Video Archives

Androgen Society 3rd Annual Meeting Review (Day 2)

Posted by Abraham Morgentaler, MD, FACS | May 2021

Abraham Morgentaler, MD, FACS, Associate Clinical Professor of Urologic Surgery at Harvard University, reviews the second day of the 3rd annual meeting of the Androgen Society, an international organization consisting of healthcare professionals interested in testosterone deficiency and its treatment. The day began with presentations on testosterone therapy and type 2 diabetes by Gary Wittert, MD, Hugh Jones, MD, and Farid Saad, MD. These presenters suggested that testosterone could lead to remission of diabetes mellitus, potentially prevent diabetes, and improve glycemic control. They were followed by a presentation on testosterone, anemia, and hematocrit by Sudarshan Ramachandran, PhD, one on COVID-19 and testosterone by Mary Samplaski, MD, and a panel discussion on testosterone’s impact on prostate cancer. Mohit Khera, MD, presented on the possibility of testosterone therapy performing a protective and/or therapeutic role against prostate cancer. Sharon Parish, MD, and Leah Millheiser, MD, presented on testosterone therapy for women and how it benefits sexual function. The day concluded with a presentation by Daniel Kelly, MD, on the complex, context-dependent relationship between testosterone and atherosclerosis.

Transrectal mpMRI Fusion Biopsy

Posted by Leonard S. Marks, MD | May 2021

Leonard S. Marks, MD, Professor and inaugural holder of the deKernion Chair in Urology at the David Geffen School of Medicine at the University of California, Los Angeles, shares lessons from the first decade of transrectal multiparametric (mp) MRI fusion prostate biopsy at UCLA. Dr. Marks explains that while fusion biopsy of the prostate has been available since 2009, the AUA only endorsed it in 2020, and very few institutions have as much experience with it as UCLA, which assembled a multidisciplinary team for its first Artemis fusion biopsy unit in 2010. Dr. Marks follows this history with a brief summary of the fusion biopsy process, emphasizing the importance of having quality MRI and involving a radiologist and a pathologist, and noting that UCLA’s system is so efficient that they are able to perform approximately 15 of these procedures per week. He then goes over key lessons the UCLA team has learned from its first 4,000 fusion biopsies, which include: (1) targeted sampling of MRI lesions using PI-RADS is necessary; (2) systematic sampling is important for finding invisible lesions; (3) tracking of prior biopsy sites is extremely helpful in detecting upgrades; (4) MRI lesions do not necessarily indicate what the pathology is; and (5) fusion biopsy provides better security than ultrasound biopsy in predicting final pathology . Dr. Marks concludes by remarking on the advantages of the transrectal versus the transperineal approach, arguing that sepsis is easily preventable, patients find the transrectal approach more comfortable, and transrectal fusion systems are more mature.

Seeing Your Last Patient On Time

Posted by Neil H. Baum, MD | May 2021

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses scheduling in a urology practice, with the goal of seeing the last patient on time. He provides six suggestions for maintaining on-time appointments. Dr. Baum stresses the importance of doing so by noting that sitting in the waiting room or exam room for a long time can increase patient anxiety and reduce their overall satisfaction. For the practice, delayed appointments create stress for staff and can increase overtime expenses. Dr. Baum suggests physicians rethink the “waiting area” as the “reception area,” and encourages physicians to make a commitment to be on time each day. He also recommends managing appointment types based on the estimated time each will take. Follow-up visits to check BPH or testosterone deficiency may only require five minutes, but a new patient or new diagnosis is likely to require a 30-minute appointment. Dr. Baum adds that doctors should not accept meetings with pharmaceutical representatives or vendors while patients are present, nor is it acceptable to make or accept phone calls while in the exam room with a patient. Finally, he notes the value of rewarding staff if they help manage an efficient schedule.

Mycoplasma and Ureaplasma Molecular Testing Does Not Correlate with Irritative or Painful Lower Urinary Tract Symptoms

Posted by A. Lenore Ackerman, MD, PhD | May 2021

A. Lenore Ackerman, MD, PhD, Director of Research for FPMRS in the Department of Urology at the University of California, Los Angeles, shares data from her research group evaluating diagnostic testing patterns for ureaplasma and mycoplasma and characterizing the associations of these bacteria with irritative lower urinary tract symptoms (LUTS) using molecular detection techniques. Dr. Ackerman explains the context and rationale for the study and reviews how it illustrates Robert Koch’s postulates. She also addresses topics such as how physicians should approach LUTS in culture-negative patients, the significance of the bacteria detected through new sensitive methods, and whether symptoms are proof of infection or if they could be related to something else. Ultimately, she concludes with two main points: that the physician’s focus should be on treating the patient, not on treating a test; and that not all bacteria are bad, as some healthy genitourinary commensal bacteria play an important role in preventing urinary tract infections.

Androgen Society 3rd Annual Meeting Review (Day 1)

Posted by Abraham Morgentaler, MD, FACS | May 2021

Abraham Morgentaler, MD, FACS, Associate Clinical Professor of Urologic Surgery at Harvard University, reviews the first day of the 3rd annual meeting of the Androgen Society, an international organization consisting of healthcare professionals interested in testosterone deficiency and its treatment. Dr. Morgentaler notes that the day began with a presentation on the history of testosterone by Dr. Nieschlag, followed by a presentation by Drs. Ethan D. Grober and Michael S. Irwig on transgender men and the physical impact of testosterone. Dr. Morgentaler then reviews a panel discussion that covered the use of free testosterone, erythrocytosis management, and the role of testosterone therapy and PDE5 inhibitors in men with erectile dysfunction and low testosterone. He goes on to summarize presentations by Drs. E. David Crawford and Omer Raheem which covered the use of androgen deprivation therapy (ADT) in local disease, biochemical failure, and advanced disease, as well as the sexual effects of testosterone. Dr. Crawford presented data showing that there is value in having a testosterone level below 20 nanograms per deciliter, and Dr. Raheem discussed a study that found that different forms of ADT should be used depending on patients’ cardiovascular issues. Dr. Morgentaler concludes by considering new testosterone formulations, including testosterone undecanoate, an oral soft gel, and injectables.