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Presented by John A. Libertino, MD, Lahey Clinic, Burlington, MA

Presented by Carrie Rinker Schaffer, PhD, University of Chicago

Presented by Mark S. Litwin, MD, University of California, Los Angeles.

Presented by Michael A. O'Donnell, MD, University of Iowa, Iowa City

Presented by Gary D. Grossfeld, MD, Marin Urology Medical Group, Greenbrae,CA.

Presented by Stephen J. Savage, MD, Memorial Sloan-Kettering Cancer Center, New York

Presented by Joseph J. Del Pizzo, MD, New York Presbyterian Hospital

Presented by Philip M. Hanno, MD, University of Pennsylvania, Philadelphia.

Presented by Craig V. Comiter, MD, University of Arizona, Tucson

Presented by Allen D. Seftel, MD, Case Western Reserve University, Cleveland

Presented by John W. Colberg, MD, Yale University School of Medicine,New Haven, CT.

Presented by Larry Lipshultz, MD, Baylor College of Medicine, Houston.

Presented by Richard Grady, MD, University of Washington, Seattle.

Presented by Ronald Rabinowitz, MD, University of Rochester (NY) MedicalCenter.

Presented by Margaret S. Pearle, MD, University of Texas SouthwesternMedical Center, Dallas.

Presented by Kevin M. Slawin, MD, Baylor College of Medicine, Houston.

Presented by Donald A. Elmajian, MD, Lousiiana State University, Shreveport

Presented by Georg Bartsch, MD, University of Innsbruck, Austria

Up to 5% of Americans will be affected by stone disease over the courseof their lifetime. Despite major advances in shockwave lithotripsy and endoscopictechnologies, we must not underestimate the role of medical therapy in preventingstone recurrence. Two studies presented at the recent AUA annual meetingand reported in this issue of Urology Times (see page 10) offer valuablelessons on this aspect of stone management.

New York-Because of potential future fluctuations in PSA levels, NewYork researchers recommend that a second PSA reading be taken several weeksafter initial measurement and prior to recommending biopsy.

Congress passed it, and the president signed it. The $330 billion, 10-yeartax cut plan will have a significant impact on the tax bills of every physicianand his or her practice. The bill largely adopts the House's prescriptionfor trimming taxes on capital gains and stock dividends for at least 5 yearswhile lowering income tax rates and encouraging business investment.

This addendum includes advice on managing gas emboli/vascular insufflation,vascular injuries, subcutaneous emphysema, pneumomediastinum, and pneumothoraxArieh L. Shalhav, MD, is associate professor of surgery and directorof minimally invasive urology, and Marcelo A. Orvieto, MD, is a fellowin minimally invasive urology, University of Chicago.As discussed in a recent "Hands On" article ("How to preventand manage laparoscopic injuries," July 2003, page 50), the overallcomplication rate related to urologic laparoscopy is approximately 4%, varyingwidely according to the procedure's technical difficulty. In this addendumto the article, we discuss how urologists can prevent and manage additionalcomplications associated with laparoscopy, including gas emboli/vascularinsufflation, vascular injuries, subcutaneous emphysema, pneumomediastinum,and pneumothorax.

In a previous issue of Urology Times, this column discussed multiple procedures and the bundling edits for a single physician ("When to bill and not to bill for multiple procedures," May 2002, page 62). This article will address multiple procedures performed at the same encounter by two separate physicians.

Chicago-One of the first large studies to determine the 10-year efficacy of brachytherapy in men with prostate cancer shows that patients receiving a dose of at least 160 Gy have a 93% chance of being free of biochemical failure and a 95.4% chance of local control at 10 years.

Chicago-A private practice setting can be just as successful with renal stone prevention as a larger academic setting, according to research presented at the AUA annual meeting here. And, if treatment is needed later, a patient can be counseled about options following an accurate assessment of the natural progression of stones.

During the recent AUA annual meeting in Chicago, the association's newBPH treatment guidelines were released. Although the update contained nomajor surprises, the framework does include specific recommendations forusing combination therapy in the treatment of certain BPH sufferers.Urology Times asked urologists if they were already using combinationtherapy, consisting of an alpha-blocker and 5-alpha-reductase inhibitorand, if so, whether this regimen was showing an improvement in patient outcomes.We also asked whether they expect to perform fewer invasive procedures forBPH.All of the urologists we spoke with have used combination therapy forBPH. They all said they see benefits from its use, even if their evidenceis anecdotal.

Post-RP, positive surgical margin carries 1.52-fold increased risk ofrecurrence

Chicago-The traditional PSA cut-point of 4.0 ng/mL for recommending abiopsy to diagnose prostate cancer is controversial, and some researchershave recommended cut-points as low as 2.0 ng/mL. Two separate studies presentedat the AUA annual meeting here have found that cut-points of 2.5 or 2.6ng/mL may be more appropriate for determining the need for prostate biopsy.