2015 Objectives and Accreditation

35th Annual Ralph E. Hopkins Urology Seminar at Jackson Hole

Winter Conference
January 28 – February 1, 2015

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The University of Colorado School of Medicine and Jackson Hole Seminars. The University of Colorado School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Colorado School of Medicine designates this live activity for a maximum of 32.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

• Identify recent advancements in MR imaging techniques including the multiparametric approach
• Analyze the status of MR imaging in prostate cancer staging including correlation between imaging and pathologic • findings at radical prostatectomy
• Identify the role of MR-targeted prostate biopsy using MR-ultrasound fusion techniques
• Examine the impact of PSA screening on CaP mortality
• Question the impact of PSA screening on over diagnosis of CaP
• Analyze novel ways of improving PSA screening with new biomarkers and MRI targeted biopsy
• Illustrate and be able to apply current definitions of CAUTI to urological patients
• Identify alternative techniques to prevent CAUTI in specific urological patients
• Examine the current problem and the literature regarding post-prostate biopsy complication
• Explain the current efforts to decrease these complications and the process put in place for risk reduction
• Identify the current indications for performing percutaneous nephrolithotomy and the basic techniques of the procedure
• Recognize the nuances of PCNL to achieve stone clearance and avoid complications
• Describe the current literature and guidelines regarding the medical management of kidney stones
• Identify the application of these management processes to the urologic patient in a practical fashion
• To review the definition of patient safety and actors that may influence outcomes
• Recognize and move beyond blame to a safety culture
• Identify selection criteria for renal cryoablation in small renal mass patients
• Review complications of renal cryoablation in small renal mass patients
• Describe the surgical technique of renal cryoablation
• Identify the sexual health function outcomes for male cancer survivors
• Discuss the prevalence of sexual dysfunctions among cancer survivors
• Modify clinical practice based on medical knowledge of male sexual dysfunctions regarding specific cancer • treatments: surgical, chemotherapeutic & radiation
• Change and improve communication skills for the evaluation of patients with sexual dysfunction after treatment of cancer

The participant will identify the physiologic differences between ischemic and high flow priapism:
• Risk factors
• Presentation
• Physical findings

The participant will modify their clinical practice in compliance with contemporary guidelines.
• When to apply emergent interventions
• What medical therapies are best practice
• What surgical therapies are best practice
• What are the sexual health function outcomes of priapism

Modify and improve clinical practice patterns through medical knowledge of the benefits and limitation of penile imaging.
• Home photos in the digital era, protecting patient health information
• Office based assessment, verifying maximal erectile capacity
• Duplex ultrasonography
• Computer tomography
• Magnetic resonance imaging

The participant will be able to modify clinical practice patterns to document PYD presentations and outcomes of interventions.
• What is the “normal” time to ejaculation?
• What is the etiology of PE?

Communication skills: how do we help the patient differentiate between ED and PE
• What is the most appropriate management approach for PE?
• Medical knowledge: what is the definition of PE?
• Where do we begin with therapy?
• What are the side effects of therapy?
• What are the outcomes of therapy?
• Before diagnosis, the clinician should be able to consider the numerous confounding variables: patient age, novelty of the sexual partner or situation, duration of the excitement phase, and recent frequency of sexual activity.
• Employ evidence based definitions for identifying lifelong versus primary PE.

Improve medical knowledge of:
• Behavioral therapy
• Pharmacological therapy
• Surgical therapy

Modify surgical practice patterns through compliance with evidence based recommendations for:
• Penile plication procedures
• Penile lengthening procedures
• Penile prosthetic procedures

