Society of Government Service Urologists
Home of the Kimbrough Urological Seminar

SGSU/Kimbrough 2018

Many thanks to Dr. John Barry for his diligence in taking the time to provide SGSU members these insights.

  • Ten minutes of mindfulness exercises (or simply sitting in an empty quiet room) may reduce anxiety and pain associated with urodynamic procedures. It was a prize winner.
  • Decellularized placental membrane grafts may turn out to be a useful matrix for spread-fixed dorsal urethroplasties.
  • Microscopic hematuria is normally gone by the 3-month follow-up visit after robotic-assisted radical prostatectomy. If it isn’t, it’s worth a work-up.
  • Prolapsed ureteroceles are rare in adults.
  • Synergistic immune-photothermal nonotherapy (SYMPHONY) works in a murine model of bladder cancer. Another prize winner.
  • Cryotherapy, radiation therapy and radical prostatectomy for localized prostate cancer have slightly different long-term quality-of-life issues; choose wisely.
  • Newly diagnosed prostate cancer patient distress is reduced with a 4-hour multidisciplinary approach.
  • PSA screening is beneficial.
  • A “Hole-in-a-Box” model for estimation of prostate size by Foley balloon palpation turned out to be a successful teaching tool, and it confirmed the expertise of faculty. It was a prize winner.
  • Cytoreductive radical prostatectomy for local management of metastatic prostate cancer may be a valid concept.
  • Shared decision making for prostate cancer treatment was associated with patent satisfaction across all races. Another prize winner.
  • A perioperative anesthesiology consultation service reduced opioid use, extended hospital stays and readmission rates. This was a People’s Choice Award – the presenter was a medical student.
  • 30% of orchiectomy patients chose replacement with testicular prostheses; some had to be removed for pain, infection or cosmetic disappointment.
  • A pathway was presented for management of Fournier’s gangrene.
  • Urethral injury during penile prosthesis surgery is rare, but it happens, even to fellowship-trained urologists. Management is by common sense approach.
  • Chronic scrotal content pain is relieved just over half the time by microsurgical denervation.
  • Patient compliance with recommended post-vasectomy semen analysis isn’t very good.
  • Semirigid ureteroscopy as a sole dilator for ureteroscopy works, but it’s debatable if it’s more cost-effective than other methods.
  • The Lean Six Sigma DMAIC process improvement method resulted in a flexible –scope readiness of 89% -from 38%.
  • Ultrasonic propulsion of kidney stones is almost ready for prime time. Another prize winner.
  • Components of urinary stones activate the NLRP3 inflammasone in female rats.
  • Children with ADHD, Asperger syndrome, autism and ODD seem to have a greater risk of eliminating dysfunctions.
  • Fibroepithelial vaginal polyps are rare.
  • The top three factors resident applicants use to rank residency programs are resident satisfaction, faculty/resident relationships, and mentoring.
  • International peace-keeping and combat deployment missions for military physicians are challenging -and rewarding.
  • Antimicrobial prophylaxis for TURP appears to be unnecessary if the urine is sterile before the procedure.
  • Al Squitieri gave an interesting talk about the German War cemetery in Glencree, Ireland.
  • BG Turlington described Colonels John Wettlaufer and John Weigel as “Gurus of Combat Urology.” John Wettlaufer signed my copy of their book, Urology in the Vietnam War on 27 March 2008; it’s on the bookshelf next to my four volume set of Campbell-Walsh Urology.
  • Failed exstrophy closures are best managed by an experienced team.
  • Most patients with cloacal exstrophy achieve urinary continence at a median of 11 years, but only after multiple procedures.
  • Subcutaneous leuprolide works.
  • Telecystoscopy for bladder cancer surveillance by allied health professionals with transmission for live interpretation by a urologist is successful.
  • FlexDex is a hand-held laparoscopic needle holder that mimics the functions of a robotic needle holder.
  • Renal denervation is a treatment option for chronic renal pain.
  • Think of lumbar and sacral spinal-mediated pathology for cases of not-so-obvious neurogenic sexual dysfunction when the neurogenital exam is positive.
  • Corporal erectile tissue fibrosis can be seen on tumescence B-mode grayscale ultrasound exam.
  • Does finasteride sometimes cause corporal fibrosis?
  • Clomiphene works in many cases of male factor infertility and testosterone deficiency.
  • Automated flow cytometry may become the new standard for the diagnosis of microscopic hematuria. It will need to be standardized for each lab. Prize winner.
  • The combination of Peyronie’s disease curvature and indentation have been successfully treated with placation and onlay tunica albuginea grafts of cadaveric fascia.
  • Collagenase and interferon injections have been used to treat Peyronie’s disease; the latter is quite a bit cheaper.
  • There was a nice historical review of the principles guiding the use of intestine in urologic surgery.
  • Check “interstitial cystitis” patients for vestibulodynia with a Q-tip exam; they may not have IC.
  • Clitoral adhesions can cause sexual dysfunction in women.
  • Vastus lateralis fascia is being rediscovered as a mesh substitute for the repair of female pelvic floor descensus.
  • A labia minora island flap can be used for female urethroplasty.
  • Patients don’t seem to mind if their teleurology practitioner is a urologist or not, as long as the practitioner is competent.
  • A screening PSA of 1.5 probably doesn’t need to be repeated for 5 or 10 years.
  • If the Select MDx, a two-gene urine test, is positive, consider Bx.
  • The Confirm Dx will give one and estimate of the probability of prostate cancer after a negative biopsy.
  • An indication for the Oncotype DxGPS is a Gleason 6 or 3+4 on Bx.
  • AR-V7 is a blood test to help predict response of androgen receptor (AR)-targeted therapy.
  • The purpose of the ABU is to protect the public. The purpose of the AUA is to support the profession.
  • Maintenance of Certification (MOC) is being changed to Life-long Learning Program (LLP). The Wright Map concept is being applied.
  • Watch Simon Sinek’s TED talk on the Golden Circle. It’s a classic.
  • Best functional studies for pediatric urodynamics = PVR and Uroflow EMG.
  • TENS pads are replacing fine needles for neuromodulation treatments.
  • There are now five approved anti-PD-L1 agents for bladder cancer.
  • Inflatable penile prosthesis (IPP) reservoir complications are not rare. One-third of sub-Scarpa’s fascia reservoirs are visible. Modeling for Peyronie’s disease seems to work most of the time when an IPP is placed. If there is an hour-glass deformity, it will get better in 6 months; any curvature of 30 degrees or less is OK. Don’t put in a sphincter and an IPP at the same time. Get under Scarpa’s fascia by scraping it off the pubic tubercle. Wait 3 months before doing IPP revision surgery.
  • Premature ejaculation (one definition is <1 minute intravaginal latency) can be treated with the oral selective serotonin uptake inhibitors (SSRIs) paroxetine and dapoxetine, or Emla cream (wash it off after 5 minutes, then have intercourse). An oxytocin antagonist is being studied. A risk of the SSRIs is suicidal ideation.
  • Therapeutic options for delayed ejaculation are vibrators, oxytocin nasal spray and carbergoline and ergot derivative.

