
AUA 2016: Experts offer guidance on the meeting
To guide you through the 2016 AUA annual meeting and help maximize your time, Urology Times’ editorial board has reviewed the program to identify the key trends and noteworthy research at this year’s meeting.
The month of May is fast approaching, and with it the AUA annual meeting, which returns to San Diego after a recent visit in 2014.
As ever, this massive meeting offers a robust scientific program of presentations on a variety of clinical topics, a wide selection of offerings on health policy, and plenty of sessions and courses to help you run your practice.
To guide you through the event and help maximize your time, Urology Times’ editorial board has reviewed the program to identify the key trends and noteworthy research at this year’s meeting.
Jump to a topic:
Health Policy
Dr. KaufmanThis year’s AUA annual meeting will feature a wide selection of sessions and courses focused on current topics in health care policy, socioeconomic issues, and practice management, according to Jeffrey E. Kaufman, MD, a urologist in private practice in Santa Ana, CA.
“It wasn’t long ago that the AUA was extremely resistant to suggestions to add health policy content to the annual meeting. How times have changed,” Dr. Kaufman told Urology Times. “Reviewing the 2016 agenda reflects the enormous interest resulting from the Affordable Care Act and last year’s Medicare Access and CHIP Reauthorization Act (MACRA). Even topics that narrowly focus on the science, technique, or technology of urology often include a value dimension related to cost or quality.”
Some of the meeting’s highlights in health policy and practice management, according to Dr. Kaufman, include the following:
- The 2-day Practice Management Conference (separate registration) offered Thursday, May 5, and Friday, May 6, discusses adapting new business models (accountable care organizations, surgical medical homes, registries, and implications of MACRA on quality reporting and reimbursement).
- Thomas Stringer, MD, will direct a presentation on physician contract negotiations on Saturday, May 7.
- Many new models emphasize integration of non-physician providers, and a course addressing that topic will be led by Claus G. Roehrborn, MD, on Saturday from 1-3 p.m.
- Coding trends and updates will be covered on Monday, May 9 in a course directed by Ronald Kaufman, Jr., MD.
- “Male Health: Strategies for Managing Lifelong Wellness” is a Sunday afternoon course directed by Richard Pelman, MD. It will emphasize prevention in men’s health, as urologists transition from treating disease to preserving wellness.
- Several presentations on medicolegal litigation will be held on Saturday, Sunday, and Monday.
- Finally, the AUA/American Association of Clinical Urologists-sponsored Health Policy Forum on Sunday from 1-3 p.m. will explore physician response to narrow networks as well as the Kaiser experience with bundled, comprehensive population health management.
Prostate Cancer Markers/Surveillance
Dr. LoebThe changing landscape of prostate cancer diagnosis and management continues to be a major theme, according to Stacy Loeb, MD, MSc.
The 2012 U.S. Preventive Services Task Force recommendation against PSA-based prostate cancer screening and increasing use of active surveillance have led to a shift in the composition of patients undergoing radical prostatectomy, Dr. Loeb said.
“Not surprisingly, active surveillance continues to be a hot topic at this year’s meeting. As more data continue to accrue showing the long-term safety of this management option, there are multiple studies looking into expanding the eligibility criteria. Look out for studies on expanding use of active surveillance in young men and using MRI-targeted biopsy to confirm eligibility,” said Dr. Loeb, assistant professor of urology and population health at New York University School of Medicine, New York.
“There are also several studies on monitoring during active surveillance, including the utility of noninvasive biomarkers and multiparametric MRI,” she added.
New biomarker findings will be another major theme at this year’s meeting.
“Look out for new data on commercially available markers, as well as some new marker tests in the pipeline,” Dr. Loeb said.
