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Leasing can result in lower payments and an option to buy, but also higherinterest ratesShould you buy or lease your practice's premises, a needed piece of equipment,or even those extra employees? Those are questions that face every urologist.

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.

Self-assessment study demonstrates 80% improvement in 55% of female patients

Orlando, FL-A sizable proportion of women with mixed stress urinaryincontinence who undergo sling surgery will benefit with concomitant resolutionof urge symptoms. However, preoperative sensory urge appears to clear moreoften than motor urge, and de novo urgency is a significant potential problemfor women being operated on for pure stress incontinence, according to resultsof a study conducted at the Cleveland Clinic.

San Francisco-A transdermal testosterone replacement gel provedboth safe and effective in long-term use, UCLA investigators reported atthe Endocrine Society annual meeting here.

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.

Q What is the current state of prostate cancer markers?With prostate cancer, we are fortunate in that it has the very best markeror combination of markers for any cancer that I'm aware of, short of skincancer where visual markers are quite good. PSA's performance for predictinglocalized prostate cancer probably exceeds the performance of other cancermarkers, such as CA125 for ovarian cancer, CEA for colon cancer, and someof the genetic markers for breast cancer.

Washington-Although urologists were victorious in a recent courtdecision excluding lithotripsy from the Stark II rule, the U.S. Departmentof Health and Human Services said it will appeal the ruling.

Orlando, FL-The use of radiopharmaceutical carbon-11 acetate in positron emission tomography (PET) appears to be more sensitive in picking up recurrent prostate cancer than standard imaging techniques, according to preliminary imaging studies presented at the AUA annual meeting.

Orlando, FL-Currently established T- and Z- bone mineral density scores may require revision in order to accurately assess changes in men receiving androgen deprivation therapy, suggests an Austrian study presented at the AUA annual meeting.

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.

Orlando, FL-Among patients who undergo radiation treatment forprostate cancer following biochemical failure post-prostatectomy, use ofthe ProstaScint immunoscintigraphy scan appears to fail at reliably locatingdisease, researchers reported at the AUA annual meeting.

An astounding article in this issue of Urology Times details how oneurologist quit all commercial insurance participation, then "optedout" of Medicare-and is not only surviving, but thriving. Mike Harris, MD, a well-trained, board-certified, respected urologistin Traverse City, MI, said "Enough is enough!" and did somethingabout it. He no longer exists in any private insurance carrier databaseand likewise does not appear anywhere on the Medicare radar screen.

Paris-An international consensus committee has recommended that men withintermediate-risk prostate cancer be treated with high-dose 3D conformalradiotherapy-with or without hormonal therapy-rather than with combinedexternal-beam radiation and brachytherapy.

HHS report says healthcare litigation is threatening patient safety and quality of careWashington-The high cost of medical malpractice insurance, both for patientsand physicians, is gaining renewed attention in Washington, with PresidentBush calling for reform and a new report by the Department of Health andHuman Services (HHS) urging legislative action.

Unknown deductibles, correction of human error, and value reassessmentcan all add upNow might be a good time for every urologist to take a look at the often-neglectedproperty or real estate tax on all the property owned by your practice.

Develop guidelines, patient-selection criteria, and methods to protectpatient privacyIn 2002 and beyond, we can expect to change the way we communicate withpatients. A few decades ago, a patient who was sent for blood tests or x-rayswas contacted if the tests were abnormal and asked to call the office in10 to 14 days to review the results with the doctor. This technique wastime consuming, and phone tag was an expensive game for both the pa-tientand the physician.

Internet Service Providers such as AOL provide connection numbers inmost major citiesThose of us who travel even occasionally find a laptop computer essential,both to work during hours that might otherwise be wasted and to keep intouch with friends, family, and business associates. A common question is,"Which Internet Service Provider (ISP) can give me access in a widevariety of places?"

Orlando, FL-The 5-alpha-reductase inhibitor finasteride (Proscar)is associated with symptom improvement in men with category IIIA chronicpelvic pain syndrome, say leading prostatitis researchers.

Orlando, FL-Treatment with an alpha blocker used commonly in men withBPH is associated with improvement of symptoms in men with moderate to severechronic non-bacterial prostatitis, said Perinchery Narayan, MD.

Orlando, FL-A newer, novel 5-alpha-reductase inhibitor offersBPH symptom relief and improvements in urinary flow rates, according tofindings from three 2-year, multicenter, phase III trials.

Orlando, FL-The relative efficacy of radical prostatectomy andexternal beam radiation therapy for treating clinically localized prostatecancer diagnosed during the PSA era appears to depend on patient risk, accordingto the results of a retrospective study.

Orlando, FL-In men with screen-detected, clinically localizedprostate cancer, radical prostatectomy appears to provide a higher 7-yearPSA progression-free rate than either radiotherapy, hormonal therapy, orobservation, according to results of a prospective follow-up study fromWashington University, St. Louis.

Orlando, FL-Patients with a common autoimmune disease are 15 timesmore likely to suffer from urinary symptoms associated with interstitialcystitis than age-matched controls, according to the results of a population-basedstudy undertaken by a multi-institutional group of Finnish researchers.

Q Can you characterize the patient who uses complementary and alternativemedicine?Virtually everybody uses complementary medicine. When you ask patientsabout the medications they are taking, they may tell you they are on oneor two drugs. But if you don't ask them, they will never tell you aboutall the vitamins and supplements they take. When you specifically ask themabout vitamins and supplements, you end up getting laundry lists. What Ifind is that many men, in particular, will say they take whatever theirwife gives them.

Newton, MA-Matritech Inc. has received FDA clearance to market the NMP22 BladderChek bladder cancer test for use in conjunction with cystoscopy. The test works like a home pregnancy test and returns results while the patient is in the physician's office, the company says.

Seattle-Despite the way it was portrayed in some of the lay media, the authors of a recent study on the "overdiagnosis" of prostate cancer insist their work should not be construed as hostile to the practice of PSA screening. In fact, says one investigator, results of the study paint an overall favorable picture of screening.

Orlando, FL-In patients with metastatic renal cell carcinoma, adjuvant interleukin-2 (IL-2) after cytoreductive nephrectomy appears to offer a superior survival benefit over nephrectomy followed by interferon alpha-2b, according to a report presented here at the American Society of Clinical Oncology annual meeting.

Traverse City, MI-In the watchful eyes of the Centers for Medicare and Medicaid Services, urologist Michael Harris, MD, does not exist. Dr. Harris-a successful, board-certified urologist in private practice-would not have it any other way.

Urodynamic tests should be tailored to an individual patient's suspected dysfunction