Ralph E. Hopkins Urology Seminar Archives

Transurethral Surgery Re-Imagined: Exploration of a Novel Robotics Platform

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

Nicole L. Miller, MD, FACS, Associate Professor of Urology at Vanderbilt University Medical Center, discusses advances in robotics that could transform rigid endoscopic surgery by giving surgeons more degrees of freedom while operating. She argues that the evolution from open surgery to minimally-invasive surgery is perhaps as significant as the discovery of anesthesia and suggests that improved robotics are continuing this surgical revolution. Dr. Miller focuses on the work of Virtuoso Surgical, Inc., which has developed a prototype for transurethral endoscopy that features two needle-sized robotic arms that allow for complex two-handed maneuvers in the smallest surgical sites in the body. She suggests that this tool and others like it could make HoLEP faster and easier, improve en-bloc resection quality in bladder tumor patients, and improve resection of uterine polyps, among other applications.

Endourological Stone Management: Complicated Cases

Posted by Jens Rassweiler, MD | Jul 2020

Jens Rassweiler, MD, Professor and Head of the Department of Urology at Klinikum Heilbronn, the academic hospital of Heidelberg University in Germany, discusses the management of complicated cases of endourological stones. First, he defines what exactly makes a case complicated, and then goes on to detail the procedures involved. He compares various management methods, noting the pros and cons of each and emphasizing the importance of staying away from open surgery when possible. He does discuss the best techniques for open surgery when it is unavoidable, but emphasizes that a combination of robotic and laparoscopic surgery is best.

Blue Light Cystoscopy: How Does It Fit into the Non-Muscle Invasive Bladder Cancer Guidelines?

Posted by Jeffrey M. Holzbeierlein, MD | Jun 2020

Jeffrey M. Holzbeierlein, MD, Director of the Division of Urologic Oncology at the University of Kansas Hospital and Director of Clinical Research for the Urology Department at KUMC, discusses how using Blue Light Cystoscopy (BLC), an enhanced imaging technique that creates a visible contrast between normal urothelium and cancer cells, can improve detection of non-muscle invasive bladder cancer (NMIBC). The AUA, EAU, and NCCN recommend BLC for use in many bladder cancer patients, especially those with positive cytology but negative white light cystoscopy (WLC), but many practitioners eschew BLC due to the expensive equipment required. Dr. Holzbeierlein suggests that the benefits may outweigh the costs, citing multiple studies that have reported increased rates of detection and lower rates of recurrence of NMIBC with BLC vs. WLC, although he acknowledges that researchers have yet to prove that the use of BLC improves progression. Dr. Holzbeierlein concludes by discussing BLC’s particular utility in detecting carcinoma in situ (CIS), which he believes leads to improved resection of CIS and thus better patient response to bacillus Calmette-Guérin.

Evidence-Based Guideline for Management of Priapism: Perspectives from AUA/EAU Guideline Panel

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

Trinity J. Bivalacqua, MD, PhD, Director of Urologic Oncology at Johns Hopkins Medicine, discusses potential solutions to the issues with bacillus Calmette-Guérin (BCG) as a treatment for high-risk non-muscle invasive bladder cancer (NMIBC). Intravesical BCG is more effective than chemotherapy for NMIBC, but approximately ⅓ of high-risk patients are BCG-unresponsive, and there is also a BCG shortage. Dr. Bivalacqua lists potential solutions to both these problems, including early cystectomy, increasing the availability of BCG by using alternative strains, and enhancing immunotherapy. He concludes by discussing research intended to characterize immune cell expression among patients with NMIBC treated with BCG which found that immune checkpoint inhibition with BCG may be beneficial in a subset of patients who experience tumor recurrence after BCG.

Innovation in the Treatment of Male Urinary Incontinence

Posted by David Utz | May 2020

Culley C. Carson III, MD, Emeritus Rhodes Distinguished Professor in the Department of Urology at the University of North Carolina School of Medicine, discusses innovations in the treatment of male urinary incontinence. He outlines different treatments and their various pros and cons, including some cutting-edge technology that is not yet available in the US. He also goes over innovations, which still need to be made in order to further improve certain technologies like the artificial urinary sphincter. He highlights how important it is to come up with a more cost-effective model because, currently, artificial urinary sphincters are extremely expensive. There are also several significant causes of revision surgery for artificial urinary sphincters, demonstrating the need for further innovation. Dr. Carson also emphasizes the importance of customizing the pumps to individual patients, and goes over current research intended to improve patient outcomes.