Dr. Loeb singled out the following abstracts from this year's meeting:
Rebecca Coley
Ganesh Palapattu
R. Jeffrey Karnes
Jehonathan H Pinthus
Dr. Loeb also highlighted these abstracts, from
MP15-02: The Effect of Radical Prostatectomy, External Beam Radiation Therapy, and Active Surveillance on Life Insurance Premiums in Patients with Prostate Cancer
Mark Biebel
MP15-04: Variation in active surveillance follow-up over two years in diverse urology practices
Amy Luckenbaugh MD
MP15-15: A Retrospective Review of a Large Active Surveillance Cohort in Patients with Prostate Cancer at the Cleveland Clinic
Yaw A. Nyame
MP15-18: Multiparametric MRI outperforms PSA Velocity for Pathologic Progression in Men on Active Surveillance for Prostate Cancer
Michael Kongnyuy
Localized PCa Treatment
Dr. GomellaLeonard G. Gomella, MD, reviewed abstracts on prostate cancer treatment and identified several key themes, including research examining the perennial debate over robotic versus open radical prostatectomy.
“The AUA abstracts relating to localized prostate cancer continue to identify improvements in outcomes with robotic vs. open radical prostatectomy. Although the absolute differences are often small, the statistical analyses do typically favor the robotic techniques,” said Dr. Gomella, professor and chairman of urology at Thomas Jefferson University, Philadelphia.
Also watch for new findings on focal and whole-gland ablation.
“With the approval in the U.S. of high-intensity focused ultrasound for the ablation of prostate tissue, there will be much interest in the abstracts that address focal and whole-gland ablation in prostate cancer, with the data suggesting encouraging outcomes,” Dr. Gomella said.
Other themes Dr. Gomella pointed to include:
- Several papers suggest that many men with high-risk prostate cancer treated by radical prostatectomy with persistent PSA elevation may not develop metastasis over the long term.
- Several European studies of extended lymph node dissections continue to demonstrate a positive impact on long-term disease control. “However, the data to be presented by several groups indicate that ‘super-extended LND’ may actually be detrimental,” Dr. Gomella said.
- Several papers will question the utility of multiparametric magnetic resonance imaging in the setting of radical prostatectomy.
Here are Dr. Gomella's selections from this year's poster and podium sessions:
Cary Robertson
Vito Cucchiara
Kathleen Herkommer
Nicolas Branger
Daniel Olvera-Posada
David Byun
Raisa Pompe
Steven Joniau
Julian Hanske
Eric Kim
Advanced Prostate Cancer
Dr. ThrasherJ. Brantley Thrasher, MD, highlighted several studies to watch out for in the area of advanced prostate cancer, including:
- a paper assessing adherence to international guidelines of androgen deprivation therapy with external beam radiation therapy
- a presentation on the role of salvage extended lymph node dissection in patients with rising PSA and positron emission tomography/computed tomography scan-detected nodal recurrence of prostate cancer
- research on novel P13K/p110beta-specific inhibitors that eliminate enzalutamide (XTANDI) resistance.
“One major theme this year is new compounds either added to other treatments or tested alone in metastatic castration-resistant prostate cancer (mCRPC) patients. Another major theme is the use of circulating tumor cells as serum biomarkers in mCRPC,” commented Dr. Thrasher, professor and chair of urology at the University of Kansas Medical Center, Kansas City.
Specifically, here are the AUA 2016 abstracts Dr. Thrasher said to watch for:
Paolo Dell’Oglio
Michael Diefenbach
Ketan K. Badani
Abduelmenem Alashkham
Daniel Porres
Dr. Thrasher also pointed to these abstracts from
PD32-02: Novel PI3K/p110beta-Specific Inhibitors Eliminate Enzalutamide Resistance in Prostate Cancer
Marcus Austenfeld
PD32-06: Long-term safety and antitumor activity of ODM-201 in chemotherapy and CYP17-inhibitor naïve patients from the ARADES and the ARAFOR trials
Neal Shore
PD32-09: Combination effect of therapies targeting the PI3K-mTOR and AR signaling pathways in prostate cancer
Jinyi Li
PD32-11: Gene Expression Analysis of Bone Metastasis and Circulating Tumor Cells from Metastatic Castrate-resistant Prostate Cancer Patients
Won-Jin Cho
PD32-12: LONG-TERM FOLLOW-UP OF CIRCULATING TUMOR CELLS AS PREDICTORS FOR SURVIVAL IN MEN TREATED WITH ABIRATERONE ACETATE FOR CASTRATION RESISTANT PROSTATE CANCER FOLLOWING CHEMOTHERAPY
Christian Meyer
Stone Disease
Dr. AssimosDean G. Assimos, MD, and Stephen Y. Nakada, MD, reviewed this year’s stone disease research. Dr. Assimos identified several themes involving percutaneous nephrolithotomy.