John M. Barry, MD

From FierceHealthCare
by Evan Sweeney |

A bill introduced by two senators on Monday designed to modernize the Department of Veterans Affairs includes a provision that would allow physicians to practice telehealth across state lines.

Introduced by Sens. John McCain, R-Ariz. and Jerry Moran, R-Kan., the Veterans Community Care and Access Act of 2017 (PDF) would consolidate community care authorities into a single program, implement data-driven access and quality standards, improve walk-in care and ensure safe prescribing practices, among a slew of other requirements.

click link to read full article

http://www.fiercehealthcare.com/regulatory/john-mccain-jerry-moran-senate-legislation-veterans-affairs-telehealth-licensing

 

From FierceHealthCare by Joanne Finnegan |

A neurosurgeon has been barred from performing any surgeries at a Veterans Affairs medical center in Mississippi but has continued to collect his salary as a legal battle goes on.

The G.V. (Sonny) Montgomery VA Medical Center in Jackson barred the doctor, Mohamed Eleraky, from seeing patients years ago, but Eleraky continues to collect his $339,177 annual salary, according to the Clarion Ledger.

Eleraky filed an amended court complaint earlier this month against the VA seeking injunctive relief and monetary damages in a jury trial.

click here to read full article

 

by Jeff Jones, President
Urological Society for American Veterans – an affiliate of the SGSU

Thanks to all who attended, and contributed to, the May 2017 meeting of the USAV in Boston, during the AUA. We had an excellent scientific program put together by the program and abstract committee of Robert Grubb, Justin Parker, Jennifer Taylor, Chris Filson and chaired by Dan Makarov. The meeting was well supported by industry partners, and included review talks on genetic analysis tools for prostate cancer and new technology for bladder cancer diagnosis, in addition to the institutional VA-derived abstracts.

In the business meeting the executive committee announced our formal affiliation with the SGSU, and our acceptance as a recognized professional society by the AUA. Deb Moore, as our secretary, is working on the approved changes to our bylaws submitted by Rob Moore, and Muta Issa, our VP, and Krish Gaitonde, our treasurer has already put the organization well into the black in our first year- great job all!  We have already been contacted by the AUA outreach regarding the upcoming AUA Congressional Advocacy day on capitol hill in March 2018, and the USAV will be contributing. Thus, we have made great strides to establish ourselves as the “go to” organization for veteran health in urology.

