MIST Procedures and Sexual Dysfunction
Faysal A. Yafi, MD, FRCSC, discusses minimally invasive surgical procedures and their impact on sexual dysfunction.
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Topic: Men’s Health
Urodynamics Review
Stephen R. Kraus, MD, MBA, FACS, provides a comprehensive review of urodynamics, discussing key concepts and practical applications in evaluating lower urinary tract function. This 14-minute presentation emphasizes the importance of understanding both the storage and emptying phases of bladder function.
Dr. Kraus details how dysfunction can arise from a bladder issue, an outlet problem, or both. Specific examples are given and complex cases are also included. Kraus notes results from various tests, such as those for stress incontinence, overactive bladder, and neurogenic bladder, help guide the use of urodynamics in clinical practice. He highlights the need for careful interpretation of test results to ensure accurate diagnosis and treatment planning.
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Post-Vasectomy Pain Syndrome
Jeffrey C. Morrison, MD, addresses post-vasectomy pain syndrome (PVPS) following vasectomy. In this 11-minute presentation, he highlights the significant challenge PVPS presents to patients and clinicians, emphasizing that a broad differential and comprehensive workup, including physical exams and diagnostic tests, is essential.
Although the cause of PVPS remains uncertain, Dr. Morrison discusses possible contributing factors, such as neuropathic, obstructive, or immune-driven etiologies. He presents treatments, both conservative approaches like scrotal support and anti-inflammatory medications, and options like neuromodulator therapy, pelvic floor physical therapy, and acupuncture.
Dr. Morrison also discusses treatment for those who require additional management, such as spermatic cord block, and surgical options, including microdenervation and vasectomy reversal.
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Surgical BPH: 2024 Updates and Where Are We Going
Nicole L. Miller, MD, FACS, delivers an incisive update on the surgical management of benign prostatic hyperplasia (BPH). In this 11-minute presentation, Dr. Miller outlines the current AUA guidelines, highlighting a broad spectrum of treatments tailored to prostate size. Trends in national data reveal that transurethral resection of the prostate (TURP) remains the dominant procedure, while minimally invasive options like UroLift have gained substantial traction.
Dr. Miller discusses emerging technologies, including the OptilumeⓇ BPH System. She also reviews promising data on MRI-guided transurethral ultrasound ablation (TULSA). Advanced laser techniques, particularly holmium pulse modulation, and thulium fiber laser, are explored for their efficacy in enucleation procedures, showing advantages in operative time, hemostasis, and same-day discharge rates. Miller highlights evolving techniques like en bloc enucleation with early apical release. A brief discussion on robotic-assisted simple prostatectomy includes recent shifts toward single-port approaches.
Dr. Miller stresses the importance of aligning treatment with patient preferences and quality-of-life goals, emphasizing shared decision-making as central to optimizing outcomes in this rapidly advancing field.
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Climacturia After Radical Prostatectomy: What is It? Why is It? How Do We Treat It?
Brian S. Christine, MD, Brian S. Christine, MD, addresses the overlooked issue of climacturia in men who have undergone radical prostatectomy.
In this 19-minute talk, Dr. Christine outlines both conservative and surgical management strategies for climacturia. Simple approaches include bladder emptying before intercourse and the use of constriction rings, pharmacologic treatments, and surgical options like suburethral slings. For patients with severe erectile dysfunction requiring penile implants, he discusses an innovative approach using a Mini Jupette sling.
Dr. Christine emphasizes the need for better preoperative counseling on climacturia and highlights the range of available treatment options tailored to individual patient needs, from conservative measures to advanced surgical interventions.
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TRAVERSE: Meaning of the Testosterone Safety Trials
Martin M. Miner, MD, reviews testosterone safety trials and recent data on the cardiometabolic effects of testosterone, addressing concerns from the FDA about off-label testosterone use among aging men. The TRAVERSE trial, conducted in response to these concerns, examines whether testosterone therapy increases the risk of myocardial infarction or stroke.
In this 12-minute presentation, Dr. Miner provides a comprehensive review of studies from 1940 to 2014, which found minimal evidence suggesting cardiovascular risks associated with testosterone. However, key studies released in 2013-2014 raised concerns about testosterone therapy, indicating a potential increased risk of non-fatal myocardial infarctions. In response, the FDA issued a directive in 2015, leading to the large-scale TRAVERSE trial, a double-blind, placebo-controlled trial that assessed testosterone gel effects over five years.
