Video Archives

Managing the Man with Ejaculatory Dysfunction

Posted by Jesse N. Mills, MD | Mar 2024

Jesse N. Mills, MD, presents management strategies for men presenting with ejaculatory dysfunctions, ranging from premature ejaculation to ejaculodynia. He begins by acknowledging that there is no current FDA-approved treatment specifically for any kind of ejaculatory dysfunction.

Dr. Mills then separates men presenting with ejaculatory dysfunction into distinct categories based on the symptom they are experiencing, and follow-up questions to ask these patients. These five main groups are Premature Ejaculation, Delayed Ejaculation, Anejaculation, Ejaculodynia, and Post-Orgasmic Illness Syndrome.

Throughout the presentation, Dr. Mills discusses each category of dysfunction and available treatment options. He concludes by highlighting the need for further study of post-orgasmic illness syndrome.

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.

Active Surveillance of Renal Mass

Posted by Frances M. Alba, MD | Mar 2024

Frances M. Alba, MD, discusses the benefits of active surveillance of small renal masses (SRM) as a treatment option. Dr. Alba begins by presenting data that most SRM have low or very low malignant potential. Despite this, SRM are removed routinely without preoperative pathologic diagnosis and Dr. Alba asserts this raises the question of significant overtreatment.

Dr. Alba then addresses metastasis, explaining that risk of metastases is exceedingly low for SRM. She describes a prediction calculator to support personalized-treatment selection and explains that regardless of treatment, the vast majority of patients will die of other causes. She emphasizes overall survival is influenced by patient risk factors.

Dr. Alba addresses quality-of-life issues for patients being treated with active surveillance, including the impact of illness uncertainty. She covers trends in active surveillance before outlining her recommendations, suggesting an initial period of six months to establish a trend. She advises asking patients about fears, concerns, and life events. She points out that active surveillance can be used to delay intervention in patients with competing medical or life issues and delayed intervention is safe.

Dr. Alba concludes by emphasizing that active surveillance is the ultimate nephron-sparing management modality and patients can be managed conservatively with serial imaging. Dr. Alba reminds practitioners that intervention for SRM imposes physical, emotional, mental, and financial burdens on patients and families, and that active surveillance can alleviate many of these concerns.

Conquering the Curve in Peyronie’s Disease

Posted by Ryan P. Terlecki, MD, FACS | Mar 2024

Ryan P. Terlecki, MD, FACS, discusses risks and benefits of Peyronie’s disease treatments, advocating for surgery as a definitive treatment. Dr. Terlecki asserts the condition is poorly understood with a “lot of garbage” in print and online. (e.g., advice not to operate early on, assumptions the injury is from tunical damage, and problematic data on intralesional injections).

From a treatment standpoint, Dr. Terlecki addresses treatment dogma he sees as problematic. He debunks claims for various treatments, like vitamin E, colchicine, Xiaflex, and pentoxifylline, and makes a case against extracorporeal shock wave therapy.

Dr. Terlecki addresses surgery and explains that, for patients with adequate rigidity, plication or grafting is effective. However, patients with inadequate function require inflatable penile prosthesis (IPP) and curvature correction. He cautions against degloving, tunical excision, and plicating for implant cases.

Dr. Terlecki concludes that Peyronie’s patients are often distressed and need clear communication and a realistic understanding of treatment risks and benefits. He calls surgery the gold standard, and says plication should be considered first for potent patients without complex defects.

Focal Cryoablation

Posted by Michael A. Gorin, MD | Mar 2024

Michael A. Gorin, MD, discusses the value of focal cryoablation as a treatment option for prostate cancer in modern practice. He begins by providing a brief overview of negative patient outcomes after whole-gland treatment, and the benefits of subtotal gland treatments in the form of focal ablation therapies like cryoablation and High Intensity Focused Ultrasound (HIFU) therapy.

Dr. Gorin notes that HIFU and cryoablation are the two most commonly used and studied modalities for prostate cancer treatment. He discusses the benefits and weaknesses of focal HIFU, with particular focus on the possibility of incomplete cancer treatment, and compares them to those of focal cryoablation.

Dr. Gorin presents the elements of focal cryoablation which reduce the risk of incomplete treatment. He presents current guidelines and devices for performing focal cryoablation which protect the patient against side effects, like urethral sloughing, which had been previously associated with cryotherapy.

Dr. Gorin concludes by demonstrating the long-term success rate for patients treated using focal cryoablation. He compares the QOL outcomes of focal cryoablation to those of HIFU, and presents a recording of a real focal cryoablation procedure.