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“My practice has seen a tremendous increase in patients’ awareness of HIFU as a treatment option," says one urologist.
Urology Times reached out to three urologists (selected randomly and asked them each the following question: What new technology will you adopt in 2018?
Dr. Kuhr“I would say the LESS procedure, laparoendoscopic single-site surgery, will make a difference this year. We are working toward that for donor nephrectomies, which we do a lot of for transplants.
It makes a couple of differences. About 12-15 years ago, we saw a significant uptick in the number of living donor transplants when we started doing laparoscopic donor nephrectomies. That’s plateaued, but is still significantly higher than 20-25 years ago. We hope single-site surgery will increase people’s willingness to come forward, because it’s even less invasive. Also, our donors usually go home on post-op day two, but patients may be able to get out the day after their surgery.
We’re also working on a new MRI technique. Because most of our patients have renal insufficiency, they can’t get a contrast CT or MRI if they’re facing a kidney transplant because of renal failure. Ironically, once kidneys fail and patients are on dialysis, they can have a contrast CT because their kidneys are already dead. But for patients still limping along with poor kidney function, not on dialysis, if they have something suspicious in the kidney, it’s hard to work up. So we’re using a new technique using ferriheme, a new contrast material to help us see the anatomy of the kidneys, as well as blood vessels, providing a helpful roadmap for us. We’ll probably be using it in 2018.
With anesthesiologists, we developed new pathways of doing donor nephrectomies without narcotics after surgery. We’re using regional anesthesia, putting in muscular blocks to block pain receptors in the surgical area, providing localized pain relief rather than systemic relief with narcotics. We hope to make it more palatable for donors so they don’t deal with the constipation, nausea, etc.”
Christian Kuhr, MD
Next: “We’re using things I wouldn’t call new, but we’re using them more."
Dr. Burks“We’re using things I wouldn’t call new, but we’re using them more. I’m using lasers far more in my practice. We’ve been using lasers for years, so they aren’t brand new, but are now clearly our standard for treating BPH.
We now have a 180-W GreenLight laser that works a lot better than the old 80-W lasers. We’re using those all the time. They work faster with better penetration, better vaporization, better everything.
We’re using InterStim all the time; I would say that’s a refinement on an older treatment. Remember, treatments don’t just happen and then remain stagnant. These are treatments we start, then they evolve, and then evolve again. Equipment gets better, technique gets better, you see better results. There aren’t many brand-new treatments that have never been done before, but refinements on older treatments improve our practice.
The InterStim has improved significantly in terms of our techniques. We are getting better results long term with better placement of the lead into the spine. The company has refined the techniques and now the lead is placed in a little pouch that stabilizes it in the gluteal pocket. There are refinements in how we do the procedure and the way we implant the generator. These are things we didn’t see a year ago.
Everybody is trying to invent new things, but a lot of the progress in medicine is doing what we already do and doing it better.”
David Burks, MD
Next: “My practice has seen a tremendous increase in patients’ awareness of HIFU [high-intensity focused ultrasound] as a treatment option.
Dr. Horchak “My practice has seen a tremendous increase in patients’ awareness of HIFU [high-intensity focused ultrasound] as a treatment option. I got involved with HIFU in 2003 and took patients out of the country to be treated. In 2015, it was FDA approved, not necessarily for prostate cancer but for the ablation of malignant tissue. Then [in summer 2017] came a CPT code we could bill under. That helped HIFU gain a foothold along with the MRI of the prostate, which is really localizing tumors a little bit better.
More of my patients are voicing interest in HIFU and focal therapy, particularly patients on active surveillance. They’re comfortable with active surveillance, but when their condition changes, these people have already said, ‘I don’t need my whole gland removed; can I do something different?’
HIFU’s readiness for prime time has been questioned and it may still not be, but I think it will get more of a push. That’s probably the biggest change I see for my practice. MRI and HIFU and the possibility of focal therapy are going to take more of a prominent place among options available for prostate cancer patients.
The benefit of HIFU is that it’s quick, there’s not a lot of morbidity, and you can redo it. The downside has been that patients had to pay out of pocket when they left the country, $20,000-$30,000 upfront. Patients still have to pay something, but insurance companies are now reimbursing them better.”
Alex Michael Horchak, MD
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