One such theme: “There is evidence that the utilization of PCNL in the United States is increasing,” said Dr. Assimos, professor and chair of urology at the University of Alabama, Birmingham. In addition, Dr. Assimos said this year’s research looks at PCNL’s safety in patients taking aspirin and the usefulness of fusion imaging during PCNL.
Finally, he said to look for research indicating that the duration of access sheath utilization may impact ureteral stricture risk.
Here are Dr. Assimos' abstract picks from this year's stone disease program:
Tatsuhiko Hoshii
Ben Chew
Brandon Otto
Husain Alenezi
Karen Stern
Daniel Sagalovich
Giorgio Bozzini
Mohammed A. Elgammal
Dr. NakadaDr. Nakada, professor and chairman of urology at the University of Wisconsin, highlighted several studies that should be of interest to urologists treating stones, including:
- a look at global trends in urolithiasis morbidity and mortality over a 20-year period
- a presentation on the effect of statins on kidney stone formation
- a population-based cohort on extracorporeal shock wave lithotripsy and the risk of diabetes mellitus.
Here are Dr. Nakada's can't-miss stone disease abstracts from the 2016 annual meeting:
Andrew Cohen
David Bayne
Michael Ordon
Adam Maxwell
George Turini, III
Sexual Dysfunction
Dr. BurnettArthur L. Burnett, II, MD, MBA, told Urology Times that a review of this year’s sexual dysfunction abstracts reveals several important themes in sexual medicine, including hypogonadism and Peyronie’s disease.
“The topic of male hypogonadism and testosterone therapy remains in mainstream discussion, with studies further defining at-risk populations and risk factors for testosterone deficiency as well as examining long-term effects of testosterone therapy on sexual function, urinary function and prostate health, and cardiovascular health,” said Dr. Burnett, professor of urology at Johns Hopkins University, Baltimore.
“For Peyronie’s disease, treatment with intralesional collagenase clostridium histolyticum (XIAFLEX) has been further evaluated with reports on real-world experiences that heighten understanding of both its therapeutic role and outcomes,” he added.
Below are the key sexual dysfunction abstracts from this year, according to Dr. Burnett:
Ahmad Haider
Christopher Wallis
James Anaissie
BPH/LUTS
Dr. KaplanIn the area of BPH/lower urinary tract symptoms, Steven A. Kaplan, MD, pointed to research on minimally invasive therapeutic advances as well as studies on risk factors for LUTS.
“Abstracts this year will focus on advances in minimally invasive therapies for BPH as well as long-term data with the Prostatic Urethral Lift and the GreenLight, holmium, and Thulium lasers,” said Dr. Kaplan, professor of urology at the Icahn School of Medicine at Mount Sinai and director of benign urologic diseases, Mount Sinai Health System, New York.
“A number of presentations will be devoted to risk factors for the development of lower urinary tract symptoms, including obesity, dyslipidemia, and physical activity. Finally, attempts at creating new indices will help us better evaluate, diagnose, and treat men with LUTS,” he added.
Here are Dr. Kaplan's abstract picks from this year's meeting:
J. Curtis Nickel
Christopher Dixon
Peter Gilling
M. Gacci
Lewis Chan
Localized Kidney Cancer
Dr. WolfUrologists attending this year’s meeting will find localized kidney cancer content covering a wide variety of subjects.
