AUA 2019

AUA 2019

AUA 2019: Internal and External Validation of a 90-Day Percentage Erection Fullness Score Model Predicting Potency Recovery Following Robot-Assisted Radical Prostatectomy

Chicago, IL (UroToday.com) Linda My Huynh, Clinical Research Coordinator at UC Irvine, presented an internal and external validation of 90-day percentage erection fullness (EF) score. In the teams previous % fullness model from 2018, they found that patients reporting a 0-24% erection fullness score post-RP were 6 times more likely to suffer from long term impotence. This model was re-developed with a 1- and 2-year potency endpoint, as an adjunct to the IIEF-5.

AUA 2019: The Role of Cytoreductive Radical Therapy in the Era of Targeted Therapy for Metastatic RCC

Chicago, IL (UroToday.com) In this crossfire debate, the focus was on the role of cytoreductive nephrectomy (CN) for metastatic renal cell carcinoma (mRCC) in the era of targeted therapy. This has been a constant debate since two major trials in this space have come out: CARMENA¹ and SURTIME².

AUA 2019: MRI Targeted Therapies for Prostate Cancer: Ready for Prime Time?

Chicago, IL (UroToday.com) Dr. Crawford moderated this debate focused on MRI-targeted therapies for prostate cancer – and is it ready for prime time? The index case is a 55 year old man whose PSA has changed from 2.5 to 3.7 in 2 years. He has had multiple repeat negative biopsies, but a SelectMDx test with 40% risk of aggressive cancer. TRUS is 45 g, and ultimately he gets a fusion biopsy that gets 2 core of Gleason 3+4=7 cancer (20% and 80%). The patient is an engineer – and asks, “My wife had a lumpectomy 8 years ago when she was diagnosed with breast cancer. Doc, why can’t you just take out part of the prostate?” Dr. Crawford polled the audience, and as expected, most of us had a similar experience before.

AUA 2019: The Impact of Histological Variants on Survival in Upper Urinary Tract Urothelial Carcinoma Patients Treated with Nephroureterectomy: A Multicenter Collaboration

Chicago, IL (UroToday.com) Radical nephroureterectomy (RNU) with or without lymph node dissection and ipsilateral bladder cuff excision represents the standard gold treatment for upper tract urothelial carcinoma (UTUC). UTUC is an aggressive tumor, burdened by high rates of recurrence and progression. Variant histology of UTUC is an important prognostic factor in patients affected by bladder cancer, and its presence is associated with adverse pathological features and worse survival outcomes. Due to the lack of data, in this study, the authors aimed to evaluate the role of variant histology in UTUC patients treated with RNU.

AUA 2019: Correlations of 1-year Change in Quality of Life in Patients with Urological Chronic Pelvic Pain Syndromes

Chicago, IL (UroToday.com) Dr. Clemens from the University of Michigan presented a study of health-related quality of life (HRQOL) in men and women with urologic chronic pelvic pain syndrome (UCPPS). UCPPS is defined as interstitial cystitis/bladder pain syndrome in women and chronic prostatitis/chronic pelvic pain syndrome in men.

AUA 2019: The Management and Efficacy of Surgical Outcomes used for Erosive Mesh in the Urethra and Bladder

Chicago, IL (UroToday.com) A group from New York with Dr. Chughtai was aimed in this systematic review to determine the safety and efficacy of different outcomes used in surgical excision of bladder and urethral mesh erosions.

AUA 2019: Facility-level Variation in Pelvic Lymph Node Dissection During Radical Prostatectomy and Effect on Overall Survival in Men with Clinically Localized High-risk Prostate Cancer

Chicago, IL (UroToday.com) Radical prostatectomy (RP) with pelvic lymphadenectomy (PLND) is a recommended treatment option for intermediate and high-risk prostate cancer. The oncologic benefits of PLND for prostate cancer remain controversial, and likewise, there is no consensus for the anatomical extent of PLND. This study sought to examine facility-level variation in the extent of PLND (using lymph node counts, not anatomical landmarks) among men with high-risk PCa, and whether there was an association with survival.

AUA 2019: Cryopreserved Placental Tissue Allograft Accelerates Time to Continence After Robotic Radical Prostatectomy

Chicago, IL (UroToday.com) Urinary incontinence (UC) is one of the most important postoperative quality of life issues following robotic radical prostatectomy (RARP). Existing data documenting early continence is heterogeneous and variably reported. Recently groups have studied the use of cryopreserved placental tissue allograft (CPTA) which was used first in local wound care to promote healing. The authors report their UC outcomes after use of CPTA during RARP.

AUA 2019: A Pilot Trial to Evaluate a High-Resolution, Non-Invasive Urodynamic Study to Monitor Electrical Activity of the Human Bladder

Chicago, IL (UroToday.com) During this moderated poster session a variety of novel techniques for evaluating and treating patients with neurogenic bladders. Urodynamic studies are the standard for measuring intravesical pressures and bladder function during filling and emptying, however, this still remains an invasive and uncomfortable procedure to perform. Less invasive and less morbid means to obtain this same diagnostic data has long been desired, particularly by those urologists caring for more complex or pediatric patients. With this study, the authors sought to evaluate the quality of a novel and external technique to measure physiologic changes in the bladder.

AUA 2019: Immersive Virtual Reality for Percutaneous Nephrolithotomy: Impact On Patient Education, Surgical Planning, and Treatment Outcome

Chicago, IL (UroToday.com) While CT and MRI imaging continue to improve in their ability to depict the anatomy, they remain limited in that they only provide two-dimensional images, which the surgeon must then mentally assemble into a 3D anatomical understanding. This is especially difficult in the preoperative planning process for percutaneous nephrolithotomy (PCNL). To address this challenge, investigators at the University of California, Irvine used patient-specific immersive virtual reality models to prepare for PCNL cases.

