Baylor College of Medicine Archives

Implantable Tibial Nerve Stimulators. Where Do They Fit in Advanced OAB Paradigm?

Posted by Christopher P. Smith, MD, MBA, MSS | Oct 2024

Christopher P. Smith, MD, MBA, MSS, explores the evolution and current advancements in tibial nerve stimulation for treating bladder dysfunction. He begins this 19-minute presentation with a brief history of percutaneous tibial nerve stimulation (PTNS), underscoring its utility in bladder disorder management.

Smith introduces two significant implantable devices, Valencia’s eco, and the Ravi system. Both devices provide customizable treatment and cater to patient preferences, though they differ in implantation methods and patient autonomy over therapy. While these devices offer innovative treatment for urge urinary incontinence, compliance remains a challenge, often due to the time commitment and multiple visits required. Dr. Smith also references the Titan implant by Medtronic, which, while not yet FDA-approved, promises quick activation post-implant and a potential solution to compliance issues.

Dr. Smith reports recent guidelines from the AUA and SUFU now classify these therapies as “minimally invasive,” encouraging earlier intervention, even without exhausting all conventional therapies. The expectation is that new guidelines may support a broader acceptance and earlier access to minimally invasive options, ultimately improving tailored patient care in managing bladder dysfunction.

Female Urethra Stricture Disease: Evaluation and Surgical Management

Posted by Oluwarotimi S. Nettey, MD, MHS | Oct 2024

Oluwarotimi S. Nettey, MD, MHS, discusses the complexities of female urethral stricture disease, which, although less common than in men, often goes underdiagnosed due to its non-specific symptoms and rarity.

In this 18-minute talk, Dr. Nettey shares this disease often coincides with lower urinary tract symptoms. While its exact causes are largely idiopathic, medical procedures like catheterization, radiation, and surgeries, as well as conditions like vaginal atrophy in postmenopausal women, can increase the risk.

Diagnosis typically involves cystoscopy, with additional imaging options providing insights into stricture location and bladder morphology. Uroflowmetry and video urodynamics offer further understanding of urinary dynamics, helping tailor treatment approaches. Non-surgical management includes vaginal estrogen and corticosteroids.

Nettey shares that endoscopic dilation is a first-line treatment but has diminishing returns with repeated procedures, while open surgical repair becomes essential in complex cases. She underscores the need for individualized management and referrals to reconstructive specialists for challenging cases, emphasizing the importance of a methodical approach in addressing this underrecognized condition.

Management of Renal Injuries: An Evidence-Based Approach

Posted by Michael Coburn, MD, FACS | Oct 2024

Michael Coburn, MD, FACS, delves into the complexities of kidney trauma management, emphasizing the challenges associated with limited high-level evidence and reliance on expert consensus.

In this 26-minute presentation, Coburn reflects on decades of experience in urologic trauma. Guidelines for trauma have seen revisions, with updates in 2017 and 2020 by the AUA and more forthcoming. He sees a shift towards non-surgical management in hemodynamically stable patients, reflecting a growing emphasis on observation rather than immediate intervention. He shares images illustrating different levels of renal injury.

Coburn relates that follow-up imaging is advised for high-grade injuries to monitor for hematoma expansion, potentially preventing severe complications. Angioembolization has emerged as a valuable tool for controlling bleeding in stable patients, reducing the need for nephrectomy. Specific injuries, such as pseudoaneurysms, often require immediate embolization, while surgical intervention is recommended when substantial kidney tissue is damaged.

Pediatric injuries are highlighted for their unique management needs. Coburn’s presentation concludes with a call for careful patient selection, especially in cases of severe vascular trauma or concomitant visceral injuries, where early intervention can mitigate future complications.

The Value of Making Your Patient Stone Free

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

Mathew Sorensen, MD, MS, FACS, examines the management of asymptomatic small kidney stones, particularly when discovered incidentally during imaging or when patients undergo surgery for a primary stone. There is a noted clinical debate on whether these additional, often small, stones warrant treatment.

In this 14-minute talk, Dr. Sorensen highlights that residual fragments frequently persist after lithotripsy, posing potential risks, including emergency visits or further surgeries. A multicenter randomized clinical trial, published in the New England Journal of Medicine, sought to clarify this issue. The results show a significantly lower relapse rate (16%) in the treatment group compared to the control group (63%)suggesting a substantial benefit in reducing future stone-related events. The study underscores the evolving approach in urology towards more proactive treatment of small stones, facilitated by less invasive technologies.

mpMRI of the Prostate and Correlation with CT +/- PSMA PET findings: Prostate Imaging Lessons for the Urologist

Posted by Desencia E. Thomas, MD | Oct 2024

Desencia E. Thomas, MD, covers the advancements in imaging techniques for prostate cancer, focusing on integrating multiparametric MRI (mpMRI) and PSMA PET imaging, and their evolving roles in diagnosis, prognosis, and management.

In this 24-minute presentation, Thomas discusses the standardized PI-RADS scoring system, which aids in assessing the likelihood of significant cancer and has undergone revisions (PI-RADS 2.1) to address limitations in lesion evaluation. She also discusses the PI-QUAL score, which assesses MRI quality, and the PRECISE scoring system, which evaluates radiologic stability for patients undergoing active surveillance. She shares several images illustrating the advantages of the scoring systems, ultimately showing the benefits of advanced imaging techniques.

The presentation highlights the role of PSMA PET. FDA-approved PSMA PET agents have shown superior sensitivity in detecting biochemical recurrence and metastasis compared to conventional imaging. The integration of PSMA PET with MP-MRI, exemplified by the new P-score system, aims to refine diagnostic accuracy and reduce the need for invasive biopsies.