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Management of colorectal liver metastasis (CRLM) has undergone significant changes in the recent past. Better understanding of the biologic behavior of the disease along with advancements in technology and systemic therapy have led to more favorable outcome after multimodal treatment in CRLM patients. Important changes in approach include emphasis on R0 resection with an adequate functioning remnant liver, liver volume remodeling techniques, more efficacious systemic therapy, non-surgical ablative therapies, and a multi-disciplinary approach. This review article addresses different issues related to the management of CRLM.

Larry E Miller,1 Melissa S Martinson,2 Joseph S Gondusky,3 Atul F Kamath,4 Friedrich Boettner,5 Samir K Bhattacharyya6 1Miller Scientific Consulting, Inc., Asheville, NC 28803, USA; 2Technomics Research, LLC, Long Lake, MN 55356, USA; 3Department of Orthopaedic Surgery, Jordan-Young Institute, Virginia Beach, VA 23462, USA; 4Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA; 5Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA; 6DePuy Synthes, Raynham, MA 02767, USA Background: While primary total hip arthroplasty (THA) is a safe and effective procedure, it is unclear whether choice of surgical approach influences health care cost. Methods: We developed an economic model in which patients receiving THA via the anterior approach (AA) by high volume anterior hip surgeons were compared to a propensity-score matched cohort of primary THA cases performed by high volume surgeons that were identified from Medicare claims (Control). Cost elements included the procedure and hospital stay, postacute care, readmission, and outpatient care through 90 days postoperatively. Costs were derived from Medicare claims and adjusted to account for nationwide payer mix. Results: Health care costs over 90 days postoperative were $17,763 with AA and $23,969 with Control, a difference of $6,206 (95% CI: $5,210–$7,204) per patient. The cost savings with AA were mainly attributable to lower per-patient costs of the index hospitalization ($13,578 vs $16,017), postacute care ($3,123 vs $6,037), and hospital readmissions ($700 vs $1,584). Conclusion: The AA for primary THA was found to lower 90-day health care costs when compared to a matched sample of THA cases. These study findings may be used to inform hospitals and health care payers regarding the cost implications associated with selection of different surgical approaches to primary THA. Keywords: anterior approach, bundle, cost, hip, Medicare, reimbursement, total hip arthroplasty

Kevin T McVary,1 Bilal Chughtai,2 Larry E Miller,3 Samir K Bhattacharyya,4 Ryan A Dornbier,1 Dean S Elterman5 1Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA; 2Department of Urology, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA; 3Department of Biostatistics, Miller Scientific, Johnson City, TN, USA; 4Health Economics & Market Access, Boston Scientific, Marlborough, MA, USA; 5Division of Urology, University Health Network, Toronto, ON, CanadaCorrespondence: Kevin T McVaryCenter for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S, First Ave, Maywood, IL 60153, USAEmail kmcvary@gmail.comAbstract: Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are highly prevalent in older men. The long-term clinical utility of lifestyle modification and oral medications for LUTS is limited. There is a great clinical need for safe, effective, and durable BPH therapies for men who unsuccessfully attempt conservative measures. Enthusiasm for transurethral resection of the prostate has declined due to surgical risk, high rates of postoperative sexual dysfunction, and the perceived invasive nature therein. Consequently, interest has grown in developing minimally invasive surgical treatments (MISTs) that are efficacious but with a more favorable risk profile in order to better align with patient preferences. This review evaluates currently available MISTs for BPH. Further, we critically examine a “Leave Nothing Behind” philosophy in MIST for BPH since implantation of permanent metallic devices may be associated with increased long-term failure rates.Keywords: benign prostatic hyperplasia, LUTS, minimally invasive surgical treatment, MIST, Rezum, UroLift

Dean S Elterman,1 Samir K Bhattacharyya,2 Michael Mafilios,3 Emily Woodward,2 Krista Nitschelm,2 Arthur L Burnett4 1University of Toronto, Toronto, ON, Canada; 2Boston Scientific Corporation, Marlborough, MA, USA; 3Health Economics Associates, San Diego, CA, USA; 4The Johns Hopkins University School of Medicine, Baltimore, MD, USACorrespondence: Michael MafiliosHealth Economics Associates, 1804 Garnet Avenue, Ste 412, San Diego, CA, 92109, USATel +1 858-367-9140Email info@hea-consulting.comAbstract: Erectile dysfunction (ED) is a common disorder in adult males that results in withdrawal from sexual intimacy, psychosocial problems (ie, poor self-esteem, depression, anxiety), decreased work productivity, and reduction in quality of life for both the men suffering from ED and their female partners. A pragmatic literature review was undertaken using PUBMED to identify original research studies published over the past 20 years that assessed the impact of ED on a male’s quality of life, the impact of ED on a female partner’s quality of life, or the economic impact of ED on employers. Twenty studies were selected for inclusion. This review showed that men with ED have a poorer quality of life than men without ED (n=9 studies). Results from a global burden of illness study showed that men with ED report substantially lower SF-36 Mental and Physical Component Summary scores and SF‐6D scores compared to men without ED (p< 0.001). Similarly, the partner is also negatively impacted by ED due to relationship difficulties and decreased sexual satisfaction (n=8 studies). Results from the Female Experience of Men’s Attitudes to Life Events and Sexuality study showed that females were significantly less satisfied and engaged in sexual activity less frequently after their partner developed ED (p< 0.001). ED also poses a substantial economic burden on employers (n=3 studies). An observational study in men aged 40– 70 showed that men with ED had significantly higher rates of absenteeism (2x) and work productivity impairment compared to men without ED (p< 0.001). Overall, this contemporary review demonstrated that ED imposes a substantial quality of life burden on men and their female partners as well as a significant economic burden on their employers. These findings underscore the need for more education and awareness of the burden of ED and greater access to appropriate ED treatments to help alleviate this burden.Keywords: erectile dysfunction, work productivity, absenteeism, burden, quality of life, economics, sexual partners, sexual dysfunction

Supplemental material, Inequities_in_the_Management_of_Erectile_Dysfunction_Manuscript_Supplementary_Table_S1_August_3_2020 for Addressing Health-Care System Inequities in the Management of Erectile Dysfunction: A Call to Action by Arthur L. Burnett, Natalie C. Edwards, Tonya M. Barrett, Krista D. Nitschelm and Samir K. Bhattacharyya in American Journal of Men’s Health