Video Archives

Non-Metastatic CRPC: Finding Advanced Disease with Next Gen Imaging Matters

Posted by Gerald L. Andriole, Jr., MD | Feb 2021

Gerald L. Andriole, Jr., MD, the Robert K. Royce Distinguished Professor and Chief of Urologic Surgery at Barnes-Jewish Hospital, the Siteman Cancer Center, and Washington University School of Medicine in St. Louis, Missouri, defines non-metastatic castration-resistant prostate cancer (nmCRPC) as having rising PSA measurements on three consecutive measurements with a PSA of greater than two. He also defines next-generation imaging as PET scans. He discusses FACBC scans and PSMA-based PET scans, as well as the history and treatment of nmCRPC. Dr. Andriole reviews the SABR-COMET study, the STOMP trial, and the ORIOLE study. He concludes that next-generation imaging is necessary for patients with nmCRPC, that metastasis-directed therapy shows benefits, and that larger and longer trials are warranted.

Best Treatment for Male Incontinence: Sphincter

Posted by Alexander Gomelsky, MD, FACS | Feb 2021

In the second part of this urologic debate, Alexander Gomelsky, MD, FACS, B.E. Trichel Professor and Chair of the Department of Urology at LSU Health Shreveport, argues that artificial urinary sphincter (AUS) is the best treatment for post-prostatectomy stress urinary incontinence. Dr. Gomelsky first describes possible surgical complications and how to set patient expectations, then reviews data on AUS and the male sling, and finally contrasts the benefits of AUS against the sling. In comparison with the sling, which is best used in patients with mild incontinence, AUS can handle any degree of incontinence including severe and persistent presentations. Noting that AUS can also be used in patients who have undergone radical therapy, those with prior urethral stricture or bladder neck contracture, and those who have undergone urethral bulking, Dr. Gomelsky suggests that AUS outperforms the sling in all scenarios. Additionally, data suggests that a sphincter would be placed after a sling failure, further underscoring its utility. Brian S. Christine, MD, argues in favor of using a sling in the first part of the debate here.

Best Treatment for Male Incontinence: Sling

Posted by Brian S. Christine, MD | Feb 2021

In the first part of this urologic debate, Brian S. Christine, MD, Director of Prosthetic Urology and Men’s Sexual Health at Urology Centers of Alabama in Birmingham, argues that the sling is the best treatment for post-prostatectomy stress urinary incontinence in men. He goes over how to select the right candidates for a sling, the pre- and post-operative procedural steps, and the resulting success rate. Dr. Christine notes that slings are best used in patients with mild to moderate stress urinary incontinence as determined by a severity grading system. He considers two options for determining incontinence severity, the pad test and the standing cough test, observing that the latter is preferable given that it is done in-office versus by the patient at home. Dr. Christine then provides a detailed explanation of the surgical steps and technique using an AdVance XP male sling. He concludes that the sling, when used on the ideal candidate with a standing cough test grade of 0, 1, or 2, results in a post-operative success rate of 82-83% of patients who are dry or pad-free. Alexander Gomelsky, MD, FACS, argues in favor of using an artificial urinary sphincter in the second part of the debate here.

Genital Reconstruction After Massive Tissue Loss

Posted by Maxx A. Gallegos, MD | Feb 2021

Maxx A. Gallegos, MD, Director of Reconstructive Urology at the University of New Mexico Health Sciences Center in Albuquerque, New Mexico, presents on genital reconstruction after patients have suffered massive tissue destruction. He addresses the epidemiology and etiology of genital tissue destruction, as well as the physiology of healing. Though rare, there are many possible ways a person can experience loss of genital skin, including burns, necrotizing fasciitis, lymphedema, self-mutilation, and sclerotic conditions. The incidence of necrotizing fasciitis is also rising, likely due to increased incidence of diabetes in the United States population. As primary intention healing is not a viable option in these severe cases, Dr. Gallegos recommends secondary intention techniques, such as grafts and fasciocutaneous flaps. Dr. Gallegos then presents several case studies, including four patients with Fournier’s gangrene, a patient with stab wounds, and a patient with lymphedema. He concludes by describing his postoperative process and how frequently patients should return for wound checks.

Can You Drive a Stick? Prevention and Management of Bleeding During Minimally Invasive Renal Surgery

Posted by Richard E. Link, MD, PhD | Feb 2021

Richard E. Link, MD, PhD, Professor of Urology and the Carlton-Smith Endowed Chair in Urologic Education at the Baylor College of Medicine, discusses techniques for preventing and managing bleeding during renal surgery, emphasizing the importance of maintaining laparoscopic surgery skills that have eroded with the increased use of robotic surgery. He explains that major bleeding complications can occur during abdominal access, critical dissection steps, or during exit from the abdomen, and surgeons need to be prepared with the correct tools and skills. Dr. Link presents a two-phase system for assessing danger and formulating a plan when major bleeding occurs. Phase 1 is short-term damage control, and involves evaluation of blood loss potential, determination of whether the blood is venous or arterial in origin, and a decision on whether the surgeon can handle the bleed laparoscopically with their skill set. Phase 2 is permanent control, and features a reassessment of response to damage control and a decision on whether the bleed can be solved laparoscopically or if the surgeon should facilitate safe open conversion. Adequate assessment is key to proper management. Dr. Link explains that robotic cases should be approached similarly, but emphasizes the importance of good teamwork and being slow and deliberate when there is a bleed during a robotic surgery.