cancer
Prostate Cancer and Prostatic Diseases (1997) 1, 54±58 ß 1997 Stockton Press All rights reserved 1365±7852/97 $12.00 Review Prostate Biopsy in the staging of prostate cancer L Salomon, M Colombel, J-J Patard, D Gasman, D Chopin & C-C Abbou Service d'Urologie, CHU, Henri Mondor, CreÂteil, France The use of prostate biopsies was developed in parallel with progress in our knowledge of prostate cancer and the use of prostate-speci®c antigen (PSA). Prostate biopsies were initially indicated for the diagnosis of cancer, by the perineal approach under general anesthesia. Nowadays prostate biopsies are not only for diagnostic purposes but also to determine the prognosis, particularly before radical prostatectomy. They are performed in patients with elevated PSA levels, by the endorectal approach, sometimes under local anesthesia.(1±3) The gold standard is the sextant biopsy technique described by Hodge4,5, which is best to diagnose prostate cancer, particularly in case of T1c disease (patients with serum PSA elevation).6±13 Patients with a strong suspicion of prostate cancer from a negative series of biopsies can undergo a second series14;15 with transition zone biopsy16,17 or lateral biopsy.18,19 Karakiewicz et al 20 and Uzzo et al 21 proposed that the number of prostate biopsies should depend on prostate volume to improve the positivity rate. After the diagnosis of prostate cancer, initial therapy will depend on several prognostic factors. In the case of radical prostatectomy, the results of sextant biopsy provide a wealth of information.22,23 The aim of this report is to present the information given by prostate biopsy in the staging of prostate cancer. -
Single Scrotal Incision Orchiopexy - a Systematic Review ______Hugo Fabiano Fernandes Novaes, José Abraão Carneiro Neto, Antonio Macedo Jr, Ubirajara Barroso Júnior
REVIEW Article Vol. 39 (3): 305-311, May - June, 2013 doi: 10.1590/S1677-5538.IBJU.2013.03.02 Single scrotal incision orchiopexy - a systematic review _______________________________________________ Hugo Fabiano Fernandes Novaes, José Abraão Carneiro Neto, Antonio Macedo Jr, Ubirajara Barroso Júnior Section of Pediatric Urology, Division of Urology Bahiana School of Medicine and Federal University of Bahia and Federal University of São Paulo ABSTRACT ARTICLE INFO _________________________________________________________ ___________________ Objective: To conduct a systematic review on single scrotal incision orchiopexy. Key words: Materials and Methods: A search was performed using Pubmed, through which 16 ar- Cryptorchidism; Orchiopexy; ticles were selected out of a total of 133. The following conditions were considered ex- Scrotum; Surgical Procedures, clusion criteria: other surgical methods such as an inguinal procedure or a laparoscopic Operative approach, retractile testes, or patients with previous testicular or inguinal surgery. Results: A total of 1558 orchiopexy surgeries initiated with a transcrotal incision were Int Braz J Urol. 2013; 39: 305-11 analyzed. Patients’ ages ranged between 5 months and 21 years. Thirteen studies used __________________ high scrotal incisions, and low scrotal incisions were performed in the remainder of the studies. In 55 cases (3.53%), there was a need for inguinal incision. Recurrence was ob- Submitted for publication: served in 9 cases, testicular atrophy in 3, testicular hypotrophy in 2, and surgical site in- December 18, 2012 fections in 13 cases. High efficacy rates were observed, varying between 88% and 100%. __________________ Conclusions: Single scrotal incision orchiopexy proved to be an effective technique and is associated with low rates of complications. -
Laparoscopic Nephrectomy
Laparoscopic Nephrectomy Information for Patients This leaflet explains: What is a Nephrectomy? ............................................................................................. 2 Why do I need a nephrectomy? ................................................................................... 3 What are the risks and side effects of laparoscopic nephrectomy? ............................. 3 Occasional risks ....................................................................................................... 3 Rare risks ................................................................................................................. 3 Very Rare Risks ....................................................................................................... 