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All of us see great clinical cases from time to time and make valuableobservations. Often there is an opportunity to present this material asa poster at scientific meetings. Until recently, the production of a high-qualityscientific poster required the use of an outside graphic arts firm at acost of more than $1,000.

Varicocele is a common clinical finding, present in approximately 15%of adult men. When the patient with a varicocele visits a urologist, itis often due to testicular discomfort or fertility-related concerns. Atthe 2003 meeting of the American Society for Reproductive Medicine, bothof these issues were addressed and are discussed in this issue of UrologyTimes.

San Antonio--Repair of clinically significant varicoceles may resultin nearly a 25% chance of natural conception, even in men who do not demonstratesignificant improvements in their postoperative seminal parameters, accordingto University of Iowa researchers.

San Antonio--Biomaterial wraps are a promising adjunct for vasovasostomy,according to results of an animal study that incorporated a biomaterialmatrix and a sealant into the conventional three-suture anastomosis. Researcherscalled this "polishing the gold standard" because of the highpatency rate of the standard procedure.

Our income tax law, the Internal Revenue Code, turned 90 in 2003. Whatstarted as a 400-page tax bill when Woodrow Wilson signed it into law in1913 now contains more than 55,000 pages. In fact, last year, Congress passedand the president quickly signed into law a $330 billion, 10-year tax cutplan-The Jobs and Growth Tax Relief Reconciliation Act of 2003. That billboth added to the page count and made a significant impact on the tax billsof many physician practices.

Many myths surround the Fair Labor Standards Act (FLSA), which governsovertime pay, but the biggest myth may be that FLSA issues are low-riskdecisions for medical practices.

Washington--Physicians who perform services, or have financial interests,in ambulatory surgery centers (ASC) are facing an uncertain future whenit comes to how much they will be paid for serving Medicare patients.

San Antonio--A retrospective study of men with cancer who elected to cryopreservetheir sperm because of cancer therapy found that 20% of men had alreadyreceived one or more cycles of chemotherapy. The recognized toxic effectsof chemotherapy and radiation on sperm cells make this a questionable practice

Q I am in a multiple-physician urology practice. One of our physiciansbelieves that billing 52332 with 52352 or 52353 with a ­59 modifiershould be paid, and that billing 52005 with 52332 with the ­59 modifiershould be paid (ie, 52005-59). When is it appropriate to use the ­59modifier?

Quebec City, Quebec--The good news is that most patients being treated for erectile dysfunction report that their treatment is working. The bad news is that a significant percentage of these same patients are often lost to follow-up for that very reason, according to a study by urologists from McGill University.

Minneapolis-American Medical Systems announces the launch of the AMS 700CXR Penile Prosthesis, which is designed for difficult surgical cases and re-insertion procedures.

The University of Nebraska Medical Center has received a 5-year grant totaling almost $9.9 million from the National Institutes of Health to further the understanding of cell signaling in relation to a variety of cancers, including cancer of the prostate.

Richard D. Williams, MD, has been elected president of the American Foundation for Urologic Disease by its board of directors, the foundation announced.

When it comes to deciding the type of treatment a man with prostate cancer receives, his age often takes precedence over life expectancy, according to a study from the University Health Network in Toronto.

The rate of use of high-cost operative procedures is not lower among Medicare beneficiaries enrolled in for-profit health plans than among those enrolled in not-for-profit health plans, according to a study in the New England Journal of Medicine (2004; 350:143-150).

Patients with Gleason scores =7 receiving an investigational form of immunotherapy for prostate cancer showed a significant survival advantage.

Repeating a familiar theme of his administration, President Bush said Tuesday that the United States must rid itself of frivolous medical liability suits.

The likelihood that an older patient will be hospitalized within a week or die shortly after undergoing prostate resection and other common procedures in an outpatient setting depends on health-related characteristics of the patient and where the surgery was performed, according to a recent article in Archives of Surgery (2004; 139:67-72).

The American Board of Urology has named two new trustees for 2004-2005-Paul H. Lange, MD, of the University Washington, Seattle, and Michael O. Koch, MD, of Indiana University, Indianapolis.

A Houston physicians' group has settled federal antitrust charges that stemmed from its use of the messenger model of dealing with health plans, according to a report in the AMA's American Medical News.

In a study comparing biochemical failure rates of popular treatments for localized prostate cancer, low-dose external beam radiotherapy showed the highest failure rate.

Obese men with prostate cancer are more likely to have aggressive tumors and to experience cancer recurrence after surgery compared with men of normal weight or those who are overweight but not obese, according to two new studies.

It's official. As widely anticipated, the Centers for Medicare & Medicaid Services announced that the nation's physicians would receive a 1.5% increase in payments for services under the Medicare Physician Fee Schedule in calendar year 2004.

Over the last 20 years, radical retropubic prostatectomy has evolvedto become the standard of care in men with localized prostate cancer. Becauseof the morbidity of this procedure, however, interest has grown in the developmentof non-surgical modalities. Unfortunately, many of these non-surgical approaches,such as monotherapy with radioactive seed implantation, have resulted indisappointing results or excessive morbidity, as in first-generation cryotherapy.

Be prepared for a short-term gain that may be a long-term pain. The AmericanMedical Association has claimed a major political victory with passage ofthe Medicare Prescription Drug Improvement and Modernization Act of 2003,and I certainly hope the AMA is correct. Certainly the pay increase overthe next 2 years is great. However, I have concerns about many of the otherissues addressed in the bill.

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.

Montreal--Novel approaches to percutaneous nephrolithotomy, includinguse of a stent instead of a tube and using smaller tubes and stone "cones,"are helping to optimize this procedure. Researchers agree that improvingsafety and reducing morbidity are the goals of these new techniques.

Minneapolis--Surgeons and other physicians across the country continueto deal with the higher costs of practicing medicine in the face of decliningreimbursements. Those factors added up to lower profit margins for U.S.physician groups in 2002 and a continuing awareness of the need to pay attentionto all of the vagaries of the business of practicing medicine. For the mostpart, urologists showed little change in reimbursement.