Charles Bankhead

Benjamin M. Brucker, MDOther female urology topics discussed at this year's AUA meeting include preoperative urodynamics for women undergoing prolapse surgery and a study on nocturia.  The Female Urology/Incontinence/Urodynamics discussions were presented by Benjamin M. Brucker, MD, of New York University Langone Medical Center, New York.  

The Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction has launched a clinical care pathway and patient road map for overactive bladder, emphasizing evidence- and expertise-based approaches to improve patient compliance with OAB therapy.

A randomized trial involving patients with medication-refractory OAB demonstrated a significant reduction in daily urge urinary incontinence episodes with onabotulinumtoxinA (Botox) injection versus sacral neuromodulation, but botulinum was associated with a higher rate of urinary tract infection and need for transient catheterization.

Family income, as manifested by grocery spending and dietary quality, is a robust predictor of nocturia.

Low-dose desmopressin nasal spray (SER120) led to a significant reduction in episodes of nocturia in a randomized trial involving older patients.

A claims-based data analysis suggested a significantly higher rate of pelvic prolapse reoperation with vaginal versus abdominal primary repair.

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		Involvement of resident physicians did not adversely affect length of stay or 30-day perioperative outcomes following minimally invasive abdominal sarocolpopexy.

		Preoperative urodynamics for women undergoing prolapse surgery did not significantly affect perioperative management, aside from revealing occult stress urinary incontinence.

		The addition of bladder ultrasound during urodynamics assessment detected wall tension and stress not indicated by vesicle pressure catheterization.

		A retrospective multicenter analysis showed that a history of radiation therapy decreased time to idiopathic erosion of an artificial urinary sphincter.

		A preclinical study showed that long-term pudendal nerve electrical stimulation accelerated recovery from stress incontinence via increased neurotrophin expression and nerve regeneration, suggesting electrical stimulation may shorten postpartum duration of stress urinary incontinence and potentially reduce the risk of later SUI development.

Minimally Invasive Surgery: Study shows huge variance with RALP cost

Infection/Inflamation: A new class of agents for IC shows promise

Infertility/Andrology: Are vasectomy and prostate Ca linked?

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Articles

Other female urology topics discussed at this year's AUA meeting include preoperative urodynamics for women undergoing prolapse surgery and a study on nocturia.

Female Urology: SUFU launches clinical care pathway for OAB patients

Men with prostate cancer treated with androgen deprivation therapy (ADT) had significant improvement in strength and exercise capacity following a 10-week program of physical activity, education, and support, according to a study reported at the AUA annual meeting in San Diego.

	Assessments before and after the program showed significant improvement in 16 of 18 outcomes. Weight and heart rate were the only measures that did not change during the exercise program.

	Developed to offset the adverse metabolic effects of ADT, the program appeared to accomplish the goal, said Lawrence Kim, MD, urology registrar at Port Macquarie Base Hospital, New South Wales, Australia.

	“The Lupron Man Plan program appears to improve the measured exercise outcomes,” Dr. Kim said during the discussion at his poster session. “The outcome does not appear to be affected by the duration of Lupron administration and the area of residence (metropolitan vs. regional). Long-term follow-up is required to assess the clinical significance.”

	ADT can increase a prostate cancer patient’s risk of cardiovascular, musculoskeletal, and metabolic complications. Studies have shown that exercise can ameliorate these adverse effects, but no formal community-based activity programs have been developed for patients with advanced prostate cancer treated with ADT.

	The Man Plan, supported by Abbott, combines resistance-based exercise, education, and support. Patients attend an introductory session, followed by supervised group training sessions twice weekly for 8 weeks and ending with an individual assessment visit.

	Dr. Kim and A/Prof Prem Rashid, PhD, consultant urologist at the Urology Center in Port Macquarie, presented results from a study to determine whether the exercise program affects clinical parameters that can be adversely affected by ADT, whether duration of ADT affects outcomes, and whether results differ between men living in metropolitan or regional areas.

	Prospectively collected data included demographics, duration of ADT, naivety to ADT (<3 months of treatment before starting the exercise program), body composition, cardiovascular parameters, and activity and strength outcomes.

	Data analysis comprised 379 patients. Paired t-test analysis of change in parameters/outcomes before and after the program showed that mean weight and heart rate did not change significantly. All other measures of interest improved during the exercise program:

	· activities: amount of exercise per day per week (

		Analysis of other objectives showed that duration of ADT (naïve vs. experienced) did not affect the outcomes, nor did residence in regional versus metropolitan areas.

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Men with prostate cancer treated with androgen deprivation therapy had significant improvement in strength and exercise capacity following a 10-week program of physical activity, education, and support, according to a study reported at the AUA annual meeting in San Diego.

Exercise program benefits men treated with androgen deprivation therapy

Men with advanced prostate cancer had similar survival with intermittent or continuous androgen deprivation therapy (ADT), pooled data from two randomized trials showed.

	After adjustment for differences between the two studies, overall survival was almost identical (hazard ratio: 0.99) in men treated with intermittent or continuous ADT, according to the data, which were presented at the AUA annual meeting in San Diego.

	Men younger than 75 years of age and with a favorable risk profile fared significantly worse with continuous ADT (

=.031). The data also showed that men 65-79 years of age with favorable prognostic features would likely remain off therapy for prolonged periods. In that subgroup, intermittent therapy proved to be noninferior to continuous therapy (HR: 1.16, 

	Intermittent ADT was also associated with less cardiovascular risk and sexual dysfunction.

