Baylor College of Medicine Archives

How has the SP Robot Affected Our Approach to Radical Prostatectomy?

Posted by Jeremy Slawin, MD, MBA | Nov 2024

Jeremy Slawin, MD, MBA, Assistant Professor of Urology at Baylor College of Medicine in Houston, Texas, highlights single-port robotic technology for radical prostatectomy and emphasizes extraperitoneal surgery. In this 21-minute presentation, he advocates for single-port robotic systems in extra-peritoneal radical prostatectomy, highlighting its potential to enhance patient outcomes while adhering to a familiar anatomical approach.

Will Xenografts Take the Tragedy Out of Transplant

Posted by Michael S. Davis, MD, MBA, MHA, FACS | Nov 2024

Michael S. Davis, MD, MBA, MHA, FACS, examines the potential of renal xenografts to alleviate the organ shortage crisis in transplantation, focusing on developments in pig-to-human kidney transplants.

In this 27-minute presentation, Dr. Davis reviews the history of transplantation, tracing advancements from early animal experiments to the refinement of immunosuppressive therapies and gene editing techniques. He highlights the tragic aspects of current transplantation, noting the limited availability of donor organs. Davis presents recent studies, including preclinical trials at the University of Alabama and NYU, that demonstrated the feasibility of pig kidney transplants in brain-dead human decedents.

With an increasing number of patients awaiting kidney transplants—projected to surpass one million by 2030—the need for innovative solutions like xenotransplantation is urgent. While pig kidneys are favored, barriers such as xeno-antigenic rejection, protein incompatibility, and potential infectious disease transmission remain significant challenges.

Impact of Resident Unionization

Posted by Mathew Sorensen, MD, MS, FACS | Nov 2024

Mathew Sorensen, MD, MS, FACS, explores the increasing trend of resident unionization in the United States, providing a comprehensive analysis of its growth, drivers, and impact on graduate medical education.

In this 23-minute presentation, Sorensen explains that unionization has become a prominent issue, with approximately 20% of US medical residents now part of unions. The drivers for unionization extend beyond salary, encompassing benefits such as fertility services, paid parental leave, wellness funds, and campus housing. He cites examples like UCLA, where non-salary demands formed a significant part of the unionization efforts. Established organizations like the Committee of Interns and Residents (CIR) are pivotal in guiding programs through this process, leveraging their extensive experience.

Sorensen shares personal experience at the University of Washington. He acknowledges animosity can arise during contract years, with threats of strikes and coordinated actions among residents creating tension. He concludes that while unionization has led to notable improvements in resident compensation and benefits, it also introduces complexities in program management and expansion, necessitating careful navigation of collective bargaining dynamics.

Tales from the GME Crypt: Managing Challenging (and Scary) Residency Dilemmas

Posted by Wesley A. Mayer, MD | Nov 2024

Wesley A. Mayer, MD, focuses on effectively managing challenges faced in residency programs, emphasizing remediation strategies over punitive measures. Drawing from his experience as a program director and assistant dean of Graduate Medical Education (GME), Dr. Mayer addresses dilemmas common in residency, outlining a practical approach to navigating issues such as technical skill deficiencies, communication breakdowns, and personal crises among trainees.

In this 20-minute presentation, Dr. Mayer differentiates remediation from probation, advocating for remediation as a supportive, non-reportable process for skill enhancement. The importance of recognizing warning signs, such as poor performance or behavioral changes, is highlighted, stressing early intervention and the role of the GME office in offering support and resources.

Updates on the Imaging for Urothelial Carcinoma

Posted by Desencia E. Thomas, MD | Nov 2024

Desencia E. Thomas, MD, presents an update on imaging techniques for urothelial carcinoma (UC), emphasizing advancements in diagnosis and staging.

In this 18-minute presentation, Dr. Thomas highlights the diagnostic accuracy of CT urography. MR urography provides an alternative for patients unable to tolerate iodine-based contrast or when CT findings are inconclusive. PET imaging, including 18-F FDG PET, excels in detecting distant metastases, but tracers like 11-C acetate and choline help minimize false positives in the urinary tract due to reduced excretion.

Dr. Thomas discusses the role of MRI in bladder cancer staging, where VI-RADS scoring helps distinguish between muscle-invasive and non-invasive cancers. This system, using T2-weighted, diffusion-weighted, and contrast-enhanced sequences, enables precise preoperative staging. Dual-energy CT (DECT) is also emerging, allowing reduced radiation exposure while retaining diagnostic value.

Key challenges include limited imaging sensitivity for early-stage UC and difficulty assessing tumor invasion depth. Dr. Thomas emphasizes that contrast-enhanced ultrasound may assist patients with contraindications to CT or MRI, although it remains less sensitive for upper tract tumors. She stresses that imaging advancements hold promise for improving UC management and minimizing invasive procedures like TURBT.