To the entire SGSU membership,

It is with a heavy heart that I report sad news. Our beloved Preston Littrell has passed away. Kathy Littrell called me yesterday to let me know that he died peacefully in his sleep early in the morning (7/27/19).

Preston served as the SGSU administrator for nearly 20 years. He attended more than 40 Kimbrough Urologic Seminars during his lifetime. He was an absolute blessing to our organization! Preston was one of the kindest and most loving people that I have ever known. He always had a twinkle in his eye and smile on his face. His heart overflowed with a sense of gratitude for life, and he was forever focused on how he could serve his fellow man and woman. We have lost a true gentleman! Please keep Kathy and Preston’s kids, his grand kids and great grandchildren in your prayers.

Below is a summary of the schedule for Preston’s services. The information can also be found at https://www.missionparks.com/obituaries/Preston-N-Sonny/  should anyone wish to leave a message on the website. Preston’s obituary will be posted there in the next few days.

Peace,
Hal

Harold A. Frazier II, MD, FACS
SGSU Secretary

Visitation:
AUG 8. 6:00 PM – 8:00 PM (CDT)
Mission Park Funeral Chapels North Cherry Ridge
3401 Cherry Ridge Drive
San Antonio, TX, 78230

Funeral:
AUG 9. 12:30 PM (CDT)
First Baptist Church of San Antonio
515 McCullough Ave
San Antonio, TX, 78215

Graveside Service:
AUG 9. 2:00 PM (CDT)
Ft. Sam Houston National Cemetery
1520 Harry Wurzbach
San Antonio, TX, 78209

Congratulations to the 2019 Annual James C. Kimbrough Seminar Award Winners – Kona, Hawaii

HG Stevenson Award for outstanding support and
dedicated service to the SGSU and urology residency
programs.

Presented to: Joseph Clark, MD.

Honorary Lifetime Membership Award for lifetime
dedicatioon and service to the SGSU.

Presented to: COL (Ret.) Noah Schenkman, MD

Prince Beach Award for best paper presented by a society
member staff physician as judged by chief residents.

Presented to: Robert Borjian, MD

Clare Scanlon Award for outstanding administrative
work on the annual seminar.

Presented to: COL Robert C. Dean, MD

Resident Competiton Clinical Research Award Winners:

• 1st Place: CPT Bradley Potts, MC, USA
• 2nd Place: Caitlyn Shepherd, MD
• 3rd Place: CPT Karmon Janssen, MC, USA

Resident Competition Basic Science Award Winners:

• 1st Place: CPT Alexandria Hertz, MC, USA
• 2nd Place: CPT Stephanie Sexton, MC, USA
• 3rd Place: CPT Patrick Leidig, MC, USA

Poster Session Winners:

• 1st Place: CPT Bradley Potts, MC, USA
• 2nd Place: CPT Jacob McFadden, MC, USA
• 3rd Place: CPT Karmon Janssen, MC, USA

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.

Click link below to view the 2019 meeting highlights !

https://govurology.org/wp-content/uploads/2019/06/sgsu-may-2019-newsletter.pdf

Military Doctors In Crosshairs Of A Budget Battle

Jordan Rau, Kaiser Health News

The U.S. military is devising major reductions in its medical corps, unnerving the system’s advocates who fear the cuts will hobble the armed forces’ ability to adequately care for health problems of military personnel at home and abroad.

The move inside the military coincides with efforts by the Trump administration to privatize care for veterans. The Department of Veterans Affairs last month proposed rules that would allow veterans to use private hospitals and clinics if government primary care facilities are not nearby or if they have to wait too long for an appointment.

Shrinking the medical corps within the armed forces is proving more contentious and complex. In 2017, a Republican-controlled Congress mandated changes in what a Senate Armed Services Committee report described as “an under-performing, disjointed health system” with “bloated medical headquarters staffs” and “inevitable turf wars.” The directive sought a greater emphasis for military doctors on combat-related needs while transferring other care to civilian providers.

Details of reductions have yet to be finalized, a military spokeswoman said. But within the system and among alumni, trepidation has increased since Military.com, an online military and veterans organization, reported in January that the Department of Defense had drafted proposals to convert more than 17,000 medical positions into fighting and support positions — a 13 percent reduction in medical personnel.

