2024 Archives

Future Directions (FD) in Molecular Targeted Imaging (MTI) and Theranostics Discussion

Posted by Robert E. Reiter, MD, MBA | Jan 2025

Robert E. Reiter, MD, MBA, highlights advances in molecular targeting and imaging in prostate cancer, with a focus on PSMA PET imaging. PSMA PET is expanding its role, particularly in identifying primary or secondary tumors when MRI results are negative or ambiguous. This application, under investigation in the Primary Two study, could reduce unnecessary biopsies and improve tumor detection.

In this 7-minute presentation, Dr. Reiter reviews PSMA-guided surgical resection using fluorescence or radioguidance to enhance precision. He asserts that this approach could reduce positive margins, optimize node removal, and support nerve-sparing techniques when appropriate, improving functional outcomes.

Reiter also discusses PSMA PET in oligometastatic disease, specifically the optimal treatment approach when few metastases are present. In addition, PSMA imaging is being explored in focal and radiation therapies, where it could provide a more accurate assessment of recurrence and treatment response; in advanced prostate cancer, PET could help identify resistant lesions for targeted radiotherapy.

PCNL Challenges: How to Keep the Train on the Rails

Posted by Wesley A. Mayer, MD | Jan 2025

Wesley A. Mayer, MD, offers a comprehensive discussion on optimizing percutaneous nephrolithotomy (PCNL), focusing on minimizing complications, strategic planning, and adaptive surgical techniques.

In this 20-minute presentation, Dr. Mayer reviews indications for PCNL with updates on guidelines. He stresses the importance of individualized treatment decisions. Mini PCNL is emphasized for challenging lower pole stones, and for smaller stones, balancing efficiency and patient outcomes.

Dr. Mayer stresses preoperative preparation, underscoring the value of detailed imaging. The choice of access (prone vs. supine) is tailored based on patient anatomy, stone location, and procedural requirements. The importance of a flexible and adaptive approach is stressed, with practical examples illustrating the decision-making process when encountering complications.

Lastly, Dr. Mayer underscores the importance of knowing when to continue versus when to safely abort a procedure, reflecting on the need for prudent judgment to optimize patient safety and surgical outcomes.

Single Incision Slings

Posted by Jason M. Kim, MD | Jan 2025

Jason M. Kim, MD, discusses single-incision slings, a less invasive option for treating stress incontinence in women. In this 9-minute presentation, Dr. Kim offers single-incision slings as a less invasive option than traditional retropubic and transobturator slings, eliminating many of the complications associated with traditional methods. He begins with a short background of midurethral slings, including possible complications and why a single incision option would be preferable.
Dr. Kim discusses the benefits of the single-incision sling and shows examples of possible options. He asserts that this less invasive therapy eliminates many complications associated with traditional methods. He also shares studies that have demonstrated its efficacy, including the 2022 Cochrane review and a randomized trial published in The New England Journal of Medicine.

Climacturia After Radical Prostatectomy: What is It? Why is It? How Do We Treat It?

Posted by Brian S. Christine, MD | Jan 2025

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.

Approach to Pyeloplasty Failure

Posted by Kirk D. Redger, MD | Jan 2025

Kirk D. Redger, MD, provides a comprehensive discussion on recurrent ureteropelvic junction (UPJ) obstruction, emphasizing diagnostic approaches, treatment strategies, and the importance of tailored patient care.

In this 13-minute presentation, Redger highlights the importance of knowing a patient’s prior interventions when determining the next steps for treatment. Treatment plans are individualized, taking into account patient goals, age, comorbidities, and previous surgeries. Frail patients, those with active malignancies, or those with poor renal function may benefit from non-surgical management like stent placement. For surgical candidates, options range from endoscopic procedures and balloon dilation to complex reconstructive surgeries, such as robotic or open pyeloplasties.