Many thanks to Dr. John Barry for his thoughtful capturing and sharing of these pearls during the sessions at the 2023 meeting Lake Tahoe, CA.

• It takes an hour to get from RNO to the Everline Resort at Lake Tahoe.
• Botox can be used to reduce postop bladder spasms.
• Sperm purification may best be done with the density gradient technique.
• Testosterone replacement therapy with oral testosterone undecanoate doesn’t appear to be associated with hepatotoxicity.
• ED treatment results would be more credible if nocturnal penile tumescence monitoring were used as an outcome measure rather than relying on questionnaires.
• The beta3-adrenoreceptor agonists (vibegron and mirabegron) are effective for treatment of the overactive bladder and seem to have better side-effect profiles and patient compliance than anticholinergics.
• Surprisingly, there seems to be no association between UTIs and fecal incontinence.
• Optilume, a drug-coated balloon, has joined the ranks of minimally invasive treatments for obstructing BPH.
• The Urolift procedure may interfere with prostate cancer screening by MRI.
• Is it safe to perform renal cryoablation in patients with chronic liver disease? Yes, but asymptomatic, small renal masses may not need to be treated in patients with limited life expectancies.
• There is an emotional toll on the surgeon when surgical complications occur.  “If you’re going to cut, you’re going to cry.”
• Triplet therapy is overtaking doublet therapy for metastatic prostate cancer.
• BCG has been reported to be safe and effective for immunocompromised patients with non-muscle invasive bladder cancer. Read the CONTRAINDICATIONS section of the package insert before deciding to prescribe it for these patients.
• A biparametric MRI (bpMRI) with no contrast agent, a shorter acquisition time, and less cost, seems to be as good at detecting clinically significant prostate cancer as the more commonly used multiparametric MRI (mpMRI).
• Why does an MRI cost so much more in the US than in the UK?
• There is an advanced practice provider transperineal prostate biopsy clinic at the Mayo Clinic in Rochester.
• Dr. Sakti Das received our Distinguished Member for 2023 Award.
• Perhaps we should stop calling Gleason 6 (Grade Group 1) a cancer? It would be less frightening for patients if it were renamed Gleason’s Disease, Schroder’s Disease, Klotz Disease or Eggener’s Disease.
• The GU Tumor Board was great fun.
• We are still waiting for a consensus definition of “stone-free” from our endourology colleagues.
• Why aren’t there dipsticks to replace 24-hour urine jugs for monitoring the urine of stone-forming patients? A test strip with sites for pH, specific gravity, calcium, sodium, citrate, oxalate, and uric acid comes to mind.
• “Doctors who use AI will replace those who don’t.”
• Focal therapy for localized prostate cancer is an interesting concept. The management spectrum for localized disease is becoming watchful waiting, active surveillance, focal therapy, radical prostatectomy and radiation therapy.
• Genomic studies on GU cancers are coming of age.
• Is it time to re-discover estrogen therapy for metastatic castrate-sensitive prostate cancer?
• The Round Table was great fun.