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Baltimore-A joint AUA-American Academy of Orthopedic Surgeons expert panel has issued guidelines for antibiotic prophylaxis in patients with total joint replacements who may face subsequent invasive urologic procedures.

Washington-The Centers for Medicare and Medicaid Services has dropped its appeal of a recent U.S. District Court ruling that lithotripsy should not be encompassed within the Stark II ban on physician self-referrals. With the withdrawal, the court's decision on the matter is final, according to the attorney representing the American Lithotripsy Society (ALS) and Urology Society of America (USA).

No area of medicine has been the subject of more hype, misinformation, and confusion than developing web sites for physician practices. Hundreds and perhaps thousands of our urologic colleagues have created web sites only to be left with a bad taste about the time, money, and effort spent on a medium that does not appear to generate more patients or improve practice efficiency.

The predictable recurrence of superficial transitional cell carcinoma of the urinary bladder is responsible for the frequent utilization of intravesical therapy. In the past 2 years, we have changed our intravesical treatment strategy at Ohio State University in an effort to enhance efficacy and reduce patient inconvenience.

Boston-Pregnant mice exposed to synthetic estrogens resulted in shorter urethras and disrupted urethral seam closures in their offspring, according to researchers from the University of California, San Francisco. They say their research supports previous cause-and-effect data regarding endocrine disruptors and genital tubercle anomalies.

Las Vegas--Most older women who want to restore continence withoutresorting to surgery are satisfied with the results of collagen injections,according to Loma Linda Medical Center researchers.

Las Vegas--A single application of cooled transurethral microwavetherapy led to clinically and statistically significant symptom improvementin a pilot study involving patients with intractable chronic prostatitis,accompanied by BPH in some cases.

Failure to account for payroll taxes will result in various penaltiesOne of the proposals the Republican-led 108th Congress is studying tostimulate the economy is a month-long "holiday" on payroll taxes.This holiday-or even another proposal for a payroll tax moratorium for 1year on an employee's first $10,000 of income-may or may not help increaseproductivity or improve the moribund U.S. economy. The proposals have, however,focused attention on the complex payroll withholding system that many urologistsmust deal with.

Use this framework to facilitate complex decisions for treatment anddisease managementMedicine is both an art and a science. One hundred years ago, physiciansplaced more emphasis on the art than on the science, as documented studiessupporting the scientific basis for therapeutic decisions were few and farbetween. Since the 1990s, a plethora of information has become availableon studies, research, and scientific investigation on the treatment of disease,outcomes, and management of entire patient populations.

Somerville, NJ-Ethicon Products, a division of Ethicon, Inc., has received FDA approval to market the Vicryl Plus Antibacterial Suture, which uses an antibacterial agent designed to reduce bacterial colonization on the suture. The antibacterial agent, triclosan (Irgacare MP), is known to be effective against Staphylococcus aureus, S epidermidis, and methicillin-resistant strains of Staphylococcus.

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.