Urology News

Surgical site infection, UTI endorsed by NQF as outcomes-based measures

The National Quality Forum recently endorsed two outcomes-based measures from the American College of Surgeons that are pertinent to urology: surgical site infection and urinary tract infection.

Large NY urology group practice partners with Mount Sinai

The Mount Sinai Hospital, New York, and Integrated Medical Professionals, PLLC (IMP)-a multispecialty practice that includes Advanced Urology Centers of New York and Advanced Radiation Centers of New York-have formed a partnership to provide easier access to screening, assessment, and treatment for complex urologic conditions, as well as improved access to radiation oncology services.

Health care issues intensify U.S. debate over conscience in the workplace

Daily finasteride boosts hair growth in men

New research suggests that finasteride (Proscar, Propecia; Merck) increases hair growth in all four areas of the scalp affected by male pattern baldness and reduces hair loss in two or more areas.

Egyptian firm in fake Avastin scam proves elusive

CAIRO (Reuters) - The trail of counterfeit copies of the multibillion-dollar cancer drug Avastin leads to an address in a crowded Cairo suburb, with no sign of the firm named by international suppliers as the source of the product.

Noradrenaline a cost-effective option for type 1 hepatorenal syndrome

NEW YORK (Reuters Health) - For reversal of type 1 hepatorenal syndrome, treatment with noradrenaline seems to work as well as terlipressin and is a lot less expensive, researchers from India report.

Forceps delivery, perineal tears tied to later pelvic problems

NEW YORK (Reuters Health) - Women who deliver with forceps assistance, as well as those who sustain perineal tears during at least two vaginal deliveries, are more likely to have pelvic floor disorders years after delivering their first child, a new study shows.

Abdominal strains common in professional baseball players

NEW YORK (Reuters Health) - More Major League Baseball players are being sidelined with abdominal muscle strains, according to a new study that suggests there may be too much focus on building strength and not enough on stretching and flexibility in the pros.

Men opting for costly new prostate cancer treatment

NEW YORK (Reuters Health) - Men diagnosed with localized prostate cancer are more likely to be treated with proton beam therapy if the technology is available nearby, a new study found.

Low rate of febrile UTI after correction of vesicoureteral reflux

NEW YORK (Reuters Health) - The incidence of febrile urinary tract infection (UTI) in children is low after successful endoscopic treatment of vesicoureteral reflux (VUR), according to a long-term follow-up study from Ireland.

In prostate cancer, other death risks may be higher

NEW YORK (Reuters Health) - Some men with prostate cancer may have increased risks of dying from causes other than the cancer itself, a new study finds.

Vitamin B and fish oil fail to prevent cancer: study

NEW YORK (Reuters Health) - Among more than 2,500 people in France with a history of heart disease, taking B vitamins or omega-3 fatty acid supplements did not reduce the risk of developing cancer in a new study. In fact, for a small group of women, fish oil was linked to higher cancer risk.

Gepirone-ER may improve sexual function in depressed men

NEW YORK (Reuters Health) - Fabre-Kramer Pharmaceuticals, the Houston, Texas-based company developing gepirone - extended release, may have the first evidence that it improves sexual function in depressed men.

Prostate size and cancer grade association questioned

NEW YORK (Reuters Health) - Although small prostates have been linked to high grade cancer, the relationship may be due to ascertainment bias rather than tumor biology, researchers suggest in a new paper.

Phosphate enemas may be deadly in elderly

NEW YORK (Reuters Health) - Sodium phosphate enemas, even in standard doses, may lead to severe metabolic disorders and death in elderly patients, warn clinicians from Israel in a paper this month in Archives of Internal Medicine.

Trimel's female sexual disorder drug meets trial goals

Androgen deprivation for prostate cancer ups peripheral vascular risk

NEW YORK (Reuters Health) - A population-based observational study indicates that androgen deprivation therapy for nonmetastatic prostate cancer is tied to an increased risk of venous thromboembolism (VTE) and peripheral artery disease (PAD).

Cephalosporin antibiotic inferior to ciprofloxacin for cystitis

Short-term use of the cephalosporin antibiotic cefpodoxime proxetil (Vantin) for the treatment of women with uncomplicated cystitis did not meet criteria for noninferiority for achieving clinical cure compared with ciprofloxacin (Cipro, Proquin), say researchers from the University of Miami Miller School of Medicine.

Blood purification may decrease mortality in patients with sepsis

NEW YORK (Reuters Health) - Blood purification appears to decrease mortality in patients with sepsis and septic shock, a new meta-analysis shows.

