2024 Archives

Utilizing ctDNA in Bladder Cancer

Posted by Leonard G. Gomella, MD, FACS | Nov 2024

Leonard G. Gomella, MD, FACS, explores the potential of circulating tumor DNA (ctDNA) and cell-free DNA (cfDNA) as biomarkers in cancer detection, treatment monitoring, and prognosis.

In this 12-minute presentation, Dr. Gomella reviews recent studies, such as those conducted at the European Association of Urology (EAU), demonstrating ctDNA’s potential for early detection, risk assessment, treatment response evaluation, and post-treatment surveillance in bladder cancer. Trials such as InVigor010 highlight ctDNA’s prognostic utility, where analysis revealed that ctDNA positivity predicted a higher risk of relapse.

Gomella reports that innovations extend to ctDNA detection in urine, offering a non-invasive method to monitor disease burden. These developments and the integration of advanced sequencing technologies mark a new era in cancer management, facilitating earlier interventions and more effective treatment planning.

2025 Medicare Part D Changes: Physician’s Perspective

Posted by Neal D. Shore, MD | Oct 2024

Mark N. Painter, CPMA, MBS, Managing Partner, Consulting LLC, CEO, PRS Urology Service Corporation, Vice President of Coding and Reimbursement Information and CEO Relative Value Studies, Inc. is joined by Neal D. Shore, MD, FACS and David S. Morris, MD, FACS to discuss the physician’s perspective on the upcoming Medicare Part D updates. They share the benefits of these changes and the possible hardships as well.

In this third part of this series, Mark briefly highlights the Medicare Part D changes, such as the reduction of the maximum out-of-pocket expenditure and the Medicare Prescription Payment Plan (MPPP) or “smoothing option”, that the first part of this series covers in more detail. Neal D. Shore, MD, FACS and David S. Morris, MD, FACS then join Mark to share their point of view as physicians on how they are planning to maneuver these changes in the best way. David S. Morris, MD, FACS discusses how he thinks these changes will give a positive outlook to a patient’s finances, for example with the smoothing option or through grants. Also, Neal D. Shore, MD, FACS shares how offices have to prepare to help patients through the process of understanding and taking advantage of these upcoming updates.

This 15-minute discussion concludes with all speakers agreeing that the financial burden on the patient is key when it comes to medications, but they are cautiously optimistic that these upcoming changes will benefit patients, although many will still rely heavily on grants and funding to get the medications they need. Both physicians share in their hope that the upcoming Medicare Part D changes will be a step in the right direction to making healthcare more accessible to all patients and a reminder: Open Enrollment begins October 15, 2024, and runs through December 7, 2024.

Implantable Tibial Nerve Stimulators. Where Do They Fit in Advanced OAB Paradigm?

Posted by Christopher P. Smith, MD, MBA, MSS | Oct 2024

Christopher P. Smith, MD, MBA, MSS, explores the evolution and current advancements in tibial nerve stimulation for treating bladder dysfunction. He begins this 19-minute presentation with a brief history of percutaneous tibial nerve stimulation (PTNS), underscoring its utility in bladder disorder management.

Smith introduces two significant implantable devices, Valencia’s eco, and the Ravi system. Both devices provide customizable treatment and cater to patient preferences, though they differ in implantation methods and patient autonomy over therapy. While these devices offer innovative treatment for urge urinary incontinence, compliance remains a challenge, often due to the time commitment and multiple visits required. Dr. Smith also references the Titan implant by Medtronic, which, while not yet FDA-approved, promises quick activation post-implant and a potential solution to compliance issues.

Dr. Smith reports recent guidelines from the AUA and SUFU now classify these therapies as “minimally invasive,” encouraging earlier intervention, even without exhausting all conventional therapies. The expectation is that new guidelines may support a broader acceptance and earlier access to minimally invasive options, ultimately improving tailored patient care in managing bladder dysfunction.

Female Urethra Stricture Disease: Evaluation and Surgical Management

Posted by Oluwarotimi S. Nettey, MD, MHS | Oct 2024

Oluwarotimi S. Nettey, MD, MHS, discusses the complexities of female urethral stricture disease, which, although less common than in men, often goes underdiagnosed due to its non-specific symptoms and rarity.

In this 18-minute talk, Dr. Nettey shares this disease often coincides with lower urinary tract symptoms. While its exact causes are largely idiopathic, medical procedures like catheterization, radiation, and surgeries, as well as conditions like vaginal atrophy in postmenopausal women, can increase the risk.

Diagnosis typically involves cystoscopy, with additional imaging options providing insights into stricture location and bladder morphology. Uroflowmetry and video urodynamics offer further understanding of urinary dynamics, helping tailor treatment approaches. Non-surgical management includes vaginal estrogen and corticosteroids.

Nettey shares that endoscopic dilation is a first-line treatment but has diminishing returns with repeated procedures, while open surgical repair becomes essential in complex cases. She underscores the need for individualized management and referrals to reconstructive specialists for challenging cases, emphasizing the importance of a methodical approach in addressing this underrecognized condition.

Current Management of T1 High Grade Bladder Cancer

Posted by Frances M. Alba, MD | Oct 2024

Frances M. Alba, MD, discusses the management of T1 high-grade bladder cancer, focusing on cases that recur following BCG therapy.

In this 14-minute talk, Dr. Alba introduces the case of a 53-year-old male with T1 high-grade bladder cancer who underwent a complete six-week BCG course but experienced recurrence within ten weeks. Dr. Alba notes that BCG failure is not uncommon, with the term “BCG unresponsive” now used to describe persistent or recurrent disease within defined timeframes after adequate BCG treatment. In these patients, continued BCG is seldom effective.

Alba highlights the AUA guidelines for these patients, recommending cystectomy as the best chance to prevent disease progression. Despite its efficacy, only a quarter of urologists in the US recommend cystectomy for BCG-unresponsive cases, with many preferring intravesical chemotherapy. Gemcitabine-docetaxel combination therapy shows promise. Alba also shares additional options, such as nadofaragine, pembrolizumab, and novel therapies, including N-803.