Managing the Post Radiation Bladder Neck and Proximal Urethral Stricture Challenges
Jay Simhan, MD, FACS, explores the challenges of post-radiation bladder neck and proximal urethral strictures.
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Topic: Erectile Dysfunction
IPP and Penile Curvature Decisions: Doing Nothing, Something or Everything
Jay Simhan, MD, FACS, examines the challenges of penile implants in patients with refractory erectile dysfunction and Peyronie’s disease.
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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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Update on Penile Implants: Best Practice and Taking Care of Complications
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.
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Changing Paradigm in the Diagnosis Band Management of Erectile Dysfunction
Mohit Khera, MD, MBA, MPH, Professor of Urology and Director of the Laboratory for Andrology Research at the McNair Medical Institute at Baylor College of Medicine, identifies the paradigm shifts presented in 2018 guidelines for erectile dysfunction (ED), and the current landscape of treating these patients with regenerative therapies.
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APP-directed Postoperative Care Clinic for Prosthetic Urology: Tips for Happier Patients
Sarah Y. Parker, MSN, AGNP-C, analyzes the establishment and operation of an APP-directed postoperative care clinic for prosthetic urology. Her focus is on enhancing patient satisfaction and outcomes through advanced practice provider (APP) involvement in postoperative care. Parker underscores the significance of a specialized clinic model that leverages the expertise of APPs to provide dedicated and continuous care for patients undergoing prosthetic urology procedures.
Parker details the essential components of an APP-directed clinic, highlighting the benefits of having APPs manage postoperative care. Effective communication and patient education are central themes. By providing thorough education, APPs empower patients to actively participate in their recovery. Parker also discusses the importance of setting realistic expectations and maintaining open lines of communication to address patient concerns promptly.
Parker highlights the integration of protocols and guidelines that ensure high-quality, consistent care. Parker’s analysis also focuses on innovation in patient care delivery. Technologies such as telehealth and other digital tools enable APPs to provide timely support and follow-up, further enhancing patient satisfaction and outcomes.
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Margin Call: Focal vs. Regional Ablation
Preston C. Sprenkle, MD, analyzes focal versus regional ablation in prostate cancer treatment, examining the nuances and outcomes associated with each approach. His discussion centers on the effectiveness, risks, and clinical decision-making processes involved in choosing between these two strategies.
Dr. Sprenkle highlights the advantages of focal ablation, including reduced side effects, such as urinary incontinence and erectile dysfunction. Dr. Sprenkle also discusses the potential benefits of regional ablation, particularly in patients with multifocal or higher-risk disease.
Multiparametric MRI (mpMRI) and targeted biopsies play crucial roles in mapping the extent of the disease and guiding the ablation strategy. Dr. Sprenkle underscores the need for a personalized approach, considering factors such as tumor size, location, Gleason score, and patient comorbidities. The discussion also covers the technical aspects and outcomes of both ablation techniques, with data on success rates, complications, and long-term efficacy.
Dr. Sprenkle highlights future directions in prostate cancer ablation, including advancements in imaging, robotic assistance, and the integration of novel therapeutic agents to enhance precision and effectiveness.
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Optimizing Success in Penile Implant Surgery
Jay Simhan, MD, FACS, focuses on optimizing outcomes in penile implant surgery, emphasizing technical performance and perioperative management. In this 17-minute presentation, Simhan suggests that reconstructive urologists should focus on patient outcomes in addition to technical aspects of surgery.
Simhan outlines a multimodal approach to pain management, combining neuropathic pain control, anti-inflammatories, and intraoperative pain blockades rather than relying on opioids alone. Further, he discusses the challenges of managing patients with priapism-related erectile dysfunction, highlighting the difficulties of delayed penile implantation in these cases. The presentation also critiques existing guidelines for antibiotic prophylaxis in penile implants, noting that the American Urological Association’s (AUA) recommendations fail to cover certain pathogens like anaerobes and fungi.
Dr. Simhan stresses the importance of collaboration across institutions to address these complex issues. He introduces the Prosthetic Urology Multi-institutional Partnership (PUMP), a coalition of urologists who address penile implant questions.
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Guidelines and Practical Applications: Artificial Urinary Sphincter
William O. Brant, MD, FACS, FECSM, reviews the 2018 American Urological Association (UAU) guidelines and practical approaches in erectile dysfunction (ED) evaluation, diagnosis, and treatment. He examines methods for evaluation and diagnosis, highlighting the psychological impacts of ED and ED’s connection to cardiovascular disease. Dr. Brant also explores specialized tests and multiple treatment options.
Dr. Brant examines other treatment modalities, such as the vacuum erection device, as a low-cost adjunct treatment. He discusses the intraurethral suppository treatment and warns that up to 30 percent of patients experience urethral pain with this option. Dr. Brant then explains the risks of injection options and surgery. He also analyzes the practicality and commitment inherent in penile prostheses, later transitioning to a discussion on the uncommonly performed arterial reconstruction option.
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Point-Counterpoint: Erectile Dysfunction After Local Therapies: PDE5 Inhibitors and Early Penile Rehab Improves ED Recovery Following Radical Surgery – Con
Aditya Bagrodia, MD, FACS, Associate Professor of Urology and Genitourinary Oncology Team Lead at the University of California, San Diego, presents the cons of using PDE5 inhibitors and early penile rehabilitation to treat erectile dysfunction post-radical prostatectomy. In this presentation, Dr. Bagrodia discusses, the known adverse effects of early use of PDE5is in patients, the failure of PDE5is to out-perform placebos, and the strengths and weaknesses of known treatment options for post-operative erectile dysfunction.
This lecture is part of a Point-Counterpoint debate. Its opposing lecture is “Point-Counterpoint: Erectile Dysfunction After Local Therapies: PDE5 Inhibitors and Early Penile Rehab Improves ED Recovery Following Radical Surgery – Pro.
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Sildenafil: 25 Years Later
25 years after the FDA approval of sildenafil, Dr. Hirsch, Dr. Rosen, and Dr. Goldstein reflect on the past and future of PDE5 inhibitors.
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Changing Paradigm in the Diagnosis and Management of Erectile Dysfunction
Mohit Khera, MD, MBA, MPH, discusses the shared decision-making model of ED treatment and the current shift toward regenerative therapies.
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