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Urology Practice Management - August 2015, Vol 4, No 4 - Choosing Wisely
Rosemary Frei, MSc

The American Urological Association (AUA)’s second set of Choosing Wisely recommendations, released June 11, 2015,1,2 incorporates feedback from the organization’s membership, which is a new approach for the group.

After the AUA released its first set of Choosing Wisely recommendations in 2013, a committee was struck in 2014 to create a second list. The committee reviewed the AUA’s practice guidelines and other publications, and sought input from its membership. This resulted in a list of 15 recommendations. The organization’s members voted on which recommendations were the most important, and the committee then arrived at the final 5, which were approved by the AUA’s Board of Directors in February 2015.

“One of the exciting things about this [second list of recommendations] is that we asked our membership to weigh in at 2 key stages of the process,” J. Stuart Wolf, MD, Chair of the AUA’s Science and Quality Council, and Professor of Urology, University of Michigan, Brighton, told Urology Practice Management. “This second list was very member-driven.”

The “Five More Things Physicians and Patients Should Question,” as the new recommendations are listed on the AUA’s Choosing Wisely document, include:

  1. Not relying solely on a urine dipstick to diagnose micro­hematuria and instead using microscopy of a properly collected urine sample

  2. Not ordering pelvic computed tomography scans for men with low-risk, clinically localized, asymptomatic prostate cancer. For this latter group, “magnetic resonance imaging of the pelvis may be useful in some men considering active surveillance,” the initiative states

  3. A third recommendation is to not prescribe antibiotics to patients who have indwelling or intermittent catheterization of the bladder unless they have signs and symptoms of a urinary tract infection, such as fever or an altered mental state.
    However, one major exception to this recommendation involves individuals who require periprocedural antimicrobials. In addition, antibiotics should be considered for patients who are undergoing the initial placement of a suprapubic tube with an accompanying skin puncture or incision

  4. Another recommendation advises that prostate-specific antigen screening for prostate cancer should only be offered to patients based on a shared decision-making process to agree on whether screening or not screening is the better choice

  5. The fifth new recommendation is to not remove synthetic vaginal mesh in asymptomatic women, because it does not provide a clear benefit in these women and may lead to bladder injury, rectal injury, or fistulas.

References

  1. American Urological Association. As part of Choosing Wisely campaign, American Urological Association identifies second list of commonly used tests and treatments to question: initiative encourages shared decision-making between urologists and patients. Press release. June 11, 2015. www.auanet.org/advnews/press_releases/article.cfm?articleNo=427. Accessed July 16, 2015.
  2. ABIM Foundation, American Urological Association. AUA list of 10 things physicians and patients should question. www.auanet.org/common/pdf/practices-resources/quality/choosing-wisely/Ten-Questions.pdf. February 2015. Accessed July 16, 2015.
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Last modified: August 17, 2015
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