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2024

Effective Strategies for Priapism

Effective Strategies for Priapism

Posted by | May 2024

R. Caleb Kovell, MD, discusses management strategies for acute refractory ischemic priapism, including shunting, tunneling, and prosthesis. Dr. Kovell begins his lecture by reviewing the erectile recovery windows and imaging techniques for establishing acute ischemic priapism.

Dr. Kovell then turns to effective treatment options after intracavernosal phenylephrine and corporal aspiration fail. He outlines various types of distal shunting, corporal tunneling, penoscrotal decompression, and early prosthesis placement.

Dr. Kovell concludes by discussing outpatient management of acute ischemic priapism. He highlights the importance of establishing the patient’s Sickle Cell Disease status, and cautioning against immediately prescribing PDE5is to outpatients.

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Bone Health and Non-Cardiovascular Side Effects of ADT

Bone Health and Non-Cardiovascular Side Effects of ADT

Posted by | May 2024

Scott B. Sellinger, MD, FACS, addresses ADT’s impact on bone health and other non-cardiovascular side effects of the therapy. He begins by noting that men on ADT are at significant risk of bone fracture, and reviewing the mechanisms behind the increased bone loss and fracture risk in these patients.

Dr. Sellinger presents best practices for assessing and treating patients with increased risk of fracture. He discusses lifestyle interventions, vitamin supplements, and other therapies to prevent bone loss.

Dr. Sellinger concludes by touching on non-cardiovascular side effects of ADT. He discusses best practices for combatting declines in mental, physical, and sexual health that result from ADT.

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TRAVERSE Trial Update

TRAVERSE Trial Update

Posted by | Apr 2024

Mohit Khera, MD, MBA, MPH, presents the latest updates from the TRAVERSE Trial, examining the cardiovascular effects of testosterone therapy. This presentation is an update to Dr. Khera’s “Results from the TRAVERSE Trial” lecture, which was presented to the Grand Rounds in Urology audience in August 2023.

Dr. Khera begins by reviewing the history of the TRAVERSE Trial and its initial results regarding the impact of testosterone therapy on cardiovascular health. He outlines the design of the TRAVERSE Trial, which concluded in January 2024 with a final enrollment count of 5,246 men.

In addition to the original secondary and tertiary endpoints regarding cardiovascular safety and prostate safety, Dr. Khera discusses other secondary endpoints in the trial. These endpoints were sexual function, depression, bone fractures, diabetes, and anemia.

Dr. Khera concludes by delving into the final results of testosterone therapy on all endpoints in the trial. He notes that the results indicate that testosterone therapy does not significantly worsen BPH symptoms and may protect against the development of anemia. However, he notes that testosterone therapy may raise the risk of bone fractures and pulmonary embolisms.

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Pros and Cons of the ReIMAGINE Trial

Pros and Cons of the ReIMAGINE Trial

Posted by | Apr 2024

Matthew R. Cooperberg, MD, MPH, discusses the strengths and weaknesses of the Risk and Screening arms of the ongoing ReIMAGINE trial. He begins by describing the two arms of the study, ReIMAGINE Screening and ReIMAGINE Risk, and then focuses on the Screening arm, digging into the participant data.

Dr. Cooperberg addresses the sequence of screening tests in the ReIMAGINE trial, and reasserts the value of PSA as an initial screening marker, using supporting evidence from the ongoing STHLM3-MRI trial.

Dr. Cooperberg concludes by explaining that ReIMAGINE Risk will be useful as a biorepository in the future. While ReIMAGINE Screening shows PSA with magnetic resonance imaging (MRI) is better than PSA alone, he reiterates that as a first screen, PSA <1 (or 1.5) is tough to beat. Dr. Cooperberg explains that MRI is useful for helping to guide biopsy and is acceptable as a second screening tool. However, other markers are more effective and less expensive in the United States.

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Fusion Biopsy Technologies and Techniques

Fusion Biopsy Technologies and Techniques

Posted by | Apr 2024

Peter A. Pinto, MD, discusses the evolution of prostate cancer biopsy and imaging techniques in the past twenty years, from blind systematic biopsies to MRI-ultrasound fusion biopsies. He begins by noting that prostate cancer was the only solid-organ tumor diagnosed without image guidance going into the 21st century.

When MRI was introduced as an imaging modality for prostate cancer diagnosis, urologists developed several different techniques for incorporating MRI into biopsy procedures. Dr. Pinto briefly covers the history and development of in-bore biopsies, cognitive fusion biopsies, and MRI-ultrasound fusion biopsies.

He concludes with reviewing the currently available devices in this space. He evaluates each system as it relates to biopsy needle targeting route, tracking and navigation, MRI-ultrasound fusion opportunities, ultrasound image acquisition, and biopsy fixation.

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