On behalf of the Urological Society for American Veterans (USAV) we invite you to attend the annual meeting of the USAV on Sunday, September 12 (10:30 am-2:30 pm, Marco Polo 706-807, Sands Expo/Venetian Hotel complex) in conjunction with the AUA annual meeting in Las Vegas.
The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, providing care to over 9 million veterans through its 1,293 health care facilities, which include 171 Veterans Administration (VA) Medical Centers and 1,112 outpatient sites of care of varying complexity. In addition to operating one of the largest health care systems in the world, VHA provides training for the majority of America’s medical, nursing and allied health professionals, with approximately 70% of all physicians in the United States completing at least part of their training in VA facilities. Today, the VA Office of Academic Affiliations (OAA) maintains more than 7,000 agreements with over 1,800 institutions, ensuring that training programs are available in every U.S. state and territory. In addition, VHA medical research programs benefit society at large. This year marks the 75-year anniversary of VA collaboration with academic institutions to provide high-quality, state-of-the-art health care to America’s veterans.
USAV is the premier professional society for the advancement of urological care for veteran patients. Through education, research and raising awareness of health care policies, USAV pursues its 3 missions: 1) promote the highest standards of urological care for American veterans, 2) advocate for the well-being of federal urological practitioners to enhance their ability to deliver the highest quality of urological care to American veterans and 3) affiliate and collaborate with the Society of Government Service Urologists (SGSU) in its missions to represent and support active and reserve urologists of the U.S. Armed Forces.
The 4-hour USAV program at the AUA is designed to review and discuss topics and opportunities unique to VA urological practitioners as well as university urologists and private urologists supporting VA Healthcare in providing care through VA community care referrals. The scientific program chair, Dr. Minhaj Siddiqui, Maryland VA/University of Maryland, and co-chair, Dr. Arvis George, Ann Arbor VA/University of Michigan, have organized a robust educational meeting you won’t want to miss! The program includes state-of-the-art presentations, keynote lectures and updates by nationally renowned speakers. In addition, there are 28 posters, moderated and unmoderated, on a wide range of urological topics. A mid-meeting break, with a light lunch, is provided while viewing the posters.
- The Genomic Prostate Score:
- Implications for Presurgical Planning. Vipul R. Patel, MD, Director of Global Robotics Institute, Celebration, Florida
- Update on VA’s Transition from CPRS to Cerner. Jeremy Shelton, MD, MS, Director of Surgical Informatics, VA National Surgery Office.
- Keynote Lecture: Finding Equanimity in a World of TMI. David Bloom, MD, Chair, Department of Urology, Jack Lapides, Professor of Urology, University of Michigan.
- Scrotal Pain: How to Manage without Going Nuts. Amin Herati, MD, Director of Male Infertility & Men’s Health, The Brady Urological Institute, Johns Hopkins University.
- New Technology in the VA: From Request to Roll Out. Kristin Chrouser, MD, MPH, Chief of Urology, VA Ann Arbor Healthcare System, S. Matthew Berge Research Professor, University of Michigan.
- The National VA Surgery Advisory Board Open Forum: What Can We Do Better at the National Level? Joshua Meeks, MD, Chair, Urology Surgery Advisory Board, National Surgical Office.
- Benefits of Disposable Cystoscopy Systems in VA Setting.
- Veterans Prostate Cancer Awareness Medical Advisory Group. Michael Crosby, CDR, USN ret., Founder and CEO.
- What is New in Industry: Key Products & Services.
We look forward to welcoming you at the USAV meeting. Finally, we wish to extend our thanks to the AUA and SGSU for their support of the Urological Society for American Veterans.