Some bedwetting in kids may be caused by constipation

Undiagnosed constipation, rather than problems with the bladder, may be to blame for nocturnal enuresis in some children, say researchers from Wake Forest Baptist Medical Center, Winston-Salem, NC.

Tyrosine kinase inhibitors linked to increased treatment-related mortality

NEW YORK (Reuters Health) - Drugs like sorafenib, sunitinib, and pazopanib - i.e., vascular endothelial growth factor (VEGF) receptor tyrosine kinase inhibitors - have improved cancer outcomes, but a new meta-analysis shows they also increase patients' risks for treatment-related fatalities.

Tension-free vaginal tape superior in stress urinary incontinence

NEW YORK (Reuters Health) - Standard tension-free vaginal tape (TVT) shows advantages over both transobdurator tape and single incision TVT mini-slings in women with stress urinary incontinence.

Vitamin D2 fails to improve heart health in chronic kidney disease

NEW YORK (Reuters Health) - In the PRIMO trial, paricalcitol (vitamin D2) did not improve measures of cardiac structure, function or left ventricular mass in patients with chronic kidney disease (CKD), as researchers had hoped.

Test for Komen looms at next Race for the Cure

AUSTIN, Texas (Reuters) - Rebecca Reza has participated in fundraising races held by Susan G. Komen for the Cure, the world's largest breast cancer charity, for the past five years. She planned to sign up for the next Race for the Cure in El Paso, Texas, with her cousin.

Erectile drugs might help premature ejaculation

NEW YORK (Reuters Health) - Most studies looking at whether erectile dysfunction drugs can help men overcome premature ejaculation problems agree that the pills make a difference, but much of the research is flawed, according to a new review of the evidence.

Tension-free vaginal tape provides lasting relief of stress urinary incontinence

NEW YORK (Reuters Health) - For women with stress urinary incontinence, tension-free vaginal tape provides lasting relief, according to results of a 10-year follow-up study conducted in Italy.

Web resource helps assess life expectancy

Researchers have completed a systematic review of prognostic indices used to calculate a patient's life expectancy, and created a Web site that puts these indices in one central location.

Nursing group updates guidelines on preventing catheter-associated UTIs

A new American Association of Critical-Care Nurses (AACN) Practice Alert stresses the use of pre- and post-catheterization assessments to gauge proper catheter use and to monitor early signs of urinary tract infection.

Successful urethral stricture, fistula repair feasible in most cases

Managing the urethral strictures and fistulas that sometimes follow prostate cancer therapies can be intimidating, but with experience, the presentations can be resolved with high success in a near majority of patients.

Intrauterine insemination success not predicted by sperm morphology

Results of a retrospective study identify several factors associated with success in achieving pregnancy after intrauterine insemination (IUI), but normal sperm morphology is not among them.

Evidence-based care in urology: The future is now

In this era of ever-increasing pressure to meet quality standards, it behooves us as a specialty to not only read but to follow our evidence-based guidelines.

Fertility status may be window into men's health

Fatherhood comes with burdens and travails, but one of the unanticipated benefits may be a lower risk of cardiovascular disease and death.

Positive surgical margins after radical prostatectomy vary by PSA, Gleason sum

The rate of positive surgical margins after radical prostatectomy in men with either organ-confined or extracapsular disease varies significantly depending on preoperative PSA and pathologic Gleason sum score.

Are you achieving your ideal urology service mix?

You probably know the financial bottom line of your practice, but how well do you understand just how you got there? To know, it's essential to periodically review your service mix.

'Meaningful use' of an EHR system: How to achieve it in your urology practice

This article defines meaningful use, lists the elements necessary to qualify for those elusive meaningful use incentives, and helps you decide whether and when your practice might want to engage in the process of EHR implementation.

What do you think of recent efforts to ban circumcision?

Urologists think it's up to parents to decide whether circumcision should be performed on their child.

Meshless cystocele repair shows promise

A new meshless cystocele repair procedure intended to circumvent the problems seen with traditional repair appears to be durable and cost effective.

Urologists say clinical guidelines, experience play complementary role

Urologists around the country discuss the extent they turn to clinical guidelines or to their own experience when deciding their approach to patient care.

In stone disease patients, obesity presents myriad challenges for urologists

Patrick Lowry, MD, discusses the scope of both obesity and stone disease, surgical and other challenges unique to managing stone disease in the obese, and steps obese adult and pediatric patients can take to lower their stone risk.

Men with significant comorbidities overtreated for prostate cancer

A recent study suggests that a substantial portion of men with comorbidities serious enough to affect their lifespan are also being subjected to likely unnecessarily aggressive therapy.

