Ralph E. Hopkins Urology Seminar Archives

Therapy for High Risk NMIBC

Posted by Colin P. N. Dinney, MD | Aug 2024

Colin P.N. Dinney, MD, defines the criteria that categorize patients as high-risk, such as tumor grade, size, and recurrence history. He underscores the importance of early and accurate diagnosis using advanced imaging techniques and molecular markers, which play a crucial role in guiding treatment decisions.

He focuses on Bacillus Calmette-Guérin (BCG) therapy, the gold standard for high-risk NMIBC. Dr. Dinney reviews BCG’s mechanisms of action, administration protocols, and factors influencing its efficacy. He also addresses the challenges posed by BCG shortages and the emergence of BCG-unresponsive disease, highlighting the need for alternative therapeutic strategies.

Further, Dr. Dinney discusses the potential of immune checkpoint inhibitors, targeted therapies, and gene therapy in the context of high-risk NMIBC. He presents data from recent clinical trials that demonstrate the promising results of these innovative approaches in achieving durable responses and reducing recurrence rates.

Early Continence Recovery After Robotic-Assisted Radical Prostatectomy: The Role of Prostatic Shape

Posted by Pierluigi Bove, MD | Aug 2024

Pierluigi Bove, MD, explores the role of prostatic shape in continence preservation and recovery after robotic-assisted radical prostatectomy (RARP). Dr. Bove begins with a review of the key preoperative anatomical landmarks and how they inform surgical strategy.

Dr. Bove presents data supporting the relationship between preoperative Membranous Urethral Length (MUL,) bladder neck preservation, prostatic shape, and continence recovery post-RARP. He notes that preserving as much of the MUL and bladder neck as possible led to significantly higher rates of continence. Additionally, he notes that prostates with no membranous urethral overlap, or “apple-shaped” prostates, had the best urinary continence recovery.

Dr. Bove concludes by presenting video examples of RARP surgical strategies which preserve/ promote continence recovery. He presents common complications during RARP and examples of how his institution has compensated for them.

Role of Lymphadenectomy in the Surgical Treatment of Clinical Localized Prostate Cancer

Posted by Mohamad E. Allaf, MD | Aug 2024

Mohamad E. Allaf, MD, discusses the use cases for lymphadenectomy in the surgical treatment of clinically localized prostate cancer. Dr. Allaf begins by addressing the rationale for performing lymphadenectomy, emphasizing its diagnostic and therapeutic potential in prostate cancer management.

A central focus of the presentation is the debate surrounding lymphadenectomy and its implications for patient outcomes. Dr. Allaf reviews the current evidence, highlighting studies that suggest extended lymphadenectomy may provide superior oncologic control by increasing the likelihood of detecting metastatic nodes in high- and intermediate-risk patients. Dr. Allaf also delves into the nuances of patient selection and determining when and how to integrate lymphadenectomy into the surgical treatment of prostate cancer.

Robotic Partial Nephrectomy for Complex Cases: Planning the Surgical Strategy

Posted by Pierluigi Bove, MD | Aug 2024

Pierluigi Bove, MD, discusses robotic-assisted partial nephrectomy, focusing on its application in complex renal cell carcinoma (RCC) cases. He begins by outlining the critical factors influencing the decision to use surgery to treat RCC.

Dr. Bove addresses the challenges that surgeons need to address when surgically treating complex RCC, including tumor size, location, and proximity to vital structures. He discusses strategies to tumor location, renal anatomic complexity, and other potential complications

He concludes with video demonstrations of robotic-assisted RCC surgery in practice. He highlights the benefits of robotic surgery, and illustrates how combining it with the surgeon’s skill results in the best outcome for the patient.

Functional and Reconstructive Urology: A New Subspecialty or Rebranding

Posted by Brian J. Flynn, MD | Aug 2024

Brian J. Flynn, MD, defines functional and reconstructive urology and its place in future and existing urological practices. Dr. Flynn introduces functional and reconstructive urology as an area that focuses on disorders related to urinary and pelvic floor dysfunctions, such as urinary incontinence, pelvic organ prolapse, and overactive bladder.

Dr. Flynn discusses the historical context of functional and reconstructive urology, explaining how aspects of functional urology and reconstructive urology have been present in urology for decades. He acknowledges that while the conditions treated are not new, the emphasis on a multidisciplinary approach and the incorporation of advanced diagnostics and therapeutic techniques justifies viewing functional and reconstructive urology as a distinct subspecialty, rather than a form of alternative medicine.
Dr. Flynn concludes by illustrating how functional and reconstructive urology impacts patient care and quality of life. He provides authoritative sources for continuing education in functional and reconstructive urology.