Nicole L. Miller, MD, FACS

Nicole L. Miller, MD, FACS

Vanderbilt University Medical Center

Nashville, Tennessee

Nicole L. Miller, MD, FACS is an Associate Professor of Urology at Vanderbilt University Medical Center where she is also on faculty for Vanderbilt’s Fellowship in Endourology and Laparoscopic Surgery. A graduate of the University of Pittsburgh School of Medicine, she received her urology residency training at the University of Virginia Health Sciences Center before completing a two-year fellowship in Endourology and Minimally Invasive Surgery at Indiana University School of Medicine. Dr. Miller’s specialties include medical and surgical treatment of kidney stone disease and BPH. Her research interests include the changing composition of renal calculi, the pathophysiology and etiologies of nephrolithiasis, and antibiotic selection for kidney stone treatment. Dr. Miller’s work has been published in the Journal of Urology, Urolithiasis, and Journal of Endourology, among others.

Articles by Nicole L. Miller, MD, FACS

When All Else Fails: Holmium Laser Enucleation of the Prostate as Retreatment for BPH

Nicole L. Miller, MD, FACS, Associate Professor of Urology at Vanderbilt University Medical Center, discusses Holmium laser enucleation of the prostate (HoLEP), particularly focusing on the retreatment setting. AUA guidelines have recently been updated and now mirror EAU guidelines which suggest sizing a prostate before determining treatment options. Dr. Miller examines case studies that underscore the effectiveness of HoLEP in removing large prostates after the patients had previously undergone unsuccessful treatments, including transurethral resection of the prostate (TURP) and prostatic urethral lift. She then analyzes outcomes of a study that compared primary HoLEP (pHoLEP) to retreatment (rHoLEP) observing that the retreatment setting patients experienced shorter operative times, shorter length of stay, had less tissue resected, and had a higher rate of urethral stricture and clot retention. In spite of its utility, HoLEP has not been widely adopted and represents 4% of procedures, which Dr. Miller attributes to the steep learning curve associated with HoLEP. Lastly, she enumerates the barriers within the US medical system to physicians undertaking the HoLEP learning process and concludes that while Europe has numerous options for physicians to learn the technique, the American focus on robotic surgery means that fewer students learn open orifices surgical procedures.

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Renal Stones: To Dust or to Basket?

Nicole L. Miller, MD, FACS, discusses the pros and cons of dusting versus basketing renal stones. She evaluates cost, time, safety, and recurrence with both procedures. The benefits of dusting include decreased procedure time, decreased disposables, lower cost, and comparable complications. The benefits of fragmentation and basketing include obtaining stone composition, improved stone-free rates, clear benefits in specific populations, and versatility with laser machines. The goals of a successful stone surgery are maximum efficiency, being stone-free, safety, and lowest cost. Looking at the type of stone and the patient will determine which method is best to use.

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Breaking Bad: Advances in Laser Lithotripsy Techniques

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.

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

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.

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

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.

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