Chicago Archives

Tips and Tricks for Robotic Ileal Ureter

Posted by Ziho Lee, MD | Sep 2024

Ziho Lee, MD, provides insights into robotic ileal ureter reconstruction, offering practical strategies for optimizing outcomes.

In this 10-minute presentation, Dr. Lee uses photos and procedure videos to outline an effective surgical strategy, starting with proximal ureter dissection to assess feasibility, followed by bowel harvest, bladder preparation, and distal anastomosis. Proper exposure is stressed as critical to ensure the best outcomes. Port placement strategies are discussed, including single setup configurations and rotating the robotic boom for upper tract access. Various tunneling techniques are detailed, including creating a mesenteric window to reduce strain and ensure smooth passage of the ileal segment.
The presentation concludes by emphasizing the importance of meticulous technique and thorough planning, especially for patients with complex histories, including prior pelvic radiation. While the indications for ileal ureter replacement are decreasing, it remains a vital tool for urologists. With careful patient selection and precise execution, surgical success rates can reach 90%, minimizing the need for future interventions.

Overview of Current Surgical BPH

Posted by Amy Krambeck, MD | Aug 2024

Amy Krambeck, MD, provides a comprehensive overview of current surgical options for treating benign prostatic hyperplasia (BPH), focusing on their efficacy, safety, and practical application. Her analysis emphasizes the evolution of surgical techniques and the criteria for selecting the most appropriate intervention for each patient.

Dr. Krambeck begins by discussing transurethral resection of the prostate (TURP), noting its potential complications, such as bleeding, infection, and the risk of TUR syndrome, which necessitates careful patient selection and postoperative monitoring. She then explores newer surgical techniques as alternatives to TURP, among these, laser therapies such as holmium laser enucleation of the prostate (HoLEP) and photoselective vaporization of the prostate (PVP). Dr. Krambeck also addresses minimally invasive surgical options like prostatic urethral lift (PUL) and water vapor thermal therapy.

The discussion includes a review of the practical considerations for each surgical option, including patient factors such as prostate size, comorbidities, and symptom severity. Complications and postoperative care are also discussed.

Panel Discussion: PROSTATE SAMPLING AND SPACING

Posted by Srinivas Vourganti, MD | Aug 2024

Arvin K. George, MD, and Srinivas Vourganti, MD

The Risks and Benefits of Rectal Spacers

Posted by Srinivas Vourganti, MD | Aug 2024

Srinivas Vourganti, MD, analyzes the risks and benefits associated with the use of rectal spacers in oncologic prostate care. His discourse emphasizes the role of rectal spacers in mitigating radiation-induced toxicity during prostate cancer radiotherapy, highlighting their potential to enhance treatment efficacy and patient quality of life.

Dr. Vourganti discusses the primary benefit of rectal spacers and examines the procedural aspects and safety profile of rectal spacer insertion. Dr. Vourganti also addresses the potential risks and limitations of rectal spacers, highlighting rare but possible complications, including infection, spacer migration, and discomfort during the insertion process.

Dr. Vourganti emphasizes the importance of patient selection and individualized treatment planning when considering the use of rectal spacers, and advocates for a thorough evaluation of each patient’s specific clinical scenario to determine the potential benefits and risks.

The Who and Why of Focal Therapies

Posted by Abhinav Sidana, MD, MPH | Mar 2024

Abhinav Sidana, MD, MPH, discusses the selection processes, objectives, and data supporting the use of focal therapy to treat prostate cancer. He begins with an overview of the state of focal therapy, and how it can be used to provide more personalized prostate cancer treatment to patients.

Dr. Sidana then compares the weaknesses of focal therapy to those of radical surgery and surveillance. He notes that while focal therapy has been criticized for its shortcomings in addressing “invisible” and multifocal cancers, radical surgery has permanent negative effects on patient QOL and that many patients on active surveillance drop out after a certain length of time.

Dr. Sidana then addresses recent advances in focal therapy which can partially mitigate some of the shortcomings of focal therapy. He focuses on advancements in MRI accuracy and specificity which makes treating multifocal and previously invisible clinically significant cancers using focal therapy effective.

Dr. Sidana concludes by outlining strategies for patient selection for focal therapy. He presents examples of ideal patient and disease characteristics for focal therapy treatment and lists relevant contraindications.