Ralph E. Hopkins Urology Seminar Archives

When All Else Fails: Holmium Laser Enucleation of the Prostate as Retreatment for BPH

Posted by Nicole L. Miller, MD, FACS | Sep 2020

Nicole L. Miller, MD, FACS, Associate Professor of Urology at Vanderbilt University Medical Center, discusses Holmium laser enucleation of the prostate (HoLEP), particularly focusing on the retreatment setting. AUA guidelines have recently been updated and now mirror EAU guidelines which suggest sizing a prostate before determining treatment options. Dr. Miller examines case studies that underscore the effectiveness of HoLEP in removing large prostates after the patients had previously undergone unsuccessful treatments, including transurethral resection of the prostate (TURP) and prostatic urethral lift. She then analyzes outcomes of a study that compared primary HoLEP (pHoLEP) to retreatment (rHoLEP) observing that the retreatment setting patients experienced shorter operative times, shorter length of stay, had less tissue resected, and had a higher rate of urethral stricture and clot retention. In spite of its utility, HoLEP has not been widely adopted and represents 4% of procedures, which Dr. Miller attributes to the steep learning curve associated with HoLEP. Lastly, she enumerates the barriers within the US medical system to physicians undertaking the HoLEP learning process and concludes that while Europe has numerous options for physicians to learn the technique, the American focus on robotic surgery means that fewer students learn open orifices surgical procedures.

Ureterocutaneostomy: A Valuable Option for Urinary Diversion in the Elderly Patient?

Posted by Margit Fisch, MD, FEAPU, FEBU | Aug 2020

Margit Fisch, MD, FEAPU, FEBU, Director and Chair of the Department of Urology and Pediatric Urology at University Medical Center Hamburg-Eppendorf in Hamburg, Germany, discusses the value of ureterocutaneostomy as a urinary diversion technique for the increasing number of older, sicker patients with urothelial carcinoma of the bladder. Dr. Fisch explains that, compared with other urinary diversions, ureterocutaneostomy is a simpler, shorter procedure with no significant quality of life differences. She then summarizes the findings of a cystectomy series, which showed that even though patients who had undergone ureterocutaneostomy were older, more likely to have comorbidities, and more likely to have had prior pelvic/abdominal surgeries and irradiation compared with patients who had received ilial/colonic conduit or continent diversion, they had the shortest surgeries and hospital stays during cystectomy, as well as no difference in 30-day complication rate. The benefits of ureterocutaneostomy are further corroborated by a study which compared ureterocutaneostomy to urinary diversion with use of bowel, and found that ureterocutaneostomy patients had shorter operating room time, shorter time in the ICU, and fewer serious complications, although they did experience higher long-term morbidity, probably because of comorbidities. Dr. Fisch notes that ureterocutaneostomy has late complications such as abscess formation, ureteral necrosis, stoma stenosis, and pyelonephritis, but concludes that conduits are no better in this area, and that the benefits of ureterocutaneostomy make it a valuable and useful diversion in elderly patients.

Renal Stones: To Dust or to Basket?

Posted by Nicole L. Miller, MD, FACS | Aug 2020

Nicole L. Miller, MD, FACS, discusses the pros and cons of dusting versus basketing renal stones. She evaluates cost, time, safety, and recurrence with both procedures. The benefits of dusting include decreased procedure time, decreased disposables, lower cost, and comparable complications. The benefits of fragmentation and basketing include obtaining stone composition, improved stone-free rates, clear benefits in specific populations, and versatility with laser machines. The goals of a successful stone surgery are maximum efficiency, being stone-free, safety, and lowest cost. Looking at the type of stone and the patient will determine which method is best to use.

Biologics in Sexual Medicine – Controversy and Therapeutic Potential

Posted by Trinity J. Bivalacqua, MD, PhD | Aug 2020

Trinity J. Bivalacqua, MD, PhD, Director of Urologic Oncology and R. Christian B. Evensen Associate Professor of Urology and Oncology at the James Buchanan Brady Urological Institute of Johns Hopkins Medicine in Baltimore, Maryland, discusses studies on biologics and low-intensity extracorporeal shock wave therapy (Li-ESWT), as well as controversial misinformation surrounding their use in sexual medicine. He reviews the results of a Li-ESWT study which displayed the treatment’s ability to improve symptoms, exercise capacity, and myocardial perforation in patients with severe coronary artery disease without indication for percutaneous coronary intervention or coronary artery bypass graft surgery. He then argues that for-profit stem cell clinics who offer biologic treatment for sexual medicine promise results with no supporting efficacy data, and that the trials these clinics use for support are not well-designed. Dr. Bivalacqua concludes that there is a demonstrated therapeutic potential for biologics, but more research is needed to support their use in sexual medicine and to prove their therapeutic value.

Urethral Strictures in Patients After Hypospadias Surgery During Childhood: Is One-Stage Buccal Mucosa Urethroplasty an Option?

Posted by Margit Fisch, MD, FEAPU, FEBU | Aug 2020

Margit Fisch, MD, FEAPU, FEBU, Director and Chair of the Department of Urology and Pediatric Urology at the University Medical Centre Eppendorf, University of Hamburg discusses patients who develop urethral strictures after hypospadias surgery during childhood. Dr. Fisch reviews some European studies that show how often hypospadias surgery causes urethral strictures, where exactly they are located, and how they are repaired. She discusses her own study that looks at one-stage Buccal Mucosa Urethroplasty as a repair option for these urethral strictures. Dr. Fisch then gives an overview of the patient population, the methodology used including the operative technique, and the outcomes. Finally, she discusses the conclusions that can be drawn from the study.