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2024

Image-Based Detection and Staging of Prostate Cancer: Is the TRUS Probe Facing Extinction?

Image-Based Detection and Staging of Prostate Cancer: Is the TRUS Probe Facing Extinction?

Posted by | Jul 2024

Peter A. Pinto, MD, explores the possibility of current imaging technology replacing the Transrectal Ultrasound (TRUS) probe in prostate cancer detection and staging. He begins with an overview of the weaknesses of the TRUS probe compared to magnetic resonance imaging (MRI) and MR/ultrasound fusion-guided biopsies in detecting and locating prostate cancer.

However, Dr. Pinto presents a comparison of the detection rates of TRUS-only biopsies with those of MR/ultrasound fusion-guided biopsies. He notes that both of these biopsy approaches can fail to detect low-risk and high-risk prostate cancers, leading to prostate cancer upgrading events.

Dr. Pinto concludes with an examination of the results from MRI-TRUS fusion biopsies. He presents the improved detection and certainty rates of the combined biopsy approach.

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Pelvic Fracture Urethral Disruption: The Hardest Straightforward Case

Pelvic Fracture Urethral Disruption: The Hardest Straightforward Case

Posted by | Jul 2024

Maxx A. Gallegos, MD, discusses Pelvic Fracture Urethral Disruption/ Injury (PFUI), including its etiology, diagnosis, preoperative planning, and treatment. He begins by debunking a few myths about the location of PFUIs and their etiologies.

Dr. Gallegos then presents the process of diagnosis for PFUIs, and which tools are inappropriate for diagnosis and preoperative planning. He discusses the benefits and setbacks of preoperatively treating PFUI patients with Primary Realignment versus Super Pubic Tube alone.

Dr. Gallegos then outlines the reconstruction challenges associated with treating PFUIs. He notes that, while the surgical steps are straightforward, complications due to the number of required sutures, lack of urethral length, and the proximity to the rectum are common.

He concludes by sharing tips, tricks, and best practices for successful urethral reconstruction after a PFUI. He compares the outcomes for males and females and presents examples of each.

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Emerging Topics in Ureteroscopy: Pressure, Temperature, and Suction

Emerging Topics in Ureteroscopy: Pressure, Temperature, and Suction

Posted by | Jul 2024

Seth K. Bechis, MD, discusses methods to reduce pain, sepsis, and other complications in the use of ureteroscopy to treat renal conditions. He begins by examining the relationship between intrarenal pressure (IRP), pain, and infection. He discusses the importance of monitoring IRP during ureteroscopy, and explores methods of reducing IRP, including irrigation control.

Dr. Bechis then discusses the issue of thermal injury in ureteroscopy. He illustrates the benefits of proper irrigation, shorter laser pedal activation time, and laser setting in preventing the denaturation of proteins in the kidney. He compares the temperatures generated by Holmium and TFL lasers, noting that TFL is a higher-energy option.

Dr. Bechis concludes by examining the role of suction in renal stone removal. He presents a demonstration of various suction devices and discusses their strengths and limitations. He warns that the use of a suction device lengthens the duration of the procedure and that suction still has room for improvement as a treatment.

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Optilume® BPH Catheter System: Optilume® BPH Product and Clinical Data Overview

Optilume® BPH Catheter System: Optilume® BPH Product and Clinical Data Overview

Posted by | Jun 2024

E. David Crawford, MD, sits down with Dean S. Elterman, MD, MSC, FRCSC, and Stephen Kaplan, MD, to discuss the evolution of BPH treatment and the Optilume® BPH Catheter System, a novel minimally-invasive surgical therapy (MIST). This is the first in a series supported by Laborie.

Dr. Elterman begins with an overview of the Optilume® BPH Drug Coated Balloon Catheter. He presents the components of the system and their utility. He presents a demonstration of the system in action.

Dr. Kaplan presents data from the clinical investigations of the effectiveness of the Optilume® BPH Catheter System. He provides an overview of the results from the EVEREST study and the landmark PINNACLE trial, which was published in the September 2023 issue of the Journal of Urology. He notes that the major benefits of the treatment include significant flow rate improvement despite the lack of tissue removal and low surgical retreatment rates.

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Orthotopic Bladder Substitutes in Females: Why We Should Do It

Orthotopic Bladder Substitutes in Females: Why We Should Do It

Posted by | Jun 2024

Fiona C. Burkhard, MD, explores the benefits of orthoptic reconstruction and nerve-sparing cystectomies for female patients. She begins by outlining factors involved in the decline of orthoptic reconstruction as a whole, including the popularity of non-nerve-sparing cystectomies over continent diversion surgeries.

Dr. Burkhard challenges the perceived superiority of non-nerve-sparing cystectomies over continent diversion surgeries. She presents multiple studies which support that cystectomies had inferior or comparable outcomes to diversion in terms of functional outcomes and urethral involvement.

Dr. Burkhard examines the differences in optimizing results for male versus female bladder cancer patients. She examines the data supporting the importance of nerve-sparing surgeries for female patients in preserving continence.

Dr. Burkhard concludes by examining the benefits of using orthoptic bladder substitutes in preserving female sexual function and preventing pelvic organ prolapse. She notes that organ-sparing cystectomies allow for female patients to become pregnant post-surgery, and that they have a lower impact on patient body image than ileal conduits.

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