Ralph E. Hopkins Urology Seminar Archives

Path to the First Penoscrotal Transplant: Pre-Clinical Studies that Led to Penile Allotransplantation

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

Trinity J. Bivalacqua, MD, PhD, Director of Urologic Oncology at the James Buchanan Brady Urological Institute of Johns Hopkins Medicine, discusses the groundbreaking penoscrotal implant surgery performed by a multidisciplinary team at Johns Hopkins Medicine in 2018. He explains their rationale for performing a procedure that many consider dangerous and unnecessary, saying that patients have a right to be normal and to decide on their own fate, and noting that they discussed the surgery with their patient, a military vet who lost his phallus from a blast injury, for years before operating. Dr. Bivalacqua goes on to summarize the pre-clinical cadaveric and ex vivo studies conducted before the procedure, emphasizing the important developments in increasing transplant tolerance and improvements in vascularizing penile allografts. He concludes by saying that the surgery was successful and thus far the graft has not shown rejection, but he notes that the procedure’s utility in clinical practice remains unknown.

New Paradigm for the Treatment of Peyronie’s Disease

Posted by David Utz | May 2020

Culley C. Carson III, MD, Professor Emeritus at the University of North Carolina School of Medicine, reviews the history of treatment options for Peyronie’s Disease. He then compares clinical results of oral therapies, injection techniques, shock wave therapy, and penile prosthesis. Since first being developed, the efficacy of several of these protocols has improved and patients have experienced a reduction in curvature. Patients with Peyronie’s Disease often report significant negative emotional toll as a result of the condition, and new advances in treatment, such as the combination of drug and lengthening device that improves penile angulation can also improve depression and emotional problems.

Perioperative Hypogonadism in Men Undergoing Radical Cystoprostatectomy for Bladder Cancer

Posted by Jeffrey M. Holzbeierlein, MD | Apr 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 KU, discusses how to improve outcomes around cystoprostatectomy. Even when this treatment is technically successful, many patients still suffer from post-surgical complications and it has a high morbidity rate. Dr. Holzbeierlein highlights significant weight loss and muscle wasting post-surgery as being associated with these increased rates of complication and death. He hypothesizes that this issue, known as cachexia, could be caused by hypogonadism, and could lead to poor outcomes after radical prostatectomies. Dr. Holzbeierlein and his colleagues conducted a study to test this hypothesis and he goes over its methods, results, limitations, and conclusions. He also previews his and his colleagues’ next steps and how their research might impact cystoprostatectomy.

Geriatric Considerations in Urinary Incontinence and Overactive Bladder (OAB)

Posted by Una Lee, MD, FPMRS | Apr 2020

Una Lee, MD, FPMRS, a urologist at the Virginia Mason Medical Center, discusses concepts physicians should consider when managing urinary incontinence and overactive bladder (OAB) in geriatric populations. First, Dr. Lee reviews the “5 M’s”: mind, mobility, medications, multi-complexity, and what matters most to the patient, or care goals/preferences. Additionally, she addresses the role of frailty in older adults, which is associated with increased risk of poor health outcomes. Lastly, she reviews data about the association of anticholinergic medication use and dementia.