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The traditional audit paradigm is outdated in the real time economy. Innovation of the traditional audit process is necessary to support real time assurance. Practitioners and academics are exploring continuous auditing as a potential successor to the traditional audit paradigm. Using technology and automation, continuous auditing methodology enhances the efficiency and effectiveness of the audit process to support real time assurance. This paper defines how continuous auditing methodology introduces innovation to practice in seven dimensions and proposes a four-stage paradigm to advance future research. In addition, we formulate a set of methodological propositions concerning the future of assurance for practitioners and academic researchers.

Objectives. To evaluate the influence of isolated, histologically identified capsular incision (CI) (exposure of benign or malignant glands to the inked surgical margin in the setting of organ-confined disease) on disease progression after anatomic radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. Methods. Between March 1993 and September 1999, 4747 men underwent RRP at the Johns Hopkins Hospital; 107 men (2.3%) were diagnosed with CI in otherwise organ-confined disease; 92 (86%) had at least 6 months (mean 30) of follow-up. We matched these CI cases (based on surgeon, age, clinical stage, final pathologic Gleason grade, and preoperative serum prostate-specific antigen level) one-for-one with controls in three additional pathologically defined groups and compared the freedom from disease progression (prostate-specific antigen level greater than 0.2 ng/mL and/or local palpable recurrence) after RRP. Results. The actuarial 3-year likelihood of freedom from disease progression was 87.8% for the CI group, 96.4% for men with organ-confined disease (P = 0.10), 91.3% for men with extraprostatic extension and negative surgical margins (P = 0.99), and 73.9% for men with positive surgical margins resulting from extraprostatic extension (P

Objectives. The techniques for hemostasis after renal tumor excision have limited the widespread application of laparoscopic partial nephrectomy (LPN). To improve hemostasis and aid visualization, we report our experience with a novel radiofrequency coagulation (RFC) technique for LPN. Methods. Ten patients underwent RFC-assisted LPN. The demographic and perioperative data were tabulated. Patients were positioned as for laparoscopic nephrectomy, and laparoscopic ports were placed. The kidney within Gerota’s fascia was mobilized, and the fat overlying the tumor was carefully removed for pathologic evaluation. Under laparoscopic guidance, a radiofrequency probe was percutaneously inserted into the lesion and deployed to coagulate the lesion and a margin of normal parenchyma. Laparoscopic scissors were used to excise the lesion; additional hemostatic maneuvers were used selectively. Results. The mean renal tumor size was 2.1 cm (range 1.0 to 3.2). The median operative time was 170 minutes and the median blood loss was 125 mL. The RFC technique resulted in complete tissue coagulation within the treated volume, thereby facilitating intraoperative visualization, minimizing blood loss, and permitting rapid and controlled tumor resection. The renal architecture was preserved, allowing accurate diagnosis of renal cell carcinoma and angiomyolipoma in 9 and 1 cases, respectively. No perioperative complications occurred. Conclusions. The use of RFC is an effective method to facilitate LPN of both exophytic and endophytic masses. By coagulating a margin of normal parenchyma, the technique minimizes blood loss and improves visualization during LPN. We anticipate this technique will broaden the clinical application for LPN.

Objectives. To establish the safety and efficacy of laparoscopic and laparoscopic-assisted nephroureterectomy. Methods. Since 1993, 25 patients with a minimum of 12 months of follow-up underwent nephroureterectomy using a total laparoscopic or laparoscopic-assisted technique. Four patients had specimen morcellation for tissue removal. All patients had regular follow-up with physical examinations, interval cystoscopy, and radiographs, depending on the metastatic potential of the tumor. Retrospective chart review was performed and assessed for operative time, blood loss, tumor pathologic stage, complications, and outcome. One patient was excluded because of an open conversion due to multiple previous abdominal surgeries and failure to progress. Results. The mean operating time was 329 minutes but decreased with experience. The median hospital stay was 4 days. Tumor stage was directly related to tumor grade. Associated bladder tumors (prior history or recurrent tumors) occurred in 50% of the patients. Ipsilateral ureteral stump site recurrence occurred in 1 patient. Although no port site seeding occurred, 1 patient, whose tumor was discovered histologically after laparoscopic pyeloplasty for presumed benign disease, developed recurrence in the renal fossa and metastatic disease. Two patients developed liver metastasis. Conclusions. Total laparoscopic and laparoscopic-assisted nephroureterectomy are acceptable alternatives to open surgery in the treatment of transitional cell carcinoma of the upper urinary tract. Tumor morcellation did not appear to adversely affect patient outcome. As with open nephroureterectomy, tumor grade is the most important prognostic indicator of local, bladder, and metastatic recurrence. No port site seeding was observed in either the total laparoscopic or laparoscopic-assisted groups.

