Urology Today Archives

In-Office Management of Female SUI: Optimizing Productivity

Posted by Robert J. Evans, MD, FACS | Mar 2024

Robert J. Evans, MD, FACS, presents guidance on how practice leaders can optimize in-office management of female stress urinary incontinence. He begins with a review of pre-visit intakes, and best-practices for gathering pertinent information in the office intake form.

Dr. Evans then turns to appropriate delegation of tasks within the practice, noting that APPs can evaluate patients in-office and initiate some treatments for female stress urinary incontinence. Additionally, the patient’s gynecologist can provide additional insight into treating female stress urinary incontinence.

Dr. Evans concludes by reviewing best practices for in-office procedures, and reiterates the importance of delegating tasks appropriately. APPs are a practice’s greatest resource for optimizing patient treatment in-office.

Tips and Tricks for Managing Stones in the Complex Patient

Posted by Colin E. Kleinguetl, MD | Feb 2024

Colin E. Kleinguetl, MD, presents guidance and strategies for kidney stone management in chronically infected and pregnant patients. He begins by discussing challenges to managing kidney stones in the pregnant patient, including:

The weaknesses of kidney stone imaging options
The pros and cons of radiation during diagnosis
The importance of working with the patient’s OBGYN during treatment
The treatment options available to pregnant kidney stone patients

Dr. Kleinguetl concludes by turning to patients with chronic UTIs, acknowledging the circular relationship between recurrent/persistent UTI and kidney stone disease. He then addresses common causes of stones in chronically infected patients and effective treatment options depending on the cause of the infection.

Long-Term Care of the Neurogenic Bladder

Posted by R. Caleb Kovell, MD | Feb 2024

R. Caleb Kovell, MD, discusses effective treatments for complex neurogenic bladder patients, including early and long-term interventions. He presents several factors physicians should take into account when treating challenging neurogenic bladder patients, including:

Male and Female Sexual Health Issues
Bladder Stones
Urinary Continence
Previous Augmentation Cystoplasty
Previous Diagnosis of Spina Bifida

Expanding the Surgical Options for Primary and Recurrent Male Stress Incontinence

Posted by Brian J. Flynn, MD | Feb 2024

Brian J. Flynn, MD, evaluates current and upcoming surgical options for treating primary and recurrent male stress incontinence. He begins by reviewing the medical, social, and urethral characteristics of male stress urinary incontinence (SUI) surgical candidates.

Dr. Flynn then evaluates the risks and benefits of male perineal slings (MPS), artificial urinary sphincters (AUS), and adjustable continence therapy (ACT) devices. He notes that, presently, the least effective surgical option also has the least risk of complications for the patient.

Dr. Flynn concludes by presenting examples of patients with various levels of male SUI and how MPS, AUS, and ACT apply to each case. He reiterates that focusing on patient quality of life is paramount in the successful treatment of male SUI.

An Algorithm to Pacify the Male Patient with Chronic Genital Pain

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

Ryan P. Terlecki, MD, FACS, presents a systematic approach to patients presenting with chronic genital pain, with the goal of identifying the underlying cause while avoiding common pitfalls with this type of patient. Dr. Terlecki begins by cautioning against assumptions about the patient, as they can cause anxieties in the provider which impact the quality of patient care.

Dr. Terlecki provides guidance on tailoring patient intake questionnaires to keep the focus on the patient’s issue and possible approaches. He gives examples of open and closed questions for male genital pain.

Dr. Terlecki then discusses the importance of setting patient expectations regarding diagnoses and what they should expect from the provider, particularly when the provider does not specialize in pain management. He then discusses common, uncommon, and overlooked causes of male genital pain.

Dr. Terlecki concludes by walking through this algorithm from intake to assessment to diagnosis and treatment. He emphasizes the importance of not dismissing patient input on treatment, but still strictly adhere to evidence-based treatment over unproven or alternative treatments.