Dr. Barry 2019 Meeting Take-Away’s

CONTRIBUTED BY JOHN M. BARRY, MD

• Single stage sacral neuromodulation may replace the two-stage procedure.
• NLRP3 inflammasome activation triggers bladder dysfunction in diabetic (Prize winner – Basic Science)
• The NLRP3 mediates bladder decompensation during bladder outlet obstruction in rats. Glyburide inhibits it. (Prize winner – Basic Science)
• The combination of low-energy shock wave therapy and phosphodiesterase-5 inhibitors corrects pelvic neurovascular injury in rats; their erections (Prize winner – Basic Science)
• There is minimal loss of functioning renal parenchyma with renal thermal therapy in
• The creation of virtual reality renal models for complex renal surgery costs a lot of
• Postoperative complications after robotic partial nephrectomy were not predicted by ASA or Charlson Co-morbidity Index. (The Charlson Comorbidity index is meant to predict survival, not complications.)
• Vasectomy reversals are usually successful in young
• Urinary diversion for benign conditions is fraught with post- operative complications, especially in fat
• The transurethral in-lay buccal graft works well for distal urethral strictures.
• Ureteral stenting for 7 days was long enough after endoscopic ureteral injuries in
• Penile calciphylaxis is almost uniformly
• The rule of “W” for the etiology of postoperative fever isn’t very accurate.
• Bladder outlet procedures are often helpful in patients with detrusor underactivity who don’t have demonstrable bladder outlet (Prize winner – Clinical)
• Patient sexual harassment of female physicians is more common than we
• Opiods are over-prescribed following robotic-assisted laparoscopic (Prize winner – clinical)
• Opiods are rarely necessary following
• Education of referring physicians and initiation of the “Hard Stop” concept resulted in elimination of pre-referral ultrasound for the evaluation of
• There is not a standardized definition of vaginal stenosis following vaginoplasty in
• It appears that women are well-represented at pediatric urology meetings, however, Invited speaker opportunities lag behind female membership
• There is an increased risk of post-operative urinary tract infections in diabetic and obese men who undergo robotic-assisted radical prostatectomy.
• Delay in radical prostatectomy is associated with higher positive margin rates and increased biochemical
• PSA screening is protective for prostate cancer mortality and patient presentation with metastatic disease. Equal access to health care negates outcome differences by
• Longer delays to radical prostatectomy by assignment to active surveillance (delaying treatment with curative intent) resulted in higher rates of positive surgical margins and Gleason
• In a racially diverse, high risk prostate cancer study, there were no significant differences in treatment choice, biochemical free survival, and metastasis-free survival in an equal access health care system.
• Use of Denonvillers’ space expansion with a degradable hydrogel was a clever way of protecting the rectum during salvage cryotherapy for recurrent prostate (Prize winner – Clinical)
• ED treatment with growth hormone, stem cells, amniotic fluid and platelet-rich plasma are not ready for prime time. Low intensity shock wave therapy for ED is
• The definition of a castrate level of testosterone should be 20, not 50.
• Increased FSH is associated with cardiovascular disease. The recent Journal of Urology article on anti-androgens is a recommended read.

• There are several clever flap procedures (Martius, Gracilis, peritoneum, inner thigh-based) to repair vesicovaginal and colovaginal fistulas.
• Mesh can be associated with a Lupus-like syndrome; this may be due to biofilm.
• A video of a successful transvesical robotic-assisted laparoscopic repair of a mid-prostatic urethral obliteration was accompanied by good
• Be careful with gentamicin dosing for prosthesis implantation surgery because older patients commonly have impaired renal function. Published guidelines are not a substitute for good judgement.
• Urethroplasty usually doesn’t result in further impairment of erectile
• Anesthesia-related complications are more common in patients over 80 years of
• B3 adrenoreceptor agonists and antimuscarinics are effective in the study of detrusor over-activity of chronic supra-sacral spinal cord transected
• Iatrogenic hypospadias in spinal cord injured patients is best prevented.
• A recurrent peri-urethral leiomyoma was successfully treated with a combined retropubic-transvaginal
• Tubulocystic renal cell carcinoma is
• Percutaneous microwave ablation, which generates frictional heat 100 times faster than radiofrequency, of T1a renal cell carcinomas was
• A dramatic, durable response to pembrolizumab for poorly differentiated metastatic bladder cancer occurred in a 43 year-old man.
• An old technique, ventriculo-ureteral shunt, for refractory hydrocephalus in a 5 year-old kidney transplant recipient was successful.
• Multidisciplinary oncology clinics resulted in improved adherence to plans of care, especially for patients who select active surveillance for prostate
• Based on a value and availability analysis, the RobotiX mentor was the winner among three virtual reality robotic surgery
• A shared medical appointment system was useful in the management of testosterone deficient
• After radical prostatectomy, arousal incontinence and climacturia are common and more troublesome for men than for their female sexual
• When staff urologists, especially oncologists, begin to speak, they tend to lose tract of
• Although there is no consensus on the value of lymphadenectomy at the time of radical or partial nephrectomy for renal cell carcinoma, it’s reasonable to remove suspicious
• After chemotherapy for germ cell testis cancer, 25% of image- negative retroperitoneums will have viable tumor or teratoma on lymph node
• After a 2-year disease-free interval, there is <10% recurrence rate for germ cell testis
• Expect >50% complications within 90 days of radical Post-op complications delay adjuvant chemotherapy. Psoas diameter is a good measure of sarcopenia.
• Tranexamic acid seems to reduce bleeding during radical Don’t’ use it in patients who have a vascular stent or have had a prior DVT or PE.
• There was an increased risk of post-radiation urinary symptoms if the prostate was >35 grams, IPSS was >7, PVR was >100 mL, peak flow rate was <11 mL/second or there was urodynamic evidence of bladder outlet
• After radiation therapy for prostate cancer, be careful with transurethral resections posteriorly (rectal fistula) and anteriorly (pubic fistula). The risk of incontinence increases with adjuvant radiation after radical Urinary diversion is usually required to treat a post-radiation pelvic fistula.
• The search goes on for a renal cell cancer prognostic
• Too bad about radical perineal prostatectomy; it is a minimally invasive procedure without the need for a robot…
• It’s reasonable to ignore a large PVR in an asymptomatic patient with no upper tract
• Single-use flexible ureterorenoscopes and miniaturized laser units are cost-effective tools for the management of calculi in deployed environments.
• In an open access system, diverse patient selection and surgeon fellowship training didn’t seem to affect outcomes of vasectomy
• The GU Bowl was a meeting highlight, as One of the program chairs looked great in his pineapple costume.