ABSTRACT
INTRODUCTION: This pilot/feasibility study evaluated a new diagnostic and treatment paradigm for patients with lower urinary tract symptoms using a software platform comprised of a mobile app, validated patient reported outcome questionnaires, bladder diaries and remote patient monitoring. METHODS: New urology referrals for lower urinary tract symptoms completed validated lower urinary tract symptoms questionnaires and 24-hour bladder diaries on a mobile app. Patients were triaged based on symptom severity into an urgent or routine office visit or a remote visit. Outcome metrics assessed include acceptability, practicality, implementation and integration. RESULTS: Of 500 urology consults there were 226 (45%) patients with new lower urinary tract symptoms referrals of whom 201 (89%) had email addresses. In all there were 182 men and 19 women, aged 18 to 87 years (mean 59, SD 17), of whom 71/201 (35%) registered, 57/71 (80%) completed the app and 41/57 (72%) elected remote visits. Mean time from urology referral to initiation of a remote or in-office diagnostic and treatment plan was 7.4 days (SD 5.9) and 7.7 days (SD 7.6), respectively. CONCLUSIONS: Of patients who completed the app 72% were triaged to a remote visit. Time from urology referral to initiation of remote or in-office diagnostic and treatment plan averaged 1 week. This paradigm for management of lower urinary tract symptoms has potential to optimize the clinical workflow, improve health care outcomes and reduce costs.
ABSTRACT
Mini-percutaneous nephrolithotomy (mini-PCNL) has been described as a safe and effective technique to eliminate stones in patients in whom a less-invasive approach is desired. It was originally developed to treat stones in the pediatric population, but has since been adapted to serve a role in the adult urologic community. This approach has been reported to result in less blood loss and postoperative pain when compared with traditional PCNL. Herein, we present a case in which a recurrent caliceal diverticulum containing stones was managed using a mini-PCNL technique in a patient who previously failed multiple other retrograde endoscopic approaches.
ABSTRACT
Adenoid cystic carcinoma of the breast (ACC) is a rare tumor, comprising <0.1% of all breast cancers. It has a unique dual-cell pattern and is indistinguishable from ACC arising from salivary tissue. It is a low-grade tumor with favorable prognosis, and rare metastasis, with unique features. It is more commonly seen in older women with a mean age at diagnosis of 63, with Caucasian women being at greatest risk. Most cases present as a painful, palpable mass in the outer quadrants of the breast, and must be diagnosed via core needle biopsy or surgical excisional biopsy. Although few other cancers resemble ACC it is commonly misdiagnosed. Given the rarity of this cancer, treatment guidelines have yet to be well established. Current treatment is focused around surgical resection, however, there are not specific recommendations for the extent of resection due to the lack of cases to draw from.
