their practices. There are still naysayers, but we now mostly recognize that the procedure is effective, so it is now about finding where it fits and how best to coordinate with IR.


Dr. Raynor mentioned that IR and urology have natural collaborations. What makes PAE different? AI: I think a lot of the collaboration you see between urology and IR is when we need the other to do something that we don’t do, whether it’s placing a nephrostomy tube or embolizing a bleed after a renal biopsy.


With PAE, however, we’re treating a disease state that is entirely treated and owned by urology. It’s as if urologists started treating hepatocellular carcinoma or something that we consider part of the IR domain. But PAE is different because there’s a bit of a turf battle, and I don’t blame them. Urologists have been studying and thinking about this disease state for years and here we are butting our heads in and saying we have a solution. I think the challenge for urologists is to step back and look objectively at how PAE can help their patients.


To be frank, there’s also underlying financial elements. The same patients who would go for urology now go to IR. The issue with PAE is that we’re competing for the same patients and IR is entering a space that has been owned by urology.


MR: You can draw parallels between other disease states in urology as well, like kidney cancer. A percentage of our patients are managed by IR with embolization. It started laparoscopic and then transitioned to IR in most places. And for a good reason, because they do it all the time.


Another disease state I think about is prostate cancer. Back in the day it was all urology. You either had a radical prostatectomy or you went on androgen deprivation therapy. Then radiation came into the fold and is now a large part of prostate cancer management, either as a primary treatment or as a secondary salvage radiation with or without surgery.


If you approach with humility and welcome questions and feedback, then things will work out great. Collaboration breaks down when egos get in the way.


So urology has taken a multidisciplinary approach for other disease states we’ve owned and I think we’re just seeing that process early on with PAE for BHP. There has been a little bit of a turf war over the last few years, but that will change as more evidence arrives. It’s the natural cycle of medical innovation.


Do you have any advice for other IRs or urologists on collaborating with each other? MR: It’s about communication. I had a good relationship with Ari already, but it’s crucial to communicate and make clear to your partners that the goal is not to steal patients. If you look at urology’s BPH volume since we’ve started this collaboration, it’s only gone up. Working together has benefitted both of us. There are patients who will


not be great candidates for PAE, and urology can offer them a better option. The rising tide of our collaboration really has lifted all boats. Working together will not be a detriment to your BPH practice, and it will only enhance it.


AI: I would add that both parties approaching the decision with humility helps. From an IR standpoint, you can’t go to the urology group and say that PAE is going to be the best for all patients. You can’t dismiss all the urology procedures, because they have value and will be best for certain patients. If you approach with humility, say that you have a procedure you think could benefit some patients and ask the urologist to work with you on it, and you welcome questions and feedback, then things will work out great. Collaboration breaks down when egos get in the way.


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