2021 Archives

Use of Social Media in Men’s Health Urologic Practice

Posted by Brian S. Christine, MD | Jan 2021

Brian S. Christine, MD, a urologist and Fellowship Director and Director of Prosthetic Urology and Men’s Sexual Health at the Urology Centers of Alabama in Birmingham, discusses the use of social media in men’s health urologic practices. He begins by discussing older mediums and why they are no longer effective at getting the word out, as well as the limitations of word of mouth. He goes on to talk about why leveraging social media platforms is important for reaching the widest possible audience and attracting new patients. Dr. Christine then explains what has worked for him and his practice and what has not. He emphasizes the importance of creating a personal website that is separate from the practice that can be linked to all of one’s social media accounts. He also highlights the social media platform that has been the most effective for him: Youtube. Youtube is particularly helpful because it allows users to upload high-quality educational videos; the majority of Dr. Christine’s new patients that seek him out on their own do so after watching one of his surgical videos. Dr. Christine then gives advice about how to be successful on Youtube and pitfalls to avoid when making videos. He offers specific tips about how to make the same kind of high-quality videos that appear on his Youtube channel. Finally, he observes that the biggest roadblock is not making the commitment to begin.

COVID-19 Vaccine Roundtable Discussion

Posted by E. David Crawford, MD | Jan 2021

E. David Crawford, MD, Professor of Urology at UC San Diego and Editor-in-Chief of Grand Rounds in Urology, interviews Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic Arizona in Scottsdale, and Neil H. Baum, MD, Professor of Urology at Tulane Medical School, about the COVID-19 vaccine—how it works, its safety, and possible side effects. Currently, Pfizer and Moderna have each created a vaccine for the novel coronavirus, both of which are mRNA vaccines containing code for the protein found within the virus. Dr. Bryce describes how this portion of RNA causes cells to synthesize what is known as a “spike protein,” which then stimulates an immune response. He observes that side effects are typically mild and similar to what one could expect with a standard flu vaccine, notwithstanding rare, severe reactions. Dr. Baum then addresses the psychological manifestations associated with COVID-19, such as anxiety, fear of contracting or spreading the disease, PTSD, depression, and even suicide. It is important to note that these symptoms are also associated with burnout which, within the medical community, impacts urologists to a greater degree. Dr. Baum warns that the stress of being a frontline worker, decreases in income, and the shift from in-person to telehealth appointments and related “Zoom fatigue” may further increase burnout among urologists.

Active Surveillance Criteria and Follow-up Protocol

Posted by Michael A. Brooks, MD | Jan 2021

Michael A. Brooks, MD, Assistant Professor of Urology and Oncology at Baylor College of Medicine in Houston, Texas, discusses active surveillance and follow-up protocol best practices. In 2020 BCM started integrating MRI Fusion Biopsy into active surveillance protocol using best evidence. Dr. Brooks starts off by discussing the evidence for this new protocol from two different North American cohorts. He looks at MRI fusion biopsy in biopsy naive men, and discusses using MRI fusion biopsy for confirmation. He considers whether we can get rid of diagnostic and confirmation systematic biopsies as they can be replaced by the more accurate MRI fusion biopsy. He continues to discuss how often the biopsy needs to be repeated and special considerations that may need to be made when using this technology. He emphasizes that this is still very new and there are some special scenarios that are under studied. Some of the special scenarios include patients with high volume GG1, patients with GG2, and African American patients. Dr. Brooks also goes over the specific protocols that Baylor College of Medicine follows before discussing some pitfalls of the MRI fusion biopsy using a few case reviews as examples.

High Intensity Focused Ultrasound (HIFU) Ablation in a Salvage Setting

Posted by John H. Jurige, Jr., MD | Jan 2021

John H. Jurige, Jr., MD, HIFU Program Director for the HIFU Center of Excellence in Louisville, Kentucky, discusses high intensity focused ultrasound (HIFU) ablation therapy for patients with radiorecurrent prostate cancer. He explains that this is a difficult subset of patients to treat, since they have very aggressive prostate cancer. Treatment will often fail, so one of the main objectives of treatment in this group must be quality of life preservation through avoidance of treatment morbidity and use of ADT. Focal HIFU is exceptional in this regard, even if its 5-year biochemical failure-free survival rates have historically been comparable to other forms of treatment. Dr. Jurige notes that these outcomes may be improved through better patient selection, and by starting patients on therapy at earlier stages of recurrence. Better patient selection, which can be more readily achieved with the recent improvements to prostate imaging, can also help prevent adverse effects like urethral stricture and rectal fistula. Dr. Jurige concludes by recommending that urologists give patients a full assessment and get all the studies they can before starting them on salvage HIFU after radiation.

Next Generation DNA Sequencing for Genitourinary Implants

Posted by Paul H. Chung, MD | Jan 2021

Paul H. Chung, MD, Assistant Professor and Director of the Division of Reconstructive Urology at the Sidney Kimmel Medical College of Thomas Jefferson University, discusses infection of genitourinary implants and how next-generation sequencing can be used to manage device infection. Presenting his results from a recently published article with the Canadian Journal of Urology, he outlines the methods, outcomes, and recommendations for clinicians, specifically those removing malfunctioning or infected penile prostheses and artificial sphincters. Dr. Chung highlights the benefits of polymerase chain reaction (PCR) and next-generation sequencing (NGS) including faster processing time, greater sensitivity, and the ability to run both fungal and bacterial analysis in the same setting. Additionally, NGS is useful in the selection of perioperative antibiotics and irrigation solutions, as well as determining how to coat devices during implant surgery. Following the presentation, Grand Rounds in Urology editor J. Curtis Nickel, MD, FRCSC interviews Dr. Chung to further discuss the clinical implications of his research. In the conversation, they compare biofilm collection techniques, noting that PCR and NGS are most helpful in a clinical setting, whereas extended culture is useful in a research setting.