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Presented by Kevin M. Slawin, MD, Baylor College of Medicine, Houston.

Presented by Donald A. Elmajian, MD, Lousiiana State University, Shreveport

Presented by Georg Bartsch, MD, University of Innsbruck, Austria

Up to 5% of Americans will be affected by stone disease over the courseof their lifetime. Despite major advances in shockwave lithotripsy and endoscopictechnologies, we must not underestimate the role of medical therapy in preventingstone recurrence. Two studies presented at the recent AUA annual meetingand reported in this issue of Urology Times (see page 10) offer valuablelessons on this aspect of stone management.

New York-Because of potential future fluctuations in PSA levels, NewYork researchers recommend that a second PSA reading be taken several weeksafter initial measurement and prior to recommending biopsy.

Congress passed it, and the president signed it. The $330 billion, 10-yeartax cut plan will have a significant impact on the tax bills of every physicianand his or her practice. The bill largely adopts the House's prescriptionfor trimming taxes on capital gains and stock dividends for at least 5 yearswhile lowering income tax rates and encouraging business investment.

This addendum includes advice on managing gas emboli/vascular insufflation,vascular injuries, subcutaneous emphysema, pneumomediastinum, and pneumothoraxArieh L. Shalhav, MD, is associate professor of surgery and directorof minimally invasive urology, and Marcelo A. Orvieto, MD, is a fellowin minimally invasive urology, University of Chicago.As discussed in a recent "Hands On" article ("How to preventand manage laparoscopic injuries," July 2003, page 50), the overallcomplication rate related to urologic laparoscopy is approximately 4%, varyingwidely according to the procedure's technical difficulty. In this addendumto the article, we discuss how urologists can prevent and manage additionalcomplications associated with laparoscopy, including gas emboli/vascularinsufflation, vascular injuries, subcutaneous emphysema, pneumomediastinum,and pneumothorax.

In a previous issue of Urology Times, this column discussed multiple procedures and the bundling edits for a single physician ("When to bill and not to bill for multiple procedures," May 2002, page 62). This article will address multiple procedures performed at the same encounter by two separate physicians.

Chicago-One of the first large studies to determine the 10-year efficacy of brachytherapy in men with prostate cancer shows that patients receiving a dose of at least 160 Gy have a 93% chance of being free of biochemical failure and a 95.4% chance of local control at 10 years.

Chicago-A private practice setting can be just as successful with renal stone prevention as a larger academic setting, according to research presented at the AUA annual meeting here. And, if treatment is needed later, a patient can be counseled about options following an accurate assessment of the natural progression of stones.

During the recent AUA annual meeting in Chicago, the association's newBPH treatment guidelines were released. Although the update contained nomajor surprises, the framework does include specific recommendations forusing combination therapy in the treatment of certain BPH sufferers.Urology Times asked urologists if they were already using combinationtherapy, consisting of an alpha-blocker and 5-alpha-reductase inhibitorand, if so, whether this regimen was showing an improvement in patient outcomes.We also asked whether they expect to perform fewer invasive procedures forBPH.All of the urologists we spoke with have used combination therapy forBPH. They all said they see benefits from its use, even if their evidenceis anecdotal.

Post-RP, positive surgical margin carries 1.52-fold increased risk ofrecurrence

Chicago-The traditional PSA cut-point of 4.0 ng/mL for recommending abiopsy to diagnose prostate cancer is controversial, and some researchershave recommended cut-points as low as 2.0 ng/mL. Two separate studies presentedat the AUA annual meeting here have found that cut-points of 2.5 or 2.6ng/mL may be more appropriate for determining the need for prostate biopsy.

Chicago-A post-treatment PSA doubling time less than 3 months followingeither surgery or radiation for localized or locally advanced prostate cancercan be a surrogate marker for eventual-perhaps inevitable-death from thedisease, according to data from a multicenter study of nearly 9,000 cancerpatients.

Chicago-Once-daily dosing with a single extended-release tablet containingciprofloxacin (Cipro), 1,000 mg, is as safe and effective as conventionalciprofloxacin, 500 mg, dosed twice a day for the treatment of complicatedurinary tract infections and acute uncomplicated pyelonephritis, accordingto the results of a large double-blind study.

Dutasteride would offer absolute risk reduction of up to 27% over 2years, study results show

Employment tax evasion can take a variety of forms, and the IRS is watchingfor themAlthough August is when the Internal Revenue Service traditionally beginsselecting those 2002 tax returns that are to be examined in greater depth,many physicians found themselves being targeted for examination soon afterthe April 15 tax deadline. After all, April 15 was also the deadline forparticipating in the IRS's "Offshore Voluntary Compliance Initiative"(OVCI)-a "come back into the fold and you will be forgiven your taxtransgressions" program.

A catchy headline or photo will grab attention and result in positivepublic relationsHealth and wellness topics are hot, and the media is interested in newmedical technologies, surgical procedures, and diagnostic techniques, aswell as fascinating medical cases with human-interest angles. Never beforehave medical practices had more opportunities for positive media exposure.

Avoid huge photos and flashy graphics, and focus on developing useful,clean content

AUA recommends 51798 any time ultrasound is performed to check for residualurineQ We use the BVI-3000 BladderScan from Diagnostic Ultrasound for residualurine. They show a shadow of amount left in the bladder on a printed report.Is this still considered a non-image? Is there any way we can use 76775using the BVI-3000?

Getting legislation passed by Congress is a complex and frustrating effortfor anyone, but especially for physicians. Our issues benefit patients andour health care system. But not everyone agrees. Physicians compete againstwell-organized special interest groups that contribute millions of dollarsto the political campaigns of our opposition.

During the past decade, serum prostate-specific antigen testing has become widely accepted as a means to improve early detection of prostate cancer. Thousands of studies have been performed to determine the most appropriate use of PSA testing and to improve its accuracy.

Chicago-Watchful waiting is a common approach to prostate cancer, especially in patients who are in the later years of their life. A certain percentage of these men will wait, change their minds, and seek intervention. Extensive research efforts have been devoted to identifying predictors of outcomes after treatment with surgery or radiation therapy, but little is known about the outcome of watchful waiting during the PSA era.

The American Medical Association has recently taken a number of steps to support key physician causes and strengthen the organization internally.

For a number of physicians, providing voluntary care is a natural extension to the professional and personal basis for their choice of career.

Chicago-Recognition of combination drug therapy for selected patients with benign prostatic hyperplasia represents one of several key changes in clinical management embraced by AUA in the organization's first-ever clinical guidelines for BPH.

FDA-approved safety device reduces needlestick injuries: Columbus, OH-The FDA-approved NeedleZap, a safety device that disintegrates the sharp portion of a hypodermic needle to help reduce accidental needlestick injuries, is now available from E Med Future, Inc.

New research on both current and promising new treatments for bladder and prostate cancer, stone disease, and BPH are making headlines at this week's AUA annual meeting. While robotics and other newer technologies took center stage last year, the emphasis at this year's meeting is on comparisons of existing techniques and outcomes data.J. Brantley Thrasher, MD, chair of AUA's Public Media Committee, briefed a group of editors and reporters yesterday on the hot topics to expect over the course of this week's meeting. Among the 1,700 abstracts being presented, these were among the highlights discussed by Dr. Thrasher:

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Nearly all of us use and depend on computers for running and operatingour medical offices. I doubt that many of us could successfully operateour practices without this evolving technology, which adds not only to improvementin the medical care we offer our patients but to the efficiency of our practices.