Preoperative Nightmares In Urology: Patients Who Have Undergone Multiple Procedures
Pierluigi Bove, MD, explores performing major urologic surgery in patients with a history of multiple previous procedures.
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Urologic Surgery
FRU Discussion
Brian J. Flynn, MD, and Alan J. Wein, MD, PhD (Hon), FACS, discuss the evolution of functional urology.
In this 16-minute discussion, Dr. Wein emphasizes the holistic approach to functional urology, which encompasses all measures to restore normal bladder function, whether through medication, pelvic floor therapy, or surgery. Of note is his stance against dividing male and female urology, advocating for an integrated approach that addresses dysfunction across genders.
Dr. Wein and Dr. Flynn discuss the overlap between storage and voiding dysfunctions, like stress and urge incontinence, which often coexist. Dr. Wein shares insights on how treating one issue can sometimes alleviate the other, though the relationship remains unclear. He stresses the importance of a unified, simplified approach to diagnosis and treatment.
Other colleagues attending the discussion provided perspective and emphasized collaborative, team-based approaches to functional urology. A urogynecologist highlighted how gynecologists primarily manage female pelvic health and storage issues, while a pediatric urologist underscored the importance of standardized nomenclature and communication across specialties.
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Posterior Stenosis – Post-Radiation or Anti-BPH Procedures
Dmitriy Nikolavsky, MD, discusses urethral stricture and stenosis management following radiation and anti-BPH procedures, highlighting surgical challenges, outcomes, and the evolution of treatment strategies.
In this 11-minute presentation, Nikolavsky explores the differences in stricture occurrence across treatment types. Surgical approaches are tailored based on oncologic status, patient preference, and local tissue health. Buccal mucosal grafts for dorsal urethroplasty are highlighted as a promising technique. Notably, dorsal-only urethroplasty has demonstrated comparable success to EPA with a lower incidence of postoperative incontinence.
Dr. Nikolavsky emphasizes the difficulties of traditional excision procedures in radiated fields, proposing dorsal-only urethroplasty as a better alternative due to its minimal disruption of adjacent structures. He shares evidence from multi-institutional studies that support its efficacy.
With a call to challenge established dogmas, Nikolavsky underscores the need to refine guidelines and expand the use of innovative approaches like dorsal urethroplasty to improve patient outcomes.
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Telesurgery for Prostate Cancer: Where Are We in 2024? – This Is a Novel Topic and Gaining Traction Around the World
David M. Albala, MD, explores the future of telesurgery, particularly in prostate cancer, emphasizing the intersection of medicine and technology. Dr. Albala relays a history of robotic surgery, beginning in the 1980s with the development of the Da Vinci Robotic System, and the Lindbergh operation in 1991.
In this 14-minute presentation, Dr. Albala highlights the importance of telesurgery in leveling global healthcare disparities. He also notes the successful implementation of telesurgery in urological procedures, such as prostatectomies and partial nephrectomies.
Despite the technological advancements, challenges persist, including economic constraints, patient awareness, and resistance to adoption. The presentation underscores the need for reliable and secure systems and robust training programs to ensure the safe implementation of telesurgery.
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Retroperitoneal Fibrosis: Turning Friendly Territory Hostile
Joshua E. Sterling, MD, MSc, addresses the complexities and surgical challenges of managing retroperitoneal fibrosis.
In this 9-minute presentation, Dr. Sterling emphasizes the shift in treatment strategy over the years. While early management relied heavily on surgical intervention, the current approach prioritizes high-dose steroids as the cornerstone of treatment. For patients unresponsive to steroids, immunosuppressive agents or monoclonal antibodies are considered. Surgery is now reserved for refractory cases or when systemic therapy is insufficient.
Sterling includes imaging and procedure videos that illustrate the challenges of retroperitoneal fibrosis. He stresses that surgeons must rely on sharp dissection rather than electrocautery to navigate the fibrosis safely. Techniques like intraluminal ICG or cystoscopy are recommended to locate the ureter amidst dense fibrotic tissue.
Dr. Sterling concludes with practical advice on teamwork, backup planning, and the importance of coordinating surgical strategies to maintain team confidence and patient safety.
Optilume® BPH Catheter System: Surgical Procedure and BPH Patient Management
E. David Crawford, MD, Dean S. Elterman, MD, MSC, FRCSC, and Garrett D. Pohlman, MD, explore the practical functionality of the Optilume® BPH Catheter System, a novel minimally-invasive surgical therapy (MIST). This is the third in a series supported by Laborie.
Dr. Elterman begins with a step-by-step demonstration of the Optilume® BPH Catheter System’s surgical procedure. For each step, he provides his perspective on best practices during the procedure.
