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