2024 Archives

Management of Renal Injuries: An Evidence-Based Approach

Posted by Michael Coburn, MD, FACS | Oct 2024

Michael Coburn, MD, FACS, delves into the complexities of kidney trauma management, emphasizing the challenges associated with limited high-level evidence and reliance on expert consensus.

In this 26-minute presentation, Coburn reflects on decades of experience in urologic trauma. Guidelines for trauma have seen revisions, with updates in 2017 and 2020 by the AUA and more forthcoming. He sees a shift towards non-surgical management in hemodynamically stable patients, reflecting a growing emphasis on observation rather than immediate intervention. He shares images illustrating different levels of renal injury.

Coburn relates that follow-up imaging is advised for high-grade injuries to monitor for hematoma expansion, potentially preventing severe complications. Angioembolization has emerged as a valuable tool for controlling bleeding in stable patients, reducing the need for nephrectomy. Specific injuries, such as pseudoaneurysms, often require immediate embolization, while surgical intervention is recommended when substantial kidney tissue is damaged.

Pediatric injuries are highlighted for their unique management needs. Coburn’s presentation concludes with a call for careful patient selection, especially in cases of severe vascular trauma or concomitant visceral injuries, where early intervention can mitigate future complications.

PCa Commentary | Volume 194 – October 2024

Posted by Edward Weber, MD | Oct 2024

PCa Commentary | Volume 194 – October 2024 Posted by Edward Weber | October 2024 The EMBARK...

2025 Medicare Part D Changes: Preparing Your Office and Patients

Posted by Mark N. Painter, CPMA, MBS | Oct 2024

Mark N. Painter, CPMA and Michael Burnett, Chief Operating Officer at Kansas City Urology Care, discuss upcoming 2025 Medicare Part D changes and how it will affect urology patients. This 12-minute discussion goes into detail of each new update to Medicare Part D, how it can affect patients who are in need of grants, subsidies or assistance, and how urology practices can aid patients in adopting and taking advantage of these new updates.

Devastated Outlet in Men

Posted by O. Lenaine Westney, MD | Oct 2024

O. Lenaine Westney, MD, focuses on managing a “devastated outlet” in patients, typically those who have undergone treatments for prostate cancer. The 11-minute presentation highlights how factors such as radiation, High-Intensity Focused Ultrasound (HIFU), and multiple manipulations to treat urinary tract issues can lead to severe complications.
Radiation’s impact on the lower urinary tract is a key concern, with fibrosis and ischemia developing over time. Dr. Westney shares images of recto-urethral or pubic-prostatic fistulas, which are associated with a high morbidity rate and often necessitate complex surgical interventions, such as cystectomy and urinary diversion. The difficulty lies in predicting which patients will develop these severe complications.
Westney emphasizes the importance of early intervention and the potential need to rethink treatment strategies. She also discusses future directions, including the possibility of identifying patients who are more likely to suffer from radiation-induced complications through genetic markers or other predictive tools.

2025 Medicare Part D Changes: Overview of the 2025 Plan

Posted by Mark N. Painter, CPMA, MBS | Oct 2024

Mark N. Painter, CPMA, Managing Partner, Consulting LLC, CEO, PRS Urology Service Corporation, Vice President of Coding and Reimbursement Information and
CEO Relative Value Studies, Inc. reviews upcoming 2025 Medicare Part D changes and what they aim to achieve. This 13-minute discussion goes into detail of each new update to Medicare Part D, including the reduction of the maximum out-of-pocket expenditure, the Medicare Prescription Payment Plan (MPPP), and “Likely to Benefit Letter” and how these can affect different patients, including those that are eligible for grants or subsidies.
Dr. Pohlman then brings up emerging complementary tests that mitigate the weaknesses of PSA alone, like the EpiSwitch® Prostate Screening (PSE) Blood Test. He explains that the EpiSwitch® PSE combines five epigenetic biomarkers with a standard PSA test in prostate cancer screening. He briefly discusses how the simplified test can be implemented in practice and how the test results are quickly and clearly delivered in patient-friendly formats to facilitate shared decision-making.

Dr. Pohlman then discusses the validation processes behind the EpiSwitch® PSE test, including its high accuracy, specificity, sensitivity, and positive/negative predictive values, which reduce the need for unnecessary prostate biopsies. He presents data supporting the benefits of using non-invasive biomarker tests like the EpiSwitch® PSE test in prostate cancer screening prior to MRI and/or prostate biopsy.

Dr. Pohlman concludes by presenting case studies where the EpiSwitch® PSE test would have prevented unnecessary biopsies and MRIs. He discusses his practice’s success in using the EpiSwitch® PSE tests to screen for prostate cancer without defaulting to invasive testing.