Dr. Pohlman then discusses the management of BPH patients and the patient’s perspective on what successful treatment looks like. He addresses pretreatment guidance and counseling for BPH patients who are eligible for the Optilume® BPH Catheter System, i.e., patients looking for a minimally-invasive BPH treatment without the need for medication.
Dr. Crawford concludes by asking Dr. Elterman and Dr. Pohlman for their perspectives on patient and physician reception of the Optilume® BPH Catheter System in their practices. Dr. Pohlman discusses his experiences with reimbursement, significant flow improvement, and options for balloon sizing. Dr. Elterman discusses the durability of patient QoL improvement, limited catheter time, and sexual function preservation.
To see the first part of this series, click here. To see the second part of this series, click here.
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Optilume® BPH Catheter System: Surgical Procedure and BPH Patient Management – Q&A Session
E. David Crawford, MD, Dean S. Elterman, MD, MSC, FRCSC, and Garrett D. Pohlman, MD, explore the practical functionality of the Optilume® BPH Catheter System, a novel minimally-invasive surgical therapy (MIST). This is the third in a series supported by Laborie.
Dr. Elterman begins with a step-by-step demonstration of the Optilume® BPH Catheter System’s surgical procedure. For each step, he provides his perspective on best practices during the procedure.
Dr. Pohlman then discusses the management of BPH patients and the patient’s perspective on what successful treatment looks like. He addresses pretreatment guidance and counseling for BPH patients who are eligible for the Optilume® BPH Catheter System, i.e., patients looking for a minimally-invasive BPH treatment without the need for medication.
Dr. Crawford concludes by asking Dr. Elterman and Dr. Pohlman for their perspectives on patient and physician reception of the Optilume® BPH Catheter System in their practices. Dr. Pohlman discusses his experiences with reimbursement, significant flow improvement, and options for balloon sizing. Dr. Elterman discusses the durability of patient QoL improvement, limited catheter time, and sexual function preservation.
To see the first part of this series, click here. To see the second part of this series, click here.
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Asymptomatic Stones: Remove Each Piece? Or Leave in Peace?
Benjamin K. Canales, MD, MPH discusses the prevalence and natural history of asymptomatic kidney stones, emphasizing that while these stones may not initially cause symptoms, they have the potential to lead to significant complications, including pain, infection, and obstruction. He identifies various factors that influence the decision-making process, such as stone size, location, composition, and patient-specific factors including age, comorbidities, and risk of future stone-related events.
Dr. Canales discusses the current guidelines and evidence-based practices for managing asymptomatic stones, including the benefits and risks associated with both intervention and observation. He highlights the criteria for selecting patients who may benefit from proactive treatment, such as those with high-risk anatomical features or a history of recurrent stones, and scenarios where a conservative approach, involving regular monitoring and preventive measures, may be more appropriate.
Technological advancements and surgical techniques have improved the safety and efficacy of stone removal procedures. Dr. Canales reviews minimally invasive options, such as ureteroscopy and percutaneous nephrolithotomy, and their role in the management of asymptomatic stones. The presentation includes a discussion on the potential complications of these procedures and the importance of patient counseling to set realistic expectations.
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Urethral Strictures and Bladder Neck Contractures Made Simple
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
Obstacles to Optimal Outcomes for Patients Undergoing Radical Cystectomy
Dr. Raj S. Pruthi discusses the obstacles to achieving optimal outcomes for patients undergoing radical cystectomy. He meticulously analyzes the multifaceted challenges encountered in the preoperative, intraoperative, and postoperative phases of radical cystectomy, a complex surgical procedure primarily performed for muscle-invasive bladder cancer.
Preoperative factors that can impede optimal outcomes, including patient comorbidities, nutritional status, and the importance of thorough preoperative assessment and optimization. He emphasizes the role of prehabilitation in enhancing patient readiness for surgery.
During the intraoperative phase, Dr. Pruthi highlights the technical intricacies of radical cystectomy, stressing the importance of surgical expertise and meticulous technique in minimizing perioperative complications. He discusses the role of minimally invasive techniques, such as robotic-assisted surgery, in potentially reducing blood loss, shortening hospital stays, and enhancing recovery.
Postoperatively, Dr. Pruthi identifies key factors that influence recovery and long-term outcomes. He underscores the significance of effective pain management, early mobilization, and comprehensive postoperative care in mitigating complications. Dr. Pruthi also discusses the challenges related to urinary diversion, including the management of neobladder and ileal conduit complications, and the impact of these diversions on patients’ quality of life.
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