Adjuvant chemotherapy: Many cystectomy patients ineligible

New data from a single institution show that more patients with urothelial carcinoma are eligible for neoadjuvant chemotherapy before radical cystectomy than for adjuvant chemo following surgery.

Bill would prohibit mandatory health insurance contracts

A developing advocacy campaign in Washington state has the AACU Government Affairs team implementing the very practices described in this space and thereby urged upon urologists in seemingly ad nauseum Calls to Action.

Robotic laparoscopic radical prostatectomy found viable in obese men

Obesity should not preclude a patient from undergoing robot-assisted laparoscopic prostatectomy (RALP), but these men may require more time for the procedure.

Is your urology practice changing with the economy?

The current trends, if allowed to continue, will change the practice of medicine as we know it, even for employed physicians. In this article, we provide an overview of the current macroeconomics of health care, how they affect practicing urologists, and what steps you can take now to ensure you receive a fair share of the health care dollar.

Charitable trusts may help lower estate taxes

There are many factors to be considered prior to implementing any type of charitable trust strategy.

Bladder ruptures: Operative management may be best

If a patient is already having surgery that would allow for access to the bladder, surgical repair can be worthwhile.

Cook Medical renews contract with large purchasing network

Cook Medical (Bloomington, IN) recently announced the renewal of a contract that supplies its urology products to more than 2,500 U.S. hospitals.

Adrenalectomies on the rise in high-volume centers

Higher-volume centers tend to treat adrenalectomy patients who are younger, have a shorter length of stay, and are less likely to die in the hospital when compared to patients treated at lower-volume centers. Researchers found that very low-volume centers treat patients who are older, more likely to be female, and covered by Medicaid or uninsured.

Saying no to insurance contracts is only way for urologists to gain leverage

I can't speak for everybody in every part of the country, but when I refused to sign contracts, my income doubled.

Orchiectomy rate linked to race, insurance status

Patients with severe testicular trauma typically face two treatment options: orchiectomy or orchidorrhaphy. A new analysis of national trauma reports suggests that race and insurance status, rather than geography, type of trauma, severity of injury, or other factors, play key roles in decisions that lead to excision or salvage of a damaged testis.

Risk profiles vary for different penile surgeries, physician says

Acceptable surgery for penile enhancement should be predictably effective, low-risk and cause no harm. However, many men are undergoing cosmetic procedures that fail to meet these criteria, according to Gary Alter, M.D.

Pelvic floor exercises post-radical prostatectomy, transurethral resection of the prostate may have value

Pelvic floor muscle exercises (PFMEs) as a treatment for urinary incontinence after prostate surgery showed no significant difference in reduction of urinary leakage between intervention and control groups in a large multicenter study. Nevertheless, the randomized controlled trial still has a positive message about a role for pelvic floor muscle training considering that although men in the control group did not receive supervised training, some were also performing PFMEs and benefited with decreased urinary leakage.

Varicocelectomy leads to testosterone increase regardless of grade

Results from a retrospective review reveal that microsurgical subinguinal varicocelectomy increases serum testosterone levels in men with clinically palpable varicoceles.

Lack of long-term sustainable growth rate fix continues to frustrate urologists and other physicians

As a result of a classic Washington decision just before Christmas, a 27.4% Medicare fee cut was delayed from its original Jan. 1 implementation date and is now scheduled, barring miraculous congressional action, to take effect on Feb. 29.

Data support American Urological Association guideline on bladder tumor re-resection

A 4-year retrospective study suggests that re-resection for all T1 bladder tumors, with and without muscle in the original specimen, can provide important prognostic information to guide treatment.

New Urology Products & Services

The newest urology products and services from Minimally Invasive Devices, Inc., Merck, GE Healthcare, Pacira Pharmaceuticals International, Iris Sample Processing, HealthForce1, Cardinal Health, and the American Urogynecologic Society.

AUA awards Dr. Fox with honorary membership

The AUA recently honored Brigadier General (U.S. Army ret.) C. William Fox, Jr, MD, with honorary membership for outstanding service to his country and his profession.

Dr. Edney named Gallagher Health Policy Scholar

The AUA's Gallagher Health Policy Scholar Program Selection Committee has selected Mark T. Edney, MD, as the 2012-2013 Gallagher Health Policy Scholar.

FDA orders new studies on mesh used in transvaginal repair

The FDA said it has ordered postmarket surveillance studies by manufacturers of urogynecologic surgical mesh devices.

Doctors over-treat enterococcal bacteriuria: study

NEW YORK (Reuters Health) - In a new study of patients with bacteria in their urine, doctors prescribed antibiotics to one in three who had no symptoms and no evidence of a urinary tract infection.

