Maryland Archives

Crossing the Divide from Transrectal to Transperineal Biopsy

Posted by Michael A. Gorin, MD | Jun 2020

Michael A. Gorin, MD, a urologist at Urology Associates of Cumberland, Maryland, and Director of Medical Affairs for Perineologic, discusses the benefits of transperineal prostate biopsy over transrectal biopsy. He notes that transrectal prostate biopsy leads to infections in 5-7% of patients, and argues that transperineal biopsy is the best alternative for avoiding infection. Dr. Gorin acknowledges that the use of a grid-stepper unit for performing transperineal biopsy can be uncomfortable for patients, but suggests that new technology like the PrecisionPoint™ Transperineal Access System solves many of these issues. The presentation is followed by a Q&A in which Dr. Gorin discusses the importance of new coding for transperineal biopsy and the potential of variable length needles.

Evidence-Based Guideline for Management of Priapism: Perspectives from AUA/EAU Guideline Panel

Posted by Trinity J. Bivalacqua, MD, PhD | Jun 2020

Trinity J. Bivalacqua, MD, PhD, Director of Urologic Oncology at Johns Hopkins Medicine, discusses potential solutions to the issues with bacillus Calmette-Guérin (BCG) as a treatment for high-risk non-muscle invasive bladder cancer (NMIBC). Intravesical BCG is more effective than chemotherapy for NMIBC, but approximately ⅓ of high-risk patients are BCG-unresponsive, and there is also a BCG shortage. Dr. Bivalacqua lists potential solutions to both these problems, including early cystectomy, increasing the availability of BCG by using alternative strains, and enhancing immunotherapy. He concludes by discussing research intended to characterize immune cell expression among patients with NMIBC treated with BCG which found that immune checkpoint inhibition with BCG may be beneficial in a subset of patients who experience tumor recurrence after BCG.

Adaptive Immune Resistance to Intravesical BCG in NMIBC: Implications for Ongoing and Future BCG Unresponsive Clinical Trials

Posted by Trinity J. Bivalacqua, MD, PhD | May 2020

Trinity J. Bivalacqua, MD, PhD, Director of Urologic Oncology at Johns Hopkins Medicine, discusses potential solutions to the issues with bacillus Calmette-Guérin (BCG) as a treatment for high-risk non-muscle invasive bladder cancer (NMIBC). Intravesical BCG is more effective than chemotherapy for NMIBC, but approximately ⅓ of high-risk patients are BCG-unresponsive, and there is also a BCG shortage. Dr. Bivalacqua lists potential solutions to both these problems, including early cystectomy, increasing the availability of BCG by using alternative strains, and enhancing immunotherapy. He concludes by discussing research intended to characterize immune cell expression among patients with NMIBC treated with BCG which found that immune checkpoint inhibition with BCG may be beneficial in a subset of patients who experience tumor recurrence after BCG.

Path to the First Penoscrotal Transplant: Pre-Clinical Studies that Led to Penile Allotransplantation

Posted by Trinity J. Bivalacqua, MD, PhD | May 2020

Trinity J. Bivalacqua, MD, PhD, Director of Urologic Oncology at the James Buchanan Brady Urological Institute of Johns Hopkins Medicine, discusses the groundbreaking penoscrotal implant surgery performed by a multidisciplinary team at Johns Hopkins Medicine in 2018. He explains their rationale for performing a procedure that many consider dangerous and unnecessary, saying that patients have a right to be normal and to decide on their own fate, and noting that they discussed the surgery with their patient, a military vet who lost his phallus from a blast injury, for years before operating. Dr. Bivalacqua goes on to summarize the pre-clinical cadaveric and ex vivo studies conducted before the procedure, emphasizing the important developments in increasing transplant tolerance and improvements in vascularizing penile allografts. He concludes by saying that the surgery was successful and thus far the graft has not shown rejection, but he notes that the procedure’s utility in clinical practice remains unknown.

New Concepts in Cavernous Nerve Localization and Functional Recovery after Radical Prostatectomy

Posted by Arthur L. Burnett II, MD, MBA, FACS | May 2020

Arthur L. Burnett II, MD, MBA, FACS, Professor of Urology at Johns Hopkins University School of Medicine, discusses therapeutic and investigational strategies for improving erectile function after prostatectomy. He goes on to discuss how cavernous nerve-sparing techniques have reduced erectile dysfunction after prostatectomy by 10-40%, how mapping cavernous nerves with novel imaging techniques can help minimize nerve and vascular injury at the time of surgery, as well as the impact of investigational, local electrostimulation of damaged cavernous nerves in an animal model cohort.