“That would be a drastic first cut,” said Dr. David Lane, a retired rear admiral and former director of the Walter Reed National Military Medical Center in Bethesda, Md.

At most risk in the current planning are positions that aren’t considered essential to troops overseas, such as training spots for new doctors and jobs that can be outsourced to private physicians and hospitals — obstetricians and primary care doctors, for example. The reductions may also limit the military’s medical humanitarian assistance and relief for foreign natural disasters and disease outbreaks.

Even in war zones, Lane warned, it would be a mistake to downplay the importance of contributions by doctors who do not specialize in trauma. In the 1991 invasion of Kuwait, for instance, cases of diseases and non-battle injuries rather than combat injuries created the most medical work, he said.

Doctors who train in the military’s highly regarded medical school — who have committed to serve in the armed forces after training— and those who do military residencies account for much of the staff serving troops overseas. A major deployment could leave the military flatfooted, said Dr. John Prescott, a former Army physician.

“The majority of folks in the military don’t stay in for their whole career, they stay in for a few years,” Prescott said. “I’m concerned there will be a very small cohort that will be available for deployment in the future.”

The military health system is responsible for more than 1.4 million active-duty and 331,000 reserve personnel, with 54 hospitals and 377 military clinics around the world. Split among the Navy, Army and Air Force, each with its own doctors and hospitals, the service has been targeted for years for overhaul to reduce redundancies and save costs.

The department has already started moving administrative functions under one bureaucracy, called the Defense Health Agency, which is slated to take over the service branch hospitals in 2021.

The budget for the next fiscal year is still being developed and final decisions have not yet been made, a Department of Defense spokeswoman, Lt. Col. Carla Gleason, said in an email. “Any reforms that do result will be driven by the Department’s efforts to ensure our medical personnel are ready to provide battlefield care in support of our forces, and to provide the outstanding medical benefits that Service members, retirees and their families deserve,” she said.

For years, critics of the broad role of the military health services have argued that many medical corps services — such as maternity care and pediatrics on bases — could be provided more effectively by civilian doctors and hospitals.

But Lane said there is too much focus on the high-profile trauma cases on the battlefield “that at the end of the day are a small portion” of medical care. “When we’re trying to put things back together that got broken during a war,” he said, “that’s what you need the most of — pediatricians, public health doctors, primary care doctors.”

Some studies commissioned by the department have concluded private hospitals could deliver less costly care, in part because doctors at hospitals take care of more patients. But the Congressional Budget Office said savings were not at all certain and that military hospitals might be less expensive if the government arranged for greater use of them.

Brad Carson and Morgan Plummer, who held senior jobs in the Department of Defense during President Barack Obama’s administration, argued in a 2016 essay that the military isn’t the best training for surgeons because it doesn’t provide them with a sufficient number of cases to develop expertise.

The military health system “has too much infrastructure, the wrong mix of providers, and predominantly serves the needs of beneficiaries who could easily have their health care needs satisfied by civilian providers at far less cost and with equal or better quality,” they wrote.

The government this year is spending $50 billion on the military health system, including Tricare insurance for more than 9 million active-duty service members, veterans, families and survivors, according to Congress’ budget office. That is roughly a tenth of the military budget. The CBO projected costs are on track to increase to $63 billion in 2033.

Defenders of the system reject the idea that non-wartime jobs can be eliminated without it hurting that core mission.

“Military health care providers between deployments maintain their clinical skills by treating service members and millions of beneficiaries,” Dr. Arthur Kellermann, dean of the school of medicine at the Uniformed Services University in Bethesda, wrote in a 2017 Health Affairs article. “Military hospitals provide valuable platforms for teaching the next generation of uniformed health care professionals and standby capacity for combat casualties.”

Prescott, the former Army doctor, said that the military may have trouble turning to civilian doctors in some regions given physician shortages, which he said the military cuts would exacerbate.

“Most hospitals are already pretty full, most health care providers are pretty busy,” said Prescott, now chief academic officer at the Association of American Medical Colleges.

Doctor shortages would increase if the military cut the slots it now has to train doctors, because there wouldn’t be new civilian residencies created to compensate. “Those positions basically disappear,” he said.