First-void urine not needed for Chlamydia testing

NEW YORK (Reuters Health) - While first-void urine specimens have been used traditionally to test for Chlamydia trachomatis, newer DNA detection methods produce reliable results using midstream specimens, a New Zealand group reports.

Affymax plans to price anemia drug below Epogen

SAN FRANCISCO (Reuters) - Affymax, which is awaiting a March decision from U.S. regulators on its application for peginesatide, plans to price the anemia drug below Amgen Inc's Epogen if it is approved.

Finasteride combo brings down PSA after biochemical recurrence

NEW YORK (Reuters Health) - Finasteride and flutamide in combination produce significant declines in prostate specific antigen (PSA) in men with biochemical failure after local therapy, researchers report.

Large Mid-Atlantic practice adds two urologists

Chesapeake Urology Associates, a large regional urology group practice in the mid-Atlantic area, recently announced that two additional urologists have joined the practice in Maryland.

Anti-VEGF drugs can be stopped in some renal cancer patients

NEW YORK (Reuters Health) - Patients with less aggressive metastatic renal cell carcinoma may be able to discontinue treatment with vascular endothelial growth factor (VEGF)-targeted agents, a new study suggests.

Robot prostatectomy no less likely to leave patients disappointed

NEW YORK (Reuters Health) - In a recent survey, men who had robotic surgery for prostate cancer and men who had lower-tech surgeries were equally likely to have sexual problems and urinary leakage afterward.

PSA screening doesn't prevent cancer deaths: study

NEW YORK (Reuters Health) - Annual screening for prostate cancer doesn't cut men's chances of dying from the disease, according to the latest results of a large screening trial.

US FDA wants new studies on surgical mesh implants

WASHINGTON (Reuters) - U.S. health regulators ordered new safety studies for surgical mesh implants that are used to hold pelvic organs in place, citing a spike in the number of complications seen for female patients, including erosion and infection.

Dr. Brubaker named dean of Loyola's Stritch School of Medicine

Linda Brubaker, MD, has been named dean of Loyola University Chicago Stritch School of Medicine.

AUA, AIUM develop joint guideline for urologic ultrasound exams

The American Institute of Ultrasound in Medicine (AIUM) and the AUA have announced the collaborative development of a practice guideline for the performance of an ultrasound examination in urology.

Percutaneous tibial nerve stimulation not cost-effective for overactive bladder: study

NEW YORK (Reuters Health) - As a first-line treatment, percutaneous tibial nerve stimulation (PTNS) is not cost-effective compared with tolterodine for overactive bladder, according to a report in the January issue of The Journal of Urology.

Aveo kidney cancer drug improves survival in late stage

REFILE: 'Double-jointed' soccer players have more injuries

NEW YORK (Reuters Health) - Soccer players with hypermobile joints may have a higher injury risk than their less flexible teammates, a study of one professional team suggests.

Some girls overestimate HPV vaccine protection

CHICAGO (Reuters) - Some adolescent girls who get the HPV vaccine to prevent cervical cancer wrongly think they no longer need to practice safe sex, U.S. researchers said on Monday.

Stone-free rate after percutaneous nephrolithotomy not lower with calcium phosphate stones

NEW YORK (Reuters Health) - Calcium phosphate content does not reduce the stone-free rate after percutaneous nephrostolithotomy (PCNL), according to a report online November 17 in The Journal of Urology.

Market dips: Now may not be time to get out

During periods of dramatic market fluctuation, it is important for investors to avoid emotional responses to investing.

American Urological Association outlines framework for robotic surgery credentialing

A new AUA standard operating practice document aims to help with robotic surgery credentialing for practicing urologists and those in training.

Don't let patient no-shows erode your urology practice's revenue

There is a lot we can do to improve our practices' efficiency and productivity. One of the simplest methods is to decrease the no-show rate, a problem that affects most medical practices.

Reimbursement fights to intensify for urologists and other physicians in 2012

Urologists and other physicians across the country now find themselves in the midst of a high stakes game of "chicken" on Capitol Hill, with their level of compensation for treating Medicare patients at stake.

New prostate specific antigen guidance should serve as 'catalyst for change'

Peter R. Carroll, MD, MPH, discusses the positive and negative aspects of the U.S. Preventive Services Task Force prostate cancer screening recommendation and provides a unique perspective on how the urology community should respond.

Coverage agreements: How they affect urology billing

Whether a coverage arrangement is in place makes all the difference when seeing another urologist's patients.

