John P. Mulhall, MD, discusses the significant sexual and non-sexual adverse events of low testosterone resulting from using androgen deprivation therapy (ADT) to treat men with prostate cancer. He emphasizes the need for physicians to counsel patients on long-term expectations and to obtain fully-informed consent prior to the initiation of this therapy.
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Fernando J. Kim, MD, MBA, FACS, discusses internal physician factors and external factors in the current medical field that can put careers and patient safety at risk. He then reviews ways in which systems thinking and professionalism can optimize outcomes in urology practices.
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Arthur L. Burnett II, MD, MBA, presents penile allotransplantation as an emerging alternative to autogenous reconstruction. He discusses the benefits for military trauma patients in particular, and the importance of considering potential complications as well as improved quality of life.
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John P. Mulhall, MD, discusses the results and implications of a study evaluating the relationship between testosterone and PSA levels in men with prostate cancer. He suggests that these findings indicate that in men with documented prostate cancer, the presence of a pretreatment PSA value below 2 should raise questions about a patient’s testosterone level.
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Adam S. Kibel, MD, argues that aggressive curative therapy is the best practice for the management of high-risk prostate cancer. He observes that local therapies like surgery, along with combination therapies like external beam radiation therapy plus brachytherapy and androgen deprivation therapy, have shown themselves to be effective for improving overall survival.
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Adam S. Kibel, MD, argues that the preponderance of evidence shows surgery outperforming radiation therapy when treating prostate cancer patients. He discusses the randomized data still needed to accurately compare these two treatments and multiple case series and a meta-analysis that favor surgery in terms of overall survival, as well as the benefit of surgery in terms of providing an opportunity for optimal staging and subsequent treatment.
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Alan W. Shindel, MD, MAS, reviews the basic scientific concepts behind low intensity shock wave therapy and the rationale for its use in the management of erectile dysfunction (ED). He discusses existing data from both animal and human models supporting this treatment, as well as the knowledge gaps that must be addressed before adopting it into clinical practice.
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Mohit Khera, MD, MBA, MPH, a panel member for the 2015 American Urological Association (AUA) Peyronie’s disease (PD) guidelines, discusses the prevalence of PD and its correlation to low testosterone. Furthermore, he summarizes the AUA statements on intralesional injections, penile stretching devices, and surgical options. He explains future directions in this setting, as well, including data from animal models testing platelet-rich plasma (PRP) and stem cells.
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Rodrigo Donalisio da Silva, MD urges urologists to manage blunt and penetrating renal trauma conservatively. He uses the 2017 American Urological Association (AUA) Urotrauma guidelines to outline this conservative approach, specifically when to perform diagnostic imaging with intravenous (IV) contrast enhanced computed tomography (CT), non-invasive management strategies, proper injury classification, and when it is necessary to intervene.
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Pierluigi Bove, MD, discusses the urological applications of haemocomponents, specifically using fibrin glue in the management of hemorrhagic cystitis. He explains the possibility of managing chronic cystitis, bladder pain syndrome, and chronic pelvic pain with platelet-rich plasma (PRP). Furthermore, he describes his upcoming project to test the effects of hyaluronic acid and PRP on the human epithelium.
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Peter Schulam, MD, PhD, argues that adopting robotic assisted surgery into urological practices can reduce medical errors and surgeon performance variability. Furthermore, he explains the need for larger and more structured medical data sets. This will enable machine learning when developing artificial intelligence (AI) to enhance prognostic and diagnostic accuracy, cancer mortality prediction, and interpretation of digitized images.
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Larissa V. Rodriguez, MD, summarizes the 2017 American Urological Association (AUA) Stress Urinary Incontinence (SUI) guidelines and critiques their limitations. In particular, she criticizes the fact that their index patient does not represent patients urologists usually see, their exclusion of non-FDA approved interventions, and their insufficient emphasis on urodynamics.
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