AUA2022: PLENARY RECAP AUA2022 Session on How I Do It: Common Urologic Procedures
By: Gopal Badlani, MD, FACS, FRCS | Posted on: 01 Sep 2022
The AUA secretary John Denstedt conceived the concept of visual illustration of common urological procedures by the experts in the field. Rather than live surgery, international participation was made possible with an unedited video recording of the procedure. Each speaker followed a format of case selection, the minimal required workup, an essential test before use of the device. They illustrated the technique with emphasis on anesthesia choice/location of service/equipment/technique/key tricks to make it easier. Troubleshooting during the case was an important feature. Immediate postoperative management instruction/followup is key in these procedures. Assessment as to what is the definition of success in their view and long-term data were illustrated.
Bipolar Enucleation and Resection
Dr. Li-Ping Xie, professor and chair of urology at the First Affiliated Hospital, Zhejiang University School of Medicine in China, demonstrated a newer technique in bipolar enucleation. He has published extensively on his technique, including a summary article in the Asian Journal of Urology.1
He demonstrated ability to deal with any size prostate using the bipolar device, a combination of enucleation and resection, to avoid the need for morcellation, as needed by laser enucleation techniques. A special loop designed by him was introduced with an ancient Chinese principle. With careful use of coagulation current, he enucleated the gland from the apex to the bladder neck, and then used the resection to remove the tissue with minimal blood loss. Postoperative care is routine as in any transurethral resection of the prostate, and his presented long-term data showed a good outcome. The learning curve for this is considerably shorter than for the laser enucleation.
Perineal Prostate Biopsy
Dr. John Thomas Wei, professor of urology at the University of Michigan and head of andrology at Michigan Medicine at Ann Arbor, demystified the ability to do a perineal biopsy under local anesthesia in the office setting. The prevalence of prostate cancer continues to increase, and the need for biopsy in a safe manner is the current need. The transrectal approach is the most common approach in the U.S. but the perineal approach is increasingly used in Europe. Until recently, this was being done under anesthesia, but Dr Wei showed in a very detailed and careful manner each aspect of doing the procedure in the clinic. The ultrasound can be done transrectally or perineally, and the ability to include MRI findings in planning biopsy was discussed. He demonstrated the disposable device that allows the biopsy to be guided to various sites in the prostate in a controlled manner. The decrease in the infection rate is a significant advantage.
Post Prostatectomy Incontinence
Dr. Jaspreet Singh Sandhu, associate professor of urology at the Weil Cornell Medical College and at Memorial Sloan Kettering Cancer Center, chaired the recently released AUA Guidelines on this topic. He demonstrated the new and improved design of the male sling, and emphasized the case selection as well the prerequisites prior to the surgery. Ruling out bladder neck contracture and bladder dysfunction, both overactivity and compliance issues, was key to the success of the procedure. Surgical approach for patients with 2 pads or fewer leaking per day was demonstrated. Steps including release of perineal tendon, passage of the needle through the obturator fossa, and tensioning were illustrated.
Mini Percutaneous Nephrolithotomy (PCNL) for Renal Stones
Dr. Janak Desai, senior urologist at Samved Hospital in Ahmedabad, India, is a pioneer in the ultra mini PCNL. Intra-renal lithotripsy with flexible scopes is an established technique in the U.S. and western world, but cost of the flexible scopes and repair has led to the development of mini PCNL, which is more invasive but faster and better in stone clearance, in addition to being cheaper. Taking this 1 step further, ultra mini PCNL with a special evacuator for stone fragments was demonstrated by Dr. Desai. Access with ultrasound guidance further decreases the radiation exposure. An internal stent was adequate for drainage, obviating the need for nephrostomy tube. The patient can be discharged on the same day.
The session viewing can be a ready reference for embarking on one of these procedures after appropriate training for access.
- Xie L, Wang X, Chen H, et al. Innovative endoscopic enucleations of the prostate—Xie’s prostate enucleations. Asian J Urol. 2018;5(1):12-16.