Latest Videos Archives

Urologic Perspective on the Current and Emerging Role of Multi-Modality Imaging and Radiogenomics

Posted by Mohummad Minhaj Siddiqui, MD | Feb 2022

Mohummad Minhaj Siddiqui, MD, Associate Professor of Surgery at the University of Maryland School of Medicine and Chief of Urology at the Baltimore VA Medical Center in Redwood, Maryland, discusses the role of precision imaging and genomics in managing localized prostate cancer. He first considers how treatment strategies will vary based on cancer aggressiveness, ranging from active surveillance in low-risk cancer to multimodal treatment in advanced and metastatic cancer. Dr. Siddiqui cites the PROMIS study which stratified risk of significant cancer based on MRI suspicion score of lesions. He points out that even at that high end of the scale, MRI identified cancers in some patients that either had insignificant or no cancer, demonstrating that imaging cannot replace biopsy. Equally important, at the low end of the scale, half of patients have cancer not shown in the scan. Dr. Siddiqui adds that while a scan may not suggest high-risk cancer, this is not the same as not having cancer. He then discusses the growth of genomic profiling in understanding genomic characteristics of prostate cancer. Genomic profiling is available for different stages of prostate cancer workup from susceptibility characterization to disease risk stratification and prediction of treatment response. The GC score in genomic characterization has similar limitations as imaging, leading to the question of whether these two modalities are capturing the same underlying issue or complementing each other. Dr. Siddiqui then describes how he uses imaging in a surgical setting for margin size and extracapsular extension at radical prostatectomy. He concludes that while it is not perfect, advanced imaging can improve risk stratification and assist with cancer staging and treatment planning. Similarly, genomics can also improve risk stratification and can reduce interventions like adjuvant radiation.

Testosterone, Weight Loss / Weight Gain, and Testosterone Replacement Therapy (TRT)

Posted by Mark A. Moyad, MD, MPH | Feb 2022

Mark A. Moyad, MD, MPH, the Jenkins/Pokempner Director of Preventive/Complementary and Alternative Medicine (CAM) at the University of Michigan Medical Center in the Department of Urology in Ann Arbor, Michigan, and Martin M. Miner, MD, Co-Director of the Men’s Health Center and Chief of Family and Community Medicine for Miriam Hospital, and Clinical Professor of Family Medicine and Urology at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, investigate the ways in which body mass index (BMI) correlates with testosterone levels and how this knowledge can be used in a medical setting. Dr. Moyad begins the discussion with Dr. Miner’s presentation on the possibility of testosterone needs increasing as BMI increases, wherein Dr. Miner found that obese men required higher doses of testosterone to reach eugonadal levels than men who were not obese. Dr. Miner states that he expects the results of a long-term safety study of testosterone will soon show that testosterone therapy is safe over the long term, allowing physicians and researchers to focus on the symptomatic benefit of testosterone in areas such as mood and cardiovascular risk. Dr. Moyad asks if weight loss and increased fitness could possibly reduce the need for testosterone therapy, to which Dr. Miner responds that it may be possible if both weight loss and a reduction in comorbidities occur but it is unlikely in patients over 60. They conclude that weight loss can help make testosterone therapy more effective but it is unclear if it would be enough to reduce testosterone therapy altogether because of a multitude of genetic variables.

PCa Commentary | Volume 162 – February 2022

Posted by Edward Weber, MD | Feb 2022

This Commentary gives an update on patient selection and monitoring for prostate cancer active surveillance.

Organizational Mission Statements for Medical Practices

Posted by Neil H. Baum, MD | Feb 2022

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, gives advice on how medical practices can formulate organizational mission statements, and explains why they are important in maintaining a motivated staff. He defines a mission statement as a truth told in advance that tells where a doctor and their practice are going. Dr. Baum then lists reasons why a practice should write a mission statement, explaining that mission statements help patients understand a doctor and their practice, separate a practice from the competition, and can bring patients closer to a practice. He also describes the essential elements of a mission statement, noting that it should contain the physician/practice’s philosophy of patient care and their principle beliefs, should state the practice’s ideals, and should inspire doctors, staff, and patients. Dr. Baum shares his own practice’s mission statement of “commitment to providing the best health care for our patients, to exceeding patients’ expectations regarding their health care, and to attention to the LITTLE details because they make a BIG difference.” He recommends that others do as he has done in his practice and make it so employees and patients regularly see the mission statement by displaying it in the reception area, exam room, and employee lounge, as well as on brochures, newsletters, stationary, websites, and blogs. Dr. Baum follows this with advice on how to craft a mission statement, suggesting that doctors look at mission statements from other businesses, review hospital mission statements, and involve all of the staff and doctors of the practice in the process. He concludes with an example of how his practice’s mission statement helped motivate his staff to pay attention to the little details and better maintain the cleanliness of the practice’s restrooms throughout the day.

The Medical Assessment and Surgical Management of Adrenal Masses for the Practicing Urologist

Posted by Wesley A. Mayer, MD | Feb 2022

Wesley A. Mayer, MD, Associate Professor of Medicine at Baylor College of Medicine in Houston, Texas, discusses how urologists should medically assess and surgically manage adrenal masses. He begins by briefly going over his sources, including the 2016 European Society of Endocrinology Clinical Practice Guideline, the 2011 Canadian Urology Association Guidelines, the 2009 American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Guidelines, material from UpToDate, and the work of Alexander Kutikov, MD, FACS. He highlights the fact that there is no AUA guideline on adrenal masses, as well as very little new guidance in this space. Dr. Mayer suggests that urologists should be more involved in managing adrenal masses since they are surgical experts of the retroperitoneum, familiar with the anatomy and pathophysiology of the kidneys and adrenal gland, and experts at minimally invasive surgery. He then defines the adrenal mass as a >1 cm lesion that can arise from the medulla or cortex. He explains that the majority are discovered incidentally and are called “adrenal incidentaloma,” and advances in modern imaging technology have significantly increased their prevalence. Most adrenal masses are benign lesions but some are not, and Dr. Mayer lists three important questions a urologist should ask to determine risk when confronted with a mass, including whether there are characteristics suggestive of a malignancy, whether the mass is hormonally active, and whether the patient has a history of malignancy. He then summarizes key points in how to evaluate adrenal masses radiologically and metabolically, and discusses when biopsy is necessary. Dr. Mayer follows this with an overview of surgical management, noting that laparoscopic adrenalectomy is standard of care for most masses and open adrenalectomy should be performed if adrenal cortical carcinoma is suspected. He also shows a video of an adrenalectomy for pheochromocytoma. Dr. Mayer concludes by explaining that follow-up is important since some masses will convert to being hormonally active and/or will have concerning growth characteristics.