Interventional Urology: The Next Paradigm Shift in Urology.

You have accessJournal of UrologyJU Forum1 Jun 2023Interventional Urology: The Next Paradigm Shift in Urology Tavya G. R. Benjamin and Ardeshir R. Rastinehad Tavya G. R. BenjaminTavya G. R. Benjamin The Smith Institute for Urology at Lenox Hill, Northwell Health, New York, New York More articles by this author and Ardeshir R. RastinehadArdeshir R. Rastinehad The Smith Institute for Urology at Lenox Hill, Northwell Health, New York, New York More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003428AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail HISTORY OF INTERVENTIONAL UROLOGY Interventional urology is a collaborative subspecialty that uses advanced imaging, interventional radiology, and surgical navigation to provide minimally invasive therapies to treat urological pathology. The field owes its existence to individuals from different backgrounds, including surgeons, chemists, physicists, philosophers, anatomists, engineers, and patients, who have all made unique contributions over the past 500 years. Interventional urology has dynamically combined discoveries of interventional radiologists, cardiologists, neurosurgeons, and radiologists, resulting in various distinctive urological applications. To understand where interventional urology will go, we must understand its elemental beginnings. Sixteenth-century discoveries elucidating blood circulation paved the way for physician-scientists like Werner Forssmann, 1 of 2 urologists to win the Nobel prize for medicine.1,2 He performed the first cardiac catheterization in 1929 using a urethral catheter to access the right heart from the left antecubital vein. He struggled to find support for this research and eventually pivoted from a career in internal medicine to urology.1 A few decades later, Howard M. Pollack, a dual-trained urologist and radiologist, founded the division of uroradiology at the University of Pennsylvania. The field of interventional urology grew out of collaborations between urology and interventional radiology. This laid the foundation for a new hybrid training paradigm in which urologists and interventional radiologists can train and work together to advance patient care. While some have argued that there is no need for urologists to learn interventional techniques or interventionists to learn urology, other specialties have incorporated interventional procedures into their practice, resulting in significant advances. Cardiology, vascular surgery, and neurosurgery have all seen remarkable progress due to the incorporation of interventional radiology techniques. Patients now have access to minimally invasive options that offer faster recovery times and reduced risk of complications compared to traditional open surgery. A LOOK AT TODAY AND THE FUTURE The hard work of past physician-scientists has paved the way for Interventional Urology to grow and flourish. The field has the foundation and framework to collaborate with various specialties to provide innovative and comprehensive care for urological patients. Recent technological advances have led to numerous advances in the diagnosis and management of urological diseases, resulting in many cutting-edge treatments. These include advanced multiparametric prostate MRI, MRI-ultrasound fusion technology that has led to changes in the early detection of prostate cancer and focal prostate cancer therapies. Recently, we successfully used gold nanoparticle technology to treat a solid organ malignancy, a beautiful culmination of 20 years of work in the field of nano-photonics led by Dr Naomi Halas.3 Other interventional urology treatments include embolization/endovascular techniques to treat angiomyolipoma, varicoceles, benign prostatic hyperplasia, and other urological diseases. Another exciting area within the field involves building an operating room that allows endourological and endovascular therapies to be performed within the same surgical suite with advanced technologies that include cone-beam CT plus 3D navigation and tracking capability, enabling intraoperative cross-sectional imaging during ureteroscopy, allowing directed navigation to residual stone fragments. This should significantly improve stone-free rate, operative time, and, most importantly, patient satisfaction. This technology could also aid in performing renal mass biopsies, percutaneous drainages/ablations, and obtaining percutaneous renal access using ultrasound or hybrid fluoroscopy imaging for stone removal or nephrostomy tube placement. While it has been an honor to be a part of these significant advances within the field, there is so much more ahead of us than behind us. In this vein, we have started to train the next generation of physicians in interventional urology. Due to increasing popularity and demand, most major academic programs around the world are recruiting well-trained urologists to lead their focal therapy divisions. With continued collaborative support, we believe an interventional urology program will be at every major medical center within the next 10 years. The partnership between interventional radiology and urology is essential for progress and innovation in the field. Future generations of physicians must possess advanced knowledge in imaging techniques such as MRI, positron emission tomography, and cone-beam CT; 3D surgical navigation; interventional methods; and a thorough understanding of the biology underlying urological diseases. Recognizing that our achievements are not owned by any individual or specialty, acknowledging collective effort is crucial. By embracing a shared vision, we can enhance the significance and impact of our work exponentially, ultimately revolutionizing medicine. REFERENCES 1. The Nobel Prize in Physiology or Medicine 1956. 2023. https://www.nobelprize.org/prizes/medicine/1956/forssmann/lecture/. Google Scholar 2. . Between cardiology and urology: Werner Forssmann's double career. Urol Int. 2019; 103(1):1-7. Crossref, Medline, Google Scholar 3. . Gold nanoshell-localized photothermal ablation of prostate tumors in a clinical pilot device study. Proc Natl Acad Sci. 2019; 116(37):18590-18596. Crossref, Medline, Google Scholar Support: This study was supported by Nanospectra Biosciences. Conflict of Interest: The Authors have no conflicts of interest to disclose. Ethics Statement: This study was exempt from Institutional Review Board review. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue 6June 2023Page: 1058-1059 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tavya G. R. Benjamin The Smith Institute for Urology at Lenox Hill, Northwell Health, New York, New York More articles by this author Ardeshir R. Rastinehad The Smith Institute for Urology at Lenox Hill, Northwell Health, New York, New York More articles by this author Expand All Support: This study was supported by Nanospectra Biosciences. Conflict of Interest: The Authors have no conflicts of interest to disclose. Ethics Statement: This study was exempt from Institutional Review Board review. Advertisement Advertisement PDF downloadLoading ...