Urology Today Archives

Image-Based Detection and Staging of Prostate Cancer: Is the TRUS Probe Facing Extinction?

Posted by Peter A. Pinto, MD | Jul 2024

Peter A. Pinto, MD, explores the possibility of current imaging technology replacing the Transrectal Ultrasound (TRUS) probe in prostate cancer detection and staging. He begins with an overview of the weaknesses of the TRUS probe compared to magnetic resonance imaging (MRI) and MR/ultrasound fusion-guided biopsies in detecting and locating prostate cancer.

However, Dr. Pinto presents a comparison of the detection rates of TRUS-only biopsies with those of MR/ultrasound fusion-guided biopsies. He notes that both of these biopsy approaches can fail to detect low-risk and high-risk prostate cancers, leading to prostate cancer upgrading events.

Dr. Pinto concludes with an examination of the results from MRI-TRUS fusion biopsies. He presents the improved detection and certainty rates of the combined biopsy approach.

In-Office Procedures and the ‘Scope’ of Practice for APPs

Posted by Terran W. Sims, NP, MSN, ACNP-C, CNN, COCN-C | Jun 2024

Terran W. Sims, NP, MSN, ACNP-C, CNN, COCN-C, discusses how to prepare and incorporate advanced practice providers (APPs) like nurse practitioners and physician assistants in urologic procedures. Ms. Sims begins by listing office procedures APPs might encounter, focusing on cystoscopy, stent removal, and difficult catheter insertion. She continues by posing a guiding question for her discussion: what is the best fit for APPs in practice?

Ms. Sims then briefly reviews differences in the scope of practice for APPs across the U.S., noting important state licensure requirements and highlighting the increasing presence of APP participation in urologic procedures. She emphasizes the American Urological Association’s (AUA) and Society of Urologic Nurses and Associates’ (SUNA) support for APP involvement, and utilizes cystoscopy as an example by detailing data that show increased levels of patient satisfaction as APPs have performed greater numbers of cystoscopy procedures.

Ms. Sims concludes by addressing the primary obstacles to additional APP role expansion: the lack of training and lack of standard curriculum. She encourages urologists to overcome these obstacles and invest in APPs by providing training, instilling confidence, and maintaining mentorship. She reiterates the benefits of APP involvement, including increased cost-effectiveness, profit margins, and team productivity.

The Business of Medicine: What Residency and Fellowship Failed to Teach Me

Posted by Colin E. Kleinguetl, MD | Jun 2024

Colin E. Kleinguetl, MD, shares insights regarding some of the practical knowledge gaps faced by urologists in residencies and fellowships. In this presentation, he outlines areas that those entering a residency or fellowship should be familiar with ahead of time, including:

Types of Practice
Practice Management
Tips and Tricks for Medical Coding
Contract Evaluation
Financial Management

Tips and Tricks of Endoscopic and Robotic Correction of POP/fSUI

Posted by Catherine A. Matthews, MD, FACS, FACOG, FPMRS | Jun 2024

Catherine A. Matthews, MD, FACS, FACOG, FPMRS, shares key steps for safe and effective endoscopic and robotic correction of POP/fSUI. In this presentation, Dr. Matthews provides guidance on:

Sacral Anatomy and Landmarks
Surgical Planes for Vaginal Dissection
Optimizing Mesh Attachment
Steps to Prevent Common Complications

Endoscopic Management of Upper Tract UC and the Role of Mitomycin

Posted by Cayce Nawaf, MD | May 2024

Cayce Nawaf, MD, discusses the relationship between mitomycin and endoscopic management of upper tract urothelial carcinoma (UC). Dr. Nawaf begins with a quick overview of upper tract UC, noting that it is relatively rare.

Dr. Nawaf then compares the outcomes of endoscopic management against those of nephroureterectomy. He illustrates the 5- and 10- year oncologic outcomes from both treatments, demonstrating the similarities between grade groups and presenting the AUA guidelines as additional support.

Dr. Nawaf addresses concerns regarding agent delivery methods to the kidney, and presents examples of nephrostomy tubes, double pigtail stents, and ureteral catheters. He presents data from the OLYMPUS Trial supporting the efficacy of retrograde delivery via ureteral catheter.

Regarding agents, Dr. Nawaf presents data on the efficacy of mitomycin While 58.8-61% of patients had a complete response to the treatment, he notes that there are moderate to severe side effects and caveats around endoscopic management of upper tract UC with mitomycin.

He concludes with a step-by-step guide to using mitomycin in treatment. Dr. Nawaf underscores the importance of selecting patients correctly for treatment based on disease grade and patient preference.