International Functional and Reconstructive Urology Update Archives

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.

Optilume

Posted by Garrett D. Pohlman, MD | Sep 2024

Garrett D. Pohlman, MD, discusses the Optilume BPH procedure, a novel treatment for benign prostatic hyperplasia (BPH). In this 11-minute talk, Pullman gives step-by-step instructions for the Optilume placement procedure, emphasizing how the treatment can be tailored to individual patients based on prostate size, anatomy, and personal preferences.

Pullman discusses the safety and efficacy of Optilume, as well as data from studies like Pinnacle and Everest. He also shares that the placement procedure can be performed in various settings, including outpatient surgery centers and offices. He asserts that Optilume BPH is a promising, durable, and patient-friendly option for treating BPH.

The Prostatic Urethral Lift (Urolift): Back to Basics

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

Matthew C. Ercolani, MD, FACS, provides an overview of UroLift, a minimally invasive procedure for benign prostatic hyperplasia (BPH). In this 11-minute presentation, Ercolani explains his reasoning for performing the UroLift procedure and its benefits compared to other options.

Dr. Ercolani reviews the optimal patient profile, best placement locations, and areas to avoid when performing the implant procedure. He then shares a video of implantation, illustrating how to customize Urolift placement and providing a “before and after” comparison.

BPH Mist Options: Rezum & Stents

Posted by Kevin C. Zorn, MD, FRCSC, FACS | Sep 2024

Kevin C. Zorn, MD, FACS, FRCSC, addresses the challenges and advancements in managing benign prostatic hyperplasia (BPH), focusing on minimally invasive surgical techniques. In this 17-minute presentation, he highlights the limitations of traditional treatments, such as transurethral resection of the prostate (TURP), and a growing demand for effective and less invasive alternative options.

Dr. Zorn explores the evolution of BPH treatments, discussing the importance of finding office-based, quick, and cost-effective solutions. He describes various less invasive technologies, including UroLift, Rezūm, and novel stent devices like iTind and Optilume.

Zorn underscores the variability in patient outcomes based on prostate anatomy and tissue composition, noting the importance of personalized treatment approaches. Moving towards a more tailored approach, similar to the precision seen in prostate cancer management, considers prostate size and tissue composition.

Laser Selection for HoLEP

Posted by Pierluigi Bove, MD | Sep 2024

Pierluigi Bove, MD, discusses the selection of lasers for Holmium laser enucleation of the prostate (HoLEP), focusing on the evolution and advancements in laser technology since 1995. In this 9-minute presentation, Bove emphasizes that the choice of laser depends on personal preference and experience, technical features, and economic considerations. Dr. Bove considers the Holmium laser the gold standard for BPH surgery due to its versatility in treating various prostate sizes and conditions such as stones.

The discussion then shifts to a comparison between the traditional Holmium laser and newer technologies like the Thulium laser with pulse modulation. Bove presents evidence suggesting that the MOSES effect, available with Holmium lasers, can improve intraoperative hemostasis, shorten operative time, and enhance outcomes.

Ultimately, the selection of the appropriate laser for prostate enucleation depends on various factors, including the surgeon’s familiarity with the technology, the type of procedure, and resource availability.