Chicago Archives

Course Introduction: Description of Terminology and Review of Guidelines

Posted by Natalie Reizine, MD | Dec 2024

Natalie Reizine, MD, delves into the current understanding, treatment options, and future directions for managing prostate cancer. In this 23-minute presentation, Dr. Reizine discusses disease progression, from localized stages to advanced and metastatic forms, emphasizing the evolving role of imaging technologies like PSMA PET scans in early detection and monitoring.

Dr. Reizine reviews the biology of prostate cancer, particularly its reliance on androgen receptor signaling, which forms the foundation for many therapeutic strategies. She highlights the importance of understanding disease-specific nuances, such as low versus high-volume metastases, to tailor treatment strategies.

Bone health in prostate cancer is emphasized, particularly for patients on long-term ADT. Similarly, dental care and endocrinology referrals are underscored as part of comprehensive management.

Dr. Reizine focuses on emerging therapies and personalized medicine approaches, with attention given to biomarkers like DNA damage repair mutations and new treatment modalities, including PARP inhibitors, radioligand therapies, and T-cell activating constructs. She underscores the need for improved predictive and prognostic biomarkers to effectively refine therapy selection and sequence treatments.

Rectal Spacer

Posted by Abhinav Sidana, MD, MPH | Dec 2024

Abhinav Sidana, MD, MPH, addresses the role of rectal spacers in reducing gastrointestinal toxicity during prostate radiation therapy. The 11-minute presentation discusses three types of FDA-approved rectal spacers: Polyethylene Glycol-Based Spacers (SpaceOAR), Hyaluronic Acid-Based Spacers, and Balloon Spacers (BioProtect).

Dr. Sidana shares images to illustrate the procedural steps for patient preparation, numbing, hydro-dissection, and accurate spacer placement, guided by imaging. Post-procedure imaging, such as MRI or CT scans, can be used to confirm correct placement.

Dr. Sidana also discusses potential complications, including minor pain and rectal fullness and rare instances of severe outcomes like rectourethral fistulas or sepsis. He notes, however, that these devices generally have a favorable safety profile.

Novel and Emerging Pathological Factors in Localized and Recurrent Prostate Cancer

Posted by Gladell P. Paner, MD | Dec 2024

Gladell P. Paner, MD, discusses novel and emerging pathological factors in localized prostate cancer, highlighting recurrent cases.

Morcellation and Potential HoLEP Complications

Posted by Amy Krambeck, MD | Nov 2024

Amy E. Krambeck, MD, presents a detailed overview of morcellation and its potential complications, particularly in Holmium Laser Enucleation of the Prostate (HoLEP). In this 14-minute presentation, she explains the technical requirements for performing morcellation.

Dr. Krambeck narrates a video of the procedure’s steps. She highlights how challenging nodules can sometimes require additional laser grooves to enable effective morcellation.

Complications during morcellation are also reviewed. Intraoperative issues include capsular perforations and bladder injuries. Injury to the ureteral orifices, while rare, can occur during morcellation. Dr. Krambeck also discusses postoperative complications and their management, including bleeding, clot retention, and infections such as UTIs or epididymitis. Incontinence, mainly urge incontinence, is another common postoperative issue. However, with proper technique, HoLEP and morcellation present low complication rates and excellent patient outcomes.

Reconstruction of Complex Upper and Mid Ureteral Strictures with Buccal Mucosa Graft Ureteroplasty

Posted by Ziho Lee, MD | Sep 2024

Ziho Lee, MD, focuses on using buccal mucosa grafts in ureteral reconstruction and highlights their value in complex cases. Buccal mucosa grafts offer a practical alternative when standard resection and anastomosis are not feasible.

In this 11-minute presentation, Dr. Lee describes onlay grafts, where the anterior surface of the ureter is slit and patched with the graft, and augmented anastomotic repairs for more severe cases with obliterated segments. He shares a short video of both techniques.
Dr. Lee emphasizes the importance of minimizing tissue manipulation and dissection, particularly in cases with fibrosis. Strategies like measuring defects with precision and securing grafts using Monocryl sutures are discussed for graft placement. He recommends using omental wrapping or attaching grafts to the psoas muscle to ensure stability and promote vascularization, especially in retroperitoneal cases.