Rachel Shapiro, PA-C, translates the NLUTD guideline: how to risk-stratify, what to surveil, and how to treat unsafe storage, retention, and continence, all while addressing autonomic dysreflexia, bowel optimization, and sexual/fertility needs.
Read More
Rachel Shapiro, PA-C, shares her experience developing a leadership role for advanced practice providers in urology.
Read More
Juan Javier-DesLoges, MD, MS, focuses on contemporary advancements in prostate cancer detection, emphasizing the integration of biomarkers and MRI for biopsy decision-making. In this 5-minute presentation, he references recent guidelines, which advocate biomarkers and MRI as tools for determining the necessity of biopsies. Studies comparing biomarkers such as 4K, PHI, SelectMDx, and XODX illustrate their ability to enhance the specificity and accuracy of cancer detection compared to PSA alone.
Dr. Javier-DesLoges stresses that MRI further refines risk stratification when combined with biomarkers. He underscores the complementary role of these tools, advocating their combined use to optimize diagnostic outcomes for patients with intermediate PSA levels.
Read More
Dr. Seth K. Bechis, MD, discusses the critical role of stone volume as a predictor of spontaneous stone passage in patients with urolithiasis. He emphasizes that while stone size has traditionally been considered the primary factor in determining the likelihood of spontaneous passage, emerging evidence suggests that stone volume offers a more accurate assessment. Dr. Bechis advocates for integrating this assessment into routine evaluation protocols.
In this 16-minute presentation, Dr. Bechis explains that stone volume, which accounts for both the size and the three-dimensional shape of the stone, provides a more comprehensive measure that correlates better with clinical outcomes. This is especially relevant in determining whether to pursue active intervention or adopt a more conservative, observational approach.
Read More
Seth K. Bechis, MD, explores the question of whether or not minimally invasive surgical therapies (MIST) should be first line treatment for BPH. He begins by highlighting the prevalence of BPH in men over 60. He acknowledges that combination therapy is extremely effective in combating BPH in the short-term, but it has several long-term risks which impact patient QoL.
Dr. Bechis highlights the negative side-effects of 5-ARIs, alpha blockers, and surgery post-medication-failure. Side-effects included increased risk of cardiac failure, dementia, depression, and sexual dysfunction.
Dr. Bechis then examines current MIST procedures for BPH treatment, including prostatic urethral lifts, water vapor thermal therapy, temporarily implanted nitinol devices, and balloons. He examines the durability, effectiveness, and side-effects for each procedure, and compares them to patients on medication
Dr. Bechis concludes by comparing the cost effectiveness of MIST procedures to the cost of medication, taking into account IPSS improvement and Quality-Adjusted Life Years over time. Overall, he suggests that MIST procedures should be explored as a first line treatment for BPH.
Read More