It was a banner year for Desai Sethi Urology Institute of Miami Miller School of Medicine at urology’s premier meeting, the American Urological Association (AUA) 2023, held April 28-May 1 in Chicago.
“At AUA2023, the institute’s faculty and researchers led and debated during plenary sessions and presented novel research in topics spanning prostate and bladder cancers to sexual function and robotic surgery. It was also a year of firsts. Studies by our investigators were selected as among the few to be published simultaneously the AUA’s flagship Journal of Urology. And for the first time, one of our patients was selected to speak at the AUA’s recently launched Patient Perspectives session,” said Desai Sethi Urology institute Chair and Founding Director Dipen J. Parekh, M.D., who spoke during the meeting’s plenary session, “Survivor Debate: Salvage Therapy for RT Failures: QOL and CS Outcomes with Surgery vs. Cryo/HIFU vs. ADT vs. Observation.”
When surveyed, the majority of audience members agreed with Dr. Parekh’s recommendation in favor of observation. “Salvage treatment in any form can be high risk and low benefits. First, do no harm,” said Dr. Parekh.
Gold Cytoscope and Sushruta Awards
Desai Sethi Urology Institute faculty received worldwide peer recognition during the meeting. Ranjith Ramasamy, M.D., associate professor of urology and director of reproductive urology at the institute, received the 2023 Gold Cystoscope Award for creative, impactful work in andrology, mentorship, clinical scholarship and research.
The award, which Dr. Parekh received in 2013, is presented annually to a urologist distinguished by outstanding contributions to the profession within 10 years of completing residency training.
Dr. Parekh was also honored with the 2023 Sushruta Award, a distinguished honor given annually to a member of the AUA affiliate organization Indian American Urological Association, which represents 600 Indian urologists practicing in the U.S. The award recognizes those who have made significant contributions to the field of medicine.
Broad Scope of Current Urology Research Presented
The scope of impactful research at the institute, the Miller School and Sylvester Comprehensive Cancer Center was a highlight of this year’s AUA experience, according to Sanoj Punnen, M.D., associate professor and vice chair of research, Desai Sethi Urology Institute and co-chair of the Genitourinary Site Disease Group at Sylvester.
“In less than two years since its beginning, the institute has notably advanced the science of urology. That’s evident given the high impact presentations and participation at AUA2023,” said Dr. Punnen, who led the project “4Kscore Predicts Progression on Active Surveillance for Prostate Cancer Independently of Clinical Information and PIRADS Score,” a poster presented by Jessica Delgado, PGY2 resident. The study found the blood-based biomarker 4Kscore predicts disease progression independently of clinical risk and MRI.
Sylvester researcher Chad R. Ritch, M.D., M.B.A., associate professor of urology at the Miller School, spoke during several sessions on bladder cancer, including in the plenary presentation “Second Opinion Cases: BCG Failure in Non-muscle Invasive Bladder Cancer (NMIBC).” Bacillus Calmette-Guerin (BCG) is a type of immunotherapy used to treat bladder cancer. Dr. Ritch also presented on bladder cancer treatment dilemmas and bladder cancer tumor markers.
Mark L. Gonzalgo, M.D., Ph.D., professor and vice chair of urology at the institute, moderated the “Bladder Cancer: Non-Invasive III” poster session and helped to select the abstracts and presentations featured during the session.
Dr. Gonzalgo shared new robotic techniques for prostate cancer during an AUA Robotics Theater, and was featured in a prostate cancer surgery video highlighting the latest surgical techniques for prostate cancer, presented by Desai Sethi urologic-oncology fellow Dinno Francis Mendiola, M.D.
“We highlighted factors that contribute to better outcomes related to urinary control after robotic surgery for prostate cancer,” Dr. Gonzalgo said.
Dr. Mendiola conducted a podium presentation, “Prostate Cancer Localized: Surgical Therapy III,” investigating whether a robotic approach to radical prostatectomy for prostate cancer would result in fewer men having urinary incontinence after surgery. Desai Sethi researchers found that early continence rates after the procedure, called Retzius-sparing robotic-assisted radical prostatectomy, were indeed encouraging, with the majority of men being completely dry or using zero to one pad per day within one week of catheter removal and by three months following surgery.
Desai Sethi Urology Institute fellow Ankur Malpani, M.D., presented during a Video Abstract Theater on Adrenal and Renal Oncology, on a complex kidney cancer case treated with robotic partial nephrectomy, which is the robotic approach to surgical removal of part of a kidney. This particular robotic approach, called circular nephrotomy, could be an option when kidney tumors are difficult to reach surgically.
Raveen Syan, M.D., assistant professor of clinical urology at the Desai Sethi Urology Institute, had several roles at the meeting, including as course co-director for the Indian AUA Annual Meeting and panelist during the debate topic “Implantable Tibial vs. SNM,” which compared implantable tibial nerve stimulation with sacral neuromodulation (SNM) for the treatment of pelvic floor disorders.
Dr. Syan was the senior author for moderated poster sessions including “Pelvic Floor Disorders Among Minority Women: Differences in Prevalence and Severity Based on Race/Ethnicity and Healthcare Setting,” presented by Miller School medical student Nathalie Perez.
“We won best poster award for ‘Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine,’” Dr. Syan said.
Dr. Syan also was senior author for “Disparities in Awareness and Treatment-Seeking Behavior for Pelvic Floor Disorders Among Minority Women,” presented by medical student Caroline Shermoen; “Examining the Influence of Race and Pelvic Floor Disorder Severity on Health-Related Social Needs Among Minority Women,” presented by medical student Sajana Satish; and “Evaluating the Presence of Female Urologists in Top Urology Departments in the United States,” presented by Miller School resident Sabika Sadiq, D.O.
