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Nephron-sparing surgery (NSS) was initially developed as a mechanism to preserve renal function in patients at risk of requiring dialysis in the face of total nephrectomy. Indications included tumors in patients with a solitary kidney, multifocal disease, or chronic renal insufficiency.

Baltimore-For patients with total PSA levels in the range of 2.5 to 4.0 ng/mL, measuring the proportion of precursor forms of PSA (pPSA) relative to free PSA (fPSA) may significantly lower the number of unnecessary biopsies compared with measuring percent-free PSA (%fPSA) alone, a new study suggests.

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.

Genoa, Italy-Hand-assisted laparoscopic nephrectomy appears to be safe and feasible for treating large renal tumors, report researchers from the University of Miami, FL. Separately, researchers from Thomas Jefferson University say the hand-assisted approach is possible in patients with renal cell carcinoma with tumor thrombus.

New York-Adding high-dose vitamin D to docetaxel (Taxotere) in regimens for androgen-independent prostate cancer patients doubles the effectiveness of docetaxel as a single agent, according to results of a nonrandomized study from Oregon Health Sciences University, Portland.

Genoa, Italy-The use of alcohol ablation of the prostate to treat patients with symptomatic bladder outlet obstruction secondary to BPH yielded promising results in a number of studies presented at the World Congress on Endourology here. Researchers reported on the use of two forms of alcohol ablation-one using an anhydrous alcohol solution and one using a viscous gel. Both technologies are considered investigative.

Q How do I charge for a bladder scan for residual urine using thenew 2003 CPT code (51798 ) if I am using an "imaging" ultrasound?

San Antonio-Complete removal of all components of an inflatable penileprosthesis offers the best strategy for avoiding potentially serious complicationsin rare instances of prosthesis failure, suggest results from a small seriesfrom the University of Texas Health Science Center, San Antonio.Erosion of a retained reservoir into the bladder subsequently led to

Paris-The International Consultation on Prostate Cancer recommends thatmen with a history of prostate cancer not be given testosterone supplementationunder any circumstance. The recommendation was the subject of lively debateat the consultation's 2002 meeting here, and some members of the audienceposed cases in which they thought hormone replacement might be appropriate.

Chicago--The American Medical Association has taken a step toward reversing a 2-decades-old policy on the national physician workforce. Since the 1980s, the organization has maintained that the country was threatened with an oversupply of doctors.

Scranton, PA-Calling the medical liability insurance crisis a"national problem that needs a national solution," President Bushrenewed his support for federal reform that would include a cap on non-economicdamages awarded to injured patients. Meanwhile, urologists and other physiciansthroughout Pennsylvania, the site of Bush's speech, canceled plans to shuttertheir practices after the governor revealed short-term measures aimed atalleviating the crisis.

Fee schedule will apply endoscopic reduction rules to cystoscopy andother CPT codes

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.

The management of patients with T1 grade III bladder cancer remains controversial,and experts disagree on the timing of radical cystectomy. In this UrologyTimes point/counterpoint discussion, James Montie, MD, and Michael Droller,MD, debate the merits of early cystectomy versus transurethral resection(TUR) and associated therapy. Dr. Montie is professor of urologic oncologyand chairman, department of urology, University of Michigan, Ann Arbor.Dr. Droller is professor and chairman of the department of urology, MountSinai Medical Center, New York. UT Editorial Consultant Robert C. Flanigan,MD, professor and chairman, department of urology, Loyola University MedicalCenter, Maywood, IL, served as moderator of the discussion.

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

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.

Philadelphia-The U.S. Preventive Services Task Force has issued a new statement on prostate cancer screening that finds "insufficient scientific evidence to promote routine screening for all men and inconclusive evidence that early detection improves health outcomes."

Bridgeport, WV-Dramatic increases in medical liability insurancerates are driving urologists-and insurers-out of West Virginia, accordingto urologist Douglas McKinney, MD, of Bridgeport, WV, who has seen his insurancepremiums more than double in the past 5 years.

Denison, TX-A non-existent cap on non-economic medical liabilitydamages and the disproportionate number of high jury awards in the country'slargest state have physicians wondering if relief will ever come, even withlegislation in the works.

Philadelphia-The City of Brotherly Love has what many say is theleast friendly climate for physicians when it comes to medical liabilityinsurance. Insurance and reimbursement problems, however, are statewidephenomena in Pennsylvania. In Scranton, located in the northeastern cornerof the state, a seven-urologist group has said it will decide in Januarywhether to close.

Las Vegas-This past summer, some Las Vegas physicians, includingfive urologists, left the emergency room at University Medical Center, sayingthat it put them at a higher risk of medical malpractice lawsuits, and theywere unable to find affordable insurance.

As medical liability insurance policies come up for renewal and legislators work on reforming the system, physicians and other observers say the nation's liability insurance crisis is worsening. The most promising solution appears to be reform at the federal level, although relief will not come soon, according to national and local physician groups, government officials, insurers, and others familiar with the situation.

Glasgow, Scotland-Results of the first prospective comparison of robot-assisted prostatectomy and traditional radical retropubic prostatectomy show comparable outcomes in margin status and complication rates. Although the robotic approach proved to be a slightly longer procedure, patients experienced less blood loss and pain and were discharged earlier from the hospital, researchers report.

Los Angeles-Although they have metastatic disease, nearly one-third of bladder cancer patients with lymph node tumor involvement following radical cystectomy will enjoy long-term survival, and urologists now have some ways of predicting who they are.

Jena, Germany-The fluorescence in situ hybridization (FISH) assay appears to be a useful, noninvasive method to monitor for tumor recurrence in patients with transitional cell carcinoma of the bladder, according to European researchers.

New York-A computer model nomogram that uses three preoperative prostate cancer variables to predict probabilities for cancer recurrence within 5 years has been successfully validated. The nomogram will not only aid physicians in making treatment decisions, but it could also help improve patients' ability to make decisions about their treatment, according to researchers from Memorial Sloan-Kettering Cancer Center in New York.