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The fiscal 2017 appropriations wrap-up package approved by Congress in early May included a $2 billion increase for the National Institutes of Health, despite a Trump administration request for a $1.2 billion reduction for the nation’s primary medical research facility. That bipartisan action, which funds the federal government through September, came in the face of President Trump’s demand to slash spending for domestic programs to pay for a huge increase in appropriations for defense.

Analyses of data from 5 years of prospective follow-up in the pivotal trial supporting regulatory approval of the prostatic urethral lift ([PUL] UroLift System, NeoTract) show that the minimally invasive procedure remains safe and provides rapid and durable benefits for men with symptomatic BPH.

In this Urology Times supplement, we’ll take a look at the science behind Rezūm, the nuts and bolts of the procedure, what sort of short- and long-term outcomes patients can expect following the procedure, and ways that urologists can educate their patients about this new technology.

"For low-grade disease, it’s certainly worth a try because nothing is really lost. For high-grade disease, I don’t know that it’s appropriate-we don’t have the data," says one urologist.

Medicare beneficiaries who undergo major urologic cancer surgery at hospitals with higher Hospital Compare Star Ratings introduced by the Centers for Medicare & Medicaid Services in 2016 have superior short-term outcomes than patients operated on at hospitals with lower Hospital Compare rating, according to data presented at the AUA annual meeting in Boston.

"Things have gotten worse. Patients are definitely more demanding," says urologist Casey McCullough, DO.

The practical application of medical necessity has taken many forms, and in this increasingly complex world of health care, understanding these applications has become a critical component of your business.

"Learning from my junior residents means realizing that sometimes, maybe even oftentimes, they may know more than I do," writes Amy Pearlman, MD.

Lawsuits involving telephone triage tend to allege failure in a physician’s duty to treat, abandonment of the patient, or provision of sub-standard care.

Urology resident Nirmish Singla, MD, discusses the insight he’s gained from the experiences and perspectives of visiting professors and residents.

"The nurse practitioner, nurse, and other ancillary providers who make up the urology team are an essential and valuable asset in the consideration of adding oral androgen receptor inhibitors into the office setting," writes Gwendolyn Hooper, PhD, APRN.

More than 96% of urologists surveyed said that incorporating abiraterone acetate (ZYTIGA) treatment into practice for patients with metastatic castrate-resistant prostate cancer is easy or manageable after overcoming initial barriers, according to new research presented at the Genitourinary Cancers Symposium in Orlando, FL.

Urologists’ compliance with nonmuscle-invasive bladder cancer guidelines has improved with respect to delivery of perioperative mitomycin, but other care measures continue to be suboptimal, according to a new study.

Researchers have developed software that can generate, in real time, whether a radical cystectomy patient is likely to be rehospitalized and when the urologist should follow up with the patient.

Findings of a retrospective study including 1,000 men with follow-up ranging to 8 years demonstrate the long-term safety and efficacy of prostatic artery embolization for relieving lower urinary tract symptoms secondary to BPH, researchers reported at the Society of Interventional Radiology annual scientific meeting in Washington.

While close to 90% of men diagnosed with prostate cancer between 1998 and 2012 had stage 1 and stage 2 disease, more than 90% underwent surgery or radiation to treat the cancer, according to a study presented at the Genitourinary Cancers Symposium in Orlando, FL.

Among ED visits within 30 days of elective ureteroscopy over the 6-month span, pain was the presenting complaint in about 60% of patients, Scott and White Medical Center researchers report.

“From our results, the Decipher test helps reassure low-risk patients that observation may be warranted or confirm that high-risk patients need additional treatment,” says study author John L. Gore, MD, MSHS.

After reading an article suggesting that surgeons are similar to athletes, Henry Rosevear, MD, argues that surgeons should start treating themselves as such and also be aware of the impact poor sleep habits can have on performance.

"As a urologic community, we should promote the use of AS for favorable-risk disease to reduce the downstream harms of screening while preserving the benefits of early detection for life-threatening cases," writes Stacy Loeb, MD, MSc.

“We believe that aggressive loco-regional resection may be worth considering in well-selected patients as a part of a multimodal approach in the management of men with node-positive prostate cancer,” says study author Bimal Bhindi, MD.

Study findings serve as a reminder of the importance of prompt and direct physical therapy referrals for pelvic floor pain patients, researchers say.

Urologists’ adherence to value-based care pathways for BPH surgery is extremely low and only modestly improved when given individualized feedback on patient outcomes, costs, and practice patterns relative to peers, say UCLA researchers.

Cryopreservation is far more cost-effective than post-treatment surgical sperm extraction and assisted reproductive technology for men with testis cancer who desire fertility preservation, new data show.