Speak Out: What current trends in urology have greatly impacted your urology practice?

More people are learning those techniques, and as surgeons do more prostates and partial nephrectomies, they will get more comfortable being in the abdomen and will expand to more procedures such as ureteral re-implants and certainly more pyeloplasties.

The results with these new techniques are as good, if not better, than open procedures. Patients also want it, because they've heard how well their friends have done, and it just sort of spreads."

"We're doing less radiation, and we're backing off over-treatment, especially on large incisions through skin fat and muscle. Of course, we're doing laparoscopy and so on. I haven't done an open prostate in 20 years.

In the field of prostate cancer, radical surgery has been losing to radiation, which I think is almost worse. Radiation turns well-differentiated cancer into poorly differentiated cancer, causes irritable symptoms in the bladder and rectum, and creates impotence by frying the arteries. I'm a cryo man myself, and that's been sort of a steady undertone.

Whether those trends will continue is a great question. Radical surgery has been losing to radiation and seeds, but now people are pushing back on radiation. I think both are going to fade in the next decade."

Anthony H. Horan, MD
Delano, CA

"In our area, the hospital is trying to put the private physicians on staff. They've tried to hire us, and when that didn't work, they hired outside urologists to compete against us. So that's a concern.

We've got a pretty big group with nine urologists, and our idea is to continue expanding and provide top service. We still think that as a private group we can provide much better service than the hospital, with all of its bureaucracy.

We have younger, very capable people, but I think we'll continue to see that increasing competition."

Arnold C. Cinman, MD
Los Angeles

"The trend is to try to do things patients want. They want to be able to have the problem diagnosed and treated quickly and effectively. The government and insurance companies want that too because it's less expensive.

Also, we have more of an ability to control resources to get our patients treated more efficiently. For example, we can do a CT scan and take care of a stone the next day without having to jockey for operating room times and facilities."

Jonathan Jay, MD
Naples, FL