“Urologists continue to explore various techniques for nephron-sparing surgery for renal cancer. There is increasing interest in the role of tumor enucleation, and in fact this is one of the topics in the Crossfire debate series on Friday,” said J. Stuart Wolf, Jr., MD, professor of urology at the University of Michigan, Ann Arbor.
Dr. Wolf also said AUA studies will examine surgery-related trends involving bleeding complications and ablation versus excision.
“With the growing awareness that discontinuation of anti-platelet therapy puts some patients at significant cardiac risk, more renal surgery is being performed without discontinuation of anti-platelet therapy. We are learning more about the impact of that practice on bleeding complications associated with renal surgery,” he said.
Finally, “There still is no clarity as to the role of thermal ablation versus excision for the management of small renal cancers, although evidence continues to be developed.”
Here are Dr. Wolf's abstract picks on localized kidney cancer:
Robert H. Blackwell
Alessandro Antonelli
Juan Jiménez
Daniel Parker
Zine-Eddine KHENE
Timothy Ito
Pediatric Urology
Dr. KoganThere are several key trends to be seen in the pediatric sessions this year, says Barry A. Kogan, MD.
“First, there are a number of investigations looking, via large databases, at actual physician behavior, for example, in ordering preoperative antibiotics. They show, not surprisingly, marked variations. In the future, it is likely that evidence-based guidelines will have to standardize care,” said Dr. Kogan, chief of urology at Albany Medical College, Albany, NY.
The second major trend relates to patient-centered care, according to Dr. Kogan, who cited a study examining various parental preferences for vesicoureteral reflux management, among others.
“These studies show the value of listening to our patients. When patient/family opinions are sought, they seem to surprise clinicians. This highlights again that the patient and family should be the focus of our care,” Dr. Kogan said.
Here are Dr. Kogan's top abstract choices in the area of pediatric urology. The first four abstracts are from
MP43-02: Insights into Pediatric Stone Disease from a Comparative Functional Analysis of the Urinary Proteome in Children and Adults
Joel Koenig
MP43-06: 24 Hour Urinary Parameters in Overweight and Obese Pediatric Patients - A Single Institution Cohort
Jathin Bandari
MP43-16: How many semen analyses are needed to evaluate the adolescent with a varicocele?
Samir Derisavifard
MP43-18: Does varicocele repair improve total motile sperm count (TMSC) in adolescents? A Pilot Study
Mihir Shah
The next four abstracts are from
MP55-05: Parental Preference Assessment for Vesicoureteral Reflux Management in Children
Geraldine Tran
MP55-08: Prevalence and risk factors of symptomatic urinary tract infection after endoscopic incision for the treatment of ureterocele in children.
Kimihiko Moriya
MP55-14: Surgical Scar Location Preference for Pediatric Kidney and Bladder Surgery: A Crowd-Sourced Population-Based Survey
Michael Garcia-Roig
MP55-18: Can We Rely on Pyuria as a Marker for UTI in the Neurogenic Bladder?: An 11 year Longitudinal Analysis
Ruthie Su
Interstitial Cystitis/Bladder Pain Syndrome
Dr. HannoFor urologists treating bladder pain syndrome, there will be many valuable presentations to look forward to at this year’s meeting, according to Philip M. Hanno, MD, MPH, professor of urology at the University of Pennsylvania, Philadelphia.
“At the nexus of radiation cystitis and bladder pain syndrome, a presentation from Royal Oak, MI explores the changes to urothelial permeability in response to radiation, leading one to wonder whether we underuse rather benign glycosaminoglycan therapies in patients who have recurrent radiation cystitis,” Dr. Hanno told Urology Times.
From the same institution, a presentation on the intravesical instillation of liposomal-tacrolimus in an animal model of chronic radiation cystitis suggests it might be useful clinically, Dr. Hanno said. “A study from Barcelona on the natural history of radiation cystitis in 315 patients is one of the largest I have seen,” he added.
Several presentations touch on the similarities and differences between bladder pain syndrome with and without Hunner lesions.
Finally, among treatments that will be discussed are a new orally administered SHIP-1 activator from Aquinox that is currently in phase II-III trials, and the use of the Liris intravesical device to slowly release lidocaine in patients with Hunner lesions.