AUA 2019: A Retrospective Audit Evaluating the Radiation Exposure During CT KUB at Two Sites of the National Health Services (NHS) Trust in the United Kingdom- Are Patients Being Subjected to Over-radiation?

Chicago, IL (UroToday.com) Radiation exposure with abdominal imaging has long been a concern – and there has been a concerted effort to help reduce radiation exposure by modifying imaging techniques (low-dose CT scan), reducing surveillance protocols (testicular cancer) and increasing patient and physician awareness of secondary malignancy potential. Yet, in certain clinical scenarios, x-rays of the abdomen (KUB’s) and CT scans are still warranted – and potentially sometimes overutilized.

AUA 2019: Understanding the Effectiveness of Lymphadenectomy in Node Only Recurrences after Nephrectomy for Kidney Cancer

Chicago, IL (UroToday.com) During the podium session on Kidney Cancer: Advanced (including Drug Therapy) at the Annual AUA 2019 meeting in Chicago, IL, Dr. Barboza presented his talk on understanding the effectiveness of lymphadenectomy in node only recurrences after nephrectomy for kidney cancer. The role of retroperitoneal lymph node dissection (RPLND) in node only recurrences after nephrectomy for renal cell carcinoma (RCC) has not been well defined. The authors tried to examine the relapse pattern after RPLND in an attempt to define appropriate borders of dissection based on primary tumor location and nodal recurrence site.

AUA 2019: Effect of Stone Composition on Surgical Stone Recurrence: Single Center Longitudinal Analysis

Chicago, IL (Urotoday.com) One of the main questions of Dr. Shuang Li’s study was to see if stone composition effect stone recurrence. She notes that a previous study found that Calcium oxalate was the least recurrent at about 30%, while brushite, struvite, and uric acid stones were at about 50%. She found that the best way to document recurrence was to track the need for a repeated surgery.

AUA 2019: Predictive Factors of Postoperative Quality of Life, Erectile Function and Continence After Robot-assisted Radical Prostatectomy

Chicago, IL (UroToday.com) The role of robot-assisted laparoscopic prostatectomy (RALP) for localized prostate cancer is evolving globally. High-quality studies investigating predictors of quality of life (QOL) and functional outcomes are lacking. The authors aimed to identify predictors of QOL, erectile function, and continence using the Be-RALP database, a nation-wide, prospectively collected, multicenter database.

AUA 2019: Molecular Chemical Imaging Endoscope, an Innovative Imaging Modality for Enhancing the Surgeon’s View During Laparoscopic Procedures

Chicago, IL (UroToday.com) New imaging modalities are constantly being innovated and created to optimize how organs are seen. Researchers strive to enhance imaging in a way that yields high efficacy and avoids improper diagnosis and identification. Dr. Arash Samiel opened his presentation by emphasizing the difficulties of successfully identifying anatomical structures in surgery.

AUA 2019: Percutaneous Biopsy for Upper Tract Urothelial Carcinoma - Safety and Diagnostic Accuracy

Chicago, IL (UroToday.com) During the Moderated Poster Session 50 on Bladder Cancer: Upper Tract Transitional Cell Carcinoma I at the Annual AUA 2019 meeting in Chicago, IL, Dr. Joseph presented his moderated poster on- Percutaneous Biopsy for Upper Tract Urothelial Carcinoma - Safety and Diagnostic Accuracy. Standard of care for obtaining a histologic diagnosis of upper tract urothelial carcinoma (UTUC) includes ureteropyeloscopy with endoscopic biopsy; however, it is not always feasible, and its diagnostic accuracy is questionable. Dr. Joseph reported their experience with percutaneous image-guided core-needle biopsy (CNB) for UTUC to better understand safety and diagnostic accuracy.

AUA 2019: Panel Discussion: Opioids and Urology – Opioids and Hypogonadism

Chicago, IL (UroToday.com) Dr. Alukal gave a summary on the association between opioids and hypogonadism.

AUA 2019: Panel Discussion: Opioids and Urology – Opioids and Kidney Stones

Chicago, IL (UroToday.com) Dr. Pais presents on the use of opioids in the management of kidney stones.

AUA 2019: Panel Discussion: Opioids and Urology - Ideal Postoperative Pain Management During an Opioid Epidemic

Chicago, IL (UroToday.com) The opioid epidemic is a serious well-known problem. There were 47,600 opioid overdose deaths in 2017 in the US (134 Americans dying every day), a 12% increase from 2016. Dr. Buvanendran gave an interesting talk on postoperative pain management during this opioid epidemic. The goal of this talk was to try and understand the concept of multimodal analgesia and what is the ideal postoperative pain management, in an attempt to stop the opioid epidemic.

AUA 2019: Update on Initial Experience with Narcotic Free Utereroscopy

Chicago, IL (UroToday.com) Overdoses due to opioid usage, both illicit and prescription based, were responsible for over 400,000 deaths in the United States between the years of 1997-2017. Due to this exponential increase in the severity of the opioid epidemic, the U.S. Department of Health and Human Services declared a state of emergency in attempts to begin to quell the loss of life and onset of addiction. In response to this, the state of Indiana has pioneered the pathway to reducing opioid usage via the creation of a prescription drug monitoring system known as INSPECT; if a physician fails to both update and monitor a patient’s INSPECT file prior to prescribing an opioid, it is punishable by law.