Ralph E. Hopkins Urology Seminar Archives

Breaking Bad: Advances in Laser Lithotripsy Techniques

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

Nicole L. Miller, MD, FACS, Associate Professor of Urology at Vanderbilt University Medical Center, discusses AUA guidelines for the treatment of ureteral stones, and compares and contrasts them to the EAU guidelines, examining several cases to illustrate similarities and differences in treatment approaches. She observes that the EAU guidelines are updated more frequently than the AUA guidelines, which often puts them ahead in terms of pain management. Dr. Miller emphasizes that shock wave lithotripsy (SWL) treatment has the least morbidity and lowest complication rate, but ureteroscopy (URS) has a higher stone-free rate in all ureteral locations. She discusses which special cases would be best treated with URS, and why a ureteral stent is not necessary after uncomplicated URS. Finally, Dr. Miller looks at how multimodal therapy for stent pain can significantly reduce narcotic usage.

Treatment of the Ureteral Stone: What Do the AUA Guidelines Say?

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

Nicole L. Miller, MD, FACS, Associate Professor of Urology at Vanderbilt University Medical Center, discusses AUA guidelines for the treatment of ureteral stones, and compares and contrasts them to the EAU guidelines, examining several cases to illustrate similarities and differences in treatment approaches. She observes that the EAU guidelines are updated more frequently than the AUA guidelines, which often puts them ahead in terms of pain management. Dr. Miller emphasizes that shock wave lithotripsy (SWL) treatment has the least morbidity and lowest complication rate, but ureteroscopy (URS) has a higher stone-free rate in all ureteral locations. She discusses which special cases would be best treated with URS, and why a ureteral stent is not necessary after uncomplicated URS. Finally, Dr. Miller looks at how multimodal therapy for stent pain can significantly reduce narcotic usage.

The First Tissue Engineered Neo-Urinary Conduit (NUC) Clinical Trial for Complete Organ Replacement: Successes, Pitfalls, Challenges

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

Trinity J. Bivalacqua, MD, PhD, Director of Urologic Oncology at Johns Hopkins Medicine, discusses the first tissue-engineered neo-urinary conduit (NUC) clinical trial for complete organ replacement in patients with bladder cancer. He explains that the standard methods of using the genitourinary (GI) tract for cystectomy in patients with bladder cancer often cause sustained and significant complications associated with exposing the GI tissue to urine, and therefore the development of a urinary diversion using autologous cell sources for a tissue-engineered urinary conduit is warranted. Dr. Bivalacqua then details the process by which his team attempted to do this: isolating smooth muscle cells, seeding them on a biodegradable PLGA scaffold, and then implanting the construct after cystectomy, first in porcine subjects and then in human patients during the phase I trial. He notes that while all the NUCs had to be explanted due to stomal stenosis or NUC stricture, his team did successfully regenerate urinary tissue using smooth muscle cells, and he hopes researchers will progress toward the development of a clinically functional urinary conduit in an ongoing multicenter phase I/II trial.

Pelvic Organ Prolapse Surgery in Women: Defining Success and Patient Satisfaction

Posted by Una Lee, MD, FPMRS | Jul 2020

Una Lee, MD, FPMRS, urologist and researcher at Virginia Mason Medical Center, reviews the evidence on non-mesh alternatives for stress urinary incontinence (SUI). She provides an overview of the causes of female SUI, presents an effective treatment tree addressing both overactive bladder and stress incontinence, and discusses treatment options. Dr. Lee encourages physicians to consider how they present treatment decisions in order to allow patients to make the choice that fits best for them. In addition to covering all possible risks and benefits, she advises physicians to also educate patients on their condition and help manage their expectations for treatment outcomes.

Renorrhaphy Techniques During Partial Nephrectomy: Technical Points and Functional Outcomes

Posted by Pierluigi Bove, MD | Jul 2020

Pierluigi Bove, MD, Assistant Professor in Urology at the Tor Vergata University of Rome and Clinical Consultant at the University Polyclinic of Tor Vergata (Rome), argues that focusing on three goals— achieving parenchymal hemostasis at the end of the resection phase, ensuring closure of the collecting system, and avoiding indirect trauma—can help physicians decide which suturing technique to utilize. He explains the necessity of suturing experience, important aspects of the patient’s lesion and vascular anatomy to consider when decision-making, and how to utilize proper resection techniques in renorrhaphy.