Jackson Hole Seminar
February 5 - 10, 2012

Educational Needs

With the many changes in medicine and urology almost daily, it is imperative that the practicing urologist remains on the cutting edge. Urologists need to keep current on assessing, diagnosing and treating urologic conditions in the clinical setting. This meeting will address new and dynamic issues in urology, specifically renal cell carcinoma, urodynamics, prostate cancer, stress urinary incontinence and nano­technology in urology. Urologists will also discuss controversial cases in reconstructive surgery, voiding dysfunction, minimally invasive surgery, genital urinary trauma, prosthetics and men’s health.

Objectives

Upon completion of this conference, participants should be able to:

• Review current literature to refine patient selection for en­doscopic management of upper tract cancer and obstruction.
• Identify instrumentation and surgical techniques that opti­mize the likelihood of success.
• Describe the alternatives for bladder reconstruction, present results and critically review what is passing the test of time in this area in the pediatric population.
• Evaluate the true risk of diabetes, heart disease and depres­sion using population-based, patient-reported data and to ap­preciate subgroups of patients who may be at greater or less risk of developing these conditions while on ADT.
• Review the conventional digital rectal examinations and methods of confirming tissue consistency.
• Identify strategies for ureteral reimplantation in complex situations of high-grade reflux, megaureter and ureteral ec­topia.
• Recognize the relationship between obesity, physical activity and diet and LUTS/BPH and identify if these relationships are influenced by race or socioeconomic status.
• Review the history of surgical robotics and identify the cur­rent status of robotic surgery. Recognize various types of new surgical robotic systems currently being developed and identify what will be expected in future.
• Describe the alternatives for complex hypospadia repair. Discuss advantages and disadvantages of each strategy; identify which clinical finding might indicate better outcome and better strategy selection.
• Contrast long-term sexual, urinary and bowel function and bother outcome following surgery or radiation for localized prostate cancer. Employ a more comprehensive understand­ing of the survivorship experience that can be used to coun­cil patients who are choosing therapy for newly diagnosed disease.
• Review the current status of urinary incontinence after radi­cal prostatectomy. Identify various methods to report urinary incontinence and limitations in comparing these results ob­jectively. Review the data on perioperative factors might be influencing urinary incontinence after prostatectomy.
• Report an update and extension of a nation-wide, population-based cohort study of long-term outcome in men with low and intermediate risk prostate cancer managed with surveil­lance, radical prostatectomy, or radiotherapy in Sweden by use of data in The National Prostate Cancer Register (NPCR) of Sweden.
• Review current literature to refine patient selection for Shock Wave Lithotripsy (SWL). Identify modifications in SWL treatment protocols designed to maximize efficacy and de­crease morbidity. Recognize the role for ureteral stenting and medical expulsive therapy.
• Describe the surgical steps of ASC and demonstrate using still and video photography, tips and techniques to perform­ing the procedure using the laparoscope.
• Identify the frequency of prolapse based on patient age. List the surgical options for pelvic organ prolapse based on the route of access and whether a surgical mesh will be used. Review randomized trials that compare abdominal to vaginal approaches for the repair of pelvic organ prolapse.
• Identify the pre-operative and intra-operative steps to per­forming robotic ureteral reimplant for stricture or ureteral vaginal fistula in women with a LUT injury following pelvic surgery.
• Describe and demonstrate (through still photography and video) successful minimally invasive abdominal and vaginal procedures to repair vesico-vaginal fistulas.
• Review current and historical literature on obliterative pro­cedures for the treatment of pelvic organ prolapse. Describe and demonstrate the LeFort colpocleisis.
• List the contraindications to performing supracervical hys­terectomy at the time of sacrocolpopexy for uterine prolapse, review current controversies surrounding supracervical hys­terectomy, and demonstrate, using video clips, the surgical technique.
• Review current use of robotic prostatectomy and compare outcomes to open prostatectomy.
• Review the status of robotic surgery for bladder cancer and kidney cancer including early outcomes and technical chal­lenges associated with the widespread adoption of these pro­cedures.
• Identify economic issues associated with the increasing use of robotic surgery for urologic malignancies.
• Assess the evidence from randomized trials of prostate cancer screening.
• Review population-based statistics on the potential advantages or disadvantages of prostate cancer screening.
• Describe the controversies surrounding prostate cancer screening including the potential for over diagnosis and treatment.
• Review the advantages and potential disadvantages of both open and robotic prostatectomy with regard to postoperative outcomes.
• Identify issues related to surgical technique that might impact positive margin rates.
• Describe specific nerve-sparing techniques and surgical modifications that may improve early continence and erectile function rates after radical prostatectomy.
• List adverse pathologic features associated with a higher risk of biochemical recurrence after radical prostatectomy.
• Review the randomized trials demonstrating the benefits of adjuvant radiation therapy on cancer-specific and overall survival.
• Assess the optimal timing of postoperative radiation therapy with focus on the potential equivalence of adjuvant and early salvage radiation approaches.
• Describe several commonly utilized strategies for selection of men for initial and/or repeat prostate biopsy.
• Explain the evolution of prostate biopsy methods from the sextant technique to more extended biopsy schemes.
• Identify prostate sampling schemes and techniques that may optimize cancer detection on both initial and repeat prostate biopsy.
• Describe the results of the SELECT trial investigating the chemopreventive effects of vitamin E and selenium.
• Assess the results of randomized trials investigating 5-α-reductase inhibitors as chemopreventive agents (PCPT and RECUCE).
• Identify the controversies around the use of 5-α-reductase inhibitors including reasons why providers may be hesitant to use these agents for chemoprevention.
• Review endogenous testosterone production.
• Describe signs and symptoms of testosterone deficiency.
• Recognize the effect of testosterone on the prostate.
• Review recent data on TRT and men with prostate cancer.
• Identify treatment recommendations for caring for men with TRT and prostate cancer.