Video Archives

Guidelines and Practical Applications: Artificial Urinary Sphincter

Posted by William O. Brant, MD, FACS, FECSM | Jul 2023

William O. Brant, MD, FACS, FECSM, reviews the 2018 American Urological Association (UAU) guidelines and practical approaches in erectile dysfunction (ED) evaluation, diagnosis, and treatment. He examines methods for evaluation and diagnosis, highlighting the psychological impacts of ED and ED’s connection to cardiovascular disease. Dr. Brant also explores specialized tests and multiple treatment options.

Dr. Brant examines other treatment modalities, such as the vacuum erection device, as a low-cost adjunct treatment. He discusses the intraurethral suppository treatment and warns that up to 30 percent of patients experience urethral pain with this option. Dr. Brant then explains the risks of injection options and surgery. He also analyzes the practicality and commitment inherent in penile prostheses, later transitioning to a discussion on the uncommonly performed arterial reconstruction option.

Multidisciplinary Approach to the Management of Advanced Prostate Cancer

Posted by Daniel P. Petrylak, MD | Jul 2023

Daniel P. Petrylak, MD, discusses the benefits of a multidisciplinary approach for prostate cancer survival rates and increased clinical efficiency. He emphasizes the need for a prostate cancer management approach involving urologists, medical oncologists, radiation oncologists, and primary care physicians, with references to nutritionists, mental health professionals, and pain management experts.

Dr. Petrylak highlights existing SEER data results, indicating that men with locally advanced and high-risk prostate cancer experience better outcomes when treated with a multidisciplinary approach. He also reviews the University of Colorado’s data on multidisciplinary teams, noting an increased survival rate at each stage of prostate cancer when compared with regional and state data.

Dr. Petrylak then analyzes the benefits of a multidisciplinary approach for other disease states, including optimized patient outcomes, increased access to specialty therapies, more efficient clinician and patient scheduling, better care coordination, and improved communication. Dr. Petrylak concludes by offering considerations pertaining to healthcare challenges, and advocating for a multidisciplinary approach.

PCNL: Obtaining Access and Preventing Infection

Posted by Benjamin K. Canales, MD, MPH | Jun 2023

Benjamin K. Canales, MD, MPH, discusses Percutaneous Nephrostolithotomy (PCNL), how to mitigate the risk of SIRS and sepsis associated with the operation, and various techniques used to perform the PCNL. In this presentation, Dr. Canales discusses, the importance of prophylactic antibiotics in infection prevention and mitigation, the history of PCNL, the risks and benefits of various sites for obtaining renal access, and the pros and cons of the known techniques for performing PCNL.

Testosterone Update on Oral Products

Posted by T. Mike Hsiech, MD, MBA | Jun 2023

T. Mike Hsieh, MD, MBA, provides an update on available oral testosterone treatments, beginning by explaining that oral testosterone is a large and growing market and outlining the development testosterone therapy over recent decades. Dr. Hsieh hones in on the three therapies most recently approved by the U.S. Food and Drug Administration (FDA), all of which are oral testosterone therapies (Jatenzo, Tlando, and Kyzatrex).

He cites a study of Oral Testosterone Undecanoate in Hypogonadal Men, which led to the approval of Jatenzo. Dr. Hsieh then addresses Tlando, and explains the study behind its approval, which found the treatment’s efficacy was 80 percent, exceeding the FDA threshold of 75 percent. He then addresses Kyzatrex, a gelatin capsule that uses a SEDDS formulation (phytosterol esters that form microemulsions in gastrointestinal fluids, allowing oral dosing of poorly-soluble drugs). As far as clinical efficacy, Kyzatrex well exceeded the FDA threshold, with 96 percent of patients achieving testosterone levels in the therapeutic range after 90 days of treatment.

Dr. Hsieh explains that, unlike Jatenzo, Tlando and Kyzatrex do not need to be taken with a high-fat meal. With all three medications, blood pressure increase is a possible side effect (though the data on hypertension was more favorable in the Kyzatrex study), and all these treatments carry FDA warnings to that effect.

Dr. Hsieh concludes that there is a wide variety of commercially available testosterone options on the market, with new oral formulations with favorable safety profiles representing exciting new options for patients. He reiterates that blood pressure should always be monitored in patients on oral testosterone.

Implementation of Markers in Clinical Practice

Posted by David S. Morris, MD, FACS | Jun 2023

David S. Morris, MD, FACS, discusses implementation of various markers in screening, diagnosing, and treating prostate cancer in community practice. He discusses the G-Minor (Genomics in Michigan ImpactiNg Observation or Radiation) trial and a retrospective analysis of the STAMPEDE (Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy) trial, wherein certain markers were able to predict both metastasis-free survival and overall survival.