International Functional and Reconstructive Urology Update Archives

Functional Urology: A New Sub-Specialty or Rebranding?

Posted by Brian J. Flynn, MD | Nov 2024

Brian J. Flynn, MD, focuses on defining and exploring the evolving specialties of functional and reconstructive urology, emphasizing the need for rebranding within the field. In this 11-minute talk, he stresses that functional urology, similar to specialties like female pelvic medicine and pediatric urology, deserves rebranding efforts.

Dr. Flynn advocates for collaboration between urologists and non-physicians to expand the field’s influence, particularly in addressing lower urinary tract dysfunctions. He also discusses how urologists can better integrate into the broader medical community, learning from global models, especially in Europe and Canada, where functional and integrative approaches are more advanced.

Functional urology is a comprehensive, patient-centered specialty with a broad scope of practice encompassing all lower urinary tract disorders.

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.

Devastated Outlet in Men

Posted by O. Lenaine Westney, MD | Oct 2024

O. Lenaine Westney, MD, focuses on managing a “devastated outlet” in patients, typically those who have undergone treatments for prostate cancer. The 11-minute presentation highlights how factors such as radiation, High-Intensity Focused Ultrasound (HIFU), and multiple manipulations to treat urinary tract issues can lead to severe complications.
Radiation’s impact on the lower urinary tract is a key concern, with fibrosis and ischemia developing over time. Dr. Westney shares images of recto-urethral or pubic-prostatic fistulas, which are associated with a high morbidity rate and often necessitate complex surgical interventions, such as cystectomy and urinary diversion. The difficulty lies in predicting which patients will develop these severe complications.
Westney emphasizes the importance of early intervention and the potential need to rethink treatment strategies. She also discusses future directions, including the possibility of identifying patients who are more likely to suffer from radiation-induced complications through genetic markers or other predictive tools.

Emerging Therapies for Female SUI – Myosites, ACT

Posted by Michael P. Feloney, MD | Oct 2024

Michael P. Feloney, MD, focuses on Adjustable Continence Therapy (ACT) for women, specifically dual-balloon adjustable continence therapy. Dr. Feloney is noted for his experience with ACT, particularly during the initial investigational trials in the early 2000s. In this 12-minute presentation, Dr. Feloney describes the implantation procedure and provides photographs and graphics illustrating the correct placement of the silicone elastomer balloons.
A notable feature of this therapy is its adjustability. Once the balloons are in place, adjustments can be made post-operatively in the office, allowing for fine-tuning based on the patient’s response. Feloney emphasizes this advantage and its potential to enhance improved continence.
Dr. Felony addresses complication rates and notes that the rates of intraoperative perforations decrease with increased experience. The therapy, currently approved in Europe, Canada, Australia, and New Zealand, shows promise as a minimally invasive option for women with recurrent stress urinary incontinence who have failed previous surgeries.