Pre-radical prostatectomy penile length returns by 4 years after surgery

Researchers found that stretched penile length following radical prostatectomy for prostate cancer decreased until 36 months post-op, then at this point, the process appears to reach a nadir and reverse itself so that by 48 months, stretched length appeared to be fully restored at 5 years post-op.

Tadalafil (Cialis): A phosphodiesterase type 5 inhibitor for the treatment of benign prostatic hyperplasia

New indication: Tadalafil once-daily 5-mg oral tablet is FDA approved for the treatment of benign prostatic hyperplasia (BPH) in patients with or without erectile dysfunction (ED).

Study: Functional outcomes better with holmium laser enucleation of the prostate vs. photoselective vaporization of the prostate

Men with lower urinary tract symptoms (LUTS) associated with large prostates had significantly greater improvement in functional outcomes when treated with holmium laser enucleation of the prostate (HoLEP) than with photoselective vaporization of the prostate (PVP).

Prostate cancer screening should monitor subgroup of young, high-risk men, study suggests

Almost half of prostate cancer deaths occur among men with PSA levels in the top 10% when assessed at age 44 to 50 years. This small group could benefit from intense surveillance over the ensuing years, whereas in about half of men, three lifetime PSA tests appear sufficient to capture the risk of prostate cancer metastases or death 10 or more years in advance.

FDA Actions in Brief January 2012 (Antares, Isentress, REMS)

Recent FDA Approvals (through December 2011) related to (Antares, Isentress, REMS)

Do recurrent urinary tract infections cause chronic kidney disease?

A child with normal kidneys is not at significant risk of developing chronic kidney disease because of recurrent urinary tract infections.

Advanced prostate cancer survival predicted by gene panel

Results from testing in an initial patient cohort indicate the potential for a six-gene, whole blood RNA-based expression panel to predict survival in men with progressive metastatic castration-resistant prostate cancer.

Most post-radical prostatectomy erectile dysfunction cases have non-neurogenic etiology

The advent of nerve-sparing radical prostatectomy and its outcomes has focused attention on the etiology of erectile dysfunction following all forms of prostate cancer intervention.

Post-radical prostatectomy erectile function recovery lower than reported

Post-radical prostatectomy erectile function recovery is much lower than physician-reported rates, a study indicates.

Localized prostate cancer death predicted by RNA signature score

A composite score calculated from a 46-gene RNA signature independently predicts cancer death among men with clinically localized prostate cancer managed by active surveillance.

Hiring a friend: Why it's a bad idea for your urology practice

Hiring a friend is usually not a good idea, because it can cause more problems in your practice than it solves.

Percutaneous nephrolithotomy: Tricks and tips for access and stone removal

Although percutaneous nephrolithotomy (PCNL) comprises only 4% to 6% of all stone surgeries, it behooves the urologist with an interest in stone disease to be facile in this treatment modality in order to offer patients the most appropriate and effective treatment for their stones.

Here's to a realistic post-radical prostatectomy potency talk

Surveys of patients and their partners have found previous numbers regarding post-op potency to be highly unrealistic, and results of recent studies, such as one from Memorial Sloan-Kettering Cancer Center, are closer to reality.

Testosterone breakthrough common in patients on androgen deprivation therapy

Among men treated with curative radiation therapy and neoadjuvant, adjuvant, or concurrent androgen deprivation therapy (ADT), about one-fourth fail to achieve or maintain true castrate levels of testosterone suppression.

Gene fusions point to radiation resistance in prostate cancer

Results of in vitro studies indicate that E-twenty six (ETS) gene fusions in prostate cancer may be a biomarker of radiation resistance and a potential target for reversing radioresistance through treatment with a poly(ADP-ribose)polymerase 1 (PARP1) inhibitor.

Denosumab results in less pain interference, according to study

Pain interference with daily functioning was significantly less in men with castrate-resistant prostate cancer who were treated with the RANK ligand inhibitor denosumab (XGEVA) compared to zoledronic acid (Zometa) as part of a multinational, double-blind, randomized trial.

Condoms for porn actors to be on Los Angeles ballot

LOS ANGELES (Reuters) - A ballot initiative requiring Los Angeles porn actors to wear condoms has qualified to go before city voters in a presidential primary election in June, organizers said on Tuesday.

Red meat consumption linked with risk for kidney cancer

NEW YORK (Reuters Health) - People who eat lots of red meat may have a higher risk of some types of kidney cancer, suggests a large U.S. study.

Statins tied to lower risk of fatal prostate cancer

NEW YORK (Reuters Health) - In a new study of middle-aged New Jersey men, statin therapy was linked to a lower risk of death from prostate cancer.