3 Before the operation .................................................................................................... 4 Day of your operation .................................................................................................. 4 How long will the operation take? ................................................................................ 4 After the operation ....................................................................................................... 4 Going home ................................................................................................................. 5 At home ....................................................................................................................... 5 Contacts ..................................................................................................................... -
The History of Microsurgery in Urological Practice
Chen-1 The History of Microsurgery in Urological Practice Mang L. Chen1, Gregory M. Buncke2 and Paul J. Turek3 1G.U. Recon, San Francisco, CA, 94114 2The Buncke Clinic, San Francisco, CA 94114 3The Turek Clinic, Beverly Hills, CA 90210 Correspondence to: Mang Chen, MD G.U. Recon 45 Castro St, Suite 111 San Francisco, CA 94114 Tel: 415-481-3980 Email: [email protected] Chen-2 Abstract Operative microscopy spans all surgical disciplines, allowing human dexterity to perform beyond direct visual limitations. Microsurgery started in otolaryngology, became popular in reconstructive microsurgery, and was then adopted in urology. Starting with reproductive tract reconstruction of the vas and epididymis, microsurgery in urology now extends to varicocele repair, sperm retrieval, penile transplantation and free flap phalloplasty. By examining the peer reviewed and lay literature this review discusses the history of microsurgery and its subsequent development as a subspecialty in urology. Keywords: urology, microsurgery, phalloplasty, vasovasostomy, varicocelectomy Chen-3 I. Introduction Microsurgery has been instrumental to surgical advances in many medical fields. Otolaryngology, ophthalmology, gynecology, hand and plastic surgery have all embraced the operating microscope to minimize surgical trauma and scar and to increase patency rates of vessels, nerves and tubes. Urologic adoption of microsurgery began with vasectomy reversals, testis transplants, varicocelectomies and sperm retrieval and has now progressed to free flap phalloplasties and penile transplantation. In this review, we describe the origins of microsurgery, highlight the careers of prominent microsurgeons, and discuss current use applications in urology. II. Birth of Microsurgery 1) Technology The birth of microsurgery followed from an interesting marriage of technology and clinical need. -
Needle Biopsy and Radical Prostatectomy Specimens David J Grignon
Modern Pathology (2018) 31, S96–S109 S96 © 2018 USCAP, Inc All rights reserved 0893-3952/18 $32.00 Prostate cancer reporting and staging: needle biopsy and radical prostatectomy specimens David J Grignon Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, IUH Pathology Laboratory, Indianapolis, IN, USA Prostatic adenocarcinoma remains the most common cancer affecting men. A substantial majority of patients have the diagnosis made on thin needle biopsies, most often in the absence of a palpable abnormality. Treatment choices ranging from surveillance to radical prostatectomy or radiation therapy are largely driven by the pathologic findings in the biopsy specimen. The first part of this review focuses on important morphologic parameters in needle biopsy specimens that are not covered in the accompanying articles. This includes tumor quantification as well as other parameters such a extraprostatic extension, seminal vesicle invasion, perineural invasion, and lymphovascular invasion. For those men who undergo radical prostatectomy, pathologic stage and other parameters are critical in prognostication and in determining the appropriateness of adjuvant therapy. Staging parameters, including extraprostatic extension, seminal vesicle invasion, and lymph node status are discussed here. Surgical margin status is also an important parameter and definitions and reporting of this feature are detailed. Throughout the article the current reporting guidelines published by the College of American Pathologists and the International Collaboration on Cancer Reporting are highlighted. Modern Pathology (2018) 31, S96–S109; doi:10.1038/modpathol.2017.167 The morphologic aspects of prostatic adenocarcinoma hormonal therapy.4,5 For needle biopsy specimens the have a critical role in the management and prognos- data described below are largely based on standard tication of patients with prostatic adenocarcinoma. -
