International Functional and Reconstructive Urology Update Archives

AUA Guidelines on Neurogenic Lower Urinary Tract Dysfunction

Posted by Stephen R. Kraus, MD, MBA, FACS | Dec 2024

Stephen R. Kraus, MD, MBA, FACS, reviews the updated neurogenic lower urinary tract dysfunction (N-LUTD) guidelines, previously known as neurogenic bladder guidelines. In this 10-minute talk, he notes that the redefined terminology reflects a more comprehensive approach, addressing both bladder and outlet dysfunction.

Kraus explains patients are classified into low, moderate, or high-risk categories based on factors like neurological disease and bladder function. The guidelines use these categories when recommending treatment. Dr. Kraus gives examples, illustrating how the guidelines provide individualized patient treatment. Further, he emphasizes that the guidelines highlight the importance of ongoing monitoring to ensure treatment efficacy and prevent complications in high-risk patients.

LUGPA Talk: Healthcare Landscape, Reimbursement

Posted by Jeffrey M. Spier, MD | Nov 2024

Jeffrey M. Spier, MD, focuses on reimbursement, healthcare policy, and the role of advocacy in the current urology healthcare landscape. In this 10-minute presentation, Spier highlights LUGPA, which represents independent urology practices, promoting best practices, business acumen in urology, and policy advocacy.

Spier emphasizes the importance of urologists and healthcare professionals engaging in legislative advocacy to address issues such as reimbursement cuts, regulatory burdens, and rising operational costs. He notes that healthcare consolidation can negatively impact patient care and stresses the need for reform, particularly in areas like the Medicare fee schedule.

Spear advocates for unity within the urology community. He remains optimistic, calling for collective efforts to secure better outcomes for both physicians and patients while urging professionals to engage at local and national levels to make meaningful change.

Non-surgical Modalities for Pelvic Floor Disorders

Posted by Oscar A. Aguirre, MD | Nov 2024

Oscar A. Aguirre, MD, discusses managing female stress urinary incontinence and related pelvic floor issues, including non-surgical treatments. In this 11-minute talk, Aguirre notes a shift away from surgeries as non-invasive options have proven effective in alleviating urinary symptoms.

Dr. Aguirre began using laser treatments for vaginal tightening in 2013, which unexpectedly improved patients’ sexual function, lubrication, and incontinence. Over time, these experiences revealed the utility of various non-surgical options, including radiofrequency and platelet-rich plasma (PRP) therapies, for enhancing both sexual health and urinary symptoms. He emphasizes that these treatments, though not FDA-approved for incontinence, have shown promising results in improving symptoms without invasive intervention.

Genitourinary Syndrome of Menopause

Posted by Kelly J. Casperson, MD | Nov 2024

Kelly J. Casperson, MD, emphasizes the essential role of vaginal estrogen in treating genitourinary syndrome of menopause (GSM). In this 9-minute talk, she explains that many women are misdiagnosed or undertreated because physicians often lack education about menopause. Vaginal estrogen, an inexpensive and effective treatment, can address multiple symptoms, including urinary tract infections (UTIs), overactive bladder, and pain during intercourse, often misinterpreted as separate issues.

Casperson highlights how GSM affects not only sexual health but also urological function, with estrogen deficiency leading to significant anatomical changes such as urethral dysfunction and vaginal atrophy. She critiques outdated misconceptions and stresses the importance of proper hormone replacement therapy over antibiotics or invasive interventions for recurrent UTIs in postmenopausal women.

Furthermore, Casperson advocates for revisiting FDA guidelines on vaginal estrogen, noting the misleading and harmful warning labels that deter its use. She encourages physicians to integrate vaginal estrogen as a first-line treatment for many menopausal symptoms.

Functional Urology Discussion

Posted by Brian J. Flynn, MD | Nov 2024

Brian J. Flynn, MD, is a professor of surgery/urology and fellowship director in Functional and Reconstructive Urology (FRU) at the University of Colorado, Anschutz Medical Center, Division of Urology, in Denver, Colorado. Dr. Flynn earned his medical degree from Temple University in Philadelphia, Pennsylvania. He completed a six-year residency in urology at Geisinger Medical Center in Danville, Pennsylvania, and a one-year fellowship in female urology and reconstructive urology at Duke University in Durham, North Carolina. He is board-certified in urology and female pelvic medicine and reconstructive surgery. Dr. Flynn earned his Bachelor of Science in biomedical engineering from the University of Rochester in Rochester, New York.

