Clinical guidelines in urology: What treatments or procedures could use them?


There are several areas where urologists feel clinical guidelines would be helpful.

"How about standard transurethral resection of the prostate? I'd be curious to know if the advent of laser technology has taken the rest of the country by storm.

There's a new technology called 'button TURP,' and some urologists locally are using it. I would be curious to see what percentage of urologists are doing a laser TURP versus this newer TURP, as well as some guidelines for which is better."
Ken-ryu Han, MD

"I would like to see guidelines for androgen deprivation therapy.

Right now, we don't have great numbers to tell us when to start therapy. To some degree, it's an imperfect judgment."
David Arend, MD
Sioux Falls, SD

"One problem we have in our country is the overuse/misuse of certain procedures. I would like to see guidelines based on economic/medical outcomes, such as the treatment of prostate cancer and use of luteinizing hormone-releasing hormone agonists. We spend roughly $800 million every year on these drugs.

We also have cancer treatments that have a great disparity in reimbursement. A lot of doctors will do the procedure that reimburses at a higher level. They should all cost the same; then we'd see doctors do what they really think is best for the patient."
Kevin Basralian, MD
Hackensack, NJ

"There have already been guidelines developed for some of the conditions I treat, but the scope of my practice is so limited, a lot of them have been covered.

I am glad they did one for priapism because I think people see that condition and aren't always sure about how to manage it. The guideline gives urologists a quick reference that they can look up and use when a patient comes in. They're all helpful, but that one is particularly useful."
Kenneth Angermeier, MD

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