Drug Therapy

Watson Pharma, Inc., has received FDA approval to market oxybutynin transdermal system (Oxytrol) for the treatment of overactive bladder, with symptoms of urge urinary incontinence, urgency, and frequency. A thin patch applied to the abdomen, hip, or buttock twice weekly, it delivers 3.9 mg per day of oxybutynin consistently and continuously through the skin into the bloodstream, according to the company.

Bethesda, MD-A combination of low-dose bacille Calmette-Guin and interferon-alpha (IFN-a) has shown promise in the treatment of bladder cancer patients who have failed initial treatment with BCG.

Seattle-Use of some over-the-counter herbal supplements may be adverselyaffecting male fertility. In an ironic twist, those supplements touted ashelping with infertility appear to be among those doing harm.

Pharmaceutical manufacturers have long been under scrutiny for the methodsthey employ in marketing their products to physicians. Now, increasing concernthat drug makers are winning physician favor by deeply discounting chemotherapymedicines is placing those physicians under the microscopes of federal andstate authorities.

Copenhagen, Denmark-An oral antidiuretic approved for the treatment ofnocturnal enuresis also appears to be effective for treating nocturia inadult men and women, according to phase III clinical trial results reportedby the multinational Nocturia Study Group.

Albuquerque, NM-A recent study by University of New Mexico psychiatristsconfirms what many urologists have observed clinically-that treatment witha PDE-5 inhibitor is effective in men with erectile dysfunction attributableto certain antidepressant medications. The research suggests that effectivetreatment of ED in men with "antidepressant-associated sexual dysfunction"-aparticularly common side effect of serotonin reuptake inhibitors-may improvetheir compliance with these agents.

Baltimore-A joint AUA-American Academy of Orthopedic Surgeons expert panel has issued guidelines for antibiotic prophylaxis in patients with total joint replacements who may face subsequent invasive urologic procedures.

The predictable recurrence of superficial transitional cell carcinoma of the urinary bladder is responsible for the frequent utilization of intravesical therapy. In the past 2 years, we have changed our intravesical treatment strategy at Ohio State University in an effort to enhance efficacy and reduce patient inconvenience.

Boston-Pregnant mice exposed to synthetic estrogens resulted in shorter urethras and disrupted urethral seam closures in their offspring, according to researchers from the University of California, San Francisco. They say their research supports previous cause-and-effect data regarding endocrine disruptors and genital tubercle anomalies.

Somerville, NJ-Ethicon Products, a division of Ethicon, Inc., has received FDA approval to market the Vicryl Plus Antibacterial Suture, which uses an antibacterial agent designed to reduce bacterial colonization on the suture. The antibacterial agent, triclosan (Irgacare MP), is known to be effective against Staphylococcus aureus, S epidermidis, and methicillin-resistant strains of Staphylococcus.

Italy-Encrustation of urinary tract biomaterial remains a challenging problem for urologists. Devices such as urinary stents and catheters invariably become encrusted with calcium oxalate after long-term placement and are difficult to later remove.

Objective assessment, drugs improve bladder symptoms

Chicago-Elevated levels of post-void residual urine appear to be relatedto recurrent urinary tract infection in older women, according to resultsof a retrospective study. In addition, lower post-void residual urine levelsare found in women who take oral estrogen replacement therapy, NorthwesternUniversity urologists report.

Recurrent urinary tract infections are so common in our female patientsthat urologists and other clinicians give little thought to their evaluationand treatment. However, new research findings may lead to some small butimportant changes in our approach to this prevalent urologic problem.

Over-the-counter fertility test receives FDA approval. Vernon Hills, IL-Lake Consumer Products introduces FertilMARQ, an FDA-approved test for male infertility.

As most urologists know, new federal standards have been established to ensure the privacy of patients' health information as part of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. In my September 2002 article, I presented limited information on HIPAA and its impact on physicians' practices, including the standards for the electronic transmission of health care transactions and the rules associated with implementation.

Dramatic changes in the management of erectile dysfunction (ED) have occurred since the first FDA-approved oral agent, sildenafil citrate (Viagra), was introduced in 1998. Prior to this time, urologists were the primary source of referral for the diagnosis and treatment of ED.

San Diego-A new once-daily formulation of ciprofloxacin (Cipro XR) is equivalent to conventional twice-daily dosing for treatment of uncomplicated urinary tract infections, according to results from a large, multicenter randomized trial. The extended-release formulation was granted FDA approval last month.

San Diego-Treatment with nitrofurantoin is superior to an estriol-containing vaginal pessary for prevention of urinary tract infections in postmenopausal women, according to results of an Israeli study.

Bladder cancer ranks among the most common human malignancies, with over130,000 newly diagnosed cases each year in the United States and Europeand over 1 million active cases undergoing annual follow-up. Given the traditionaltechnique for diagnosis and monitoring based on passage of a cystoscopeinto the bladder, it is only natural that great efforts are now being focusedtoward finding alternative or confirmatory noninvasive techniques usingurine-based assays.

OIG document sayssome drug marketing practices may violate anti-kickback statute

Urologists can play important part in new research paradigm, Dr. vonEschenbach says

89% of patients satisfied with temporary stent, which is spontaneouslypassed in 8 days

Two agents show long-term efficacy and safety in a broad range of patients

Orlando, FL-Treatment of Peyronie's disease with verapamil appears to be effective, but the drug's role is still in question and is still being investigated. In research presented at the annual AUA meeting in Orlando, FL, verapamil showed good results when applied as a topical gel, but a second study suggested that the gel does not appear to be absorbed into the tunica albuginea.

Orlando, FL-Men with erectile dysfunction who fail initial treatment with sildenafil citrate (Viagra) are seeing varying degrees of improvement when therapy is supplemented with other agents, vacuum devices, or education and counseling.

Primary care specialties now account for more than 75% of the prescriptionswritten for sildenafil citrate (Viagra), and this percentage increases almostmonthly. The number of prescriptions written by urologists has remainedstable, and as the erectile dysfunction market increases, urology's percentageof the whole continues to decline. As a specialty, urologists are very busy, and the ratio of patients tophysicians is high. Urology residents who are finishing training have atremendous number of practice opportunities, ranking second only to residentsin dermatology, according to a recent AMA survey. Just look at the numberof classified pages in this issue of Urology Times, which list some of theseopportunities, and compare it with those in an issue of 5 or 10 years ago.

Orlando, FL-Using serum testosterone levels rather than labelguidelines to re-dose patients on luteinizing hormone-releasing hormone(LHRH) agonist depot therapy can substantially reduce treatment costs andimprove a patient's quality of life, according to researchers at Case WesternReserve University, Cleveland.

Orlando, FL-Combining sildenafil citrate (Viagra) with a popularantidepressant shows positive results for patients with premature ejaculation,according to results from two separate studies from Israel and Italy. Bothpapers were presented at the AUA annual meeting here.

Orlando, FL-Intermittent androgen deprivation appears to be as effectiveas continuous androgen deprivation in the treatment of advanced prostatecancer, say researchers from the University of Liege, Belgium.