What do you hope/expect to see in urology or in your practice this year?

"What I hope to see next year is continuing improvement in standards of care when we’re talking about [prostate-specific antigen] screening and prostate cancer diagnosis and treatment," says urologist Michael Cox, MD.

“We have already seen an uptick in patients coming in for vasectomies. With the recent change from the Supreme Court and potential limitations on access to abortion, we’re seeing patients who are already worried, and that’s their reason for vasectomies, as opposed to, they’re just done having children and it’s time.

I definitely see more patients expressing that as their No. 1 reason for vasectomy consultation. I expect that to continue into next year. I don’t know if we can do any more vasectomies than we do already, but we are seeing more and more people saying they are investigating vasectomies because they’re worried about that.

What I hope to see next year is continuing improvement in standards of care when we’re talking about [prostate-specific antigen] screening and prostate cancer diagnosis and treatment. Anecdotally, we have seen more locally advanced and aggressive prostate cancers with the use of active surveillance.

We offer active surveillance like everyone else, but I think that in my 12 years of practice we’re seeing more advanced prostate cancers—what might’ve been Gleason 6 is turning into Gleason 7 on subsequent biopsies. I think that’s a consequence of more active surveillance. We’re definitely seeing more men being treated for intermediate-grade prostate cancer vs low-grade.

If we’re going to recommend active surveillance, we need to offer more tests, so we can further restratify men and make sure they’re getting the appropriate treatment or keep a closer eye on the active surveillance.”

Michael Cox, MD

Savannah, Georgia

“Our practice is beginning to see a shift from a pandemic mindset—the amount of time we were spending in virtual encounters—and moving back to practice patterns from 2018 to 2019.

The practice won’t be totally the same, but the pandemic way of thinking and telemedicine helped revolutionize some things for us and, maybe, streamline our practices. I think we’re headed toward a hybrid of what we saw before the pandemic while adding things we thought made us more efficient in our practices during the pandemic.

I mainly work in andrology. Virtual appointments have been a boon because I could see many more patients than previously, and they didn’t have to travel far distances. They also avoided clinic parking difficulties and waiting room congestion. Patients really appreciated that.

Next year, we’ll see increasing efficiency, make access easier for our patients, especially people from quite a distance away, but we’ll also get back to decreased restrictions from COVID-19. I’m looking forward to seeing people in the office. It’s really different talking to someone just on the phone.

As far as medical treatments, I think we’ll see more widespread germline testing, infertility, DNA fragmentation, and microfluids will be coming forward, and an implantable [percutaneous tibial nerve stimulation] device for overactive bladder.”

Justin Nork, DO

San Diego, California

Nelson N. Stone, MD, a New York, New York-based urologist

"We’re about to change the way we train," Nelson N. Stone, MD, says.

“Over the past 35 years, I’ve worked with others developing therapies and equipment for treating prostate cancer, and I’ve trained urologists around the world in new techniques.

This year, we’re launching a product that can be used in both training and actual procedures. It’s a video system that will enable a supervising urologist to see what residents or other physicians see—through their eyes—by linking into equipment the treating physician is using.

It can be used across industries and other medical specialties, but, as a matter of disclosure, I helped develop the urology line of products. Part of the incentive for this was that during COVID-19, you couldn’t get together for training, even as we developed new techniques.

The system uses both augmented reality and extended reality, employing a headset with a see-through optic display that projects the image of the operative field, and even imaging video, into their eye. A teacher can be in 1 location and a trainee at another, anywhere in the world. What the student sees in his headset, the trainer sees in another. With these headsets, the trainer can see the inside of the bladder wall, for example, to make sure no small cancer was missed. The trainer sees every move the student makes through his eyes. Conversely, the trainee can watch what an experienced surgeon is doing.

We’re about to change the way we train.

Instead of doctors taking time from their practices to spend a couple days teaching, the doctors can do a video session after 5 o’clock and show a trainee exactly how to perform a procedure. They can see what the trainee sees during an actual surgery while getting input directly from the video system.

We expect this to take off in 2023.”

Nelson N. Stone, MD

New York, New York

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