We are already planning our meeting in San Francisco in May 2018, and we hope our agenda will be published in the AUA program book for the first time this year.

In additional to our open member’s forum and national email roster, we are building a member-only page to place VA-specific items like SOP’s, personnel and equipment justifications, etc. to assist urology at each geographic location get the support they need to execute the VA urology mission, without having to locally “reinvent the wheel” every time.

We hope all of you will be encouraged to join both the USAV and SGSU, so we can grow our organizational infrastructure, capability, and influence. The dues are really very modest, so please sign-in and join- the organization is here to serve you, its membership.

Thank you!

By NIKKI WENTLING | STARS AND STRIPES Published: October 24, 2017

WASHINGTON – Department of Veterans Affairs Secretary David Shulkin argued Tuesday that a House plan for veterans’ health care was too restrictive and wouldn’t offer enough veterans the choice of private-sector care.

House lawmakers and VA officials hashed out details Tuesday of two proposals outlining major changes to the VA’s community care programs. Both would effectively end the Veterans Choice Program that was created in 2014 following the VA wait-time scandal to extend VA care into the private sector. The plans do away with a rule that allows veterans to seek private sector care when they are forced to wait more than 30 days for an appointment or live more than 40 miles driving distance from a VA facility.

click link below to read full article:

https://www.stripes.com/news/house-considers-major-changes-to-va-health-care-1.494240

 

The Federal Government annually invests millions of dollars for prostate cancer research through the Prostate Cancer Research Program (PCRP) and the National Institutes of Health (NIH).

https://secure3.convio.net/zero/site/SPageServer/?pagename=ProtectProstateCancerResearch

click link for full article on Zero website

The PCRP, part of the Congressionally Directed Medical Research Programs (CDMRP) at the Department of Defense, is one of the most effective programs in the world designed to produce treatments and, one day, a cure for prostate cancer. Funding from the PCRP has supported the development of  three new treatments for advanced disease in the last five years and was instrumental in accelerating the approval of Zytiga®  (abiraterone acetate) by two years. 
The program is now focused on improving diagnosis to reduce overtreatment and accurately determine life-threating disease from indolent tumors.

ZERO is working to maintain $13.2 million in funding for prostate cancer awareness and education.  The President’s FY2017 budget request eliminates funding within the Centers for Disease Control and Prevention’s (CDC’s) comprehensive cancer control program for prostate cancer activities. This funding supports the development and dissemination of content to help patients and providers have a better-informed discussion about treatment options. It also provides needed funding for important surveillance activities that help providers, epidemiologists, and researchers better understand the disease, its incidence, and progression.

We urge Congress to protect prostate cancer prevention and education funding and provide $13.2 million for the CDC in the FY 2017.

Register as an advocate today! 

(receive alerts on how to help protect and grow this funding)

A nationwide physician shortage has hit a Colorado VA hospital particularly hard, forcing it to reschedule or postpone dozens of surgeries because it doesn’t have enough anesthesiologists and certified registered nurse anesthetists.

Approximately 65 to 90 nonemergency surgeries at the Eastern Colorado Health Care System have been pushed off because of the shortage, caused in recent months because staff have left for other jobs or are on paternity and maternity leave, a hospital spokeswoman told The Denver Post. In July, the publication reported that the VA hospital had one of the worst wait times for care in the nation.

click link to read full article

http://www.fiercehealthcare.com/healthcare/doctor-shortage-forces-colorado-va-hospital-to-postpone-surgeries

 

  • VA Chief Wants to Get Rid of Healthcare Deadwood

    ‘Accountability’ comes up repeatedly at hospital association meeting

  • by Joyce Frieden
    News Editor, MedPage Today

WASHINGTON — Getting rid of under-performing employees and hiring more healthcare professionals are just a few of the ways that Secretary of Veterans Affairs David Shulkin, MD, wants to improve the healthcare provided by his agency.

“Part of what we have had to do is to say that not everybody has the right or privilege to work at the VA,” said Shulkin at the American Hospital Association annual meeting on Monday. “When people lose their values, or deviate from our purpose or what our mission is, they lose that right.”

Trump extends private-sector health care program for vets


WASHINGTON (AP) — President Donald Trump signed a bill Wednesday to temporarily extend a program that lets some veterans seek medical care in the private sector, part of an effort by the president to deliver on a campaign promise.

click link to read full article

http://hosted.ap.org/dynamic/stories/U/US_TRUMP_VETERANS_AFFAIRS?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2017-04-19-15-16-28

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