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2024

Functional and Reconstructive Urology: A New Subspecialty or Rebranding

Brian J. Flynn, MD, defines functional and reconstructive urology and its place in future and existing urological practices. Dr. Flynn introduces functional and reconstructive urology as an area that focuses on disorders related to urinary and pelvic floor dysfunctions, such as urinary incontinence, pelvic organ prolapse, and overactive bladder.

Dr. Flynn discusses the historical context of functional and reconstructive urology, explaining how aspects of functional urology and reconstructive urology have been present in urology for decades. He acknowledges that while the conditions treated are not new, the emphasis on a multidisciplinary approach and the incorporation of advanced diagnostics and therapeutic techniques justifies viewing functional and reconstructive urology as a distinct subspecialty, rather than a form of alternative medicine.
Dr. Flynn concludes by illustrating how functional and reconstructive urology impacts patient care and quality of life. He provides authoritative sources for continuing education in functional and reconstructive urology.

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High Intensity Focused Ultrasound Ablation Outcomes – TR, In Bore

Behfar Ehdaie, MD, MPH, discusses High-Intensity Focused Ultrasound (HIFU) ablation, particularly focusing on its application in treating prostate cancer. The presentation highlights the recent advancements and clinical outcomes associated with both transrectal (TR) and in-bore HIFU procedures.

Dr. Ehdaie emphasizes the precision and minimal invasiveness of HIFU and outlines the selection criteria for patients. He also discusses the integration of real-time imaging with magnetic resonance imaging (MRI) in in-bore HIFU.

Dr. Ehdaie highlights the promising results demonstrated in clinical outcomes of HIFU ablation, making HIFU an attractive option for eligible patients. He also addresses the ongoing challenges and future directions in HIFU research. The potential for combining HIFU with other therapeutic modalities, such as immunotherapy and targeted therapies, is a promising avenue for enhancing treatment efficacy.

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Managing Screen Time Isn’t Just for Kids: Tips to Break the Spell

Catherine A. Matthews, MD, FACS, FACOG, FPMRS, addresses the pressing issue of excessive screen time, emphasizing its impact on adults as well as children. She discusses the physical and psychological consequences of prolonged screen use, including eye strain, disrupted sleep patterns, decreased physical activity, and increased stress and anxiety. Dr. Matthews also discusses the psychological impact of screen time, noting that excessive use is linked to higher levels of stress, anxiety, and depression.

Dr. Matthews concludes by drawing clear parallels between addiction and screen time in children and adults. She provides practical tips for reducing screen time and increasing interpersonal interaction.

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Focal Therapy for Prostate Cancer

Fernando J. Kim, MD, MBA, FACS, discusses the benefits of focal therapy in prostate cancer treatment. He begins with a review of the weaknesses of non-focal options in the treatment of prostate cancer.

Dr. Kim then highlights the clinical and practical benefits of focal therapy. He emphasizes the advantages that focal therapy offers to underserved and vulnerable populations, and he presents supporting data and demonstrations.

Dr. Kim concludes with a comparison of the results from mpMRI fusion biopsies and targeted cryoablation. He outlines possible future directions for focal therapy and other technologies in the treatment of prostate cancer.

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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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