Video Archives

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.

New Horizons in Robotic Reconstructive Urology

Posted by Brian J. Flynn, MD | Jun 2023

Brian J. Flynn, MD, discusses the emerging field of robotic reconstructive urology, shedding light on its emergence as a distinct specialty within the medical community.

In this 20-minute presentation, Dr. Flynn covers current trends and perspectives on robotic reconstructive urology from the Society of Genitourinary Reconstructive Surgeons, barriers to adoption, implementation strategies, and practical examples of robotic reconstructive surgery in sacrocolpopexy and vesicovaginal fistula repair.

Recurrent UTIs in Women: Ask the Guideline

Posted by Jennifer T. Anger, MD, MPH | Jun 2023

Jennifer Anger, MD, MPH, discusses American Urological Association (AUA) guidelines regarding recurrent urinary tract infections (rUTIS) in women. She begins by discussing antimicrobial stewardship and the consideration of collateral damage, explaining antimicrobial resistance among uropathogens has increased dramatically in the past 20 years.

Dr. Anger characterizes the index patient for the 2019 rUTI guideline as an otherwise healthy adult female with an uncomplicated, culture-proven rUTI associated with acute-onset symptoms. She summarizes guideline highlights, including the recommendation that clinicians obtain a complete patient history and perform a pelvic examination in women presenting with rUTIs. Additionally, clinicians should obtain urinalysis, urine culture, and sensitivity with each symptomatic acute cystitis episode prior to initiating treatment for rUTIs.

Dr. Anger outlines first-line therapy (nitrofurantoin, TMP-SMX, and fosfomycin) and explains clinicians should use as short a duration of antibiotics as reasonable for rUTI patients with an acute cystitis episode. For patients with urine cultures resistant to oral antibiotics, clinicians may treat with culture-directed parenteral antibiotics for as short a course as reasonable.

Dr. Anger discusses use, dosing, and duration of prophylactic antibiotics and points out that clinicians may offer cranberry prophylaxis for rUTIs, but explains that studies are lacking in this area. Clinicians should repeat urine culture to guide further management when UTI symptoms persist following antimicrobial therapy.

In peri- and post-menopausal women with rUTIs, clinicians should consider vaginal estrogen therapy to reduce the risk of recurrence. Dr. Anger then highlights the 2022 UTI Guideline Update and explains randomized, controlled trials that contributed evidence to this amendment report.

Case Discussion: Early Detection of Prostate Cancer

Posted by Thomas E. Keane, MD | Jun 2023

Thomas E. Keane, MD, leads a discussion with Dr. Kader and Dr. Crawford concerning the case study of a 63-year-old patient presenting with increasing PSA levels. The panel navigates through the various considerations and next steps in patient management, with an emphasis on personalized care in prostate cancer management.

After reiterating the importance of gathering comprehensive medical history and meticulously examining the patient’s PSA history, the panel discusses the range of options available, including ordering further tests such as blood or urine tests, an MRI, or even performing a biopsy. The panel explores the complexities behind treatment decision-making, emphasizing the need to carefully weigh the risks and benefits of each approach.

Drawing upon their vast experience, the panel discusses the significance of risk calculators in evaluating the patient’s condition. While these tools provide valuable insights, the panel underscores their limitations, emphasizing the need for continued research and refinement. Additionally, they explore the emerging role of MRI in detecting high-grade prostate cancer, emphasizing the importance of standardized and high-quality interpretation to ensure accurate diagnoses.