Vanderbilt University School of Medicine Archives

Treatment of the Ureteral Stone: What Do the AUA Guidelines Say?

Posted by Nicole L. Miller, MD, FACS | Jul 2020

Nicole L. Miller, MD, FACS, Associate Professor of Urology at Vanderbilt University Medical Center, discusses AUA guidelines for the treatment of ureteral stones, and compares and contrasts them to the EAU guidelines, examining several cases to illustrate similarities and differences in treatment approaches. She observes that the EAU guidelines are updated more frequently than the AUA guidelines, which often puts them ahead in terms of pain management. Dr. Miller emphasizes that shock wave lithotripsy (SWL) treatment has the least morbidity and lowest complication rate, but ureteroscopy (URS) has a higher stone-free rate in all ureteral locations. She discusses which special cases would be best treated with URS, and why a ureteral stent is not necessary after uncomplicated URS. Finally, Dr. Miller looks at how multimodal therapy for stent pain can significantly reduce narcotic usage.

Transurethral Surgery Re-Imagined: Exploration of a Novel Robotics Platform

Posted by Nicole L. Miller, MD, FACS | Jul 2020

Nicole L. Miller, MD, FACS, Associate Professor of Urology at Vanderbilt University Medical Center, discusses advances in robotics that could transform rigid endoscopic surgery by giving surgeons more degrees of freedom while operating. She argues that the evolution from open surgery to minimally-invasive surgery is perhaps as significant as the discovery of anesthesia and suggests that improved robotics are continuing this surgical revolution. Dr. Miller focuses on the work of Virtuoso Surgical, Inc., which has developed a prototype for transurethral endoscopy that features two needle-sized robotic arms that allow for complex two-handed maneuvers in the smallest surgical sites in the body. She suggests that this tool and others like it could make HoLEP faster and easier, improve en-bloc resection quality in bladder tumor patients, and improve resection of uterine polyps, among other applications.

FDUS 2018-Next Generation Developments in Bladder Cancer

Posted by Sam S. Chang, MD, MBA | Sep 2018

Sam S. Chang, MD, MBA, and Michael S. Cookson, MD, led the “Next Generation Developments in Bladder Cancer” session at the Future Directions in Urology Symposium (FDUS) 2018. These consensus statements represent a comprehensive analysis of current issues, challenges, and advancements in urology from a panel of international experts.

Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guidelines

Posted by Sam S. Chang, MD, MBA | Feb 2018

Sam Chang, MD, MBA, who has served as chair of the American Urological Association (AUA) guidelines panel for non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC), provides an overview of updated non-metastatic MIBC treatment guidelines, including a comprehensive treatment algorithm. He also discusses directions of future research for the disease.

Robotic Cystectomy Versus Open Cystectomy: What Do We Know?

Posted by Sam S. Chang, MD, MBA | Feb 2018

Sam Chang, MD, MBA, delineates the benefits and shortcomings of both robotic and open cystectomy, specifically in terms of morbidity, compilation, and recurrence rates for patients, and the learning curve associated with each method for clinicians. He also discusses how the financial cost of robotic surgery factors into this comparison.