Jackson Hole Seminars

Mutliparametric MRI for Solid Masses: Accurate Detection of Clear Cell Renal Cell Carcinoma to Direct Patient Care

Jeffrey A. Cadeddu, MD, Ralph C. Smith, MD, Distinguished Chair in Minimally Invasive Urologic Surgery, Director of The University of Texas (UT) Southwestern Clinical Center for Minimally Invasive Treatment of Urologic Cancer, and Professor of Urology and Radiology at UT Southwestern Medical Center in Dallas, Texas, discusses multiparametric magnetic resonance imaging (mpMRI) for small renal masses (SRM). Dr. Cadeddu emphasizes the use of mpMRI and a clear cell likelihood score (ccLS) as a promising, reliable, non-invasive, and cost-effective means of renal tumor characterization that can eliminate the need for biopsy in most patients.

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Kidney Tumor Ablation in 2022: Optimal Outcomes

Jeffrey A.Cadeddu, MD, discusses optimal outcomes in kidney tumor ablation. He reviews reliable and reproducible 5+ year data comparing ablation effectiveness and outcomes to that of surgery and emphasizes that for tumors of <3 cm, tumor ablation is indicated. Dr. Cadeddu explains that ablation is nephron-preserving and minimizes chronic kidney disease progression, is less expensive than conventional surgery, reduces risk of metastatic potential associated with AS, and in addition to tumor size, histologic subtype is an important consideration in treatment decision-making.

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AUA Urethral Stricture Guideline Review

John Thomas Stoffel, MD, Associate Professor of Urology and Chief of the Division of Neurourology and Pelvic Reconstruction within the University of Michigan Department of Urology in Ann Arbor, Michigan, reviews the 2016 American Urological Association (AUA) Urethral Stricture Guideline, focusing on diagnosis & initial management, dilation & internal urethrotomy, as well as managing longer strictures with urethroplasty.

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Overactive Bladder vs. Interstitial Cystitis: Overlapping Conditions?

John Thomas Stoffel, MD, Associate Professor of Urology and Chief of the Division of Neurourology and Pelvic Reconstruction within the University of Michigan Department of Urology in Ann Arbor, Michigan, discusses how to differentiate overactive bladder (OAB) from interstitial cystitis (IC), as well as how to appropriately treat both conditions. He begins with some background, explaining that OAB is common and affects 30 to 50 million women worldwide. IC is also common, and may affect between 2 and 17% of US adults. Dr. Stoffel argues that despite this prevalence, clinicians do not understand the depth of these conditions nor how to differentiate them. He then defines OAB as “[urinary] urgency, with or without urgency incontinence, usually with increased daytime frequency and nocturia,” whereas IC is an unpleasant sensation (pain, pressure, discomfort) perceived to be related in the urinary bladder, associated with LUTS, of greater than 6 weeks duration in the absence of infection. Dr. Stoffel posits that IC is more associated with sensory symptoms while OAB more associated with motor symptoms. He then discusses the work-up for OAB and IC, explaining that the work-up for the former should include a physical exam, urine analysis, and a voiding diary, while the work-up for the latter should feature a physical exam, a history of symptoms, urinalysis, urine culture, and urine cytology. Dr. Stoffel moves on to treatment strategies, describing the treatment of OAB as like a ladder, moving sequentially from behavioral therapy to medications to neuromodulation/onabotulinum toxin. He recommends tracking outcomes for OAB with patient reported outcome measures (PROMS), and highlights the effectiveness of behavioral therapies such as timed voiding/fluid management, weight loss, and biofeedback. Dr. Stoffel also notes that there are no clear winners among OAB medications, and he emphasizes the need to define patients’ expectations. He describes the treatment strategy for IC as less like a ladder than a grab bag, explaining that “initial treatment type and level should depend on symptom severity, clinician judgment, and patient preferences.” Dr. Stoffel briefly considers the evidence for neuromodulation and onabotulinum toxin, concluding that they are effective for OAB, but there is little extended data in IC.

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Off-Label Use of Xiaflex for Peyronie’s Disease

Jesse N. Mills, MD, Associate Clinical Professor and Director of the Men’s Clinic at UCLA, discusses techniques for Xiaflex on and off label, and when and how it can be used to treat Peyronie’s disease. These include alternative injection techniques, plaques involving the penile urethra, use for men on anticoagulation treatments, and non-goniometric deformity.

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