Wise choices in urology 1 Do not perform a bone scan on a patient with prostate cancer when there is a low probability that the cancer has spread. A bone scan is used to see whether the cancer has spread to the patient’s bones. Most patients with prostate cancer have a very low risk of bone metastasis. For that reason, a bone scan is generally not recommended for patients with prostate cancer. A bone scan is advised when: • the prostate-specific antigen (PSA) level is higher than 20 ng/ml; • the Gleason score is 8 or higher; • the tumor in the prostate has progressed to an advanced stage; • the patient has symptoms that may indicate the presence of bone metastases. 2 Do not administer antibiotics to a patient with prostatitis without fever, unless the urine sample shows bacterial growth. Many men have symptoms that may look like prostatitis. When the patient has no fever, it is not immediately necessary to start antibiotics. Research shows that a low percentage of men with these symptoms actually have a bacterial prostate infection. 3 A scrotal ultrasound should not be standard practice for boys with an undescended testicle. Physical examination is very important in boys with an undescended testicle. A scrotal ultrasound offers hardly any additional information. These patients should therefore not be offered an ultrasound on a routine basis. An ultrasound may be be indicated, for example in extremely obese children. An abdominal CT scan should not be standard practice in patients with microscopic hematuria. 4 The presence of blood in the urine may indicate the presence of a tumor in the urinary tract. These minute levels of blood are often too small to be visible, but can be detected with a dipstick test or under a microscope. It is possible to assess the risk of urinary tract cancer in these patients. If the risk is low or moderate, an abdominal ultrasound may be performed. If there is a major risk that cancer is present, a CT scan should be performed immediately. An abdominal ultrasound or cystoscopy should not be standard practice for recurring bladder infections. 5 Recurring bladder infections are a frequent problem among women. The cause of these infections is almost never identified. An abdominal ultrasound and cystoscopy (endoscopic examination of the bladder) rarely reveal the cause. For that reason, these tests are not recommended as standard practice. About ‘Wise Choices’ Dutch Urological Association References: Richtlijn Prostaatcardinoom [Guidelines on Prostate Carcinoma] (2014). Richtlijn Bacteriële urineweginfecties bij adolescenten en volwassenen [Guidelines on bacterial urinary tract infections in adolescents and adults] (2009). SWAB Guidelines on Antibacterial Therapy of Patients with Bacterial Central Nervous System Infections. Richtlijn niet scrotale testis [Guidelines on non-scrotal testis] (2012). Tasian G.E., Copp, H.L., Baskin, L.S. (2011). ‘Diagnostic imaging in cryptorchidism: utility, indications, and effectiveness.’ Journal of Pediatric Surgery. 46, 2406-2413. Richtlijn Hematurie [Guideline for Hematuria] (2010). These ‘Wise Choices in urology’ are part of the ‘Choosing Wisely Netherlands’ campaign. The Dutch Association of Medical Specialists, the scientific bio¬medical societies and the Netherlands Organi-sation for Health Research and Development (ZonMw) aim to encourage discussions between medical specialists and patients about healthcare options and when they are useful or necessary. ‘Wise Choices’ are evidence-based recommendations that should be part of the doctor-patient dialogue. These options allow doctors and patients to define the best treatment for a specific patient in mutual consultation. The Federation of Patients and Consumer Organizations in the Netherlands (NPCF) is a partner in the ‘Choosing Wisely Netherlands’ campaign. More information about Choosing Wisely is available on the program website www.choosingwiselynetherlands.org