11th Urology Today Conference

Managing Screen Time Isn’t Just for Kids: Tips to Break the Spell

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

Catherine A. Matthews, MD, FACS, FACOG, FPMRS, addresses the pressing issue of excessive screen time, emphasizing its impact on adults as well as children. She discusses the physical and psychological consequences of prolonged screen use, including eye strain, disrupted sleep patterns, decreased physical activity, and increased stress and anxiety. Dr. Matthews also discusses the psychological impact of screen time, noting that excessive use is linked to higher levels of stress, anxiety, and depression.

Dr. Matthews concludes by drawing clear parallels between addiction and screen time in children and adults. She provides practical tips for reducing screen time and increasing interpersonal interaction.

Success with Sacral Neuromodulation

by Robert J. Evans, MD, FACS | Jul 2024

Robert J. Evans, MD, FACS, provides practical guidance on successfully incorporating sacral neuromodulation (SNM) into a urology practice. He begins by discussing proper documentation strategies to avoid SNM being rejected by insurance.

Dr. Evans then shares his approach to patient education and engagement. He presents the available options for SNM devices and implantation procedures. He outlines the ideal patient profile for staged versus peripheral nerve evaluation procedures, and he discusses the level of patient engagement required for rechargeable versus non-rechargeable SNM devices.

Dr. Evans concludes by providing guidance on troubleshooting. He presents common technical issues and patient experiences with SNM devices. For each issue, he presents solutions which can be implemented in-office.

Urethral Strictures and Bladder Neck Contractures Made Simple

by R. Caleb Kovell, MD | Jul 2024

R. Caleb Kovell, MD, provides an overview of the diagnosis, treatment, and management of urethral strictures and bladder neck contractures. In this presentation, he provides anatomical and surgical examples of urethral stricture:

Presentation
Work-Up
Endoscopic and Surgical Management
Post-Treatment Follow-Up

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

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

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

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

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

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.

Expectations for Mentorship Among APPs: What Urologists Should Know

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

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

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

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.