O. Lenaine Westney, MD, Author at Grand Rounds in Urology

Devastated Outlet in Men

Posted by O. Lenaine Westney, MD | Oct 2024

O. Lenaine Westney, MD, focuses on managing a “devastated outlet” in patients, typically those who have undergone treatments for prostate cancer. The 11-minute presentation highlights how factors such as radiation, High-Intensity Focused Ultrasound (HIFU), and multiple manipulations to treat urinary tract issues can lead to severe complications.
Radiation’s impact on the lower urinary tract is a key concern, with fibrosis and ischemia developing over time. Dr. Westney shares images of recto-urethral or pubic-prostatic fistulas, which are associated with a high morbidity rate and often necessitate complex surgical interventions, such as cystectomy and urinary diversion. The difficulty lies in predicting which patients will develop these severe complications.
Westney emphasizes the importance of early intervention and the potential need to rethink treatment strategies. She also discusses future directions, including the possibility of identifying patients who are more likely to suffer from radiation-induced complications through genetic markers or other predictive tools.

OAB – Tier 3, Botox

Posted by O. Lenaine Westney, MD | Sep 2024

O. Lenaine Westney, MD, focuses on the challenges of managing overactive bladder (OAB) in post-prostatectomy patients, particularly those who have undergone radiation therapy. In this 13-minute presentation, Westney explains that while most patients with localized prostate cancer return to baseline urinary function after treatment, a significant subset experiences long-term urinary symptoms. Adding radiation increases the incidence and severity of OAB symptoms.
Dr. Westney explains the AUA management guidelines for OAB, which lack specific recommendations for men treated for prostate cancer, highlighting the need for better data. She discusses various treatment approaches, including pharmacological options, pelvic floor exercises, and neuromodulation, but notes the scarcity of research in this patient population. Botulinum toxin and sacral nerve stimulation show promise but require further investigation.
Dr. Westney shares a case of a 67-year-old man treated with salvage prostatectomy and radiation. Despite interventions like artificial urinary sphincter (AUS) and botulinum toxin, his symptoms persisted. His case illustrates the challenges involved in treating these patients.

Improving Patient Decision-Making in Urinary Diversion: Satisfaction Over Regret

Posted by O. Lenaine Westney, MD | Aug 2024

O. Lenaine Westney, MD examines the psychological and emotional impacts of urinary diversion, emphasizing how these procedures profoundly affect patients’ lives. She discusses the main types of urinary diversions—ileal conduit, continent cutaneous diversion, and orthotopic neobladder—detailing their indications, advantages, and potential complications.

Dr. Westney advocates for a collaborative approach in which urologists and patients engage in open dialogues about the risks and benefits of each urinary diversion method. She emphasizes the importance of integrating patients’ values, goals, and quality of life considerations into the treatment planning process.

Dr. Westney also addresses common sources of decisional regret among patients, such as unmet expectations and unanticipated complications. Utilizing case studies and real-world examples, Dr. Westney demonstrates how effective communication and patient-centered care can lead to higher satisfaction rates and reduced instances of regret.

Diversity in Academic Urology: Where We Stand and Next Steps

Posted by O. Lenaine Westney, MD | Aug 2024

O. Lenaine Westney, MD, analyzes demographic data within academic urology, noting the underrepresentation of certain groups, particularly women and minorities, in faculty and leadership positions. She emphasizes the importance of diversity for fostering innovation, improving patient care, and enriching the educational environment.

Dr. Westney highlights successful initiatives and programs that have been implemented to promote diversity within the field. She discusses the impact of targeted recruitment efforts, diversity training, and mentorship programs designed to support underrepresented groups.
The presentation also addresses the role of institutional policies and leadership commitment in driving change. Dr. Westney advocates for the establishment of clear diversity goals, accountability measures, and dedicated resources to support diversity and inclusion efforts. She underscores the importance of creating a supportive and inclusive culture that values diverse perspectives and experiences.