Wesley A. Mayer, MD

Wesley A. Mayer, MD

Baylor College of Medicine

Houston, Texas

Wesley A. Mayer, MD, is an associate professor of urology, the vice chair for education of the Scott Department of Urology, and an assistant dean of graduate medical education at Baylor College of Medicine in Houston, Texas. Dr. Mayer earned his medical degree from Baylor College of Medicine, graduating with highest honors. He completed his internship in general surgery and his urology residency at the University of Pennsylvania in Philadelphia, Pennsylvania. Dr. Mayer is fellowship-trained in advanced robotic, laparoscopic, and endoscopic surgery in Baylor College of Medicine’s Scott Department of Urology.

Dr. Mayer specializes in advanced minimally invasive surgical treatments for urologic diseases including robotic, laparoscopic (including single-site), endourologic, and percutaneous surgery. He has a special interest in kidney cancer, kidney stones, upper urinary tract reconstruction, adrenal masses, and transplant urology. He has also published research and has been invited to speak on these topics at several national and international conferences. Dr. Mayer has been repeatedly selected as a “Top Urologist in Houston, Texas” in The Leading Physicians of the World and a “Top Doc” in Houstonia Magazine.

Dr. Mayer is an accomplished educator. He received prestigious Norton Rose Fulbright Faculty Excellence Awards for educational leadership, as well as for teaching and evaluation. He was nominated for the 2020 Distinguished Faculty Award at Baylor College of Medicine and for a national teaching award from the Resident and Fellows Committee of the American Urological Association (AUA). Dr. Mayer has been an invited faculty member for several national educational courses, including the AUA’s Annual Oral Board Examination Review course and the AUA’s Mentored Laparoscopy course. Dr. Mayer served on the Accreditation Council for Graduate Medical Education’s (ACGME) Urology Milestones 2.0 Working Group, which created competency-based developmental outcome goals used by all accredited urology residency programs in the United States. He has participated in a number of task forces for the Society of Academic Urologists and for the ACGME’s Urology Standing Panel for Accreditation Appeals. Dr. Mayer has published widely on innovations in surgical education, co-authoring over 30 publications on cutting-edge surgical technology and techniques, and he has been an invited panelist at numerous national and international conferences concerning a variety of topics in education.

Disclosures:

Talks by Wesley A. Mayer, MD

Programmatic and Institutional Paradigms for Building and Sustaining a Successful Wellness Program

Wesley A. Mayer, MD, presents actionable programmatic and institutional paradigms for building and sustaining a successful wellness program within one’s practice or institution while avoiding burnout. He begins by defining the elements of burnout, their impact on institution-wide productivity, and the high rate of burnout in the field of Urology.

Dr. Mayer then turns to the ACGME’s well-being requirements for Urology programs. While these requirements were intended to preserve the wellness of faculty and residents in theory, Dr. Mayer highlights that the lack of specific goals in institutional wellness programs can lead to “hedonistic” initiatives and inconsistent results.

Dr. Mayer then turns to how his own institution, the Scott Department of Urology at Baylor Medical School, sought to consistently address burnout. He outlines the paradigm created by his department, the tools they used to evaluate the success of their efforts, and the results.

He concludes by enumerating the steps other institutions can take to implement similar anti-burnout programs. He provides suggestions for national-level interventions, and reinforces the need for intentionality behind wellness programs.

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Mini Percutaneous Nephrolithotomy: Should We Find Space in Our Endourologic Toolbox?

Wesley A. Mayer, MD, discusses miniaturized percutaneous nephrolithotomy (mPCNL). He explains procedures for dilating the tract, pointing out many sizes of metal dilators and sheaths available to surgeons. He covers the vortex effect, stent placement, and nerve block. Dr. Mayer then summarizes the American Urological Association (AUA)/ Endourological Society Guideline from 2016 for the surgical management of renal stones.

Dr. Mayer then compares mPCNL to standard PCNL (sPCNL) and retrograde ureteroscopy and proposes a framework for operative decision-making. Dr. Mayer examines mPCNL vs. sPCNL, whereby studies showed no difference in volume of damaged parenchyma or in systemic response to surgery-induced tissue trauma. He shares another study that showed higher average intrapelvic pressures using mPCNL, more time spent in the “danger zone” and greater dissemination of bacteria into other organs.

Dr. Mayer describes challenges in interpreting the literature, such as what qualifies as mPCNL, outcome metrics, follow up, imaging methods used, and what constitutes “stone-free.” He shares data illustrating that stone-free rates between mPCNL and sPCNL are comparable. The data also shows that transfusion risk favored mPCNL, as did length of hospital stay. However, operative time favored sPCNL. Dr. Mayer shares a retrospective review that indicated for larger stones, sPCNL was superior.