Kathryn Beasley, a retired Navy captain who is director of government relations for health affairs at the Military Officers Association of America, said she was also concerned with unforeseen consequences of dramatic cuts.

“Everything’s tied together, there’s a lot of interdependencies in these things,” she said. “You pull a string on one and you might feel it in an area you don’t expect.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

The HILL.com
Feb. 14, 2019

Washington is often disconnected from the veterans communities, and that division can lead to ineffective policies, former Air Force officer Michael Haynie told Hill.TV.

“The extent to which we have conversations in D.C. about the social, economic, wellness concerns of this community without connecting those conversations back to the communities in which veterans are going to live, work, raise families I think is pretty short-sighted,” Haynie told Hill.TV’s Krystal Ball and Shermichael Singleton this week on “Rising.”

Click here to read full article

https://thehill.com/hilltv/rising/430015-former-air-force-officer-calls-washingtons-approach-to-veteran-health-care-short-sighted

Click link below to view the 2018 meeting highlights !

https://docs.google.com/viewer?url=https://govurology.org/wp-content/uploads/2018/08/sgsu-2018-meeting-newsletter.pdf

• HG Stevenson Award for outstanding support and dedicated service to the SGSU and urology residency programs. Presented to: Gerald Jordan, MD
  .
• Honorary Lifetime Membership Award for lifetime dedication and service to the SGSU.
  Presented to: John M. Barry, MD
  .
• Prince Beach Award for best paper (#65) presented by a society member staff physician as judged by chief residents. Presented to: Thomas Rozanski, MD
  .
• Clare Scanlon Award for outstanding administrative work on the organization of the Mock Oral Boards for many years. Presented to: COL Inger Rosner, MD.
  .
• Clinical Research Award Winners:
  • 1st Place: #9 – Capt Theodore R. Saitz, MC, USAFR
  • 2nd Place:#11 – MAJ Dantae Bowie, MC, USA
  • 3rd Place: #1 – Maj Pansey Uberoi, MC, USAF
    .
• Basic Science Award Winners:
  • 1st Place: #2 – LT Chad Pusteri, MC, USN
  • 2nd Place:#5 – CPT Joseph Fantony, MC, USA
  • 3rd Place:#20 -CPT Karmon Janssen, MC, USA
  • People’s Choice Award: #12 – Leah Williams, Ms3
  • Honorable Mention: #22 – LT Ryan Gillis, MC, USN
    .
• Poster Session Winners:
  
  • 1st Place: #55- CPT Alexandria Hertz, MC, USA
  • 2nd Place: #62-LCDR Eric Biewenga, MC, USN
  • 3rd Place: #52- CPT Karmon Janssen, MC, USA

Job Opportunity Available

Immediate opening at Lexington VAMC for a full-time VA Urologist. A faculty appointment is available with the affiliate institution (University of Kentucky) and competitive salary/benefits come with the position.  Lexington, Kentucky is a very desirable location with affordable housing, good schools and it is a safe city to raise a family. Not to mention, it is the Horse Capital of the World and for Bourbon enthusiasts, this is the center of it all. The preferred candidate would be an early to mid-career Urologist with minimally invasive experience or minimally invasive surgery fellowship training who would, after 2-3 years, transition to the Chief of Urology (VAMC) position, however, all applicants will be considered (including graduating residents in 2019).  The DaVinci Xi Robot is available and owned by our facility.  All subspecialties are represented at Univ. of Kentucky and our VA has an excellent working relationship with the affiliate institution such that our Veterans receive world class, subspecialty and general urology care. If you are looking for a change, a great place to live and work, and a gratifying job, look no further. Also, Urologists leaving the military before a retirement (short of 20 years) are eligible to transfer/purchase your years of military service into the VA retirement system! This is a huge benefit. Please share this with colleagues/residents/fellows in your programs. Please send application/CV to David M. Preston, MD, Chief, Urology Service, VAMC Lexington – email (david.preston2@va.gov < Caution-mailto:david.preston2@va.gov > ) and by phone, please text 859-396-3323 identifying your interest and contact number and Dr. Preston will reply back.