Strong Conflict of Interest Policies are not Associated With Decreased Industry Payments to Academic Urology Departments.

OBJECTIVE: To identify whether institutions with strong conflicts of interest (COI) policies receive less industry payments than those with weaker policies. While industry-physician interactions can have collaborative benefits, financial COI can undermine preservation of the integrity of professional judgment and public trust. To address this concern, academic institutions have adopted COI policies. It is unclear whether the strength of COI policy correlates with industry payments in urology. MATERIALS AND METHODS: 131 US academic urology programs were surveyed on their COI policies, and graded according to the American Medical Student Association (AMSA) criteria. Strength of COI policy was compared against industry payments in the Center for Medicare and Medicaid Services Open Payments database. RESULTS: Fifty-seven programs responded to the survey, for a total response rate of 44%. There was no difference between COI policy groups on total hospital payments (P = .05), total department payments (P = .28), or dollars per payment (P = .57). On correlation analysis, there was a weak but statistically nonsignificant correlation between AMSA Industry Policy Survey Score and Open Payments payments (ρ = -0.14, P = .32). CONCLUSION: Strength of conflicts of interest policy in academic urology did not correlate to industry payments within the Open Payments database. Establishment of strong COI policy may create offsetting factors that mitigate the intended effects of the policy. Further studies will be required to develop the evidence base for policy design and implementation across various specialties.

Evaluation of the Risks and Benefits of Computed Tomography Urography for Assessment of Gross Hematuria.

OBJECTIVE: To model the risk of radiation-induced malignancy from computed tomography urography (CTU) in evaluation of gross hematuria and contrast this with the benefits of urinary tract cancer detection when compared to renal ultrasound. METHODS: A PUBMED-based literature search was performed to identify model inputs. Estimates of radiation-induced malignancy rates were obtained from the Biological Effects of Ionizing Radiation VII report with dose extrapolation using the linear no-threshold model. RESULTS: Male gender and age over 50 years were associated with a relative risk of upper tract malignancy of 2.04 and 2.95, respectively. The risk of upper tract malignancy missed by renal ultrasound ranged from 0.055% in females under 50 to 0.51% in males over 50. Risk of CTU-induced malignancy with associated loss of life expectancy ranged from 0.25% and 0.027 years in females under 50 to 0.08% and 0.0054 years in males over 50. For CTU to be superior to renal ultrasound, an undiagnosed upper tract malignancy would have to carry a loss of life expectancy of 49.2 years in females under 50, 13.4 years in males under 50, 2.6 years in females over 50, and 1.1 years in males over 50. CONCLUSION: In low-risk patients, CTU for evaluation of gross hematuria may carry a significant risk of radiation-induced secondary malignancy relative to the diagnostic benefit offered over renal ultrasound.

Modeling the Incidence of Secondary Malignancy Related to Ionizing Radiation Use in the Management of Nephrolithiasis.

OBJECTIVE: To model the risk of secondary malignancy and associated mortality due to ionizing radiation from the evaluation and management of nephrolithiasis. METHODS: A PUBMED-based literature search was performed to identify model inputs, specifically annual incidence of nephrolithiasis sub-stratified by age and gender and radiation exposure associated with nephrolithiasis episodes. Estimates of age and gender specific radiation-induced malignancy and mortality rates were obtained from the BEIR VII Phase 2 report with dose extrapolation using the linear no-threshold model. RESULTS: Incidence of new diagnoses of nephrolithiasis ranged from 42/100,000 in males 20-30 years old to 248/100,000 in males 60-70 years old. Radiation exposure per nephrolithiasis episode was 37.3 mSv over a 2-year period. Data regarding average stone episodes per patient with nephrolithiasis was limited and conservatively estimated at 1.5. Modeled lifetime attributable risk of secondary malignancy and subsequent mortality in individual stone patients ranged from 0.096% and 0.085%, respectively, in males over the age of 70 to 0.59% and 0.39% in females 20-30 years old. In the USA, overall incidence of secondary malignancy and associated mortality related to nephrolithiasis management was calculated to be 862.7 and 545.3 cases/year, respectively. CONCLUSION: This model suggests that ionizing radiation from the management of nephrolithiasis carries a small but significant risk of causing secondary malignancy. This knowledge must be considered when using modalities that involve radiation in the diagnosis and therapeutic management of nephrolithiasis.