HOW I DO IT

• Using darolutamide in advanced prostate cancer: How I Do It

  Hamilton Joelle, MD Urology Centers of Alabama, Homewood, Alabama, USA

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  Darolutamide is a nonsteroidal androgen inhibitor FDA approved for the treatment of castration-resistant non-metastatic prostate cancer (nmCRPC). After decades of offering androgen deprivation therapy (ADT) alone or first-generation androgen receptor blockers for patients whose PSA was rising despite castrate levels of testosterone, there are now three different treatment options to add to ADT. These include apalutamide approved in February 2018, enzalutamide FDA approved in June 2018, and darolutamide approved July 2019. Each of these androgen receptor pathway blockers, when added to ADT or surgical orchiectomy, prolongs metastasis-free-survival (MFS) and median survival (MS). This paper focuses on the use of the newest approved agent in this class, darololutmide.

  Keywords: prostate cancer, castrate-resistant, non-metastatic disease, antiandrogen, darolutamide,

  Jun 2021 (Vol. 28, Issue 3 , Page 10673)
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• How I Do It: PureWick female external catheter: a non-invasive urine management system for incontinent women

  Uhr Alex, Glick Lydia, Barron Suzanne, Zavodnick Jillian, Mark R. James, Shenot Patrick, Murphy Alana, MD Department of Urology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA

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  Catheter associated urinary tract infections (CAUTIs) are common hospital-acquired infections and remain a significant medical and financial challenge to the healthcare system. Despite this risk, incontinent women may require prolonged catheterization to accurately monitor urine output and prevent skin breakdown. The PureWick Female External Urinary Catheter is a promising non-invasive urine collection system for use in incontinent women that may help reduce CAUTI rates, maintain skin integrity, accurately quantify urine output, and avoid extra healthcare costs.

  Keywords: urinary incontinence, catheter associated UTI (CAUTI), female external collection device,

  Jun 2021 (Vol. 28, Issue 3 , Page 10669)
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• How I Do It: The pudendal nerve block for pediatric ambulatory urologic surgery

  Okoro Chinonyerem, Cannon Shannon, Low Daniel, Lendvay S. Thomas, MD Department of Urology, University of Washington Medical Center, Seattle, WA

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  Regional analgesia is an important adjunct for perioperative pain management in the setting of pediatric penile surgeries. Caudal epidural analgesia (CEA) is the most common analgesic technique performed, but it has limitations and associated morbidity. The pudendal nerve block (PNB) is an effective alternative to CEA with a lower risk profile; in prior examination of the approach, PNB has been demonstrated to have similar postoperative pain control outcomes. We describe our technique and highlight observations made as we have transitioned from CEA to PNB for many patients.

  Keywords: pudendal nerve block, regional anesthesia, pediatric urology, pain management,

  Apr 2021 (Vol. 28, Issue 2 , Page 10648)
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• DNA analysis for prostate specimen verification: How I Do It

  Salib Andrew, Mark Ryan J., MD Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

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  Prostate cancer is the most common malignancy affecting men. Prostate biopsy remains the key clinical tool for selecting appropriate treatment options. The process of specimen collection and diagnosis is multistep and vulnerable to human error along every stage. Specimen provenance testing (SPT) aims to provide certainty that biopsy results can be trusted when recommending life changing treatments and has emerged as a necessary tool in medicine to counteract human error and specimen contamination. In this study we report our practice's experience using the Know Error test to verify prostate biopsy specimens. In this study, we retrospectively reviewed the results of a specific SPT known as Know Error which is used in our institution for specimen verification during prostate biopsy. Over a period of 16 months, we identified 445 patients with a total of 921 specimens. The percentage of patients who had 1, 2 or 3 specimens analyzed was 29%, 38%, and 30%, respectively. Our cohort's rate of specimen verification was 92.8% with a 2.8% contamination rate. The pathology reports for 445 patients were then examined to determine Gleason Grade Group (GG) showing 180 GG1 and 148 GG2 patients. Cross reference of pathology reports and Know Error reports showed 8 GG1 and 9 GG2 patients had contaminated biopsy specimens. Specimen provenance complications such as contamination can negatively impact patient counselling and treatment modalities leading to unnecessary intervention and detrimental patient outcomes.

  Keywords: DNA analysis, specimen contamination, prostate biopsies, specimen provenance complications,

  Feb 2021 (Vol. 28, Issue 1 , Page 10568)
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• How I Do It: Modification of technique to safely position patients with super obesity in dorsal lithotomy for ureteroscopic management of kidney stones

  Allen Jordan, Streeper M. Necole, MD Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA

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  Obesity is a known risk factor for recurrent nephrolithiasis and it can be challenging to provide safe surgical intervention in the super obese population. Despite high weight limits on surgical beds, these often do not take into account positioning the patient on the end of the bed for dorsal lithotomy, which can risk an unsteady bed. In addition, depending on patient habitus the leg stirrups may not accommodate. There is limited literature that discusses the technical approach for positioning super obese patients in dorsal lithotomy when the weight limit approaches or exceeds the capacity of equipment available. In this article, we present a modified positioning technique to improve bed stability, which also provides an alternative if the patient's legs are not supported by available leg stirrups. From our experience, this modified dorsal lithotomy positioning for ureteroscopy is feasible and safe in patients with super obesity. Surgical intervention on this population requires appropriate planning and teamwork to ensure safe positioning.

  Dec 2020 (Vol. 27, Issue 6 , Page 10488)
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