Dr. Flynn’s focus is in functional and reconstructive urology with an active
practice in male/female urinary incontinence, voiding dysfunction, urethral stricture disease, and robotic bladder/ureteral reconstructive surgery. He is a national leader in the use of minimally invasive surgical techniques and robotics for the treatment of urinary incontinence, bladder neck contracture, urethral stricture, and ureteral obstruction. He has developed new techniques for AUS, ProACT, bladder neck
reconstruction, and suprapubic catheter placement.

Dr. Flynn has authored numerous clinical papers, surgical videos, and textbook chapters. He has also presented internationally on surgical management of urethral stenosis with an emphasis on non-transecting techniques, post-prostatectomy incontinence, genitourinary fistula, and ureteral stricture disease.

Alan J. Wein, MD, PhD (hon), FACS, is Professor of Clinical Urology and Director of Business Development and Mentoring at the Desai Sethi Institute of Urology at the University of Miami Miller School of Medicine. He is Emeritus Professor of Urology/Surgery and Emeritus Chief of Urology and Program Director of the Perelman School of Medicine at the University of Pennsylvania.

Dr. Wein received his undergraduate degree from Princeton University and completed medical school, surgery, basic research, and urology training at the University of Pennsylvania (Penn). After serving in the army following his training, he returned to Penn where he ultimately became Chief of Urology and Director of the Residency Program (for 38 and 44 years, respectively). Dr. Wein holds an honorary PhD from the University of Patras, Greece and was conferred an honorary professorship by the Institute of Urology, Russian Ministry of Health.

Dr. Wein’s primary interests include the physiology and pharmacology of the lower urinary tract, evaluation and management of urinary incontinence and all types of lower urinary tract and pelvic floor dysfunction; problems with prostate enlargement and obstruction; and the evaluation and management of prostate, bladder, and kidney cancer. He has received numerous awards and honors for excellence in the field of urology and has been recognized nationally and internationally through his many affiliations and professional memberships. These include the American Association of Genitourinary Surgeons (AAGUS), the Clinical Society of Genitourinary Surgeons (CSGUS); the American Surgical Association; the Society of Surgical Oncology; the Society of Urologic Oncology (where he is a founding member); the Society of Pelvic Surgeons; Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU); the International Continence Society (ICS); Société Internationale d’Urologie (SIU); the American Urological Association (AUA); the European Association of Urology (EAU); and the Royal Society of Medicine.

Dr. Wein’s most notable awards include the Urodynamics Society Lifetime Achievement Award; the F. Brantley Scott Award of the American Foundation for Urologic Diseases; the Hugh Hampton Young Award of the AUA; the Ferdinand C. Valentine Award of the New York Academy of Medicine; the National Association for Continence Continence Care Champion Award; Lifetime Achievement Awards from SUFU, the ICS, and the SIU; the Ellis Island Medal of Honor; and the Keyes Medal by the AAGUS, which is recognized as the greatest individual citation in the specialty, awarded for outstanding contributions in the advancement of urology. Most recently, an annual mentorship award in his name has been commissioned by SUFU and another by the division of urology at Penn. Dr. Wein has authored or co-authored over 1,000 papers and book chapters, held multiple editorial positions on scientific journals and has edited or co-edited over 35 books. He is currently the editor-in-chief of Neurourology and Urodynamics and Urology Case Reports. Dr. Wein was editor-in-chief of the ninth, 10th, and 11th editions of Campbell-Walsh Urology, the gold standard textbook in the field and the name of the 12th and succeeding editions has been changed to Campbell-Walsh-Wein Urology to reflect his contributions to the field. Two chairs have been raised and named in his honor in the division of urology, department of surgery at the University of Pennsylvania Perelman School of Medicine.