1999 American Urological Association Gallup Survey: changes in physician practice patterns, treatment of incontinence and bladder cancer, and impact of managed care.

PURPOSE: The Health Policy Survey and Research Committee of the American Urological Association and the Gallup Organization have performed a yearly survey of American urologists since 1992 to assess practice patterns. The results of the 1999 survey are presented. MATERIALS AND METHODS: A random sample of 503 urologists was interviewed in February and March 1999. Major content areas were physician practice patterns, the impact of managed care, and the treatment of pediatric patients, prostate cancer and benign prostatic hyperplasia, female incontinence and bladder cancer. RESULTS: The average urologist is 46.8 years old, certified by the American Board of Urology, sees 78 patients and performs 3.1 major surgical procedures weekly, refers moderate and complex pediatric procedures to specialists, and receives 40.6% of practice income from managed care. CONCLUSIONS: In an era when large group practices seem to be the norm remarkably 32% of urologists remain in solo practice. There has been a shift in where urologists spend their time, that is more in the office and less in the operating room. Minor and major open surgical procedures increased from 12.4 weekly to 16.4 and 2.9 to 3.1 in 1995 and 1999, respectively. Most urologists are comfortable treating straightforward pediatric problems such as cryptorchidism but refer more complex problems to pediatric urologists. Managed care represents an ever increasing proportion of urologist practice income, while office expenses continue to increase.

1998 American Urological Association Gallup Survey: changes in physician practice patterns, treatment of ureteral stones and impact of managed care.

PURPOSE: The American Urological Association first commissioned the Gallup Organization to conduct a study to assess urologist practice patterns in 1992. We present the results of the seventh consecutive Gallup Survey performed for the Association. MATERIALS AND METHODS: A random sample of 537 American urologists who completed urological residency and practiced at least 20 hours weekly in 1997 were interviewed by telephone in March 1998. Major topic areas included general demographics, practice patterns, treatment of ureteral stones and experience with managed care. RESULTS: Demographic trends indicated a significant decrease in average urologist age from 49.4 years in 1992 to 46.8 in 1998. Of the urologists 99% reported that they treat ureteral stones. Managed care had an increasingly larger role in most practices, particularly in the western United States, where 73% of urologists reported that they contract with a Medicare health maintenance organization. CONCLUSIONS: The average age of practicing urologists significantly decreased, which may be due to an increasing number of urologists retiring at an earlier age, although this finding is not clear. Nearly all urologists treated ureteral stones with considerable consistency. Finally, managed care appeared to have a major impact on most urologists throughout the United States.

1997 American Urological Association Gallup survey: Changes in diagnosis and management of prostate cancer and benign prostatic hyperplasia, and other practice trends from 1994 to 1997.

PURPOSE: The American Urological Association first commissioned the Gallup Organization to conduct a study to assess urologist practice patterns in 1992. We present the results of the 1997 survey, the sixth consecutive Gallup survey performed for the Association. MATERIALS AND METHODS: A random sample of 502 American urologists who had completed urological residency and practiced at least 20 hours weekly in 1996 was interviewed by telephone in February and March 1997. RESULTS: Emerging trends showed significant changes since 1994 in how urologists diagnosed and treated prostate cancer. The survey revealed a significant change in the tests routinely ordered to stage newly diagnosed prostate cancer and for diagnostic evaluation of patients with benign prostatic hyperplasia. CONCLUSIONS: Urologists are becoming more cost conscious and effective in ordering pretreatment testing. Urologists are becoming more oriented toward medical treatment for the management of benign prostatic hyperplasia, and less laser surgery is being performed.

Subspecialization, recruitment and retirement trends of American urologists.

PURPOSE: Trends of urology workforce, subspecialization, recruitment practices, retirement planning, practice characteristics and managed care impacts in the United States were assessed. MATERIALS AND METHODS: In February 1996 the executive interviewing branch of The Gallup Organization selected randomly and interviewed by telephone 507 practicing urologists in the United States who had provided urological patient care for more than 20 hours per week, practiced in 1995 and completed a urological residency program. RESULTS: Several important issues emerged. Urologists think we may be training too many urologists, subspecialty board certification would be a divisive issue to urology as a whole and 90% of urologists have an active retirement plan, although 23% are not funding the plan fully. CONCLUSIONS: The American Urological Association Gallup Poll, as refined by the Health Policy Survey and Research Committee, continues to be a unique and valuable tool in assessing practice patterns, gathering demographic data and measuring opinions of the American urologist. This information will help us chart our way to the twenty-first century.

Practice trends of American urologists in the treatment of impotence, incontinence and infertility.

PURPOSE: Trends of urologist practice patterns in evaluating and treating impotence, incontinence and infertility in the United States were assessed. MATERIALS AND METHODS: In July 1995 the executive interviewing branch of the Gallup Organization selected randomly and interviewed by telephone 533 practicing urologists in the United States who had provided urological patient care for more than 20 hours per week, practiced in 1994 and completed a urological residency program. RESULTS: Treatment of male sexual dysfunction and female urinary incontinence comprises a significant portion of the professional activity of United States urologists. However, evaluation and management of male infertility occupy a small portion of the average urological work load. While more than half of United States urologist office clinical laboratories were inspected in 1994, only 2% failed evaluation due to major deficiencies. CONCLUSIONS: Male sexual dysfunction and female urinary incontinence are major areas of urological practice in the United States but male infertility is not. Few United States urologist clinical laboratories failed inspection because of major deficiencies.

Practice trends in the diagnosis and management of benign prostatic hyperplasia in the United States.

