Ralph E. Hopkins Urology Seminar Archives

Stress Urinary Incontinence: Non-Mesh Alternatives

Posted by Una Lee, MD, FPMRS | May 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.

ERAS Pathways in Radical Cystectomy

Posted by Jeffrey M. Holzbeierlein, MD | May 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 the variability associated with ERAS pathways & the impact of utilizing this methodology following cystectomy. He goes on to discuss how to optimize cystectomy through ERAS-based prehab, pre-operative, intraoperative, and post-operative pathways and presents data that demonstrates how these pathways may improve patient outcomes. Finally, Dr. Holzbeierlein discusses the preliminary results of a University of Kansas research program that adapted interactive, iPad-based cystectomy tutorials to understand if personalized education platforms could help improve perioperative care and outcomes within this patient population.

Management of High-Grade T1 Bladder Cancer

Posted by Jeffrey M. Holzbeierlein, MD | May 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, talks about how to manage high-grade T1 bladder cancer (HGT1BC). He discusses 5-year progression rates of HGT1BC, pathological substratification of the disease, and risk calculators to estimate patient progression. Dr. Holzbeierlein concludes by discussing enhanced cystoscopy, the value of re-resection, and the importance of bacillus Calmette-Guerin (BCG) maintenance in HGT1BC.

The Role of Immunonutrition in Bladder Cancer & the SIMMUNE Trial (S1600)

Posted by Jeffrey M. Holzbeierlein, MD | May 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 the role of immunonutrition in bladder cancer. He highlights some of the research showing why nutrition should play an important role in improving outcomes for radical cystectomy, a treatment for bladder cancer that is underutilized due to the high number of poor outcomes. Dr. Holzbeierlein goes on to discuss the SIMMUNE trial (S1600), which he is leading at the KU Medical Center. In the pilot, they gave patients a specialized immunomodulating drink, which Dr. Holzbeierlein emphasizes is a commercially available drink that patients can purchase themselves online, prior to surgery. He outlines the methods of the study as well as the results and the conclusions that were drawn. Finally, Dr. Holzbeierlein stresses that this is an easy intervention that most doctors could implement immediately.

Adaptive Immune Resistance to Intravesical BCG in NMIBC: Implications for Ongoing and Future BCG Unresponsive Clinical Trials

Posted by Trinity J. Bivalacqua, MD, PhD | May 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.