	“Intermittent therapy should be considered for use in routine practice since it is associated with no reduction in survival. It may be particularly beneficial for patients who are good responders to initial therapy,” said first author Fernando Calais da Silva II, MD, director of the urology service at Centro Hospitalar de Lisboa Central in Lisbon, Portugal.

	Relatively few trials have compared continuous and intermittent ADT for advanced prostate cancer. Pooling data from published studies offers a means to examine the relative safety and efficacy of the two strategies.

	Dr. da Silva reported findings from an analysis of two trials involving 1,544 patients who were randomized to continuous or intermittent ADT following induction therapy. The trials had similar protocols, data collection, and follow-up management.

	In both trials, patients received 3 months of induction therapy with cyproterone (Cyprostat) and monthly depot injections of a luteinizing hormone-releasing hormone analog. In both trials, patients who achieved a PSA level <4.0 ng/mL were eligible for randomization to continued treatment with the same regimen or to intermittent therapy. In one trial, intermittent ADT was the same as induction, and in the other, patients received only cyproterone.

	The pooled data showed no difference in survival between continuous and intermittent ADT (

	Subgroup analysis showed that patients who had no metastases, Gleason score <7, were age <75 years, and who achieved a PSA level <1.0 ng/mL at randomization had a good prognosis. In that low-risk group, continuous therapy led to worse survival as compared with intermittent ADT (HR: 1.60). Investigators found no difference in treatment effect between the two studies. In a model that incorporated the same variables but changed age to 65-79 years, intermittent ADT was not inferior to continuous therapy.

	Other analyses showed that patients with M1 status had similar survival with both ADT strategies, as did patients with normal bone scans, one to six hot spots, or more than six hot spots.

	“Among patients with low PSA at randomization (<1.0 ng/mL), intermittent therapy is better than continuous,” Dr. da Silva said. “Among the 1,544 randomized in both studies, 741 (48%) had a PSA less than 1 after 3 months of induction therapy.”

		During follow-up of the low-risk subgroup, 25 patients on continuous ADT died of cardiovascular causes as compared with 10 randomized to intermittent therapy.

Men with advanced prostate cancer had similar survival with intermittent or continuous androgen deprivation therapy, pooled data from two randomized trials showed.

Intermittent androgen deprivation therapy appears viable for advanced prostate cancer

Thulium vapoenucleation of the prostate (ThuVEP) provided significant and durable symptomatic improvement in benign prostatic obstruction, long-term follow-up of a clinical series showed.

	Average peak urinary flow (Qmax) doubled immediately after treatment and continued to increase during the first year of follow-up in 124 men. The improvement observed at 12 months was maintained at 48 months (7.6 mL/sec vs. 20 mL/sec). Improvement in post-void residual (PVR) volume followed a similar pattern, as did International Prostate Symptom Score (IPSS) and quality of life.

	ThuVEP proved safe intraoperatively and during long-term follow-up, as no complication affected more than 6.5% of patients, and most occurred in fewer than 5% of patients, as reported at the AUA annual meeting in San Diego.

	“Thulium vapoenucleation is a safe, efficacious, and durable procedure for the treatment of symptomatic BPO,” said first author Christopher Netsch, MD, a urologist at Asklepios Klinik Barmbek in Hamburg, Germany. “The incidence of late complications with thulium vapoenucleation was very low.”

	The findings came from a group of men treated with ThuVEP during 2007 and 2008. The patients had a mean age of 71 years and mean prostate volume of 58 cc. Total procedural time averaged 74 minutes, including 32.5 minutes for enucleation, during which an average of 25 grams of tissue was resected.

	The mean Qmax increased from 7.6 mL/sec at baseline to 15.4 mL/sec at discharge, which occurred within 24 hours in all cases (

<.001). Mean PVR declined from 107.5 mL to 20 mL at discharge (

	At the 12-month follow-up, mean Qmax had increased to 21 mL/sec and stayed at that level during long-term follow-up (

=.001). PVR ranged between 10 mL and 15 mL during follow-up from 12 to 36 months and stood at 25 mL at the 48-month evaluation (

	The mean International Prostate Symptom Score improved from 21 at baseline to 3 at 12 months and remained at 4 after 48 months (

=.001). Global QoL score averaged 5 at baseline, declined to 1 at 12 months, and remained at 1 through the remainder of follow-up (

	Dr. Netsch reported that nine patients (7.3%) required second-look procedures in the immediate postoperative period. Reasons were failed morcellation in two cases, clot retention in three, and residual tissue at the apex of the prostate in four.

	Early postoperative complications consisted of acute urinary retention in eight patients (6.5%), clot retention without surgical revision and residual prostate adenoma in four cases each (3.2%), urinary tract infection (UTI) with signs of bacteremia and hemorrhage requiring coagulation in three cases each (2.4%), blood transfusion and incomplete morcellation in two cases each (1.6%), and a ureteric orifice injury in one patient that required transient use of a double-J stent.

	The list of complications at 48 months comprised seven cases of UTI, two cases each of epididymitis and bladder neck sclerosis, and one case of urethral stricture.

	None of the patients required repeat treatment during follow-up, Dr. Netsch said.

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Thulium vapoenucleation of the prostate provided significant and durable symptomatic improvement in benign prostatic obstruction, long-term follow-up of a clinical series showed.

Charles Bankhead

Articles

Female Urology: SUFU launches clinical care pathway for OAB patients

Exercise program benefits men treated with androgen deprivation therapy

Intermittent androgen deprivation therapy appears viable for advanced prostate cancer

Thulium vapoenucleation found safe, efficacious in BPH