Mac Overmyer

PSA velocity and PSA doubling time, once considered promising tools for identifying the need for intervention in prostate cancer patients under active surveillance, now appear to have failed to meet that promise.

Among surgeons contemplating performing a minimally invasive partial nephrectomy, the choice of procedure boils down to the approach that provides the highest level of comfort for the surgeon.

A non-bone-anchored male sling appears to resolve mild to moderate post-prostatectomy incontinence in up to 80% of patients and may also lead to significant improvement in erectile and sexual function.

A study by psychologists and urologists has found that factors affecting erectile function after prostatectomy have much the same impact after other prostate cancer treatments.

Researchers at the University of California, San Francisco have developed a new surgical approach they call a "T-shunt" that appears to resolve ischemic priapism efficiently and effectively with minimal morbidity.

A significant number of patients undergoing open or robotic radical prostatectomy have unrealistic expectations about postoperative sexual function.

The substantial decrease in the use of LHRH agonists in the U.S. since 2004 may not be entirely explained by a recent reduction in physician reimbursement.

Urologists who own or who have an interest in ambulatory surgical centers perform more than three times as many stone surgeries as non-owners do.

Clinicians confronting acute urinary retention (AUR) would do well to not only resolve the retention, but to also look for and treat comorbid disease, which amplifies the risk of death in a disease state already associated with a high incidence of mortality.

San Francisco-AUA's recommendation that PSA screening for prostate cancer be avoided in men with an anticipated life expectancy of less than 10 years appears to be a guideline more honored in the breach, according to a study from the San Francisco VA Medical Center published in JAMA (2006; 296:2336-42).

For clinicians, serious conundrums accompany the 80-year-old patient who arrives in the waiting room with an elevated PSA. This is the man who puts urologists and family practitioners dead center in a damned-if-you-do, damned-if-you-don't situation.

Cleveland-Dean G. Assimos, MD, professor of urology at the Wake Forest School of Medicine, Winston-Salem, NC, asked a simple question here at the World Congress of Endourology: "Is the Internet a reliable source of information for dietary recommendations for stone formers?"

Cleveland-Urologists at Emory University, Atlanta, may or may not have slain an urban myth, but at the very least, the team has given it a sound kick. Cola in moderation does not change urine chemistries significantly, and therefore does not appear to raise the risk of forming stones, the team concluded after comparing cola to deionized water in a randomized, prospective pilot study.

Cleveland-A Harvard Medical School study published last year in JAMA (2005; 293:455-62) established a link between obesity and kidney stone formation. Now researchers at the University of Minnesota have taken the next step with a study showing that obese men and women have at least one, if not more, urine abnormalities that increase their risk of stone formation.

Cleveland-There is a commonly held view that obese patients tend to present greater surgical challenges and have more complications after percutaneous nephrolithotomy. Researchers from Albert Einstein College of Medicine in New York have challenged that belief.

Cleveland-Intravenous ketorolac tromethamine is safe and appears to be effective at alleviating pain following percutaneous nephrolithotomy (PNL) procedures in properly selected patients, according to a study from the Methodist Hospital Institute for Kidney Stone Disease and Indiana University School of Medicine, Indianapolis.

Washington-Trichloroethylene (TCE) is a chlorinated hydrocarbon once commonly used as a degreasing agent in industrial settings. The nonflammable, colorless fluid may also be found as an ingredient in adhesives, paint removers, typewriter correction fluids, and spot removers. Although a clear-cut link between TCE and cancer has yet to be established, the chemical is the subject of a recent report calling for research on how it causes cancer and other adverse health effects.

Cleveland-Two studies from the University of Minnesota and one from the University of Tennessee presented at the World Congress of Endourology tackled three important questions raised by the use of nephrostomy tubes: Which configuration best minimizes pain? How small can the tube be and remain effective? When can a nephrostomy tube be abandoned altogether?

Washington-Members of the Coalition for the Advancement of Prosthetic Urology (CAPU) spent several days during the last week of September pounding the halls on Capitol Hill, lobbying Congress to improve payment for prosthetic urology procedures and seeking comprehensive insurance coverage for prosthetic urologic procedures. Now they wait to see what their efforts may have won.

Atlanta-For the past several years, Andrew P. Evan, PhD, chancellor's professor of anatomy and cell biology at Indiana University, Indianapolis, and his colleagues have pursued the etiology of kidney stone formation, stone by stone.

Atlanta-Using extracorporeal shockwave therapy (ESWT) to reduce pain and to correct some deviation in Peyronie's disease is a relatively new concept whose application appears to be more extensive in Europe than in the United States. The majority of European studies on this topic involve small cohorts of 30 or fewer patients, and although several have included control groups who did not undergo treatment, none of these trials included sham treatment to define the strength of the placebo effect.

Atlanta-A study presented at the AUA annual meeting by researchers from Columbia University in New York asked the provocative question, Are physicians overusing intravesical therapy in patients with T1 bladder cancer?

Atlanta-A calculator that can instantly predict short-and long-term risks of recurrence and progression in patients with stage Ta/T1 bladder cancer is a few clicks away.

Atlanta-How many significant clinical advances began like this?

Atlanta-Up to half of all bladder cancer patients receiving Bacillus Calmette-Gu?rin (BCG [TheraCys, TICE BCG]) therapy will fail to respond or relapse within 5 years, but those who make it through the first year have a better chance at responding to subsequent therapy than those who fail sooner. The response rate of those who fail after a year is similar to the response rate of patients who have yet to receive their first treatment, according to a University of Iowa study presented at the AUA annual meeting.

Atlanta-Conducting a second transurethral resection to restage bladder cancer should be a routine practice, according to Harry Herr, MD, attending physician at Memorial Sloan-Kettering Cancer Center, New York. The results are diagnostic, therapeutic, and invaluably prognostic, he said.

Atlanta-Sometimes studies are more notable for the questions they raise than for the ones they answer. Kevin T. McVary, MD, professor of urology at Northwestern University Feinberg School of Medicine, Chicago, presented a study at the AUA annual meeting showing that the phosphodiesterase type-5 inhibitor sildenafil citrate (Viagra) improves both erectile function and lower urinary tract symptoms, but has no apparent effect on flow rates.

New Hyde Park, NY--Although transurethral resection of the prostate remains the gold standard for the treatment of BPH, the expense of the treatment can be too much for some patients.

Winston-Salem, NC--Well over one-third of men with localized prostatecancer are opting for brachytherapy as their primary treatment, accordingto a recently published study. Past and current data indicate the proportionof prostate cancer patients choosing brachytherapy has grown from 1.4% in1992 to 3.0% in 1995 to 36% in 1999-the latest year for which comprehensivedata are available.

Chicago--Advances in technology and technique are allowing computed tomography to image lesions and tumors as small as 2 mm in diameter in the kidney, bladder, and urinary tract of high-risk patients, according to a study presented here at the annual meeting of the Radiological Society of North America.