Video Archives

TURP in 2024

Posted by Granville L. Lloyd, MD | Sep 2024

Granville L. Lloyd, MD, provides a comprehensive overview of therapies for benign prostatic hyperplasia (BPH), focusing on the evolution from medical to procedural interventions. In this 9-minute presentation, he highlights the ongoing development and competition among various technologies, emphasizing procedural therapy over medical management in terms of sexual outcomes. Dr. Lloyd’s presentation describes the wide array of procedural options, including TURP, Rezūm, UroLift, and newer approaches like Optilume.

The economic and clinical burden of BPH is underscored. Dr. Lloyd advocates for a personalized approach to selecting the appropriate therapy, utilizing the best tool available for each patient while acknowledging the evolving role of newer technologies.

Female SUI: Bulking

Posted by Alexandra Rogers, MD | Sep 2024

Alexandra Rogers, MD, focuses on female stress urinary incontinence and treatment options. In this 12-minute presentation, she begins by reviewing updates in the American Urological Association (AUA) guidelines for treatment options.

Dr. Rogers discusses slings, a longstanding treatment since 1998, which remain effective. Rogers also highlights the growing popularity of bulking agents, particularly the polyacrylamide hydrogel approved in 2020, noting its safety and repeatability. As a less invasive alternative that can be performed in an office setting, bulking agents offer an acceptable risk-benefit ratio for many patients, especially those hesitant to undergo invasive procedures.
Rogers discusses the importance of offering multiple treatment options to those with SUI, with a focus on minimizing complications and recovery time.

HoLEP

Posted by Lori B. Lerner, MD | Sep 2024

Lori B. Lerner, MD, delves into the complexities of enucleation techniques for treating benign prostatic hyperplasia (BPH), emphasizing the importance of understanding prostate anatomy. In this 11-minute presentation, she highlights how individual anatomical variations influence surgical decisions and outcomes, particularly in laser enucleation.

Dr. Lerner outlines different approaches to enucleation, involving strategic incisions to address each patient’s specific anatomy. She discusses complex cases, such as patients with a significant portion of their prostate extending into the bladder, nodular prostates, or elevated bladder necks, which necessitate tailored approaches.

Dr. Lerner’s presentation underscores the necessity of careful preoperative imaging, using tools like MRI or CAT scans, to map the prostate’s structure and guide the surgical approach. She advocates against routine excessive testing, emphasizing responsible and targeted use of diagnostic tools to inform clinical decisions without unnecessary expenditure. Lerner also addresses potential complications such as postoperative stress urinary incontinence.

The Battle of Biopsies: Results of a Multi-institutional Randomized Trial of Transrectal vs Transperitoneal Prostate Biopsy

Posted by Mohamad E. Allaf, MD | Sep 2024

In this 21-minute conversation, Mohammed E. Allaf, MD, Johns Hopkins University, Baltimore, Maryland, advocates for a reevaluation of current biopsy practices, suggesting that the transperitoneal approach may offer a safer option for patients, particularly in the context of rising concerns over antibiotic resistance.

Contemporary Management and Prevention of Artificial Urinary Sphincter Erosion

Posted by Jeffrey Loh-Doyle, MD | Sep 2024

Jeffrey Loh-Doyle, MD, provides a detailed analysis of artificial urinary sphincter (AUS) erosion, focusing on its causes, risk factors, management, and prevention. In this 18-minute presentation, Dr. Loh-Doyle examines this complication of the gold standard treatment for moderate to severe male stress urinary incontinence.
Dr. Loh-Doyle stresses the importance of identifying and managing AUS erosion. Patients may present with symptoms such as worsening incontinence, perineal or scrotal swelling, or, in more subtle cases, no symptoms at all. Cystoscopy is necessary to confirm erosion, especially in cases of severe discomfort or urinary retention. He discusses treatment, which involves removing the AUS device, draining the bladder with a catheter, and, depending on the severity of the erosion, repairing the urethra.
Prevention is key, especially in high-risk patients. Loh-Doyle advocates for conservative management, including using lower-pressure balloons, delayed activation, and educating patients on deactivating the device to reduce compressive forces. He also shares that, while AUS is effective, repeated erosions increase the likelihood of poor outcomes.