Muta M. Issa, MD, FACS, MBA, President, USAV
SATURDAY JAN. 23 – PODIUM WINNERS
1st Place: CPT Bradley Potts, MC, USA
2nd Place: LCDR Charles Rhinehart, MC, USN
3rd Place: Kevin Krugoff, MD
MEDICAL STUDENT WINNER
1st Place: 2LT Timothy Brandt, MC, USA
SUNDAY JAN. 24 – POSTER WINNERS
1st Place: Capt Jessica Saeger, MC, USAF
2nd Place: Capt Tarah Woodle, MC, USAF
MEDICAL STUDENT WINNER
1st Place: Tara Sweeney, VA
2nd Place: 2LT Zachary Janatpour, MC, USA
SGSU 2021 Member’s Business Meeting
Thursday, Jan. 21 – 3:30pm, Pacific Time
Reminder that the Member’s Annual Business Meeting will be held online via Zoom – see below link.
Topic: SGSU Business Meeting
Below is a link for the Zoom meeting. We ask that you please arrive 5 minutes before the meeting starts and mute yourself upon arrival. Please use the Zoom chat feature for comments or questions.
Time: Jan 21, 2021 03:30 PM Pacific Time (US and Canada) Join Zoom Meeting
The SGSU is very saddened to announce that Dr. Martin L. Dresner (“Dr. Jazz”), Tucson, AZ, passed away on Dec. 20, 2020 in his sleep at 80 years of age.
Dr Dresner received the SGSU Honorary Lifetime Membership Award in 2016 for being a loyal and very active member of SGSU and rarely, if ever, missing a meeting. He was a positive role model/mentor for many and a strong advocate of the Kimbrough meetings.
Our deepest sympathy and condolences go out to his family and all those who considered him a loyal friend. We know he will be dearly missed.
Dr. Dresner will be recognized at the SGSU Business Meeting on Thursday, Jan. 21 at 3:30PM.
Invitation to the Colonel David G. McLeod Day of Celebration event on March 19
The Uniformed Services University of the Health Sciences will be hosting a celebration in honor of retired Army Colonel (Dr.) David McLeod’s life, along with his academic and scientific contributions to the Department of Defense and the nation. We would be honored if you could join us for the virtual celebration on Friday March 19, 2021 from 9:00 a.m. – 4:30 p.m. (Eastern time). The day’s events will be divided as follows:
9:00 a.m. – 12:00 p.m. – Academic/Scientific Symposium highlighting works of Dr. McLeod
12:00 p.m. – 1:00 p.m. – Break
1:00 p.m. – 2:00 p.m. – Celebration of Dr. McLeod’s Life
2:00 p.m. – 2:30 p.m. – Break
2:30 p.m. – 4:30 p.m. – Open Forum Remembrances
The Open Forum will consist of 24 individuals who will be given five minutes each to talk about their personal interactions with and remembrances of Dr. McLeod. If you would like to participate in the virtual Open Forum, please email Sharon Holland at email@example.com as soon as possible.
Please click here for the invitation for the livestream link and RSVP information. We hope you will be able to join us as we pay tribute to Dr. McLeod.Sincerely,
Craig D. Shriver, M.D., FACS, COL, USA (Ret)
Director, Murtha Cancer Center (MCC) / Research Program (MCCRP)
Department of Surgery, School of Medicine, USU
Oliver H. Beahrs Professor of Surgery
Uniformed Services University
Murtha Cancer Center Director
Walter Reed National Military Medical Center
In Memoriam: Colonel David G. McLeod, MD, JD, MC (1935-2020)
The Society of Government Service Urologists sends condolences to the family and friends of Colonel David G. McLeod, MD, JD, MC, USA of the Walter Reed National Military Medical Center. Dr. McLeod passed away peacefully on Friday, Dec. 18 at his home in North Carolina. Col McLeod will be recognized at the SGSU Business Meeting on Thursday, Jan. 21 at 3:30PM.
Pictured is past AUA President, Dr. John Barry awarding Col David McLeod the AUA Distinguished Contribution Award in 2009.
