Topic: Men’s Health

Priapism: How Do We Manage and How Do We Learn How to Manage in 2024

by Thomas J. Walsh, MD, MBA, MS | Oct 2024

Thomas J. Walsh, MD, MBA, MS, discusses practical strategies for evaluating, diagnosing, and managing ischemic priapism. He begins with an overview of the symptoms, diagnosis, associated risks, and standard treatment procedures for the management of ischemic priapism.

Dr. Walsh then turns to effective treatment options after intracavernosal phenylephrine and corporal aspiration fail. He outlines various types of distal shunting, corporal tunneling, penoscrotal decompression, and early prosthesis placement.

Dr. Walsh concludes by addressing the lack of standardized training for treating ischemic priapism. He outlines a simulation curriculum designed to quickly train and presents the results from the pilot study.

The Association Between Testosterone Treatment and Incident of Cardiovascular Events among Testosterone Deficient U.S. Veterans

by Thomas J. Walsh, MD, MBA, MS | Oct 2024

Thomas J. Walsh, MD, MBA, MS, provides a detailed examination of the relationship between testosterone treatment and the incidence of cardiovascular events among testosterone-deficient U.S. veterans.

In this 19-minute presentation, Dr. Walsh outlines the background of testosterone deficiency, noting ongoing concerns regarding its safety, particularly its potential to increase the risk of heart attacks, strokes, and other heart-related issues.

Drawing on data from a large cohort of U.S. veterans, Dr. Walsh discusses the incidence of cardiovascular events in patients undergoing testosterone therapy compared to those who do not receive such treatment. He discusses the methodology used in the study, including the selection of participants, the duration of follow-up, and the statistical analyses employed to control for confounding variables.

Update on Penile Implants: Best Practice and Taking Care of Complications

by Jesse N. Mills, MD | Oct 2024

Jesse N. Mills, MD, delivers an insightful presentation on the latest advancements and best practices in using penile implants.

In this 14-minute discussion, Dr. Mills reviews prep and surgical techniques. He also discusses both early and late complications associated with penile implants and outlines strategies for addressing issues such as infection and erosion. He stresses the importance of patient follow-up to ensure early detection and management of complications, thereby improving long-term outcomes.

Dr. Mills concludes by emphasizing the need for continuous education and skill development among urologists to keep pace with advancements in penile implant technology and surgical techniques. His presentation is a comprehensive guide for clinicians seeking to enhance their practice in managing penile implants and caring for patients experiencing complications.

Urodynamics Review

by Stephen R. Kraus, MD, MBA, FACS | Sep 2024

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.

TURP in 2024

by Granville L. Lloyd, MD | Sep 2024

Granville L. Lloyd, MD, provides a comprehensive overview of therapies for benign prostatic hyperplasia (BPH), focusing on the evolution from medical to procedural interventions. In this 9-minute presentation, he highlights the ongoing development and competition among various technologies, emphasizing procedural therapy over medical management in terms of sexual outcomes. Dr. Lloyd’s presentation describes the wide array of procedural options, including TURP, Rezūm, UroLift, and newer approaches like Optilume.

The economic and clinical burden of BPH is underscored. Dr. Lloyd advocates for a personalized approach to selecting the appropriate therapy, utilizing the best tool available for each patient while acknowledging the evolving role of newer technologies.

HoLEP

by Lori B. Lerner, MD | Sep 2024

Lori B. Lerner, MD, delves into the complexities of enucleation techniques for treating benign prostatic hyperplasia (BPH), emphasizing the importance of understanding prostate anatomy. In this 11-minute presentation, she highlights how individual anatomical variations influence surgical decisions and outcomes, particularly in laser enucleation.

Dr. Lerner outlines different approaches to enucleation, involving strategic incisions to address each patient’s specific anatomy. She discusses complex cases, such as patients with a significant portion of their prostate extending into the bladder, nodular prostates, or elevated bladder necks, which necessitate tailored approaches.

Dr. Lerner’s presentation underscores the necessity of careful preoperative imaging, using tools like MRI or CAT scans, to map the prostate’s structure and guide the surgical approach. She advocates against routine excessive testing, emphasizing responsible and targeted use of diagnostic tools to inform clinical decisions without unnecessary expenditure. Lerner also addresses potential complications such as postoperative stress urinary incontinence.

BPH Morcellation

by Amy Krambeck, MD | Sep 2024

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.

TRAVERSE: Meaning of the Testosterone Safety Trials

by Martin M. Miner, MD | Sep 2024

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.

Management of Peyronie’s Disease

by Ayman Soubra, MD | Sep 2024

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.

Post-Vasectomy Pain Syndrome

by Jeffrey C. Morrison, MD | Sep 2024

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.

Optilume

by Garrett D. Pohlman, MD | Sep 2024

Garrett D. Pohlman, MD, discusses the Optilume BPH procedure, a novel treatment for benign prostatic hyperplasia (BPH). In this 11-minute talk, Pullman gives step-by-step instructions for the Optilume placement procedure, emphasizing how the treatment can be tailored to individual patients based on prostate size, anatomy, and personal preferences.

Pullman discusses the safety and efficacy of Optilume, as well as data from studies like Pinnacle and Everest. He also shares that the placement procedure can be performed in various settings, including outpatient surgery centers and offices. He asserts that Optilume BPH is a promising, durable, and patient-friendly option for treating BPH.

Should MIST be First Line Treatment for BPH?

by Seth K. Bechis, MD | Sep 2024

Seth K. Bechis, MD, explores the question of whether or not minimally invasive surgical therapies (MIST) should be first line treatment for BPH. He begins by highlighting the prevalence of BPH in men over 60. He acknowledges that combination therapy is extremely effective in combating BPH in the short-term, but it has several long-term risks which impact patient QoL.

Dr. Bechis highlights the negative side-effects of 5-ARIs, alpha blockers, and surgery post-medication-failure. Side-effects included increased risk of cardiac failure, dementia, depression, and sexual dysfunction.

Dr. Bechis then examines current MIST procedures for BPH treatment, including prostatic urethral lifts, water vapor thermal therapy, temporarily implanted nitinol devices, and balloons. He examines the durability, effectiveness, and side-effects for each procedure, and compares them to patients on medication

Dr. Bechis concludes by comparing the cost effectiveness of MIST procedures to the cost of medication, taking into account IPSS improvement and Quality-Adjusted Life Years over time. Overall, he suggests that MIST procedures should be explored as a first line treatment for BPH.

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