Video Archives

FRU Discussion

Posted by Brian J. Flynn, MD | Sep 2024

Brian J. Flynn, MD, and Alan J. Wein, MD, PhD (Hon), FACS, discuss the evolution of functional urology.

In this 16-minute discussion, Dr. Wein emphasizes the holistic approach to functional urology, which encompasses all measures to restore normal bladder function, whether through medication, pelvic floor therapy, or surgery. Of note is his stance against dividing male and female urology, advocating for an integrated approach that addresses dysfunction across genders.

Dr. Wein and Dr. Flynn discuss the overlap between storage and voiding dysfunctions, like stress and urge incontinence, which often coexist. Dr. Wein shares insights on how treating one issue can sometimes alleviate the other, though the relationship remains unclear. He stresses the importance of a unified, simplified approach to diagnosis and treatment.

Other colleagues attending the discussion provided perspective and emphasized collaborative, team-based approaches to functional urology. A urogynecologist highlighted how gynecologists primarily manage female pelvic health and storage issues, while a pediatric urologist underscored the importance of standardized nomenclature and communication across specialties.

Urethral Injuries Related to Pelvic Fractures: Contemporary Approach and Recommendations

Posted by Reynaldo Gomez, MD, FACS | Sep 2024

Reynaldo Gomez, MD, FACS, covers two key aspects of reconstructive surgery for pelvic fracture-related urethral injuries (PF UIs): the timing of reconstruction and refinements in surgical techniques. In this 10-minute presentation, Gomez first addresses the mandatory three-month waiting period before reconstruction, noting that this time frame can be shortened in certain cases. The second part of the talk addresses refinements in the surgical technique, emphasizing the importance of preserving bulb arteries during reconstruction to avoid ischemia.

Posterior Stenosis – Post-Radiation or Anti-BPH Procedures

Posted by Dmitriy Nikolavsky, MD | Sep 2024

Dmitriy Nikolavsky, MD, discusses urethral stricture and stenosis management following radiation and anti-BPH procedures, highlighting surgical challenges, outcomes, and the evolution of treatment strategies.

In this 11-minute presentation, Nikolavsky explores the differences in stricture occurrence across treatment types. Surgical approaches are tailored based on oncologic status, patient preference, and local tissue health. Buccal mucosal grafts for dorsal urethroplasty are highlighted as a promising technique. Notably, dorsal-only urethroplasty has demonstrated comparable success to EPA with a lower incidence of postoperative incontinence.

Dr. Nikolavsky emphasizes the difficulties of traditional excision procedures in radiated fields, proposing dorsal-only urethroplasty as a better alternative due to its minimal disruption of adjacent structures. He shares evidence from multi-institutional studies that support its efficacy.

With a call to challenge established dogmas, Nikolavsky underscores the need to refine guidelines and expand the use of innovative approaches like dorsal urethroplasty to improve patient outcomes.

Telesurgery for Prostate Cancer: Where Are We in 2024? – This Is a Novel Topic and Gaining Traction Around the World

Posted by David M. Albala, MD | Sep 2024

David M. Albala, MD, explores the future of telesurgery, particularly in prostate cancer, emphasizing the intersection of medicine and technology. Dr. Albala relays a history of robotic surgery, beginning in the 1980s with the development of the Da Vinci Robotic System, and the Lindbergh operation in 1991.

In this 14-minute presentation, Dr. Albala highlights the importance of telesurgery in leveling global healthcare disparities. He also notes the successful implementation of telesurgery in urological procedures, such as prostatectomies and partial nephrectomies.

Despite the technological advancements, challenges persist, including economic constraints, patient awareness, and resistance to adoption. The presentation underscores the need for reliable and secure systems and robust training programs to ensure the safe implementation of telesurgery.

Cardiometabolic Health for Men with Advanced Prostate Cancer: Lessons Learned and Future Directions

Posted by Andrew W. Hahn, MD | Sep 2024

Andrew W. Hahn, MD, addresses cardiometabolic health in men with advanced prostate cancer, focusing on the impacts of hormone therapy and strategies for managing cardiovascular risks.

In this 10-minute talk, Dr. Hahn highlights the common overlap of prostate cancer and cardiometabolic risk factors and underscores the necessity of evaluating cardiovascular risk in prostate cancer patients. He reviews data indicating that androgen deprivation therapy (ADT) can indirectly increase cardiovascular risks by altering body composition and intensifying metabolic syndrome. Adding androgen receptors nearly doubles cardiovascular event risk. Despite FDA advisories, guidelines, and the availability of cardiovascular risk assessments, many patients undergoing ADT lack appropriate cardiovascular monitoring.

Dr. Hahn highlights future directions in identifying men at heightened risk for cardiovascular events using imaging and genomic biomarkers. Promising approaches include myocardial perfusion PET scans and exploring genomic markers that correlate with cardiovascular toxicity in hormone therapy. Managing cardiometabolic health in advanced prostate cancer requires careful risk assessment and personalized approaches. Biomarkers are needed to effectively predict cardiovascular complications from hormone therapy.