Latest Videos Archives

Tales from the GME Crypt: Managing Challenging (and Scary) Residency Dilemmas

Posted by Wesley A. Mayer, MD | Nov 2024

Wesley A. Mayer, MD, focuses on effectively managing challenges faced in residency programs, emphasizing remediation strategies over punitive measures. Drawing from his experience as a program director and assistant dean of Graduate Medical Education (GME), Dr. Mayer addresses dilemmas common in residency, outlining a practical approach to navigating issues such as technical skill deficiencies, communication breakdowns, and personal crises among trainees.

In this 20-minute presentation, Dr. Mayer differentiates remediation from probation, advocating for remediation as a supportive, non-reportable process for skill enhancement. The importance of recognizing warning signs, such as poor performance or behavioral changes, is highlighted, stressing early intervention and the role of the GME office in offering support and resources.

Current State of the Art in Bladder-Preserving Trimodality Therapy for Muscle-Invasive Bladder Cancer

Posted by Jason A. Efstathiou, MD, DPhil | Nov 2024

Jason A. Efstathiou, MD, DPhil, FASTRO, FACRO, emphasizes the growing interest in bladder preservation therapies as an alternative to radical cystectomy for muscle-invasive bladder cancer (MIBC). While cystectomy remains an effective treatment, it is not performed in about half of eligible patients. Trimodality therapy (TMT), combining maximal transurethral resection (TUR), chemotherapy, and radiation, offers a promising bladder-sparing approach.

In this 11-minute presentation, Dr. Efstathiou compares outcomes between TMT and cystectomy, showing no significant difference in metastasis-free or cancer-specific survival. A shift toward biomarker-driven management is also highlighted, with specific markers, such as MRE11 and immune signatures, indicating better responses to chemoradiation. Immunotherapy is increasingly integrated into treatment regimens, with promising trials like SWOG 1806 exploring the addition of immune checkpoint inhibitors to chemoradiation.

TMT, now recognized by major guidelines, offers patients a viable option with preserved bladder function, improved quality of life, and less life interference. The presentation stresses the need for improved staging, expanded access to bladder-sparing options, and informed decision-making to optimize outcomes for MIBC patients.

Management of Peyronie’s Disease

Posted by Ayman Soubra, MD | Nov 2024

Ayman Soubra, MD, addresses the treatment of Peyronie’s disease. In this 24-minute presentation, he begins by reviewing the condition, its pathophysiology, and its prevalence. Dr. Soubra also discusses the evaluation of Peyronie’s disease, including a thorough medical history, examination for familial traits (such as Dupuytren’s contractures), and physical examination.

Several treatment options exist, from noninvasive oral and topical therapies to mechanical therapies like vacuum and traction devices. Dr. Soubra discusses intralesional collagenase injections at length. This therapy is FDA-approved based on clinical trials and significantly improves penile curvature. For severe cases, surgical options such as tunical plication or grafting may be necessary, especially for patients with significant deformities or erectile dysfunction. Soubra shares indications and techniques for this procedure in detail.

Dr. Soubra recommends multimodal approaches tailored to the patient’s specific goals and severity of symptoms.

Morcellation and Potential HoLEP Complications

Posted by Amy Krambeck, MD | Nov 2024

Amy E. Krambeck, MD, presents a detailed overview of morcellation and its potential complications, particularly in Holmium Laser Enucleation of the Prostate (HoLEP). In this 14-minute presentation, she explains the technical requirements for performing morcellation.

Dr. Krambeck narrates a video of the procedure’s steps. She highlights how challenging nodules can sometimes require additional laser grooves to enable effective morcellation.

Complications during morcellation are also reviewed. Intraoperative issues include capsular perforations and bladder injuries. Injury to the ureteral orifices, while rare, can occur during morcellation. Dr. Krambeck also discusses postoperative complications and their management, including bleeding, clot retention, and infections such as UTIs or epididymitis. Incontinence, mainly urge incontinence, is another common postoperative issue. However, with proper technique, HoLEP and morcellation present low complication rates and excellent patient outcomes.

Updates on the Imaging for Urothelial Carcinoma

Posted by Desencia E. Thomas, MD | Nov 2024

Desencia E. Thomas, MD, presents an update on imaging techniques for urothelial carcinoma (UC), emphasizing advancements in diagnosis and staging.

In this 18-minute presentation, Dr. Thomas highlights the diagnostic accuracy of CT urography. MR urography provides an alternative for patients unable to tolerate iodine-based contrast or when CT findings are inconclusive. PET imaging, including 18-F FDG PET, excels in detecting distant metastases, but tracers like 11-C acetate and choline help minimize false positives in the urinary tract due to reduced excretion.

Dr. Thomas discusses the role of MRI in bladder cancer staging, where VI-RADS scoring helps distinguish between muscle-invasive and non-invasive cancers. This system, using T2-weighted, diffusion-weighted, and contrast-enhanced sequences, enables precise preoperative staging. Dual-energy CT (DECT) is also emerging, allowing reduced radiation exposure while retaining diagnostic value.

Key challenges include limited imaging sensitivity for early-stage UC and difficulty assessing tumor invasion depth. Dr. Thomas emphasizes that contrast-enhanced ultrasound may assist patients with contraindications to CT or MRI, although it remains less sensitive for upper tract tumors. She stresses that imaging advancements hold promise for improving UC management and minimizing invasive procedures like TURBT.