Mayo Clinic Archives

Transmeatal Urethral Surgery: Distal, Proximal, and Short Stricture Repair

Posted by J. Nicholas Warner, MD | Sep 2024

J. Nicholas Warner, MD, outlines techniques for managing anterior urethral strictures through endoscopic urethroplasty. In this 8-minute presentation, Dr. Warner discusses different approaches—distal, proximal, and management of short strictures.

Dr. Warner shares cases, including images and surgical videos illustrating the steps for each approach. He discusses patient criteria for each methodology and success rates.

Transurethral Incision and Transverse Mucosal Realignment

Posted by J. Nicholas Warner, MD | Sep 2024

J. Nicholas Warner, MD, discusses advancements in endoscopic urethroplasty, focusing on techniques for addressing bladder neck and vesicourethral anastomotic stenosis. In this 7-minute presentation, which includes a video of a procedure, Dr. Warner outlines the transurethral incision and transverse mucosal realignment technique, emphasizing the initial scar identification, resection, and dilation strategies.

Warner asserts that advancements in endoscopic techniques have shown promising results in treating urethral strictures, with a focus on optimizing patient outcomes through refined surgical strategies.

OAB – Tier 3, SNS – Interstim

Posted by Christopher E. Wolter, MD | Sep 2024

Christopher E. Wolter, MD, focuses on sacral neuromodulation (SNM), specifically InterStim, and its role in treating voiding dysfunction. In this 11-minute presentation, Wolter outlines the historical development of neuromodulation, emphasizing SNM’s effectiveness compared to medications. It also offers the potential to manage fecal incontinence, neurogenic bladder dysfunction, and even interstitial cystitis in some cases.
Dr. Wolter discusses the operative approach for SNM placement, highlighting the importance of proper technique. He illustrates the procedure with photographs and x-rays, providing step-by-step instructions and suggestions to ensure a successful outcome.

Outpatient Exercise, Nutrition, and Psychologic Support and Pre-Rehabilitation for Urologic Cancer

Posted by Logan G. Briggs, MD | Nov 2023

Logan G. Briggs, MD, discusses the results of his upcoming paper on the efficacy of a range of interventions in improving outcomes for urologic cancer patients. Dr. Briggs and his co-authors examined over 400 randomized control trials (RCTs) that met criteria for design, population, review, and other factors, with 372 focusing on prostate cancer, 24 on bladder cancer, 20 on kidney cancer, and 14 on testicular cancer.

The research team then examined the outcomes of nutrition, exercise, counseling, and pre-/rehabilitative interventions with the quality of life, physical/functional performance, cost-effectiveness, cardiometabolic profile, erectile function, and continence for each disease. Their analysis of these RCTs showed that 71% of interventions achieved positive results.

With a goal of creating personalized, cost-effective pre-/rehabilitation programs for urologic cancer patients, Dr. Briggs suggests further work will need to be done in analyzing cost effectiveness, variance by race/ethnicity, and clinical significance of these findings. He also further discusses the significant amount of data from these RCTs showing the potential importance of these interventions for men with prostate cancer undergoing androgen deprivation therapy.

Point-Counterpoint: HoLEP vs. GreenLightTM PVP – HoLEP

Posted by Karen L. Stern, MD | Nov 2023

Karen L. Stern, MD, discusses holmium laser enucleation of the prostate’s (HoLEP’s) greater efficiency, safety, and durability compared to GreenLightTM photosensitive vaporization of the prostate (PVP). Dr. Stern references a 2020 study that found improved outcomes with HOLEP over PVP regarding operative time, tissue removal, International Prostate Symptom Score (IPSS) at one year, Qmax, post-void residual volume (PVR), and post-operative prostate-specific antigen (PSA). Dr. Stern then discusses small-volume prostates, emphasizing HoLEP’s effectiveness.

However, she acknowledges that PVP and transurethral resection of the prostate (TURP) are acceptable modalities in treating small-volume prostates, contrary to the treatment of large-volume prostates. Dr. Stern then reviews American Urological Association (AUA) guidelines. These note that HoLEP may serve to treat BPH and lower urinary tract symptoms (LUTS) regardless of prostate size. The AUA further notes that PVP may be less effective for large-volume prostates.

In a review of other factors, the AUA cites a 2020 study showing that PVP had a bladder outlet obstruction retreatment rate of about 27% compared to HoLEP at 5%. Dr. Stern also explains that the majority of HoLEP patients experience same-day catheter removal and discharge from hospital stays. She then evaluates the safety profile of HoLEP and PVP, finding a low rate of perioperative complications with HoLEP and high rates of urgency with PVP. Dr. Stern highlights the increased quality of life produced by HoLEP and its increased durability, boasting a reoperative rate of less than 1% per lifetime. Dr. Stern completes her discussion by reiterating HoLEP’s status as the gold standard in the surgical treatment of BPH.

This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: HoLEP vs. GreenLightTM PVP– GreenLightTM PVP.”