McLeod Obituary Legends in Urology PDF
Meeting Abstract Take-Aways. Kimbrough 2020
CONTRIBUTED BY JOHN M. BARRY, MD
- The principle of regenerative pharmacology is to stimulate the body to self-heal in situ. Local administration of the chemokine CXCL12 is being studied in a nonhuman primate male model of chronic post-prostatectomy erectile dysfunction and post-prostatectomy urinary incontinence. We hope it works.
- The distribution of research papers presented at the Kimbrough has been stable for the past decade.
- With machine learning, we are, at last, approaching a more reasonable definition of the level of microscopic hematuria to trigger a urologic evaluation.
- Post-operative intraurethral lidocaine may not reduce dysuria after endourologic procedures in anesthetized patients.
- Opioid-free ureteroscopy for stone disease is associated with less frequent post-procedure requests for opioids when compared with patients routinely prescribed post-procedure opioids. (A clinical science award winner.)
- After uncomplicated ureteroscopy for ureteral and renal stones, ureteral stents are probably unnecessary.
- Vasovasostomies by general urologists who did not complete fertility fellowships were usually successful.
- Respect for clinical standards is necessary for the diagnosis and treatment of male hypogonadism.
- Based on small numbers, erectile function and penis length after radical prostatectomy are not improved with sildenafil or pentoxifylline.
- A multidisciplinary testicular torsion pathway was shown to decrease time from ER to OR.
- Bicycling is the most common cause of pediatric renal hilum injuries.
- Opioid prescriptions for minor pediatric urologic surgeries are not very common.
- Referring pediatricians need to be educated in the preliminary assessment of primary monosymptomatic nocturnal eneuresis. Something as simple as a pre-referral voiding diary and urinalysis would be quite helpful.
- Dual energy computerized tomography DECT) may be of use in the assessment of complex renal cysts because iodine uptake can be quantified, and iodine enhancement suggests malignancy.
- Prolonged CT observation of Bosniak 2F renal cysts resulted in the development of contrast allergies three times as often as a malignancy diagnosis (6% vs 2%). (Check the 2019 update for Bosniak cyst classification and, if need be, modify your surveillance protocols.)
- Stapling across a left renal vein tumor thrombus, removing the left kidney, and then addressing the IVC portion of the tumor thrombus is safe and gives one better exposure of the IVC for removal of the IVC portion of the thrombus.
- Predictors for upstaging clinical T1 renal malignancy are evolving.
- An enhanced recovery after surgery (ERAS) protocol with multimodal pain management resulted in a one-day improvement in the return of gastrointestinal continuity (P not quite significant), and an improvement in pain scores in the partial nephrectomy group (P barely significant).
- Barrington’s reflexes were studied in rats. (First Prize, Basic Science.)
- Male urethral slings were quite successful for the treatment of post-radical prostatectomy urinary incontinence.
- Dyspareunia in women is common.
- Annexin A1 enhanced the resolution of bladder inflammation following bladder de-obstruction in rats. It inhibits the NLRP3 inflammasome. (Another basic science award winner.)
- After radical prostatectomy in the setting of equal access to and receipt of health care, there were no significant differences between African-American and Caucasian men with the long-term outcomes of risks of metastasis and overall death. (First Prize, Clinical Science.)
- Not surprisingly, experience reduces surgical times and reduces complication rates for robotic-assisted laparoscopic retroperitoneal lymph node dissections.
- Post-robotic-assisted laparoscopic prostatectomy pain management with local anesthetic wound injection and scheduled acetaminophen and ketorolac dosing significantly reduced the need for post-operative opioids.
- The need for 3 incontinence pads per day 6 months after radical prostatectomy is a reasonable indication for surgical treatment of the leakage. The “3-pads/day-at-6-months” rule? (A clinical science winner.)
- After minimally invasive radical prostatectomy, a single 14-hour postoperative hemoglobin evaluation seemed to be all that was necessary to recognize a bleeding event.
