R. Caleb Kovell, MD, provides an overview of the diagnosis, treatment, and management of urethral strictures and bladder neck contractures. In this presentation, he provides anatomical and surgical examples of urethral stricture:
Presentation
Work-Up
Endoscopic and Surgical Management
Post-Treatment Follow-Up
R. Caleb Kovell, MD, discusses management strategies for acute refractory ischemic priapism, including shunting, tunneling, and prosthesis. Dr. Kovell begins his lecture by reviewing the erectile recovery windows and imaging techniques for establishing acute ischemic priapism.
Dr. Kovell then turns to effective treatment options after intracavernosal phenylephrine and corporal aspiration fail. He outlines various types of distal shunting, corporal tunneling, penoscrotal decompression, and early prosthesis placement.
Dr. Kovell concludes by discussing outpatient management of acute ischemic priapism. He highlights the importance of establishing the patient’s Sickle Cell Disease status, and cautioning against immediately prescribing PDE5is to outpatients.
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Jay Simhan, MD, FACS, focuses on optimizing outcomes in penile implant surgery, emphasizing technical performance and perioperative management. In this 17-minute presentation, Simhan suggests that reconstructive urologists should focus on patient outcomes in addition to technical aspects of surgery.
Simhan outlines a multimodal approach to pain management, combining neuropathic pain control, anti-inflammatories, and intraoperative pain blockades rather than relying on opioids alone. Further, he discusses the challenges of managing patients with priapism-related erectile dysfunction, highlighting the difficulties of delayed penile implantation in these cases. The presentation also critiques existing guidelines for antibiotic prophylaxis in penile implants, noting that the American Urological Association’s (AUA) recommendations fail to cover certain pathogens like anaerobes and fungi.
Dr. Simhan stresses the importance of collaboration across institutions to address these complex issues. He introduces the Prosthetic Urology Multi-institutional Partnership (PUMP), a coalition of urologists who address penile implant questions.
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R. Caleb Kovell, MD, discusses effective treatments for complex neurogenic bladder patients, including early and long-term interventions. He presents several factors physicians should take into account when treating challenging neurogenic bladder patients, including:
Male and Female Sexual Health Issues
Bladder Stones
Urinary Continence
Previous Augmentation Cystoplasty
Previous Diagnosis of Spina Bifida
Firas Mourtada, MSE, PhD, DABR, discusses the physics of high-dose rate (HDR) brachytherapy in this talk sponsored by the American Brachytherapy Society (ABS). Dr. Mourtada enumerates prostate cancer treatment options before identifying HDR brachytherapy as the ultimate approach for dose escalation, asserting that with image guidance, HDR for prostate can be implemented safely and result in an increase in biochemical disease-free survival.
Dr. Mourtada describes the advantages of HDR brachytherapy technology and illustrates how brachytherapy delivers high dose within the prostate, with less dose to surrounding normal tissue. He enumerates advantages such as bringing the source close to the target, using inverse-planning, and the potential for high-efficacy combined with lower-risk of toxicity or secondary malignancy.
Dr. Mourtada reviews common radionuclides in brachytherapy before defining HDR and addressing methodology, workflow, and equipment involved in using transrectal ultrasound (TRUS) for prostate brachytherapy. He explains the feedback loop and illustrates the iterative contouring and reconstruction of the gland that takes place during this workflow and the optimization settings involved.
Dr. Mourtada turns to radiation safety, emphasizing the importance of time, distance, and shielding and citing regulatory radiation safety programs, ALARA (as low as reasonably achievable,) and QMP (Quality Management Program.) He reviews radiation terminology and emphasizes the importance of radiation dosimeters and required radiation area signs.
Dr. Mourtada then concludes that prostate HDR with real-time image guidance provides high-quality implants with an efficient process using inverse planning, HDR radiation exposure is minimal due to the afterloading technology and ALARA controls, and quality management steps are essential to providing high-quality HDR implants.
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