“Two fascinating papers from the Cleveland Clinic on oral cyclosporine may also help the clinician in treating patients with severe symptoms,” Dr. Hanno added.
Below are Dr. Hanno's abstract picks in IC/BPS:
Fei Ma
Yoshiyuki Akiyama
Akira Furuta
Yoshiyuki Akiyama
Joan Palou
Daniel Shoskes
Daniel Shoskes
Kenneth Peters
Yuan Xiao
Katsumi Shigemura
Bernadette Zwaans
Bernadette Zwaans
Infertility
Dr. HotalingA review of this year’s infertility abstracts yielded three major themes, according to James M. Hotaling, MD, MS, assistant professor of surgery (urology) at the University of Utah Health Care, Salt Lake City. The themes are:
- predictors of sperm retrieval in sub-populations of men with non-obstructive azoospermia undergoing microsurgical testicular sperm extraction
- lack of proper evaluation of male factor infertility by reproductive urologists
- long-term impact of varicocele and varicocele repair on fertility and somatic health.
Dr. Hotaling also advised AUA attendees to watch for:
- a comparison of paternity rates and time to conception between adolescents with varicocele who underwent microsurgical varicocele repair or had observation only
- a study evaluating cardiovascular implications of varicocele
- research on prostate cancer risk in vasectomy patients.
Here are Dr. Hotaling's can't-miss abstracts from this year's meeting:
Selahittin Çayan
The below abstracts are all from
MP91-06: Varicoceles are Associated With Increased Risk of Cardiac Disease and Other Comorbidities: An Analysis of U.S. Claims Data.
Kai B. Dallas
MP91-07: Fertility in professional soldiers population with varicocele
Guy Verhovsky
MP91-09: Do testicles involved with germ-cell tumors contribute to fertility?
Igal Shpunt
MP91-12: Vasectomy and Risk of Prostate Cancer in a Screening Trial
Jonathan Shoag
MP91-16: First Report from the Andrology Research Consortium
Keith Jarvi
Female Urology
Dr. RazStudies covering serial onabotulinumtoxinA (Botox) injections in patients with neurogenic bladder, mid-term outcomes following sub-urethral sling removal, and a novel home-based treatment for refractory overactive bladder are among the noteworthy pieces of research from AUA 2016, according to Shlomo Raz, MD, professor of surgery/urology at the University of California School of Medicine, Los Angeles.
Specifically, here are Dr. Raz's top abstract picks for female urology from this year's meeting:
Rose Khavari
Alexandra Rehfuss
Sebastian Ludwig
Jeannine Foster
Bradley Potts
Karen Noblett
Veronique Phe
Satoru Kira
The below abstracts are from
MP65-08: 12 MONTH FOLLOWUP OF 22 PATIENTS IN THE SOLECT TRIAL FOR SUI
Stephan De Wachter
MP65-11: Adjustment of mesh tension could be improving the success rate of anti-incontinence surgery: The efficacy and safety of transobturator adjustable tape (TOA) sling operation
Myung Ki Kim
MP65-12: Autologous Transobturator Urethral Sling Placement for Female Stress Urinary Incontinence
Brian Linder
MP65-17: Low-frequency transcutaneous electrical stimulation of foot can be a novel home-based treatment for refractory OAB
Yosuke Matsuta
Trauma/Reconstruction
Dr. MoreyUrologists interested in trauma/reconstruction should watch for studies looking factors affecting feasibility of same-day anterior urethroplasty, hypogonadism as a risk factor for artificial urinary sphincter cuff erosion, and the best way to prepare a buccal mucosa graft for urethroplasty, among other papers, according to Allen F. Morey, MD, professor of urology at the University of Texas Southwestern Medical Center, Dallas.
Here are Dr. Morey's abstract selections in trauma/reconstruction:
Jeremy Reese
Nathan Chertack
Matthias D Hofer
Eric Wisenbaugh*
Michele Simões
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