'Urologic Diseases' project enters bold second phase

Q Give us some background on the Urologic Diseases in America project. What is it, and what is it meant to accomplish?

Q Were you able to look at every urologic disease, or did you focus on certain ones?

Q Give us some examples of what you learned in the first phase of Urologic Diseases in America.

A In the first phase of UDA, we learned a great deal about the immense financial burden that urologic diseases place on our country. We learned that although the malignant diseases garner a lot of media attention, it is the benign urologic diseases that really run up the bill in our specialty. In fact, urinary tract infection in women is the most costly urologic disease in America. Another very expensive disease is urinary incontinence in both women and men.

Q In which specific two or three areas of urology has UDA provided the most new information?

A One of the interesting things that we've learned comes from the field of urolithiasis. While we've watched technology explode in a positive way in the management of patients with stones over the last 15 to 20 years, we've also seen a commensurate increase in both the number of dollars spent on patients with stones and the number of stones that have been diagnosed. One of the collaborators with whom we're working, Dr. Peggy Pearle, from the University of Texas Southwestern in Dallas, has some very provocative explanations-drawn from UDA data-as to why the country may be seeing an increase in its stone burden, and it has to do with international climate change.

Another area that's been very interesting is prostate cancer. Because of the demographic nature of the disease, it always draws a lot of attention, including from the federal government, which has shown an interest in managing the quality of services that the specialty of urology delivers to men with prostate cancer. Dr. David Penson, a UDA collaborator from the University of Southern California, has been particularly interested in examining the way services are delivered to men with prostate cancer and how they vary geographically, by patient age, and by racial or ethnic background. He's come up with some very interesting findings based on UDA analyses.

For example, most would agree that ultrasound guidance is critical when performing prostate biopsies. Although most data sources we've examined show a rapid increase in the use of ultrasound with prostate biopsies over the last 15 years, as recently as 2001, fully one in five prostate biopsies in this country was done without any ultrasound guidance at all.