University of Washington Archives

Implantable Tibial Nerve Stimulation (iTNS): Revi

Suzette E. Sutherland, MD, MS, URPS | Sep 2024

Suzette E. Sutherland, MD, MS, URPS, focuses on implantable tibial nerve stimulation (ITNS) for treating overactive bladder and urinary incontinence. In this 17-minute presentation, she introduces the Revi device featured in the OASIS trial.

After discussing the Revi device’s benefits, Dr. Sutherland reviews the implantation procedure and the 12-month data from the OASIS trial, which show promising results. The device is considered safe, with no serious adverse events reported. Minor issues such as discomfort were easily resolved with reprogramming, a feature of note with this device.
Sutherland emphasizes the importance of ease of use, safety, and flexibility in choosing ITNS devices. As more implantable devices enter the market, factors like surgical complexity, reprogrammability, battery replacement needs, and ongoing support will determine their success.

Bladder Microbiome and Recurrent UTIs: Preventing Those Nasty Buggers

Suzette E. Sutherland, MD, MS, URPS | Apr 2024

Suzette E. Sutherland, MD, MS, URPS, addresses the role of the microbiome in recurrent urinary tract infections (UTIs). She begins this 26-minute presentation by reviewing the bladder microbiome, noting that microbes support immune function and maintain the integrity of the bladder lining. She then transitions to prevention and treatment of the condition.

Non-antibiotic prevention strategies are discussed, focusing on hydration, cranberry supplements, estrogen, and probiotics. Probiotics are emphasized for their role in reducing UTI recurrence, but Sutherland stresses the importance of proper diagnosis and judicious antibiotic use to avoid contributing to antibiotic resistance. Catheter-associated UTIs are also addressed, with a preference for clean intermittent catheterization and bladder irrigation with gentamicin in severe cases. Overall, Dr. Sutherland advocates for a conservative, evidence-based approach, using antibiotics only when necessary to preserve the efficacy of these crucial medications.

The Association Between Testosterone Treatment and Incident of Cardiovascular Events among Testosterone Deficient U.S. Veterans

Thomas J. Walsh, MD, MBA, MS | Mar 2024

In this 19-minute presentation, Thomas J. Walsh, MD, MBA, MS, University of Washington, Seattle, Washington, highlights the need for further research to clarify the long-term effects of testosterone therapy on cardiovascular health, advocating for a balanced approach that weighs the potential benefits against the risks. Dr. Walsh’s presentation underscores the importance of personalized medicine in managing testosterone deficiency.

Neoadjuvant Immune-Checkpoint Inhibition for Muscle-Invasive Bladder Cancer

Petros Grivas, MD, PhD | Feb 2021

Petros Grivas, MD, PhD, Associate Professor of Oncology at the University of Washington School of Medicine in Seattle, argues for the use of immune-checkpoint inhibition over cisplatin-based chemotherapy for muscle-invasive bladder cancer (MIBC) based on promising level 1 evidence. He begins with an overview of the PURE-01 trial, which found that single-agent pembrolizumab safely achieved a pTO of 42% and a down-staging rate of 54%. Dr. Grivas continues by discussing the possibility of imaging endpoint use, reaching the conclusion that more validation is necessary before progress can be made in this area. He then returns to the PURE-01 trial, reviewing the surgical safety data which demonstrate high-grade complications post-pembrolizumab in 34% of patients, a significant minority. Dr. Grivas follows this by looking at the wider landscape of phase 2 trials in MIBC beyond just PURE-01, noting that they have shown promising pathologic complete response rates and rates of pathologic downstaging to non-muscle invasive disease. He looks to the future, suggesting that with more data and validation physicians will be able to treat patients based on their individual biology. Dr. Grivas concludes by arguing that it may be possible to use immune-checkpoint inhibition in patients who are unfit for cisplatin or to even avoid using cisplatin altogether, but notes that there is a need for more high-quality studies to inform discussions.

Improving Specificity of PSA Screening with Serum and Urine Markers – Who Doesn’t Need a Prostate Biopsy?

Daniel W. Lin, MD | Aug 2020

Daniel W. Lin, MD, Chief of Urologic Oncology at the University of Washington, discusses improving the specificity of PSA screening using serum and urine markers to determine which patients do not need a prostate biopsy. He lists the ideal biomarker characteristics, including sensitivity and specificity, correlation with disease outcome, reproducibility, low cost, quick and easy assay, and high negative predictive value. He then discusses some of the major studies done on pre-diagnosis biomarkers for prostate cancer, highlighting how PHI score, 4Kscore, and PCA3, among other markers, all significantly reduce the biopsy rate compared with older diagnostics like percent free PSA. Dr. Lin concludes by noting how urologists can further reduce unnecessary biopsies through smart screening strategies, including biennial rather than annual PSA screenings and considering not biopsying men with low early PSA scores.