- The diagnosis of hypogonadism in active duty men increased from 2006 to 2015. Were generally accepted diagnostic criteria for male hypogonadism met?
- Al Squitieri’s “Name the Disease” prize at the 1970 Kimbrough meeting was a classic. It was for a goldfish swimming in a urine collection bag – AKA “Ictyuriosis” (fish in the urine)…
- 3-D reconstructive images may aid in surgical planning for minimally invasive surgery.
- IgG-4-related inflammatory renal pseudotumor is rare.
- Granulomatous prostatitis after BCG immunotherapy for non-muscle invasive bladder cancer may be associated with a lower grade of prostate cancer than that seen with other causes of prostatic inflammation.
- Postmortem sperm retrieval is a controversial topic. Guidelines have been developed for deceased organ donors in the civilian community and the issue is being studied in the military.
- Non-classical congenital adrenal hyperplasia (NCCAH) due to testicular adrenal rest tumors is rare.
- Corporal thrombosis usually responds to anticoagulation.
- The LRINEC Score (elevated C-reactive protein, elevated WBC, decreased hemoglobin, increased serum sodium, elevated plasma creatinine, elevated blood glucose) is a useful screening app to diagnose necrotizing fasciitis. It can be found in MDCalc as a cellphone app.
- Late metastasis from a T1b renal cell carcinoma is rare.
- A radical cystectomy ERAS algorithm was applied to renal surgery patients. It worked.
- Plasma cell balanitis is rare; circumcision can be curative.
- Automated flow cytometry will provide a new reference range for significant microscopic hematuria.
- Extravesical common sheath ureteroneocystostomy for duplicated systems is successful.
- Testosterone replacement therapy for organ-confined Gleason 6 and 7 prostate cancer with undetectable PSA after radical prostatectomy was safe.
- There is a wide variance in opioid prescribing patterns after non-endoscopic urologic office procedures.
- A standardized ERAS algorithm for renal surgery didn’t make a difference in hospital length-of-stay, 30-day readmission rate or complication rate. (See the disagreeing results from the ERAS study above.)
- The teardrop meatoplasty modification of the urethral mobilization and advancement repair (UMAR) for hypospadias works.
- Opioid prescribing patterns for robotic surgeries are variable among prescribers. This agrees with an earlier abstract about opioid prescribing practices.
- In pre-clinical studies, the Thulium fiber laser seems to be a competitive alternative to the standard Holmium:YAG laser for lithotripsy. The fibers of the former are smaller, quite flexible, and operate from a standard 110-volt outlet.
- A Renal Hereditary Syndrome Clinic (RHSC) was established to facilitate genetic counseling, provide accurate genetic testing, and improve imaging compliance rates. It was successful.
- Late relapse following complete response to radiation or chemotherapy for clinical stage II germ cell testis tumors is rare. It is accompanied by high recurrence and mortality rates after retroperitoneal lymph node dissection.
- Proper preoperative education is critical to ensure proper choice of urinary diversion after radical cystectomy. To find out if your team is doing a proper job with this task, periodically administer the Functional Assessment of Cancer Therapy – Bladder Cystectomy (FACT-BI-Cys) validated patient health survey to longitudinally assess the quality of life for these patients.
- Compliance with dosing intervals for luteinizing hormone-releasing (LHRH) agonists injections isn’t very good. As expected, this resulted in ineffective testosterone suppression.
- Men with high risk prostate cancer (HRPC) and low serum testosterone levels who were treated with testosterone had no higher rates or time to biochemical recurrence than men with HRPC and normal testosterone levels or low, untreated testosterone levels.
- Different PSA reference ranges for Caucasian, African-American and Hispanic men may not be necessary.
- Testosterone therapy doesn’t seem to result in significant PSA changes in men on active surveillance for prostate cancer.
- Research on stem cell therapy for treating post prostatectomy incontinence has focused on both injecting stem cells as well as targeting in-situ regeneration of tissue with small molecules.