PURPOSE: The American Urological Association (AUA) first commissioned the Gallup Organization of Princeton, New Jersey to conduct a study to assess urologists' practice patterns in 1992. MATERIALS AND METHODS: In August 1994 a random sample of 514 American urologists was surveyed by the Gallup Organization regarding practice patterns for the diagnosis and management of benign prostatic hyperplasia (BPH). It asked questions regarding the practice patterns of respondents in their diagnosis and management of BPH. RESULTS: The survey revealed that 99% of the respondents were aware of and used the AUA symptom score index, and that 21% of these respondents had altered their diagnosis and management strategies because of its existence. CONCLUSIONS: Therapeutic recommendations of the respondents based upon AUA symptom score index severity parallel the recently announced federal Agency for Health Care Policy and Research BPH practice guidelines.

Practice trends in the diagnosis and management of prostate cancer in the United States.

PURPOSE: The American Urological Association first commissioned the Gallup Organization of Princeton, New Jersey to conduct a study to assess urologists' practice patterns in 1991. MATERIALS AND METHODS: A random sample of 514 American urologists was surveyed by the Gallup Organization regarding practice patterns used in the staging and treatment of prostate cancer. The third annual survey taken during August 1994 asked questions regarding the practice of respondents in their diagnosis and management of prostatic cancer. RESULTS: The survey revealed that 95% of the respondents would recommend radical prostatectomy for men younger than 70 years with confirmed clinically localized prostate cancer. CONCLUSIONS: In this patient age group, surprisingly, the survey resulted in some interesting facts: 1) 13% regard hormonal manipulation for early stage cancer appropriate, 2) the respondents used extensive numbers of diagnostic staging studies in the new prostate cancer patient with a prostate specific antigen of less than 10 and 3) despite the obvious increased costs, the majority of patients receiving hormone manipulation were being treated with luteinizing hormone-releasing hormone agonists rather than orchiectomy.

Familial paraganglioma.

Extra-adrenal pheochromocytomas and paragangliomas are rare tumors of neural crest origin, most commonly found in the retroperitoneum. Because these tumors are so uncommon, relatively little is known about their natural history. Comparisons between adrenal pheochromocytomas and extra-adrenal pheochromocytomas have appeared in the medical literature. Like pheochromocytomas, paragangliomas may occur as functional or nonfunctional tumors. Furthermore, although the hereditary occurrence of pheochromocytomas is well documented, the familial nature of paragangliomas is unclear. We present the first report of a mother and son with nonfunctional paragangliomas occurring in the same anatomic location and describe their care and treatment.

A new treatment for invasive squamous cell bladder cancer: the Nigro regimen: preoperative chemotherapy and radiation therapy.

We report 5 cases of invasive squamous cell bladder cancer treated with preoperative mitomycin C and 5-fluorouracil in combination with preoperative external beam radiation therapy (the Nigro regimen), and the subsequent apparent cure of 3 of the 5 patients.

Complications associated with preoperative radiation therapy and Iodine-125 brachytherapy for localized prostatic carcinoma.

Twenty-five consecutive patients with localized adenocarcinoma of the prostate treated with 1,050 rad preoperative radiation therapy and Iodine-125 seed brachytherapy arreviewed. Significant long-term postoperative complications included radiation cystitis (12%), radiation proctitis (4%), genital and leg edema (12%), stress incontinence (8%), total incontinence (4%), and impotence (26%). Complications occurred in 75 per cent of patients who received additional postoperative radiation. Improved staging with CT scan, lymphangiography, and Chiba needle biopsy of any possibly abnormal lymph nodes provided excellent preoperative staging with only 1 patient (6%) upstaged at surgery to Stage D1.

Symptomatic stage C carcinoma of prostate. Traditional therapy.

Of 119 consecutive patients with adenocarcinoma of the prostate, 54 patients had clinical Stage C disease and are the subject of this study. Of these 54 patients, 52 underwent transurethral prostatectomy and bilateral orchiectomy as their initial treatment; estrogens were not prescribed. The mean age of the patients with Stage C disease was seventy-three years, the average survival 6.4 years, and the five and ten-year survivals were 66 and 20 per cent, respectively. Stage C patients treated in this series did as well as those treated with radiation or radical extirpation.

Neonatal circumcision: a ten-year overview: with comparison of the Gomco clamp and the Plastibell device.

The records of 5,882 live male births were reviewed to ascertain the incidence and nature of complications following neonatal circumcision. Approximately one half of the patients were circumcised with the Gomco and half with the Plastibell. The incidence of complications was 0.2%; most frequent were hemmorrhage, infection, and trauma, there were no deaths; and no transfusions were given.

Adrenal myelolipoma.

A myelolipoma of the adrenal gland is reported. Diagnostic features include (1) hyperlucent mass on intravenous pyelography with renal displacement, (2) an avascular mass on arteriography and venography, (3) solid tissue mass on B-mode ultrasonography, and (4) no clinical or chemical evidence of adrenal hyperfunction.

Ureteral response to partial obstruction. Smooth muscle hyperplasia and connective tissue proliferation.

A technique for producing a reversible form of partial ureteral obstruction in the experimental animal has been described. The response of the rabbit ureteral muscularis to partial obstruction was characterized by hypertrophy of the smooth muscle cells within the first 3 days followed by hyperplasia of the leiomyocytes which appeared to continue as long as the obstruction was present. Deposition of connective tissue was noted between the smooth muscle cells after 2 weeks of partial obstruction increasing to a marked extent by 8 weeks.