The physician will be able to appropriately triage patients based on:
• Angulation of deformity
• Presence or absence of co-existing ED
• Effectively communicate the impact on penile length of surgical options
• Enhance informed consent
• Appreciate evidence based outcomes data
• Communicate and educate the attendees about the diagnosis and clinical course of penile calciphylaxis.
• Describe diagnostic techniques to identify penile calciphylaxis and understand why biopsy is contraindicated in this condition
• Describe the minimal local treatment techniques to treat penile calciphylaxis as an end stage disease.
• Describe Neurogenic voiding dysfunction and contributing pathophysiology
• Summarize diagnostic and intervention optimal practices
• Recognize and appreciate consequences and complications of Neurogenic voiding dysfunction
• Comprehend the reported and varied impacts of provider behavior on health care delivery
• Distinguish the definitional consequences of professionalism as it applies to medical care
• Recognize the emerging role of provider evaluation and possible benefits for providers
• Comprehend the complexity of symptoms presentation, patient desires and expectations, and appropriate evaluations of these.
• Evaluate the varied types of new interventions and a thorough overview of the therapeutic balance associated with them.
• Review the unique consequences of pelvic floor interventions and their impact on clinical outcomes.
• Recognize the magnitude and implications of the complications related outcome deficiency
• Identify and provide options for avoidance, awareness, and management of complications
• Explain and appreciate aspects of informed consent and shared decision making critical for mutual (patient and physician) satisfaction
• Recognize why PPI occurs and some aspects of surgical technique that may decrease risks associated with these interventions
• Delineate the importance of recognition, assessment, and characterization of symptoms and bother.
• Contrast options with risks, benefits, and reasonable outcomes associated with interventions for PPI.
• To recognize diagnosis and treatment of children with undescended testis, reflux and enuresis.
• To modify and improve knowledge and therapy in accordance with the current guidelines
• Review the etiology and evaluation of urethral stricture
• Review the chronic management of urethral stricture including dilation and urethrotomy
• Review new techniques for anterior urethroplasty
• Establish an algorithm for anterior urethroplasty
• Discuss current techniques for prostate imaging and evaluate their relative merits
• Describe the concept and techniques of image-guided MR-TRUS fusion targeted biopsies for diagnosing prostate cancer
• Describe the concepts underpinning focal therapy for prostate cancer
• Recognize new nanotechnology development to identify prostate cancer cells in the gland
• Explain new real-time spectrophotometry studies in development to identify pCa cells in the gland
• Review how these new technologies can affect and aid treatment of localized prostate cancer patients
• Identify the selection criteria for focal therapy of prostate cancer
• Explain the rationale of focal therapy
• Summarize the history of focal therapy in prostate cancer
• Recognize technical differences between supine and prone approach for PCNL
• Identify when PCNL is an optimal choice for the patient
• Review complications of PCNL
• Determine the use of thromboelastography in the clinical setting
• Describe the coagulation cascade
• Summarize the clinical parameters to apply thromboelastography
• To appreciate the causes of delayed orgasm
• To interpret the evaluation of delayed orgasm
• To outline the clinical care pathway in delayed orgasm management
• Review benign prostatic hyperplasia molecular processes
• Review the effects of inflammation in prostate cancer
• Recognize the sites of BPH and prostate cancer in the gland
• Assess medical knowledge
• Describe patient care
• To recognize the most important features of the AUA guidelines and be able to modify personal clinical practice patterns to be in compliance with the recommendations.
• Review diagnosis
• Instruct about avoiding second or third circumcision (which does not cure buried penis)
• Breakdown pre-operative patient optimization and preparation
• Recognition of the high rate of concomitant urethral stricture disease and lichen sclerosis
• Examine the four steps required for surgical correction
• The anatomy of medical malpractice action
• Tips to avoid medical malpractice actions
• Tips to optimize legal deposition and courtroom outcomes
• Medical knowledge and patient care to describe the best options for the diagnosis, immediate treatment, delayed treatment, and follow up of patients with iatrogenic ureteral injuries.
• Medical knowledge and patient care to describe how to avoid causing urethral injuries, and how to optimize primary treatment, secondary treatment, and tertiary treatment plans. Also to understand how a history of radiation treatment negatively affects outcomes.
• Establish and set the stage for a state-of-the-art about the evidence on what we know about PSA screening
• Identify differences between the European versus the USA way, and see if there is a possibility for a consensus
• By using the available scientific evidence attempt to identify the place for advanced imaging in primary diagnosis of prostate cancer in local and/or distant disease. Also using these techniques for treatment selection will be discussed.
• Discuss several focal therapy options using the available scientific evidence
• Review concept of focal therapy and discuss which possible improvements (if any) are needed before focal treatment is considered mainstream
• Communicate important issues regarding the means of patient follow-up of those treated with a focal therapy
• Discuss the available data both on prevention and treatment of decreased bone-mineral-density or skeletal related events
• Retrieve practical take-home messages on these subjects
• Discuss single or maintenance bladder installations of intravesicle chemotherapy or immunotherapy: which patients, when, and how.
• Analyze the problem of identifying at risk patients
• Identify indications for surgical treatment of renal stones
• Identify complications due to surgical treatment of renal stones
• Review outcomes of surgical treatment of renal stones
• Identify the surgical treatment modalities for BPH
• Explain the technology of green light laser for treatment of BPH
• Review the clinical data in green light laser for treatment of BPH
• Assess the role of surgical robot devices in urologic oncology
• Describe the advancement in technology of existing robotic surgery devices
• Compare benefits of the new generation of surgical robotic devices
• Express pros and cons of the new generations DaVinci device on the patient and user site
• Explain the medical and engineering aspects of optical biopsy needle and associated technology
• Identify the clinical application of optical biopsy needle in prostate cancer patients
• Recognize the future applications of optical spectroscopy-guided devices