Latest Videos

Fusion Biopsy Technologies and Techniques

Fusion Biopsy Technologies and Techniques

Posted by | Apr 2024

Peter A. Pinto, MD, discusses the evolution of prostate cancer biopsy and imaging techniques in the past twenty years, from blind systematic biopsies to MRI-ultrasound fusion biopsies. He begins by noting that prostate cancer was the only solid-organ tumor diagnosed without image guidance going into the 21st century.

When MRI was introduced as an imaging modality for prostate cancer diagnosis, urologists developed several different techniques for incorporating MRI into biopsy procedures. Dr. Pinto briefly covers the history and development of in-bore biopsies, cognitive fusion biopsies, and MRI-ultrasound fusion biopsies.

He concludes with reviewing the currently available devices in this space. He evaluates each system as it relates to biopsy needle targeting route, tracking and navigation, MRI-ultrasound fusion opportunities, ultrasound image acquisition, and biopsy fixation.

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Practical Steps for Clinical Efficiency Relative to Physician Burnout

Practical Steps for Clinical Efficiency Relative to Physician Burnout

Posted by | Apr 2024

Ryan P. Terlecki, MD, FACS, offers actionable steps to keep a clinical practice efficient in the face of the epidemic of physician burnout. In this presentation, he discusses how the first step in keeping an efficient and effective practice is to develop a familiarity with:

The Differences Between Efficiency and Effectiveness
The Role of Planning, Consistency, and Reevaluation in Quality Improvement
Management Strategies Which Prioritize Workflow and Well-Being

Dr. Terlecki frames burnout management around a few key principles for efficient and effective clinical practice. He provides real-world examples and applications of these steps to combat and compensate for physician burnout in both practice and academic settings.

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Treatment of Male Stress Urinary Incontinence

Treatment of Male Stress Urinary Incontinence

Posted by | Apr 2024

Brian S. Christine, MD, provides guidance on the assessment and treatment of stress urinary incontinence (SUI) after radical prostatectomy. Dr. Christine begins by discussing the pelvic support changes that happen in men post-prostatectomy, the relationship between the loss of pelvic support and incontinence, and the different mechanisms behind moderate and severe SUI.

Dr. Christine encourages urologists to assess each post-prostatectomy patient presenting with SUI symptoms using a thorough work-up to determine SUI mechanism and severity, an awake cystoscopy to visualize the function of the external sphincter, and a Standing Cough Test. He explains that these three steps in SUI assessment allows the attending physician to ensure that the treatment will match the severity and mechanism of the patient’s incontinence.

He then explores the process of selecting the optimal treatment between the two principal surgical options for treating male SUI: the male sling and the artificial urinary sphincter. Dr. Christine reiterates the importance of tailoring the therapy based on the information gathered during the assessment, and advises urologists to visit surgeon educators on-site and develop their surgical placement skills.

Dr. Christine concludes by exploring the treatment of recurrent SUI in men who have been previously treated for SUI. He provides guidance on treating men with a prior male sling and men with a malfunctioning or affected artificial urinary sphincter.

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The Modern (Overlapping) Relationship Between Active Surveillance and Focal Therapy

The Modern (Overlapping) Relationship Between Active Surveillance and Focal Therapy

Posted by | Apr 2024

Mark Emberton, MD, FRCS, discusses the overlap between active surveillance and focal therapy in modern prostate cancer treatment. He begins by arguing that the proliferation of MRIs, which can accurately identify previously non-visible lesions, makes active surveillance unviable as a default treatment, emphasizing the survival rates of patients on active surveillance.

Dr. Emberton then presents an example case of a patient presenting with a lesion and the options physicians have for treatment. He compares the risks and benefits of treating the patient with focal therapy or monitoring the patient with active surveillance.

Dr. Emberton concludes by addressing the role of patient choice in prostate cancer treatment. He notes that informed patients tend to prefer treatment over surveillance, with little to no long-term regret about the decision. Patients opting for active surveillance over focal treatment tend to regret their decision not to treat the lesion earlier.

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Deciphering Options for Testosterone Replacement Therapy and Managing Withdrawal

Deciphering Options for Testosterone Replacement Therapy and Managing Withdrawal

Posted by | Apr 2024

Jesse N. Mills, MD, discusses the importance of testosterone replacement therapy and presents an algorithm for determining treatment and managing withdrawal. He begins with an overview of the history of the study of testosterone, from the first recorded effects of castration to the warning against the over-prescription of testosterone therapy issued in 2015 by the FDA.

Dr. Mills discusses the AUA guidelines for testosterone replacement therapy and the lack of on-label options for treatment. He presents options for on-and-off-label testosterone replacement therapy.

Dr. Mills then presents an algorithm for determining the best treatment option for the patient, beginning by addressing male fertility concerns. He addresses questions of lab work, transference, insurance, administration, and other patient and physician concerns.

Dr. Mills concludes with the discontinuation of testosterone replacement therapy and when it is indicated. He discusses the available options for weaning patients off of testosterone, cautioning strongly against abrupt discontinuation.

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