- Despite changes to government service urology, there continues to be similar types of research presented at the SGSU meetings.
- It is possible to not place a ureteral stent after uncomplicated ureteroscopy for proximal ureteral and renal stones.
- Using machine learning based on risk factors and real-world results can help predict those who would most benefit from undergoing a microscopic hematuria workup.
- Intraurethral lidocaine instillation after endourology procedures under anesthesia did not improve postop dysuria.
- It is possible to avoid routine opioid prescriptions after ureteroscopy without increasing patient morbidity.
- Xtandi (enzalutamide) is FDA approved for metastatic castrate sensitive prostate cancer (new indication as of December 2019), metastatic castrate resistant prostate cancer and nonmetastatic castrate resistant prostate cancer (sponsored symposium).
- A retrospective review showed that in appropriately selected patients, a general urologist can obtain patency rate approaching 90% after vasovasostomy
- Incidence data from the Defense Medical Epidemiology Database from 2006-2015 showed that rates of hypogonadism increased significantly among active duty males.
- Interim results of treatment with placebo, sildenafil, and pentoxifylline after RALP showed no difference in IIEF between the treatment arms after one year, and that IIEF scores were worse 1 year after RALP across all interventions.
- We saw how a testicular torsion care pathway was created that may decrease time from presentation to the emergency department to the operating room.
- In the pediatric population, renal vascular injuries are managed differently depending on age group (mostly nonoperatively), but outcomes do not significantly vary with age.
- A single institution retrospective chart review of pediatric patients who underwent minor urological surgeries showed that opioid prescribing rates are low and that older patients were more likely to be prescribed opioids.
- Referral patterns for pediatric monosymptomatic nocturnal enuresis (PMNE) had not changed over a 9-year period, with similar percentages of patients having undergone behavioral modification, alarms, and pharmacotherapy before referral to pediatric urology.
- A dual energy CT scan may help stratify risk in patient with complex renal cysts.
- Surveillance of indeterminate renal cysts is costly and progression over time can aid in clinical decision making.
- A multi-center retrospective review showed that in patients with cT1 renal cancer, tumor size, male sex, diabetes, advanced age, and those treated with radical nephrectomy were statistically more likely to be upstaged.
- An enhanced recovery after surgery (ERAS) protocol for nephrectomy showed improvements in time to bowel function and pain control, particularly with open nephrectomy.
- Electrical stimulation of the proximal urethra in rats with and without supraspinal spinal cord injury showed that urethra to bladder reflexes require suprasacral involvement (Basic Science winner).
- Male slings have low rates of complication at 30 days with the most common being urinary retention and wound dehiscence.
- A survey of women presenting to a general urology clinic showed that almost half of the sexually active women had dyspareunia.
- In a rat bladder model of bladder outlet obstruction, annexin A1 can inhibit the effect of NLRP3 dependent caspase-1 activity and improve bladder recovery after deobstruction.
- A query of the Center for Prostate Disease Research database showed that despite younger age at diagnosis of prostate cancer and higher initial PSA, African American men who undergo radical prostatectomy have similar metastasis rate and overall survival when treated in an equal access healthcare system (Clinical Research winner).
- Surgeon experience contributes to decreased operative time and overall complication rate for robotic assisted RPLND, and therefore can be safely performed by experienced robotic surgeons.
- Surgeon administered TAP block and scheduled acetaminophen and ketorolac can decrease opioid use in patients undergoing robotic assisted radical prostatectomy.
- Patients requiring greater than 3 pads per day and extremely bothered one month after radical prostatectomy are less likely to recover continence and should be appropriately counseled.
- Routine postoperative hemoglobin checks poorly predicts need for blood transfusion after minimally invasive radical prostatectomy.
- Removing the reservoir in revision penile prosthesis surgery can be challenging; however, always remove the reservoir if there is an infection.
