2024

Expanding the Surgical Options for Primary and Recurrent Male Stress Incontinence

Expanding the Surgical Options for Primary and Recurrent Male Stress Incontinence

Posted by | Feb 2024

Brian J. Flynn, MD, evaluates current and upcoming surgical options for treating primary and recurrent male stress incontinence. He begins by reviewing the medical, social, and urethral characteristics of male stress urinary incontinence (SUI) surgical candidates.

Dr. Flynn then evaluates the risks and benefits of male perineal slings (MPS), artificial urinary sphincters (AUS), and adjustable continence therapy (ACT) devices. He notes that, presently, the least effective surgical option also has the least risk of complications for the patient.

Dr. Flynn concludes by presenting examples of patients with various levels of male SUI and how MPS, AUS, and ACT apply to each case. He reiterates that focusing on patient quality of life is paramount in the successful treatment of male SUI.

Read More
Prostate MRI for Dummies

Prostate MRI for Dummies

Posted by | Feb 2024

Sadhna Verma, MD, FSAR, presents an overview of the use of multiparametric MRI in evaluating the prostate. Dr. Verma begins by reviewing the three elements of a multiparametric MRI in prostate cancer treatment: T2 Weighted Imaging (T2W), Diffusion Weighted Imaging (DWI), and Dynamic Contrast Enhanced (DCE) Imaging.

Dr. Verma presents examples of T1 and T2 Weighted (T2W) MRI images, which are used to illustrate the zonal anatomy of the prostate. She notes that T1 and T2 MRI is weak when it comes to identifying problems in the transition zone.

Dr. Verma then moves to Diffusion Weighted Imaging (DWI) to measure cell diffusion as a means of locating tumors. However, she notes that DWI is not very accurate for recently-biopsied patients.

Dr. Verma concludes by briefly touching on Dynamic Contrast Enhanced (DCE) Imaging to measure tumor vascularity, and how DCE combines with T2W and DWI to give each identified lesion a PI-RADS (Prostate Imaging Reporting and Data System) score. She emphasizes that a PI-RADS score should only be used in detection of clinically significant prostate cancer, and presents examples of how prostate cancer can be identified in peripheral zones, transition zones, and extra-prostatic locations through the use of multiparametric MRI.

Read More
An Algorithm to Pacify the Male Patient with Chronic Genital Pain

An Algorithm to Pacify the Male Patient with Chronic Genital Pain

Posted by | Feb 2024

Ryan P. Terlecki, MD, FACS, presents a systematic approach to patients presenting with chronic genital pain, with the goal of identifying the underlying cause while avoiding common pitfalls with this type of patient. Dr. Terlecki begins by cautioning against assumptions about the patient, as they can cause anxieties in the provider which impact the quality of patient care.

Dr. Terlecki provides guidance on tailoring patient intake questionnaires to keep the focus on the patient’s issue and possible approaches. He gives examples of open and closed questions for male genital pain.

Dr. Terlecki then discusses the importance of setting patient expectations regarding diagnoses and what they should expect from the provider, particularly when the provider does not specialize in pain management. He then discusses common, uncommon, and overlooked causes of male genital pain.

Dr. Terlecki concludes by walking through this algorithm from intake to assessment to diagnosis and treatment. He emphasizes the importance of not dismissing patient input on treatment, but still strictly adhere to evidence-based treatment over unproven or alternative treatments.

Read More
Optimizing In-Office Management for BPH, by the Numbers

Optimizing In-Office Management for BPH, by the Numbers

Posted by | Feb 2024

Ricardo R. Gonzalez, MD, outlines an algorithm to determine optimal in-office BPH treatment options for both patient and practice. Dr. Gonzalez begins by categorizing BPH treatment options by risk and benefit, ranging from non-invasive to open surgical options.

While categorizing BPH treatment options, Dr. Gonzales gives examples of optimal treatment options based on patient presentation and priorities. He walks through the algorithm based on different patient priorities, emphasizing that a systemic approach to BPH treatment is necessary to pair the correct treatment with individual patients.

Read More
Surgical Training for Radical Prostatectomy – Should the Open Approach Still Be Taught? Which Patients? Retropubic, Perineal, Mini-Incision, etc.?

Surgical Training for Radical Prostatectomy – Should the Open Approach Still Be Taught? Which Patients? Retropubic, Perineal, Mini-Incision, etc.?

Posted by | Feb 2024

Guilherme Godoy, MD, MS, explores the question of whether or not to teach residents open radical prostatectomy, weighing multifunctional surgical skills with robotic advancements. He then explains that the open approach to radical prostatectomy is the gold standard in the medical community; however, the robotic approach is more commonly performed.

Dr. Godoy proceeds by questioning whether a sufficient number of open-approach radical prostatectomies are being conducted to warrant training residents in this method. Referring to a 2020 study, he finds that perhaps too few open-approach procedures are occurring to allow for resident proficiency.

Dr. Godoy then asks whether the open approach offers any benefits, exploring four situations in which the open approach is preferred over the robotic method. Dr. Godoy then cites a 2007 study to evaluate the learning curves of open-approach radical prostatectomy subtypes compared to the robotic approach, finding drastic differences in the climb to proficiency.

He completes his presentation by stressing that resident skill and comfort level should be considered in the debate between the open and robotic approaches. Following the presentation, audience members offer points of consideration regarding rural populations, new robots, and current robot malfunctions during radical prostatectomies.

Read More

Join the GRU Community

- Why Join? -