The TRAVERSE study is notable as the longest randomized, controlled trial on testosterone safety among hypogonadal men to date. Findings indicate that testosterone therapy poses low cardiovascular risk, improves sexual health, and has no significant impact on prostate cancer risk or progression. This suggests that normalized testosterone levels may reduce risks of mortality and adverse cardiovascular events, without elevating prostate cancer concerns.
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Optilume for BPH
Sunchin Kim, MD, offers an in-depth exploration of OptilumeⓇ, a novel therapy for benign prostatic hyperplasia (BPH).
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The King of Enucleations: HoLEP
Mitchell R. Humphreys, MD, MPH, delves into benign prostatic hyperplasia management and holmium laser enucleation (HoLEP).
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CAPTAIN: A Randomized Controlled Trial of MRI-Guided Transurethral Ultrasound Ablation of the Prostate versus Radical Prostatectomy
Xiaosong Meng, MD, PhD, explores the ongoing CAPTAIN trial, a multinational, randomized clinical study comparing transurethral ultrasound ablation (TULSA) with radical prostatectomy in patients with intermediate-risk prostate cancer. The CAPTAIN trial builds on the TACT study, which demonstrated the safety and efficacy of whole-gland ablation using TULSA.
In this 11-minute presentation, Dr. Meng outlines the eligibility criteria for the CAPTAIN trial participants and reviews the study schema. The trial aims to provide level 1 evidence of safety and efficacy, addressing the need for robust comparative studies to support guideline adoption of ablative technologies.
The trial evaluates outcomes including quality of life, urinary continence, erectile function, and long-term efficacy, with follow-up extending to 10 years. The study’s findings are anticipated to substantiate the use of TULSA as an effective and patient-preferred alternative to radical prostatectomy, potentially influencing clinical practice and reimbursement policies.
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Beyond the Semen Analysis 2024: State of Art Male Fertility Testing
Larry I. Lipshultz, MD, critically examines the limitations of traditional semen analysis in evaluating male infertility and advocates for the adoption of advanced diagnostic techniques.
In this 23-minute presentation, Dr. Lipshultz shares that semen analysis still relies on parameters like sperm count, motility, and morphology. Lipshultz underscores the need for innovative tests beyond standard semen analysis, introducing several emerging techniques. He highlights DNA fragmentation testing and epigenetic testing. Emerging assays like non-obstructive azoospermic (NOA) tests and sperm fertility window assessments offer further diagnostic precision. Whole genome sequencing, utilizing advanced nanopore technology, is poised to revolutionize male infertility diagnostics by identifying specific genetic anomalies.
Dr. Lipshultz asserts that traditional semen analysis is outdated and should be supplemented with new advanced, functionally informative tests to enhance diagnostic accuracy and patient care in infertility treatment.
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Management of Peyronie’s Disease
Ayman Soubra, MD, addresses the treatment of Peyronie’s disease. In this 24-minute presentation, he begins by reviewing the condition, its pathophysiology, and its prevalence. Dr. Soubra also discusses the evaluation of Peyronie’s disease, including a thorough medical history, examination for familial traits (such as Dupuytren’s contractures), and physical examination.
Several treatment options exist, from noninvasive oral and topical therapies to mechanical therapies like vacuum and traction devices. Dr. Soubra discusses intralesional collagenase injections at length. This therapy is FDA-approved based on clinical trials and significantly improves penile curvature. For severe cases, surgical options such as tunical plication or grafting may be necessary, especially for patients with significant deformities or erectile dysfunction. Soubra shares indications and techniques for this procedure in detail.
Dr. Soubra recommends multimodal approaches tailored to the patient’s specific goals and severity of symptoms.
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BPH Morcellation
Amy E. Kramback, MD, presents a detailed overview of morcellation and its potential complications, particularly in Holmium Laser Enucleation of the Prostate (HoLEP). In this 14-minute presentation, she explains the technical requirements for performing morcellation.
Dr. Rebeck narrates a video of the procedure’s steps. She highlights how challenging nodules can sometimes require additional laser grooves to enable effective morcellation.
Complications during morcellation are also reviewed. Intraoperative issues include capsular perforations and bladder injuries. Injury to the ureteral orifices, while rare, can occur during morcellation. Dr. Krambeck also discusses postoperative complications and their management, including bleeding, clot retention, and infections such as UTIs or epididymitis. Incontinence, mainly urge incontinence, is another common postoperative issue. However, with proper technique, HoLEP and morcellation present low complication rates and excellent patient outcomes.
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