Urology Today Archives

Expectations for Mentorship Among APPs: What Urologists Should Know

Posted by Mikel L. Gray, PhD, FNP, PNP, CUNP, CCN-AP, FAANP, FAAN | May 2024

Mikel L. Gray, PhD, PNP, FNP, CUNP, CCCN, FAANP, FAAN, provides guidance on how Urologists and APPs can get the most out of mentorships. Dr. Gray begins by reviewing the critical importance of APPs in Urology, and highlighting the AUA’s history of explicit support of APPs in urologic practice.

Dr. Gray then outlines the general experiences of APPs regarding training and fellowship in urology practices, and the lack of available structure for advancement. He outlines the various paths for APPs to enter into practice, and the challenges they represent.

Dr. Gray then turns to the role of the Urologist in mentoring urologic APPs. He explicitly highlights the “4 Cs” that the Mentor Urologist must actively facilitate for a successful mentorship: Connection, Conversation, Community, and Culture.

Dr. Gray concludes by providing guidance on what an APP should actively seek out in a mentor. He underscores the importance of finding the right mix of subspecialty and general urology in a practice, and seeking both Urologist and APP mentors.

APP-Directed Management of Female Sexual Health and GU Syndrome of Menopause

Posted by Aleece R. Fosnight, MSPAS, PA-C, CSCS, CSE, IF, NCMP, HAES | May 2024

Aleece R. Fosnight, MSPAS, PA-C, CSCS, CSE, IF, NCMP, HAES, discusses APP-lead treatment of female sexual health and genitourinary syndrome of menopause (GSM). Ms. Fosnight begins by describing symptoms of GSM, including hormonal, sexual, and GI symptoms. She notes that, while up to 84% of menopausal women face GSM symptoms, half have never been treated.

Ms. Fosnight then turns to GSM diagnosis and treatment options, including hormonal treatments, non-hormonal treatments, and physical therapy. For each treatment, she addresses safety, side effects, and contraindications.

Ms. Fosnight concludes by emphasizing the importance of clear communication and preventative action. As many menopausal patients are likely to experience GSM, she emphasizes the importance of a frank, supportive dialogue between practitioner and patient, noting that there are many safe treatment options available.

Bladder Cancer: Optimizing Detection and Minimally-Invasive Management

Posted by Alejandro R. Rodriguez, MD | May 2024

Alejandro R. Rodriguez, MD, discusses detection and minimally invasive management of bladder cancer. Dr. Rodriguez begins by noting that bladder cancer is the 10th most-commonly diagnosed cancer worldwide, and presents the American Urological Association (AUA) risk stratification that provides the basis for non-muscle-invasive bladder cancer (NMIBC) management.

Dr. Rodriguez notes that the most frequent treatment for NMIBC is Transurethral Resection of Bladder Tumor (TURBT.) While he contends that conventional TURBT is the best tool for clinical staging of NMIBC, he enumerates the risks and drawbacks of the procedure.

Dr. Rodriguez then describes narrow-band imaging (NBI) as an additional modality, and presents data showing that TURBT performed in NBI modality reduces NMIBC recurrence risk. Further, NBI with white light cystoscopy TURBT may lower recurrence risk with little-to-no effect on risks of adverse events.

Finally, Dr. Rodriguez turns to the role of TUR in muscle-invasive bladder cancer (MIBC), with a focus on clinical staging, histology and grade, and bladder preservation options. He notes that trimodality therapy is the primary option for patients with MIBC that seek bladder preservation as an alternative to radical cystectomy.

Care Considerations for the Man on ADT

Posted by Alejandro R. Rodriguez, MD | May 2024

Alejandro R. Rodriguez, MD, discusses the management of metabolic, cardiovascular, and other side effects of Androgen Deprivation Therapy (ADT). In this lecture, Dr. Rodriguez highlights common side effects of ADT as a treatment, including:

Bone-Density Loss
Cardiovascular Disease
Diabetes and Other Metabolism Changes
Sexual Dysfunction

For each of these conditions, Dr. Rodriguez presents management strategies that can be used by physicians, patients, and members of the patients’ care team.

Effective Strategies for Priapism

Posted by R. Caleb Kovell, MD | May 2024

R. Caleb Kovell, MD, discusses management strategies for acute refractory ischemic priapism, including shunting, tunneling, and prosthesis. Dr. Kovell begins his lecture by reviewing the erectile recovery windows and imaging techniques for establishing acute ischemic priapism.

Dr. Kovell then turns to effective treatment options after intracavernosal phenylephrine and corporal aspiration fail. He outlines various types of distal shunting, corporal tunneling, penoscrotal decompression, and early prosthesis placement.

Dr. Kovell concludes by discussing outpatient management of acute ischemic priapism. He highlights the importance of establishing the patient’s Sickle Cell Disease status, and cautioning against immediately prescribing PDE5is to outpatients.