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AUA2023: REFLECTIONS Mastering the Basics: How the Experts Do It

By: Gopal Badlani, MD, FACS, FRCS, Wake Forest University, Winston-Salem, North Carolina | Posted on: 19 Sep 2023

This session at AUA2023 was conceived by Secretary Dr John Denstedt based on feedback from the audience at the 2022 meeting. Common surgical procedures were demonstrated by experts. Please consider reviewing the video presentations at the AUA site for the 2023 meeting (April 29, 7:45 to 8:45 am Plenary).

Figure 1. Torsion of the testicle.

Dr Micah Jacobs from U.T. Southwestern addressed a case emblematic of a typical teenage patient who might show up in an adult or pediatric emergency room. It discussed the workup and determining factors for a decision to bring the patient to the operating room, including imaging and nonimaging assessment. The procedure for orchiopexy and possible orchiectomy was discussed. Aftercare and follow-up care recommendations included a discussion of pre- and postoperative counseling for the patient and family (Figure 1).

Dr Mantu Gupta from Mount Sinai, New York, highlighted the advantages, clinically and pathologically, of en-bloc enucleation of bladder tumors. He discussed various lasers and methodologies to achieve complete tumor removal with good lateral and deep margins. This includes tips and tricks, such as laser settings and clinical nuances, that help facilitate the procedure, especially for the novice. Technique mastery and applications to en-bloc enucleation of ureteral and collecting system tumors were also discussed (Figure 2).

Figure 2. Laser enucleation of bladder tumor.

Olivier Traxier from Paris, France, is the leading expert in ureteroscopy and laser use in the upper tract. His video demonstrated the 3 pulsed laser (Ho:YAG-TmF and Tm:YAG) for stones and upper tract urothelial cancer. He presented the various settings to maximize the advantage of each laser, emphasizing the physician input in setting the energy.

Wayne J. G. Hellstrom from Tulane demonstrated techniques and approach to ventral and dorsal penile plication. Approximately 4% of adult men have Peyronie’s disease (PD), which can cause both physical and psychologic distress. Oral meds are no longer recommended. The only Food and Drug Administration–approved agent for the treatment of PD, collagenase Clostridium histolyticum (Endo, Malvern, Pennsylvania), may not be available, may not be covered by insurance, or may result in treatment failure. Surgery remains the gold standard for the treatment of PD. After passing defined indications, penile plication remains as a simple, successful, and reversible outpatient procedure with minimal complications. A nonincisional approach using baby Allis clamps and a near-to-far and far-to-near imbricating, nonabsorbable-braided suture with buried corporal knots provides a greater than 90% success rate. The preferred plication technique for dorsal, lateral, and ventral penile curvatures was detailed with explanatory videos (Figure 3).

Figure 3. Plication for Peyronie’s disease.