Volume 17, Number 3Review ArticlesImpact of the US Preventive Services Task Force Grade D Recommendation: Assessment of Evaluations for Elevated Prostate-specific Antigen and Prostate Biopsies in a Large Urology Group Practice FollowiTreatment Impact AssessmentGregory C McMahonGordon A BrownKathleen F McGinleyOn October 7, 2011, the United States Preventive Services Task Force (USPSTF) released their evidence statement and grade D recommendation against prostate-specific antigen (PSA)–based prostate cancer screening. Using a time series design, we assessed the effect of this recommendation upon evaluations for elevated PSA levels and prostate biopsies in our large urology group practice. We found that, despite a 24.1% increase in total visits, the 32 urologists in our practice completed 16.4% fewer evaluations for elevated PSA levels (317 fewer evaluations per month; P = .017) and 21.4% fewer prostate biopsies (42 fewer biopsies per month; P = .001) in the 2 years following the USPSTF grade D recommendation. [Rev Urol. 2015;17(3):171-177 doi: 10.3909/riu0696] © 2015 MedReviews®, LLCProstate cancer screeningProstate-specific antigenProstate biopsiesUnited States
Volume 18, Number 4Review ArticlesBarriers to Accessing UrethroplastyTreatment UpdateDavid O SussmanGordon A BrownMichael J ConsoloKirin K SyedChristopher RobisonJacob McFaddenDavid I ShalowitzBradley D FiglerUrethroplasty is an effective treatment for men with anterior urethral strictures, but is utilized less frequently than ineffective treatments such as internal urethrotomy. We sought to identify provider-level barriers to urethroplasty. An anonymous online survey was emailed to all Mid-Atlantic American Urological Association members. Six scenarios in which urethroplasty was the most appropriate treatment were presented. Primary outcome was recommendation for urethroplasty in ≥ three clinical scenarios. Other factors measured include practice zip code, urethroplasty training, and proximity to a urethroplasty surgeon. Multivariate logistic regression identified factors associated with increased likelihood of urethroplasty recommendation. Of 670 members emailed, 109 (16%) completed the survey. Final analysis included 88 respondents. Mean years in practice was 17.2. Most respondents received formal training in urethroplasty: 43 (49%) in residency, 5 (6%) in fellowship, and 10 (11%) in both; 48 respondents (55%) had a urethroplasty surgeon in their practice, whereas 18 (20%) had a urethroplasty surgeon within 45 minutes of his or her primary practice location. The only covariate that was associated with an increased likelihood of recommending urethroplasty in ≥ three scenarios was formal urethroplasty training. Most members (68%) reported no barriers to referring patients for urethroplasty; the most common barriers cited were long distance to urethroplasty surgeon (n = 13, 15%) and concern about complications (n = 8, 9%). Urethroplasty continues to be underutilized in men with anterior urethral strictures, potentially due to lack of knowledge dissemination and access to a urethroplasty surgeon. Appropriate urethroplasty utilization may increase with greater exposure to urethroplasty in training. [Rev Urol. 2016;18(4):188-193 doi: 10.3909/riu0731] © 2016 MedReviews®, LLCUrethroplastyUrethral stricturesBarriersPhysician practice patterns
Volume 19, Number 2Review ArticlesUtilization of Individualized Prostate Cancer and Genomic Biomarkers for the Practicing UrologistManagement UpdateGregory C McMahonGordon A BrownThomas J MuellerProstate cancer encompasses a complex heterogeneous disease spectrum. Physicians and patients are faced with the ambiguity of who should be screened, biopsied, rebiopsied, treated, or provided with adjuvant therapy. Personalized outcomes and treatments are especially important given the varied nature of the disease, plethora of treatment options, risks of morbidity, and quality of life. Today’s practicing urologist has a multitude of tests from which to choose, creating the difficult task of appropriate use. This review focuses on two blood-, one urine-, and five genomic-based tests, which, when used in the appropriate clinical setting, can facilitate the patient-physician decision-making process. [Rev Urol. 2017;19(2):97–105 doi:10.3909/riu0730] © 2017 MedReviews®, LLCProstate cancerGenomic testsPersonalized medicine
Volume 19, Number 4Practice ProfileSuccessfully Integrating Radium Ra 223 Dichloride Injection Into a Urology PracticeGregory C McMahonGordon A Brown[Rev Urol. 2017;19(4):248–251 doi: 10.3909/riu0782] © 2018 MedReviews®, LLC