Video Archives

Finding a New Perspective with Locum Tenens

Posted by Neil H. Baum, MD | Jan 2021

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, presents the benefits of locum tenens, a contractual arrangement in which a physician works temporarily in another practice. These work assignments vary in duration and serve several purposes, including to fill vacancies in communities without urologists or to offer a break for a full-time urologist and/or those working in rural communities, who are often on-call 24/7. For doctors, locum tenens can decrease stress and lower the risk of burnout, as well as allowing them to gain experience by working with a new patient population in a different hospital or clinical setting. Semi-retiring urologists may use locum tenens as they transition, and newly-minted practitioners may use such assignments to determine the best practice fit for a permanent position. Dr. Baum touts the financial benefits: such as paid living expenses and travel costs, and possible stipends while on assignment. Additional perks include focusing on clinical work sans office politics, business responsibilities, or paperwork. He concludes with a review of the contract details, drawing attention to key areas such as compensation and malpractice coverage, as well as exclusions like health insurance and retirement.

Active Surveillance Criteria and Follow-up Protocol

Posted by Michael A. Brooks, MD | Jan 2021

Michael A. Brooks, MD, Assistant Professor of Urology and Oncology at Baylor College of Medicine in Houston, Texas, discusses active surveillance and follow-up protocol best practices. In 2020 BCM started integrating MRI Fusion Biopsy into active surveillance protocol using best evidence. Dr. Brooks starts off by discussing the evidence for this new protocol from two different North American cohorts. He looks at MRI fusion biopsy in biopsy naive men, and discusses using MRI fusion biopsy for confirmation. He considers whether we can get rid of diagnostic and confirmation systematic biopsies as they can be replaced by the more accurate MRI fusion biopsy. He continues to discuss how often the biopsy needs to be repeated and special considerations that may need to be made when using this technology. He emphasizes that this is still very new and there are some special scenarios that are under studied. Some of the special scenarios include patients with high volume GG1, patients with GG2, and African American patients. Dr. Brooks also goes over the specific protocols that Baylor College of Medicine follows before discussing some pitfalls of the MRI fusion biopsy using a few case reviews as examples.

High Intensity Focused Ultrasound (HIFU) Ablation in a Salvage Setting

Posted by John H. Jurige, Jr., MD | Jan 2021

John H. Jurige, Jr., MD, HIFU Program Director for the HIFU Center of Excellence in Louisville, Kentucky, discusses high intensity focused ultrasound (HIFU) ablation therapy for patients with radiorecurrent prostate cancer. He explains that this is a difficult subset of patients to treat, since they have very aggressive prostate cancer. Treatment will often fail, so one of the main objectives of treatment in this group must be quality of life preservation through avoidance of treatment morbidity and use of ADT. Focal HIFU is exceptional in this regard, even if its 5-year biochemical failure-free survival rates have historically been comparable to other forms of treatment. Dr. Jurige notes that these outcomes may be improved through better patient selection, and by starting patients on therapy at earlier stages of recurrence. Better patient selection, which can be more readily achieved with the recent improvements to prostate imaging, can also help prevent adverse effects like urethral stricture and rectal fistula. Dr. Jurige concludes by recommending that urologists give patients a full assessment and get all the studies they can before starting them on salvage HIFU after radiation.

Next Generation DNA Sequencing for Genitourinary Implants

Posted by Paul H. Chung, MD | Jan 2021

Paul H. Chung, MD, Assistant Professor and Director of the Division of Reconstructive Urology at the Sidney Kimmel Medical College of Thomas Jefferson University, discusses infection of genitourinary implants and how next-generation sequencing can be used to manage device infection. Presenting his results from a recently published article with the Canadian Journal of Urology, he outlines the methods, outcomes, and recommendations for clinicians, specifically those removing malfunctioning or infected penile prostheses and artificial sphincters. Dr. Chung highlights the benefits of polymerase chain reaction (PCR) and next-generation sequencing (NGS) including faster processing time, greater sensitivity, and the ability to run both fungal and bacterial analysis in the same setting. Additionally, NGS is useful in the selection of perioperative antibiotics and irrigation solutions, as well as determining how to coat devices during implant surgery. Following the presentation, Grand Rounds in Urology editor J. Curtis Nickel, MD, FRCSC interviews Dr. Chung to further discuss the clinical implications of his research. In the conversation, they compare biofilm collection techniques, noting that PCR and NGS are most helpful in a clinical setting, whereas extended culture is useful in a research setting.

A Better Mousetrap: Minimally-Invasive Management of Symptomatic Caliceal Diverticular Stones in the Era of Robotic Surgery

Posted by Richard E. Link, MD, PhD | Dec 2020

Richard E. Link, MD, PhD, Professor of Urology and the Carlton-Smith Endowed Chair in Urologic Education at the Baylor College of Medicine, discusses the pros and cons of different techniques for managing caliceal diverticular stones, a simple problem requiring a complex solution. The presentation aims to provide a framework for the identification and management of this condition since there are not enough high-quality studies to have a definitive strategy. Dr. Link discusses caliceal diverticulum incidence, etiology, and presentation, as well as the specific qualities of stones in caliceal diverticula, noting that stone formation is not caused by the presence of a caliceal diverticulum, but rather by the same metabolic anomalies experienced by other stone formers. He then dissects the different surgical options for treatment, including: extracorporeal shockwave lithotripsy (ESWL), which results in stone-free rates of ≤25% and should only be used in patients who cannot tolerate more effective therapy; ureteroscopic management, which is superior to ESWL but still has low success rates; and percutaneous management, which was the gold standard treatment before the era of robotic surgery, and results in a stone-free rate between 70 and 100%, although it can be a challenging surgery. Dr. Link also discusses laparoscopic diverticulectomy and robotic true partial nephrectomy, more aggressive approaches that may be needed if percutaneous management fails. He concludes with several case studies, emphasizing that treatments should be tailored to individual patients.