Video Archives

Adjuvant Treatment for Recurrent Urethral Strictures: Optilume Drug-Coated Balloon (DCB)

Posted by Salvatore Micali, MD | Jul 2023

Salvatore Micali, MD, discusses the treatment of recurrent anterior urethral strictures using the Optilume drug-coated balloon. Dr. Micali provides a brief overview of urethral strictures, emphasizing anterior urethral strictures, their causes and recurrence, and their impact on patient QoL.

Dr. Micali touches on the two best-known treatments for urethral strictures, endoscopic urethrectomy by the Sachse method and urethroplasty. He notes that recurrence of urethral strictures is less likely in patients who underwent urethroplasty, but that patients prefer the minimally-invasive endoscopic urethrectomy.

To combat recurrent anterior urethral strictures, Dr. Micali examines the Optilum drug-coated balloon (DCB) in combination with endoscopic urethrectomy. He explains the advantages of using an anti-proliferative drug-coated balloon to dilate the urethra after an endoscopic urethrectomy in order to prevent recurrent strictures.

Dr. Mical concludes by guiding the audience through a study comparing patients treated with the Optilum DCB versus patients treated with only an endoscopic urethrectomy over one year. He includes video demonstrations of the Optilume DCB operation.

Clinical Update on PSMA Diagnostics and Therapies

Posted by Phillip J. Koo, MD | Jul 2023

Philip J. Koo, MD, discusses the current status of PSMA PET and its role in the diagnosis, treatment, and management of prostate cancer. Dr. Koo highlights the uses of PSMA PET in patients with initial diagnosis, biochemical recurrence, and oligometastatic disease, and the variety of radiopharmaceuticals available for theranostic treatment of patients.

Dr. Koo emphasizes the evolving landscape of prostate cancer staging, with PSMA PET only being appropriate to use at certain stages. Dr. Koo concludes that PSMA PET, while not yet ready for “Prime Time,” is a powerful tool in prostate cancer management, poised to shape the future of diagnosis and patient care.

Common Drug-Induced Sexual Dysfunction in Men

Posted by Maria Uloko, MD | Jul 2023

Maria Uloko, MD, discusses symptoms, causes, and treatments of post-finasteride syndrome (PFS) and post-SSRI sexual dysfunction (PSSD) in men. She begins by defining PFS, noting its controversial status in urology. Dr. Uloko outlines PFS symptoms, including depression, suicidality, and anxiety. She explains that these psychiatric symptoms often worsen when medical professionals dismiss them as results of finasteride use.

Dr. Uloko then considers the incidence of PFS, emphasizing the need to study PFS in the treatment of male pattern hair loss and highlighting the NIH’s inclusion of PFS in its 2015 list of Rare and Genetic Diseases. She discusses how 5-alpha-reductase inhibitors cause PFS, later evaluating the results of androgen deprivation in animal models as well. This leads Dr. Uloko to highly recommend validating patient concerns. She completes her discussion of PFS by advocating for a biopsychosocial approach to treatment, noting the importance of medication cessation and educating patients.

Dr. Uloko proceeds by discussing PSSD in men. She first reviews PSSD and its symptoms, noting that the prevalence of persistent sexual side effects following SSRI discontinuation is unknown. She lists common SSRIs and explains their use in treating depression and premature ejaculations. Dr. Uloko then discusses how discontinuation of the drug can increase serotonin activity. She explains how serotonin negatively affects sexual factors, signaling PSSD’s mechanism of action. Dr. Uloko transitions into a discussion on the pathophysiology of PSSD and explores the debate surrounding this topic. She then focuses on PSSD treatment, proposing that urologists utilize a biopsychosocial approach and address correctable factors. She concludes her discussion by emphasizing the need for patient validation and further research on PFS and PSSD.

Molecular Imaging

Posted by Andrei H. Iagaru, MD, FACNM | Jul 2023

Andrei H. Iagaru, MD, FACNM, discusses the roles of nuclear medicine modalities, prostate-specific membrane antigen (PSMA), and theranostics in the treatment of prostate cancer. He notes that three specific modalities – PET/MRI, PET/CT, and SPECT/CT – can all contribute to the prostate cancer treatment process. Dr. Iagaru explains the tracer principle in nuclear medicine and describes the PET/MRI and PET/CT modalities, noting that PET/MRI is useful in the early stages of prostate cancer. He describes the replacement of PET/MRI with PET/CT in later prostate cancer stages, followed by the application of SPECT/CT.

Dr. Iagaru then reviews the importance of PSMA and its aid in identifying clinically significant prostate cancer. He cites data on PSMA use for biopsy guidance and high-intensity focus ultrasound while also referencing studies showing value in patients with high-risk prostate cancer undergoing PSMA PET/MRI before prostatectomy. He then reviews PSMA at biochemical recurrence, citing the CONDOR study and a study from Stanford University, the latter of which found a 65% positive 18F-DCFPyL PET/CT scan rate among patients with prostate-specific antigen (PSA) under 0.5.

Dr. Iagaru stresses the importance of modern scanners, highlighting the inability of 20-year-old scanners to track PSA under 0.5. He then demonstrates the use of PSMA theranostics in prostate cancer treatment by explaining diagnostic and therapy compounds, highlighting VISION trial results and subsequent approval of the 177Lu-PSMA-617 therapy. Dr. Iagaru refers back to SPECT/CT use and emphasizes its capabilities in post-treatment evaluation and theranostic considerations. He concludes with praise for nuclear medicine advancements in the treatment of prostate cancer, signaling the reality of personalized medicine thanks to molecular imaging, theranostics, and new data.

Nonverbal Communication

Posted by Neil H. Baum, MD | Jul 2023

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses 14 practical tips to enhance body language skills for stronger connections and improved patient care. Drawing from his vast experience, Dr. Baum highlights the remarkable correlation between effective communication skills and enhanced patient satisfaction scores, improved compliance, and potentially superior outcomes. He underscores the fact that a significant portion of human interaction is conveyed through nonverbal means, emphasizing the crucial role of body language in conveying genuine emotions and establishing a profound connection with patients.

Throughout the presentation, Dr. Baum provides practical advice to healthcare professionals, cautioning against common distractions such as diverting attention to computers or cell phones during patient encounters. Dr. Baum highlights the impact of simple yet powerful gestures like smiling and employing a firm handshake. By emphasizing the importance of respecting personal space, healthcare providers can also create a comfortable and secure environment for patients. By implementing the suggested tips, practitioners can enhance their ability to connect with patients, foster trust, and ultimately improve the doctor-patient relationship, resulting in more positive healthcare experiences for all parties involved.