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A 16-year-old female presents with irritative voiding symptoms progressing to “urinary retention.” Evaluation with a renal, bladder, pelvic sonogram shows two normal kidneys. What is the differential diagnosis?

Delay to urethroplasty for bulbar urethral strictures is associated with repetitive interventions, stricture lengthening, and more complex repairs that have a greater risk for failure, while scheduling-related delay to reconstruction exposes men to risk for stricture-related complications, according to separate studies presented at the AUA annual meeting in Boston.

"There are direct endocrine consequences of opioid use, including hypogonadism, that adversely impact men’s health," write Michael S. Leapman, MD, and Steven A. Kaplan, MD.

New legislation to modify the Stark antitrust law to remove barriers so independent physicians can take advantage of advanced payment model opportunities provided to accountable care organizations in the Affordable Care Act has been introduced with the backing of the major organizations representing urology.

"The potential GOP tax bill makes it difficult to know exactly how the landscape will look in 2018... nevertheless, there are some items you can take care of before the end of the year that can impact your 2017 taxes and overall financial plan," write Jeff Witz, CFP, and David Zemon.

In this article, we provide a summary of CPT changes for 2018, the Medicare Physician Fee Schedule final rule, and the final rule for the Quality Payment Program.

“If nearly three-fourths of currently practicing urologists become fed up with practice and leave the field, how will we meet patient demand?” asks Jeffrey Kaufman, MD.

"This survey adds to the growing body of evidence that a significant percentage of physicians, including urologists, continue to see shortcomings in their EHRs," writes Robert A. Dowling, MD.

The overall use of active surveillance in men with low-risk prostate cancer is 14.2%, according to an examination of the National Cancer Data Base.

In this "Malpractice Consult" column, Dawn Collins, JD, also discusses cases involving penile pain following cystoscopy, alleged failure to diagnose kidney obstruction, and death follow stent placement.

Other pipeline products discussed in this round-up include and advanced renal cell carcinoma agent, a bladder cancer detection agent, and a BPH treatment.

While urologists are generally comfortable discussing patients’ sexual orientation, they report that both their knowledge of care of transgender patients and training in such care are lacking.

"All the surgeons I know think that while they may not be the best in the world at what they do, they are clearly above average (think Lake Wobegon, but as adults). Hence, it can be a little disconcerting when data is produced that suggests that at least half of us have room for improvement," writes Henry Rosevear, MD.

A month after Hurricane Harvey’s aftermath, Houston-based urologist Steven Canfield, MD, says his practice is still having to reschedule operating room times to help out with the hurricane-induced OR shortage.

It’s hard to argue against an erectile dysfunction treatment that is potentially disease modifying, is noninvasive, and seems to do no harm. The treatment, low-intensity shock wave therapy, has yet to earn the FDA’s approval but is widely used in other countries. Early results from ongoing U.S. trials are promising.

The use of intravesical cisplatin nanoparticles reduces cancer cell proliferation while limiting drug absorption beyond the bladder barrier, according to early findings.

Researchers from The Cancer Genome Atlas Research Network have outlined five distinct expression subtypes of muscle-invasive bladder cancer, each of which may be targetable by different treatments.

In patients with refractory urgency urinary incontinence (UUI), sacral neuromodulation (InterStim) and onabotulinumtoxinA (Botox) produce similar reductions in mean daily UUI episodes, according to 24-month follow-up data on patients treated in a randomized trial.

“The APMs being designed by LUGPA allow for participation by all urologists regardless of their practice setting or affiliation,” explains Alec Koo, MD.

“Care process models… represent a way to decrease variation and waste, and thereby they lead to improved outcomes and significant cost reductions,” says Jay T. Bishoff, MD.

“The answer is to remove the barriers and frustrations that are causing burnout so that physicians can focus on their role as care providers,” advises Paul DeChant, MD, MBA.

Nearly three-fourths of men with very low-risk prostate cancer underwent active surveillance as a primary therapy, according to a study presented at the LUGPA annual meeting in Chicago.

In his health policy briefing, Deepak A. Kapoor, MD, discusses LUGPA’s comments to CMS regarding MACRA and the 2018 Medicare physician fee schedule.

The association and its member groups are “leading the way” in developing urology-specific measures that can be used for MIPS quality reporting, says LUGPA President Neal D. Shore, MD.

Overexpression of a specific pair of genes might provide early warning of prostate cancer patients’ likelihood of progressing to metastatic disease.

If members of the Medicare Payment Advisory Commission have their way, the new Merit-based Incentive Payment System will be sent into oblivion, never to be heard of again.

A recently proposed bill “offers transparency measures that provide stakeholders further elucidation of how money moves through the pharmaceutical supply chain,” writes the AACU’s Brian Henderson.