Video Archives

Implantable Tibial Nerve Stimulators. Where Do They Fit in Advanced OAB Paradigm?

Posted by Christopher P. Smith, MD, MBA, MSS | Oct 2024

Christopher P. Smith, MD, MBA, MSS, explores the evolution and current advancements in tibial nerve stimulation for treating bladder dysfunction. He begins this 19-minute presentation with a brief history of percutaneous tibial nerve stimulation (PTNS), underscoring its utility in bladder disorder management.

Smith introduces two significant implantable devices, Valencia’s eco, and the Ravi system. Both devices provide customizable treatment and cater to patient preferences, though they differ in implantation methods and patient autonomy over therapy. While these devices offer innovative treatment for urge urinary incontinence, compliance remains a challenge, often due to the time commitment and multiple visits required. Dr. Smith also references the Titan implant by Medtronic, which, while not yet FDA-approved, promises quick activation post-implant and a potential solution to compliance issues.

Dr. Smith reports recent guidelines from the AUA and SUFU now classify these therapies as “minimally invasive,” encouraging earlier intervention, even without exhausting all conventional therapies. The expectation is that new guidelines may support a broader acceptance and earlier access to minimally invasive options, ultimately improving tailored patient care in managing bladder dysfunction.

Female Urethra Stricture Disease: Evaluation and Surgical Management

Posted by Oluwarotimi S. Nettey, MD, MHS | Oct 2024

Oluwarotimi S. Nettey, MD, MHS, discusses the complexities of female urethral stricture disease, which, although less common than in men, often goes underdiagnosed due to its non-specific symptoms and rarity.

In this 18-minute talk, Dr. Nettey shares this disease often coincides with lower urinary tract symptoms. While its exact causes are largely idiopathic, medical procedures like catheterization, radiation, and surgeries, as well as conditions like vaginal atrophy in postmenopausal women, can increase the risk.

Diagnosis typically involves cystoscopy, with additional imaging options providing insights into stricture location and bladder morphology. Uroflowmetry and video urodynamics offer further understanding of urinary dynamics, helping tailor treatment approaches. Non-surgical management includes vaginal estrogen and corticosteroids.

Nettey shares that endoscopic dilation is a first-line treatment but has diminishing returns with repeated procedures, while open surgical repair becomes essential in complex cases. She underscores the need for individualized management and referrals to reconstructive specialists for challenging cases, emphasizing the importance of a methodical approach in addressing this underrecognized condition.

Current Management of T1 High Grade Bladder Cancer

Posted by Frances M. Alba, MD | Oct 2024

Frances M. Alba, MD, discusses the management of T1 high-grade bladder cancer, focusing on cases that recur following BCG therapy.

In this 14-minute talk, Dr. Alba introduces the case of a 53-year-old male with T1 high-grade bladder cancer who underwent a complete six-week BCG course but experienced recurrence within ten weeks. Dr. Alba notes that BCG failure is not uncommon, with the term “BCG unresponsive” now used to describe persistent or recurrent disease within defined timeframes after adequate BCG treatment. In these patients, continued BCG is seldom effective.

Alba highlights the AUA guidelines for these patients, recommending cystectomy as the best chance to prevent disease progression. Despite its efficacy, only a quarter of urologists in the US recommend cystectomy for BCG-unresponsive cases, with many preferring intravesical chemotherapy. Gemcitabine-docetaxel combination therapy shows promise. Alba also shares additional options, such as nadofaragine, pembrolizumab, and novel therapies, including N-803.

Management of Renal Injuries: An Evidence-Based Approach

Posted by Michael Coburn, MD, FACS | Oct 2024

Michael Coburn, MD, FACS, delves into the complexities of kidney trauma management, emphasizing the challenges associated with limited high-level evidence and reliance on expert consensus.

In this 26-minute presentation, Coburn reflects on decades of experience in urologic trauma. Guidelines for trauma have seen revisions, with updates in 2017 and 2020 by the AUA and more forthcoming. He sees a shift towards non-surgical management in hemodynamically stable patients, reflecting a growing emphasis on observation rather than immediate intervention. He shares images illustrating different levels of renal injury.

Coburn relates that follow-up imaging is advised for high-grade injuries to monitor for hematoma expansion, potentially preventing severe complications. Angioembolization has emerged as a valuable tool for controlling bleeding in stable patients, reducing the need for nephrectomy. Specific injuries, such as pseudoaneurysms, often require immediate embolization, while surgical intervention is recommended when substantial kidney tissue is damaged.

Pediatric injuries are highlighted for their unique management needs. Coburn’s presentation concludes with a call for careful patient selection, especially in cases of severe vascular trauma or concomitant visceral injuries, where early intervention can mitigate future complications.

2025 Medicare Part D Changes: Preparing Your Office and Patients

Posted by Mark N. Painter, CPMA, MBS | Oct 2024

Mark N. Painter, CPMA and Michael Burnett, Chief Operating Officer at Kansas City Urology Care, discuss upcoming 2025 Medicare Part D changes and how it will affect urology patients. This 12-minute discussion goes into detail of each new update to Medicare Part D, how it can affect patients who are in need of grants, subsidies or assistance, and how urology practices can aid patients in adopting and taking advantage of these new updates.