International Functional and Reconstructive Urology Update Archives

Non-Invasive Therapies for OAB

Posted by Janine L. Oliver, MD | Sep 2024

Janine L. Oliver, MD, focuses on updated treatment approaches in non-invasive therapies for overactive bladder (OAB). In this 9-minute presentation, Oliver discusses abandoning the previous step-therapy model and now highlights a broader range of non-invasive options.
Oliver discusses the new guideline category of non-invasive therapies requiring active patient participation. Of particular interest are stimulation therapies such as transcutaneous tibial neuromodulation (TTNS) and magnetic stimulation, which offer non-invasive, at-home treatment options. While non-invasive therapies remain crucial in OAB management, Oliver emphasizes the need for more research into these novel approaches. These therapies hold promise but require further exploration to optimize patient outcomes.

Overview of Axonics SNM Therapy: A Community-Based Perspective

Posted by Matthew C. Ercolani, MD, FACS | Sep 2024

Matthew C. Ercolani, MD, FACS, highlights the importance of sacral nerve modulation (SNM) in treating patients with urinary and fecal incontinence, particularly in rural or community-based settings where access to tertiary care is limited. In this 10-minute presentation, Ercolani, a robotic cancer surgeon, emphasizes that while SNM has been available since 1997, many patients remain unaware of its benefits. He considers SNM especially useful in remote areas, as it provides long-term relief for patients without requiring frequent follow-up.
Dr. Ercolani reviews the procedure for SNM therapy, emphasizing the importance of precise surgical techniques. He provides suggestions for the most successful implantation procedure, including fluoroscopy, proper lead placement, and doctor education on sacral anatomy. The presentation also underscores the importance of comprehensive clinical support, which ensures patients understand how to manage their devices post-surgery.

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.