Objectives. To present the preliminary results of renal ablative cryosurgery in selected patients. Methods. Seven patients were treated, all of whom had small peripheral tumors and chose not to undergo partial or radical nephrectomy. Four patients underwent a rib-sparing flank incision; the remaining three underwent laparoscopy. All tumors were biopsied before cryoablation. Intraoperative ultrasound was used to monitor the cryolesion. Results. There were no intraoperative complications. The estimated blood loss averaged 111 mL. To date, 6 of the 7 patients have undergone at least one follow-up computed tomography scan (14.2 months average follow-up); all these scans demonstrated partial resolution of the lesion. Clinically, the patients tolerated the procedure without any renal complications or significant changes in creatinine. Conclusions. This limited clinical trial has demonstrated the feasibility of treating small peripherally located renal tumors with cryosurgery with minimal morbidity and a favorable outcome. Further studies are necessary to determine the long-term efficacy of this treatment modality.

Researchers have found that the volume of exceptions generated by a continuous auditing system can be overwhelming for an internal audit department to investigate. In this paper, we propose a framework that systematically prioritizes exceptions based on the likelihood of an exception being erroneous or fraudulent. The framework consists of six stages: 1) generation of exceptions using defined rules, 2) assignment of suspicious scores to exceptions using belief functions, 3) exception prioritization, 4) exception investigation by auditors, 5) rule confidence refinement by back propagation, and 6) rule additions by a rule learner algorithm. We also simulated the proposed framework using an experiment. The results from the experiment show that the framework has the potential to effectively prioritize exceptions in practice.

The objective of this paper is to examine the relationship between an independent audit and financial reporting conservatism in the small private commercial bank setting. We use the timely recognition of probable losses and the minimal use of discretionary accruals as proxies for conservatism. Intuition and prior literature leads us to hypothesize that banks that are audited should exhibit greater conservatism in financial reporting than those banks that are not audited. However, we find evidence that persistently audited banks are on average less conservative. In contrast, we find evidence that banks are on average more conservative in the period in which they switched from not being audited to audited. Collectively, the evidence suggests there is an initial positive relationship between an independent audit and financial reporting conservatism. However, there is a negative relationship between an independent audit and financial reporting conservatism when an independent audit is a persistent occurrence.

Absent regulatory requirements, 64% of small private commercial banks voluntarily procured an independent audit in our dataset. Hence, it can be argued that an independent audit may have a perceived value. In our study, we examine whether the decision to procure an audit is systematic. First, we model and predict the decision to procure a voluntary audit using classification learning algorithms. We find, in particular, that the IBK and Random Forest learning algorithms have the highest cross-validated prediction accuracy of 81% and 80% respectively, thus supporting the claim that the decision to procure an audit is not made arbitrarily, but rather systematically, and therefore is amenable to analysis. Second, we use logistic regression to identify those characteristics that may systematically influence the decision to procure an independent audit. Generally, we find that bank size, profitability, growth, leverage, complexity of operations, and type of ownership may systematically influence the decision to procure an independent audit. In contrast, banks that are less capitalized are less likely to procure an audit.

We describe our surgical technique for rapid ligation of the renal hilum during transperitoneal laparoscopic nephrectomy. This technique is reliable and provides an efficient method of hilar ligation.

Crossed renal ectopia is a rare congenital malformation. We report a case of renal cell carcinoma in a 51-year-old man with right-to-left crossed fused renal ectopia. The patient was treated with ultrasound-guided laparoscopic heminephrectomy. Postoperative three-dimensional computed tomography showed normal perfusion of the remaining part of the kidney, with good excretion of contrast from both units of the cross-fused kidney.