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PEER-TO-PEER CLINCIAL CONVERSATIONS |
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Optimal TURBT: Do Skilled Urologists Really Need Photodynamic Diagnosis (PDD)?
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Michael Cookson, MD, MMHC, and Trinity J. Bivalacqua, MD, PhD
The 2023 AUA annual meeting included the Bladder Cancer Forum, featuring a debate discussing whether skilled urologists need photodynamic diagnosis (PDD) to perform an optimal TURBT. Drs. Michael Cookson and Trinity Bivalacqua, who were participants in this debate, join Dr. Neal Shore to highlight the takeaways from the session.
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Highlights from the 2023 American Urological Association Annual Meeting
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| Intermediate Risk NMIBC: Surveillance and Treatment Challenges
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| Paolo Gontero, MD, and Gary D. Steinberg, MD
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| Paolo Gontero and Gary Steinberg debate surveillance or treatment and the challenges of intermediate risk non-muscle invasive bladder cancer regarding the case of a 67 male with a history of gross hematuria for six months with no work-up during that time period.
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| Optimal TURBT: Do Skilled Urologists Really Need PDD?
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| Trinity J. Bivalacqua, MD, Ph.D. and Michael Cookson, MD, MMHC
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| This debate discussed whether skilled urologists need PDD to perform an optimal TURBT. Michael Cookson took the position that no, skilled urologists do not really need blue light cystoscopy. Trinity Bivalacqua then presented, taking the position that yes, skilled urologists do need blue light cystoscopy.
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| Pathology or 'Markers': What is More Important?
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| Charles Guo, MD, and David McConkey, MD, Ph.D.
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| During this debate, Charles Guo and David McKonkey discussed the significance of pathology and markers in determining the most suitable treatment for bladder cancer, discussing the potential advantages of neoadjuvant chemotherapy and organ preservation. |
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| Very High Risk NMIBC: Radical Cystectomy or Intravesical Therapy
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| Seth P. Lerner, MD, FACS, and J. Alfred Witjes, MD, Ph.D.
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| Seth Lerner and J. Alfred Witjes debate on whether to perform a radical cystectomy or intravesical therapy for high-risk non-muscle invasive bladder cancer (NMIBC). The discuss a case of a 74-year-old female with high-grade T1 urothelial carcinoma. Audience poll: 48% recommended induction intravesical BCG followed by maintenance BCG, 36% recommended radical cystectomy. Dr. Witjes argued for immediate radical cystectomy due to high risk of progression in high-risk NMIBC. Dr. Lerner discussed intravesical therapy as the optimal therapy.
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| What is the "Best" Diversion: Conduit or Neobladder? |
| Bernard Bochner, MD, FACS, and Arnulf Stenzl, MD |
| In this debate over whether a conduit or neobladder is the best form of urinary diversion and a case presentation of a 74 year old Caucasian man who presented with painless gross hematuria, Bernie Bochner took the position of using an ileal conduit for urinary diversion. Arnulf Stenzl then discussed how these patients should be given a neobladder urinary diversion. |
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| Optimizing BCG Therapy/Managing BCG Toxicity |
| Wassim Kassouf, MD, and Badrinath Konety, MD, |
| Wassim Kassouf and Badrinath Konety debate optimizing BCG therapy and managing BCG toxicity with Wassim Kassouf taking the side of optimization and Badrinath konety on the side of managing BCG toxicity. |
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| Optimal Management of cN+ Muscle Invasive Bladder Cancer
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| Petros Grivas, MD, Ph.D., and Max Kates, MD
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| During this Bladder Cancer Fourm debate, Petros Grivas and Max Gates debated the optimal management of clinical N+ muscle invasive bladder cancer. Beginning with a case presentation, Petros Grivas then took the position of primary cisplatin-based chemotherapy followed by switch maintenance avelumab. Max Kates then made the argument for local consolidation in patients with cN+ muscle invasive bladder cancer.
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| Bladder Preservation in Muscle Invasive Bladder Cancer: Myth or Reality
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| Jason Efstathiou, MD, and Maria Ribal, MD, Ph.D.
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| During this debate, following a case presentation of a 75-year-old man with MIBC who preferred bladder-sparing options, Jason Efstathiou discussed the role of trimodality therapy and emphasized its importance in filling the gap for patients who do not undergo radical cystectomy. Maria Ribal then argued that radical cystectomy is the best option. |
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