Robot-Assisted Radical Prostatectomy in a Patient with a Preexisting Three-Piece Inflatable Penile Prosthesis
www.kjurology.org DOI:10.4111/kju.2010.51.1.70 Case Report Robot-Assisted Radical Prostatectomy in a Patient with a Preexisting Three-Piece Inflatable Penile Prosthesis Kyung Hwa Choi, Seung Hwan Lee, Won Sug Jung1, Byung Ha Chung Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, 1National Health Insurance Corporation Ilsan Hospital, Goyang, Korea We report a rare case of robot-assisted laparoscopic radical prostatectomy (RARP) in Article History: a patient with a preexisting penile prosthesis. In this case, we completed RARP without received 27 August, 2009 14 October, 2009 removing the reservoir by using a deflation-inflation technique, and there were no com- accepted plications related to the prosthesis. The patient had a negative surgical margin. The Corresponding Author: preserved three-piece inflatable penile prosthesis continued to function properly in 1 Byung Ha Chung month. Reservoir-preserving RARP is technically feasible and safe. However, it is im- Department of Urology, Yonsei portant to be aware of device-related complications. Long-term studies on the mechan- University Health System, Gangnam Severance Hospital, 712, Eonju-ro, ical survival rate and patient satisfaction should be also performed. Dogok-dong, Gangnam-gu, Seoul Key Words: Robotics, Prostatectomy, Penile prosthesis, Prostatic neoplasms 135-720, Korea TEL: +82-2-2019-3474 FAX: +82-2-3462-8887 E-mail: [email protected] Prostate cancer has been reported to occur most frequently CASE REPORT in men over 40 years of age. In organ-confined cases, radical prostatectomy is the treatment of choice. After the in- 1. Patient troduction of the da VinciⓇ surgical system (Intuitive The patient was a 64-year-old male diagnosed with aci- Surgical, Sunnyvale, USA), robot-assisted laparoscopic nar-type prostate adenocarcinoma with a Gleason score of radical prostatectomy (RARP) has become a mainstay of 6 (3+3) by prostate biopsy. -
Percutaneous Ultrasound-Guided Renal Biopsy; a Comparison of Axial Vs
Percutaneous ultrasound-guided renal biopsy; A comparison of axial vs. sagittal probe location FARNAZ SHAMSHIRGAR1, SEYED MORTEZA BAGHERI2* 1Resident of Radiology, Iran University of Medical Sciences, Tehran, Iran 2Department of Radiology, Hasheminejad Kidney Center (HKC), Iran University of Medical Sciences, Tehran, Iran Background. Renal biopsy is an important method for diagnosis of renal parenchymal abnormalities. Here, we compare the effectiveness and complications of percutaneous ultrasound- guided renal biopsy using axial vs. sagittal probe locations. Methods. In a cross-sectional survey, in 2012, patients with a nephrologist order were biopsied by a radiology resident. Renal biopsy was done on 15 patients using axial (A group) and the same number of biopsies done with sagittal probe location (S group). The two groups were compared in term of the yields and complications of each method. Results. In the A group, the ratio of glomeruli gathered to the number of obtained samples was significantly higher than in the S group. Nine patients in the A group (60%) required only two samplings, whereas 66.7% in the S group required more than two attempts. Microscopic hematuria was more common in the A; conversely, gross hematuria was less common in the A group. Meagre hematomas were more frequent in the S group .When compared with hemoglobin level before biopsy, its level 24 hours after biopsy was similar within groups. Conclusion. Our study shows that percutaneous ultrasound-guided renal biopsy using axial probe provides better yield with fewer efforts and fewer serious complications. Keywords: Percutaneous renal biopsy, Ultrasound-guided renal biopsy, Ultra-sonography probe location. INTRODUCTION plications and related post therapeutic side effects may cause another complication such as vascular Percutaneous renal biopsy is an important occlusion, acute obstruction of renal output, renal method to diagnose most kidney diseases.