Dr. Roger Sur
speaker
102 appearances
1 recordings
1 series
first heard Oct 2024
last heard Oct 2024
Dr. Roger Sur’s voice in public audio — every appearance, attributed to the second.
Trend
recordings per month · last 12 monthsNo recordings in the last 12 months.Older appearances are listed below; set an alert to hear about the next one.
Appearances
We know that TURBT procedure is critical in the care of patients with non-muscle invasive bladder cancer. With data that shows that CIS was missed by TURBT in more than 45% of radical cystectomy cases and 86% of residual tumors have been found at the original resection site, it's clear that enhanced visualization could be a significant benefit during TURBT's.
Further, with only 23% of patients coming back for re-resection, it's all the more important to do a complete TURBT right from the start.
This week on the Backtable Podcast. Isn't a stone a three-dimensional object? Shouldn't we be looking at volume of stone? You think about it, it totally makes sense. It's the volume of the stone that probably makes a lot more sense than the two-dimensional. It's kind of dumbing it down when really we should be looking at volume. So that I think is one of the futures is to look at
How much stone are you leaving behind? And not just in two dimensions, but in three dimensions. You can see there's emerging research demonstrating the importance of volume. So I think when you're gonna see that more and more, that people will be talking about how much volume is left behind and how that translates to all those things that you were talking about, post-op problems.
It's going great, Aditya. I'm really honored to be here. And I'm glad you're my host, actually, because it makes it super comfortable for me since we're good friends.
I thought maybe step back and give broad perspective to all of our audience because we've got some, you know, young people that are still in training. We have people recently out of training. We have people like yourself and myself that are, I guess, maybe mid-career working towards senior careers. And then there are people who've been around for quite some time.
If we roll back the clock to the 70s and beyond, it was open surgery was phenomenal. you know, state of the art and really was the standard of care. But then somewhere in the 70s, three major players came in was the introduction of percutaneous stone surgery going through the back.
And then the introduction of shockwave lithotripsy that really trying to change things because now we no longer had to
cut people or put things in people we just broke them up from the outside using acoustic energy and then came ureteroscopy first there were rigid devices and then we were able to introduce flexible devices and then flexible steerable devices so there's this constant migration and iteration of our technology and i would say for the past since that time there's those are the three players uh that are available to uh patients and depending on your
desire for how much morbidity you're willing to accept as well as you know what type of stone free rates you're trying to achieve you choose one of the three accepting the pros and cons of each of the technologies
So, yeah, great question. I think what we've seen more recently is that ureteroscopy has really become a dominant player.
It was unclear, I would say, 20 years ago when ureteroscopy was still kind of new and with lasers being used because shockwave was still very commonly used and most people didn't want to subject themselves to a scope procedure when you could just have an acoustic energy being used in the outside. Why would you want to have a scope in a stent place?
But what we've seen with the data is that ureteroscopy outcomes appear to be superior to shockwave lithotripsy. And that's somewhat of a broad statement across the board. I'm sure there's some situations where shockwave has its place. But broadly speaking, I think most people would admit that ureteroscopy is a better procedure out there.
And that speaks to also the studies showing the use of ureteroscopy has grown increasingly. And simultaneously, the use of shockwave lithotripsy lithotripsy has declined. And whereas percutaneous surgery, it makes up more of a minority of the surgeries. It's still there available, but it's still kind of a background player reserved for larger stones.
So that being said, ureteroscopy has become much more common And we thought, hey, we're going to break them up with the homium laser. And there's a new laser out there. And isn't that good enough? And then shouldn't we be done?
But what we found is that even though we break up these stones and hope that some of them will pass and remove some of the bigger pieces with fragments, we found that actually leaving pieces behind has been a problem.
Specifically, the Edge Consortium, which actually I'm a part of, we had a publication demonstrating that there were 20 to 40% complication rates associated with leaving stone fragments behind.
For example, if you left a fragment behind, you could end up in the ER, you could have sepsis, you might need a stent or even another ureteroscopy, sometimes being hospitalized or just, like I said, emergency visit. So there are definitely complications associated with leaving stones behind. And even though we have lasers and we're breaking them up and dusting them,
We're still not at where we want to be for the patients.
I think, you know, she and many of the thought leaders recognize there's this term out there called clinically insignificant residual fragments. It's an acronym that's used in the stone literature. They would say, well, they're just insignificant residual fragments of three to four millimeters or two millimeters. Well, I think she was astute to realize that No fragment actually is insignificant.
Showing 1–20 of 102 · page 1 of 6
Next →