He compares mPCNL with ureteroscopy, finding that, while length of stay is longer with mPCNL, stone-free rates are similar. One comparison examined ultra-mini PCNL (umPCNL) and ureteroscopy, and indicated that umPCNL had favorable operative time, cost, complications, and stone-free rates. Dr. Mayer outlines the drawbacks of ureteroscopy before concluding by emphasizing that size matters and practitioners should choose wisely among various treatment procedures, including mPCNL and umPCNL.

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Innovations in Urologic Residency Education

Wesley A. Mayer, MD, Associate Professor of Medicine, Assistant Dean of Graduate Education, and Vice Chair of Education in the Scott Department of Urology at Baylor College of Medicine in Houston, Texas, discusses innovations in urologic residency education in the face of changing technology and COVID-19. He begins with a brief history of medical training, explaining that the apprenticeship model was standard until around the start of the 20th century, when William Halstead began to develop the traditional surgical education experience featuring intense and repetitive experiences with surgical patients. Dr. Mayer then lists new challenges in modern surgical training, including work-hour restrictions, influence from other high-stakes fields, an increasingly litigious environment, rising expectations from the public, a progressive physician shortfall, and generational changes in learning style and needs. He argues that to meet these challenges, modern surgical training should: leverage simulators as well as inanimate and animate models; deconstruct complex surgeries into component skills; incorporate structured objective assessment tools; utilize concise, constructive, real-time feedback; address broader stressors impacting trainees, such as wellness and burnout; develop non-surgical skills; and innovate through servant leadership. Dr. Mayer then discusses recent innovations in open surgical training, highlighting the benefits of using cost-effective models based on cheaper materials and 3D printing rather than expensive traditional benchtop models and cadaveric simulations. He moves on to look at innovations in endoscopic surgical training and innovations in laparoscopic/robotic surgical training, emphasizing the benefits of virtual reality training models and video-based coaching. Dr. Mayer summarizes the recent experience of resident education in the Scott Department, particularly focusing on the department’s participation in a trial of SIMPL, a smartphone-based surgical skills assessment tool. He then briefly expands upon innovative feedback models and ways to manage trainee wellness and burnout. Dr. Mayer also considers the effect of COVID-19 on surgical training, observing that while the pandemic led to reduced resident work hours and increased concern that residents would not be able to meet minimum case requirements, the rise of videoconferencing allowed for the positive development of nationwide urology didactics. He closes the presentation by discussing innovative educational uses of social media and the importance of non-technical skills training.

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The Medical Assessment and Surgical Management of Adrenal Masses for the Practicing Urologist

Wesley A. Mayer, MD, Associate Professor of Medicine at Baylor College of Medicine in Houston, Texas, discusses how urologists should medically assess and surgically manage adrenal masses. He begins by briefly going over his sources, including the 2016 European Society of Endocrinology Clinical Practice Guideline, the 2011 Canadian Urology Association Guidelines, the 2009 American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Guidelines, material from UpToDate, and the work of Alexander Kutikov, MD, FACS. He highlights the fact that there is no AUA guideline on adrenal masses, as well as very little new guidance in this space. Dr. Mayer suggests that urologists should be more involved in managing adrenal masses since they are surgical experts of the retroperitoneum, familiar with the anatomy and pathophysiology of the kidneys and adrenal gland, and experts at minimally invasive surgery. He then defines the adrenal mass as a >1 cm lesion that can arise from the medulla or cortex. He explains that the majority are discovered incidentally and are called “adrenal incidentaloma,” and advances in modern imaging technology have significantly increased their prevalence. Most adrenal masses are benign lesions but some are not, and Dr. Mayer lists three important questions a urologist should ask to determine risk when confronted with a mass, including whether there are characteristics suggestive of a malignancy, whether the mass is hormonally active, and whether the patient has a history of malignancy. He then summarizes key points in how to evaluate adrenal masses radiologically and metabolically, and discusses when biopsy is necessary. Dr. Mayer follows this with an overview of surgical management, noting that laparoscopic adrenalectomy is standard of care for most masses and open adrenalectomy should be performed if adrenal cortical carcinoma is suspected. He also shows a video of an adrenalectomy for pheochromocytoma. Dr. Mayer concludes by explaining that follow-up is important since some masses will convert to being hormonally active and/or will have concerning growth characteristics.

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