Dr. Syan also authored a poster along with senior author Katherine Amin, M.D., FRCSC assistant professor of female pelvic medicine and reconstructive surgery (FPMRS) at the Miller School, “Language-Related Disparities in Acute Postoperative Pain Management Following Pelvic Floor Reconstructive Surgery.” Presented by medical student Fatima Khan, the moderated poster presentation highlighted Dr. Amin’s work to understand native-language inequities.
Dr. Amin, who is assistant professor of clinical urology and FPMRS/urogynecology fellowship director, spoke at the Society of Academic Urology, giving an overview of the history of social media and how urologists can constructively implement it into their practice for promoting patient education and professional development.
In addition, Dr. Amin’s efforts were highlighted at the Society of Women in Urology (SWIU) meeting. She currently serves as task force chair for SWIU at AUA Sections, an initiative to host SWIU events at each of the eight AUA Annual Section Meetings to increase visibility, promote mentorship and encourage meaningful representation at the section level.
Urology and Sexual Health
On the topic of sexual function, Thomas Masterson, M.D., assistant professor of urology at the institute, took part in a plenary debate titled “Crossfire: Controversies in Urology: It Is Ethical to Charge for PRP, Shock Wave, and Stem Cell Therapy for Erectile Dysfunction,” in which he argued that it is reasonable to charge for safe and in-demand restorative therapies for erectile dysfunction. Dr. Masterson also presented on the rare but bothersome issue of painful nocturnal erections within the Sexual Medicine Society of North America agenda track.
Emad Ibrahim, M.D., director of the clinical andrology lab at the Desai Sethi Urology Institute and director of the Male Fertility Research Program at The Miami Project to Cure Paralysis, presented “Penile Vibratory Stimulation (PVS): The Method of Choice for Anejaculation after Spinal Cord Injury.”
“Spinal cord injury is the leading cause of the inability to ejaculate in young men. After spinal cord injury, 90% of these men will need a method of assisted ejaculation to achieve biological fatherhood, and penile vibratory stimulation is the gold standard for treating this condition,” said Dr. Ibrahim, who is also assistant professor of urology and neurological surgery at the Miller School. “Our video presentation during AUA taught attendees new skills and techniques for performing PVS to treat ejaculatory dysfunction in men with spinal cord injury.”
Dr. Ibrahim was awarded a $3.25 million grant by the Department of Defense for a four-year study on the use of an oral medication to treat an infertility issue that affects most men with spinal cord injury.
Dr. Ramasamy presented on several sexual medicine topics, including “Understanding the New Oral Testosterone Formulations,” “Sexual Function/Dysfunction: Medical, Hormonal and Non-Surgical Therapy I” and “New Frontiers in Sexual Medicine: Shock Wave Therapy, P-Shot, Stem Cells — Where Is the Beef?”
“As urologists, we need to educate ourselves first, and educate our patients, so we can have an active role in this discussion,” Dr. Ramasamy concluded about shock wave therapy, PRP and stem cells as treatments for erectile dysfunction.
Simultaneous Presentations and Publications
Two studies presented by Dr. Ramasamy’s team during the meeting — one on a type of short-acting testosterone therapy and another looking at whether platelet-rich plasma (PRP) works to treat erectile dysfunction (ED) — were simultaneously published in the Journal of Urology, one of the highest-impact journals in the specialty.
Miller School of medicine student Brian Ledesma won best abstract at the late-breaking abstract session for his and his team’s work on PRP for erectile dysfunction.
“This is a double feather in the cap and a well-deserved recognition of his impressive research,” said Ledesma’s mentor Dr. Ramasamy.
Dr. Ramasamy also presented on research by Desai Sethi researchers on the use of a popular wearable device to study heart rate during sex.
“Our findings suggest wearable devices are reliable measures of physiologic changes during sexual activity and could pave the way for research aimed at helping people overcome sexual dysfunction,” Dr. Ramasamy said.
AUA selected one of Dr. Ramasamy’s patients at the Institute, Reuben Samuels, to participate in a “Patient Perspectives” program, designed to enhance patient-physician communications and shared decision making. Reuben shared his experience as a cystic fibrosis patient advocating for sexual health care in “Self-Advocacy for Sexual Health Concerns in Patients with Cystic Fibrosis.” This was the second year of the Patient Perspectives program at AUA and the first time a patient from the Miller School was featured.
Other Desai Sethi researchers presenting at AUA2023 included:
- Hemendra Shah, M.D., on the debate topic “Robotic Waterjet Ablation (Aquaablation) vs. HOLEp for BPH Treatment”
- Himanshu Arora, Ph.D., “Exogenous Nitric Oxide, S-Nitrosylates the CSF1 Receptor to Sensitize the Castration-Resistant Prostate Cancer Cells to CSF1R Blockade”
- Kajal Khodamoradi, Ph.D., “Androgen Receptor Signaling in the Human Penis Is Similar Regardless of Serum Testosterone Level”
- Libert Ramos, D.N.P., M.S.N./Ed., APRN-C., “Utilization of APPs within the Contemporary Men’s Health Center: From Patient Assessment to Procedures and Bridging the Gap to Primary Care”
- Shivank Bhatia, M.D., “Prostate Artery Embolization — Multicenter Retrospective Experience of 1,000 Patients with Short-, Mid-, and Long-Term Follow Up”