- ExoDx is a urine-based genomic test that can be used to assess risk of high-grade prostate cancer in men with PSA of 2-10 who are considering prostate biopsy (sponsored symposium).
- PD-1 pathway inhibitors, antibody-drug conjugates (enfortumab vedotin), and molecularly targeted agents such as FGFR3 inhibitors (erdafitinib) have revolutionized advanced bladder cancer management and how we think about the disease (sponsored symposium).
- Low-intensity shockwave, stem cell therapy, and platelet rich plasma should be considered experimental therapies for treating ED until appropriate RCTs have demonstrated proven efficacy and safety.
- Dr. Al Squitieri reflected on memorable events over the past 50 years of Kimbrough Urological Seminars – some things have definitely changed.
- There has been a lot of progress in the management of castrate resistant prostate cancer with newer agents, although the optimal sequencing has yet to be defined.
- The VA healthcare system offers many opportunities for urologists in terms of leadership, career and helping to train urology residents; there are pros, cons, and many benefits in working as a urologist in the VA system.
- Many urologists fantasize about being NASCAR drivers.
- There are big changes ahead for military medicine as the Defense Health Agency (DHA) takes over health care delivery functions, although the readiness functions will remain with the military departments. Individual Critical Task Lists (ICTLs) will define what a urologist must maintain proficiency on for readiness. Knowledge, Skills and Abilities (KSAs) are specialty-specific skills utilized by the expeditionary clinician and will “help Commanders make decisions regarding deployment by optimizing the readiness of their clinicians, MTF, and address gaps prior to deployment.”
- There is wide variance between urologist prescribing patterns of opioids for pain control following similar clinic procedures.
- In a retrospective study, there was no significant improvement in length of stay, complications rates or 30-day readmission rates after implementation of an enhanced recovery clinical care pathway for nephrectomy.
- Teardrop Urethral Mobilization Advancement Repair (T-UMAR) improved cosmesis, reduced meatal stenosis and adhesion formation compared to UMAR.
- Pelvic fracture associated urethral injury is challenging to treat and the optimal management is not certain; there is significant morbidity if not reconstructed properly and one should consider referring these patients to high volume centers.
- There is no clear evidence on optimal sequencing of drug treatment for metastatic castrate resistant prostate cancer and there are many ongoing and planned clinical trials for prostate cancer patients (sponsored symposia).
- A retrospective review of robotic assisted laparoscopic surgery showed that prescribing patterns for opioids are variable despite similar surgery and similar patient populations and provide evidence for establishment of local standardized prescribing guidelines.
- Thulium Fiber Laser (TFL) is a viable alternative to conventional holmium laser for lithotripsy and clinical studies are in progress.
- As percent seminoma in the orchiectomy specimen increased, the incidence of necrosis, surgical complexity, and the need for concurrent ancillary procedures at the time of post-chemotherapy RPLND increased.
- Evaluating patients with suspected hereditary renal cancer in a multidisciplinary clinic may increase imaging and follow-up compliance rates while better identifying at-risk patients with a strong family history.
- Late relapse after chemotherapy for stage II germ cell tumor is rare and the primary therapy should be surgical.
- In patients undergoing radical cystectomy, proper preoperative counseling is critical to ensure understanding of the benefits of the type of urinary diversion.
- Clinicians prescribing LHRH agonists for prostate cancer should following dosing instructions and schedules, and routinely check testosterone levels.
- Men with high risk prostate cancer after prostatectomy have no higher rates of biochemical recurrence on testosterone therapy.
- There is an apparent difference in prostate cancer behavior after RP in Hispanic men compared to AA and Caucasian men in an equal access setting – higher PSAs in Hispanic males appears less predictive for BCR.
- Testosterone therapy can be safe in men on active surveillance for prostate cancer.
- Aquablation therapy for BPH shows promising results and may be especially beneficial for patients with very large prostates as there is significantly reduced tissue removal time (sponsored symposia).