2021 Archives

Seeing Your Last Patient On Time

Posted by Neil H. Baum, MD | May 2021

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses scheduling in a urology practice, with the goal of seeing the last patient on time. He provides six suggestions for maintaining on-time appointments. Dr. Baum stresses the importance of doing so by noting that sitting in the waiting room or exam room for a long time can increase patient anxiety and reduce their overall satisfaction. For the practice, delayed appointments create stress for staff and can increase overtime expenses. Dr. Baum suggests physicians rethink the “waiting area” as the “reception area,” and encourages physicians to make a commitment to be on time each day. He also recommends managing appointment types based on the estimated time each will take. Follow-up visits to check BPH or testosterone deficiency may only require five minutes, but a new patient or new diagnosis is likely to require a 30-minute appointment. Dr. Baum adds that doctors should not accept meetings with pharmaceutical representatives or vendors while patients are present, nor is it acceptable to make or accept phone calls while in the exam room with a patient. Finally, he notes the value of rewarding staff if they help manage an efficient schedule.

Mycoplasma and Ureaplasma Molecular Testing Does Not Correlate with Irritative or Painful Lower Urinary Tract Symptoms

Posted by A. Lenore Ackerman, MD, PhD | May 2021

A. Lenore Ackerman, MD, PhD, Director of Research for FPMRS in the Department of Urology at the University of California, Los Angeles, shares data from her research group evaluating diagnostic testing patterns for ureaplasma and mycoplasma and characterizing the associations of these bacteria with irritative lower urinary tract symptoms (LUTS) using molecular detection techniques. Dr. Ackerman explains the context and rationale for the study and reviews how it illustrates Robert Koch’s postulates. She also addresses topics such as how physicians should approach LUTS in culture-negative patients, the significance of the bacteria detected through new sensitive methods, and whether symptoms are proof of infection or if they could be related to something else. Ultimately, she concludes with two main points: that the physician’s focus should be on treating the patient, not on treating a test; and that not all bacteria are bad, as some healthy genitourinary commensal bacteria play an important role in preventing urinary tract infections.

Androgen Society 3rd Annual Meeting Review (Day 1)

Posted by Abraham Morgentaler, MD, FACS | May 2021

Abraham Morgentaler, MD, FACS, Associate Clinical Professor of Urologic Surgery at Harvard University, reviews the first day of the 3rd annual meeting of the Androgen Society, an international organization consisting of healthcare professionals interested in testosterone deficiency and its treatment. Dr. Morgentaler notes that the day began with a presentation on the history of testosterone by Dr. Nieschlag, followed by a presentation by Drs. Ethan D. Grober and Michael S. Irwig on transgender men and the physical impact of testosterone. Dr. Morgentaler then reviews a panel discussion that covered the use of free testosterone, erythrocytosis management, and the role of testosterone therapy and PDE5 inhibitors in men with erectile dysfunction and low testosterone. He goes on to summarize presentations by Drs. E. David Crawford and Omer Raheem which covered the use of androgen deprivation therapy (ADT) in local disease, biochemical failure, and advanced disease, as well as the sexual effects of testosterone. Dr. Crawford presented data showing that there is value in having a testosterone level below 20 nanograms per deciliter, and Dr. Raheem discussed a study that found that different forms of ADT should be used depending on patients’ cardiovascular issues. Dr. Morgentaler concludes by considering new testosterone formulations, including testosterone undecanoate, an oral soft gel, and injectables.

Industry Perspective: Panel Discussion on Cxbladder Genomic Urine Test for Bladder Cancer

Posted by Siamak Daneshmand, MD | May 2021

Siamak Daneshmand, MD, Associate Professor of Urology and Director of Clinical Research at the University of Southern California (USC), along with Anne Schuckman, MD, Assistant Professor of Clinical Urology at the USC, and Sima P. Porten MD, MPH, Associate Professor at the USC participated in a panel discussion on the Cxbladder Genomic Urine Test for Bladder Cancer at the 5th Annual International Bladder Cancer Update. Dr. Daneshmand reviews a research study that audited the clinical utility of the Cxbladder monitor assay and found that it accurately ruled out patients who did not have recurrent UC, enabling low risk patients to undergo cystoscopy at a longer-than-recommended interval, thereby reducing the cystoscopy burden by 39%. He then asks Drs. Porten and Schuckman questions about their experience with Cxbladder, leading the two to discuss ideal patient populations for Cxbladder, in-home sampling procedures, and situations wherein Cxbladder is most effective.

Freehand Transperineal Prostate Biopsy Under Local Anesthesia

Posted by Michael A. Gorin, MD | May 2021

Michael A. Gorin, MD, a urologist with Urology Associates of Cumberland, Maryland, explains the benefits of transperineal prostate biopsy compared to the transrectal approach for prostate cancer patients. First, he discusses the complications of transrectal biopsy, specifically infection risk, and demonstrates how the transperineal approach can decrease this risk without contributing to antibiotic resistance. He then explains how transperineal biopsy aids in improved detection and cancer upgrading. Dr. Gorin goes on to review transperineal biopsy methods, including the use of the Precisionpoint Transperineal access system. Finally, he summarizes block techniques and biopsy templates for freehand transperineal prostate biopsy under local anesthesia in the outpatient setting.