Urology Today Archives

Practical Steps for Clinical Efficiency Relative to Physician Burnout

Posted by Ryan P. Terlecki, MD, FACS | Apr 2024

Ryan P. Terlecki, MD, FACS, offers actionable steps to keep a clinical practice efficient in the face of the epidemic of physician burnout. In this presentation, he discusses how the first step in keeping an efficient and effective practice is to develop a familiarity with:

The Differences Between Efficiency and Effectiveness
The Role of Planning, Consistency, and Reevaluation in Quality Improvement
Management Strategies Which Prioritize Workflow and Well-Being

Dr. Terlecki frames burnout management around a few key principles for efficient and effective clinical practice. He provides real-world examples and applications of these steps to combat and compensate for physician burnout in both practice and academic settings.

Deciphering Options for Testosterone Replacement Therapy and Managing Withdrawal

Posted by Jesse N. Mills, MD | Apr 2024

Jesse N. Mills, MD, discusses the importance of testosterone replacement therapy and presents an algorithm for determining treatment and managing withdrawal. He begins with an overview of the history of the study of testosterone, from the first recorded effects of castration to the warning against the over-prescription of testosterone therapy issued in 2015 by the FDA.

Dr. Mills discusses the AUA guidelines for testosterone replacement therapy and the lack of on-label options for treatment. He presents options for on-and-off-label testosterone replacement therapy.

Dr. Mills then presents an algorithm for determining the best treatment option for the patient, beginning by addressing male fertility concerns. He addresses questions of lab work, transference, insurance, administration, and other patient and physician concerns.

Dr. Mills concludes with the discontinuation of testosterone replacement therapy and when it is indicated. He discusses the available options for weaning patients off of testosterone, cautioning strongly against abrupt discontinuation.

Pain Management Advice for Urologists in the Wake of the Opioid Crisis

Posted by Brian J. Flynn, MD | Apr 2024

Brian J. Flynn, MD, discusses the opioid crisis in the United States, and the role of urologists in taking action against this growing problem. Dr. Flynn begins by highlighting factors that contribute to the opioid epidemic’s growth, with a specific focus on Colorado. He drives home the urgency behind addressing this epidemic by emphasizing the ubiquity of opioid related deaths across all ages, genders and socio-economic strata.

Dr. Flynn argues that the problem lies specifically in prescribing opioids in far excess post-surgery, as most patients take only a fraction of what is prescribed, with extra pills then being distributed to, and consumed by, non-patients. He underlines the correlation between the number of opioids prescribed and the number of opioid related deaths.

Dr. Flynn examines the role of Urology in prescribing opioids relative to other fields of medicine in prescribing opioids, finding that urologists land somewhere in the middle in terms of prescribing opioids to patients. He looks at different urology surgeries and recommends alternatives to opioids to address patients post-op pain.

Dr. Flynn concludes with a review of the ALTO project from Colorado that aims to offer alternatives to fentanyl whenever possible. He provides practical solutions to address the opioid epidemic at the physician level, but recognizes that changes at multiple levels of practice and legislature are needed to address it effectively on a national scale.

Managing the Man with Ejaculatory Dysfunction

Posted by Jesse N. Mills, MD | Mar 2024

Jesse N. Mills, MD, presents management strategies for men presenting with ejaculatory dysfunctions, ranging from premature ejaculation to ejaculodynia. He begins by acknowledging that there is no current FDA-approved treatment specifically for any kind of ejaculatory dysfunction.

Dr. Mills then separates men presenting with ejaculatory dysfunction into distinct categories based on the symptom they are experiencing, and follow-up questions to ask these patients. These five main groups are Premature Ejaculation, Delayed Ejaculation, Anejaculation, Ejaculodynia, and Post-Orgasmic Illness Syndrome.

Throughout the presentation, Dr. Mills discusses each category of dysfunction and available treatment options. He concludes by highlighting the need for further study of post-orgasmic illness syndrome.

Conquering the Curve in Peyronie’s Disease

Posted by Ryan P. Terlecki, MD, FACS | Mar 2024

Ryan P. Terlecki, MD, FACS, discusses risks and benefits of Peyronie’s disease treatments, advocating for surgery as a definitive treatment. Dr. Terlecki asserts the condition is poorly understood with a “lot of garbage” in print and online. (e.g., advice not to operate early on, assumptions the injury is from tunical damage, and problematic data on intralesional injections).

From a treatment standpoint, Dr. Terlecki addresses treatment dogma he sees as problematic. He debunks claims for various treatments, like vitamin E, colchicine, Xiaflex, and pentoxifylline, and makes a case against extracorporeal shock wave therapy.

Dr. Terlecki addresses surgery and explains that, for patients with adequate rigidity, plication or grafting is effective. However, patients with inadequate function require inflatable penile prosthesis (IPP) and curvature correction. He cautions against degloving, tunical excision, and plicating for implant cases.

Dr. Terlecki concludes that Peyronie’s patients are often distressed and need clear communication and a realistic understanding of treatment risks and benefits. He calls surgery the gold standard, and says plication should be considered first for potent patients without complex defects.