Philadelphia Archives

Optimizing Success in Penile Implant Surgery

Posted by Jay Simhan, MD, FACS | Apr 2024

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.

Long-Term Care of the Neurogenic Bladder

Posted by R. Caleb Kovell, MD | Feb 2024

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

Physics of HDR Brachytherapy for Urologists

Posted by Firas Mourtada, MSE, PhD, DABR | Sep 2023

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.

Next Generation DNA Sequencing for Genitourinary Implants

Posted by Paul H. Chung, MD | Jan 2021

Paul H. Chung, MD, Assistant Professor and Director of the Division of Reconstructive Urology at the Sidney Kimmel Medical College of Thomas Jefferson University, discusses infection of genitourinary implants and how next-generation sequencing can be used to manage device infection. Presenting his results from a recently published article with the Canadian Journal of Urology, he outlines the methods, outcomes, and recommendations for clinicians, specifically those removing malfunctioning or infected penile prostheses and artificial sphincters. Dr. Chung highlights the benefits of polymerase chain reaction (PCR) and next-generation sequencing (NGS) including faster processing time, greater sensitivity, and the ability to run both fungal and bacterial analysis in the same setting. Additionally, NGS is useful in the selection of perioperative antibiotics and irrigation solutions, as well as determining how to coat devices during implant surgery. Following the presentation, Grand Rounds in Urology editor J. Curtis Nickel, MD, FRCSC interviews Dr. Chung to further discuss the clinical implications of his research. In the conversation, they compare biofilm collection techniques, noting that PCR and NGS are most helpful in a clinical setting, whereas extended culture is useful in a research setting.

Panel Discussion: Next Generation Genomics and Prostate Cancer Biomarkers

Posted by Leonard G. Gomella, MD, FACS | Oct 2020

Leonard G. Gomella, MD, FACS, leads a panel discussion with Gerald L. Andriole, Jr., MD; Alan H. Bryce, MD; Brian F Chapin, MD; E. David Crawford, MD; Steven E. Finkelstein, MD, FACRO; A. Karim Kader, MD, PhD; and Neal D. Shore, MD, FACS on how biomarkers are being used to treat prostate cancer. Biomarkers are used to diagnose PCa and to decide whether or not to biopsy or repeat biopsy. They also discuss how biomarkers are used to treat localized disease and advanced disease. Both tissue and liquid biopsies are used for somatic DNA mutations, with liquid biopsies becoming increasingly important since it gives real-time results. Guidelines for germline testing and counseling are being updated, and germline testing for family members is becoming increasingly important. PARP inhibitors are now approved for detecting BRCA mutations. There is broader approval for the medication olaparib for both germline and somatic testing. They also review the updated biomarker map. They discuss how these changes will shape precision medicine and personalized care. It is essential for the urology community to be familiar with all these aspects of testing and clinical applications. They discuss why the PCA 3 test has been declining. They also discuss the need to send a clear message to primary care physicians.