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.
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:
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:
PD08-01: Prediction of the cancer state to inform a personalized management program for prostate cancer
PD08-07: Molecular Progression of Gleason 6 Prostate Cancer: Tracking of Specific Clones by Image-Guided Biopsy
MP07-01: Validation of a genomic risk classifier to predict prostate cancer death in high risk patients
R. Jeffrey Karnes
MP07-12: Abdominal obesity, altered adipokynes and elevated C-peptide levels are associated with high Gleason score in patients undergoing diagnostic prostate biopsy: Data from prospective registry
Jehonathan H Pinthus
Dr. Loeb also highlighted these abstracts, from Prostate Cancer: Localized: Active Surveillance II:
MP15-02: The Effect of Radical Prostatectomy, External Beam Radiation Therapy, and Active Surveillance on Life Insurance Premiums in Patients with Prostate Cancer
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
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:
Here are Dr. Gomella's selections from this year's poster and podium sessions:
MP18-15: EFFICACY OF HIGH INTENSITY FOCUSED ULTRASOUND (HIFU) AS A PRIMARY MONOTHERAPY FOR LOW RISK LOCALIZED PROSTATE CANCER: OUTCOMES FROM THE ENLIGHT TRIAL
PD30-06: Assessing the role of time from prostate cancer diagnosis to radical prostatectomy: can surgery be postponed safely?
PD30-11: Prognostic factors for biochemical recurrence more than ten years after radical prostatectomy
MP57-03: Is a negative mpMRI really able to rule out significant prostate cancer?
MP57-12: The impact of infectious complications after prostate biopsy on radical prostatectomy surgical outcomes: A population-based analysis
MP57-13: The Effect of Smoking on 30-Day Morbidity Following Malignancy-Related Prostatectomy.
PD37-10: Long-term oncological outcomes in patients with biochemical recurrence after radical prostatectomy
PD37-11: Functional outcomes after extended vs. super-extended pelvic lymph node dissection for intermediate and high-risk localized prostate cancer.
MP69-15: Impact of weekday on radical prostatectomy outcomes
MP80-14: MRI Prior to Prostatectomy Does Not Improve Surgical Outcomes
Dr. ThrasherJ. Brantley Thrasher, MD, highlighted several studies to watch out for in the area of advanced prostate cancer, including:
“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:
PD28-07: Assessment of the rate of adherence to international guidelines of androgen deprivation therapy with external beam radiation therapy- a population-based study
PD28-02: An iPod-Guided Slow Breathing Intervention to Control Hot Flashes in Advanced Prostate Cancer Patients on Hormone Therapy
MP50-02: Does The Number Of Lymph Nodes Sampled During Radical Prostatectomy Impact Risk of Biochemical Recurrence in Patients With Seminal Vesicle Invasion?
Ketan K. Badani
MP50-08: Can Angiotensin-Converting Enzyme Inhibitors Reduce the Incidence, Severity, and Duration of Radiation Proctitis?
MP50-11: The role of salvage extended lymph node dissection (LND) in patients with rising PSA and PET/CT scan detected nodal recurrence of prostate cancer
Dr. Thrasher also pointed to these abstracts from Prostate Cancer: Advanced (Including Drug Therapy) III:
PD32-02: Novel PI3K/p110beta-Specific Inhibitors Eliminate Enzalutamide Resistance in Prostate Cancer
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
PD32-09: Combination effect of therapies targeting the PI3K-mTOR and AR signaling pathways in prostate cancer
PD32-11: Gene Expression Analysis of Bone Metastasis and Circulating Tumor Cells from Metastatic Castrate-resistant Prostate Cancer Patients
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
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:
PD18-02: Synchronous Real-time Virtual Sonography with Three-Dimensional Computed Tomography Scan Navigation to create percutaneous renal access to the target calix during percutaneous nephrolithotomy
PD18-10: Dusting vs Basketing During Ureteroscopic Lithotripsy-What is More Efficacious? Final Results from the EDGE Research Consortium
PD23-01: The Effect of Continued Aspirin Therapy in Patients Undergoing PCNL
PD23-09: Is prolonged use of ureteral access sheath safe?
MP33-09: Contemporary Trends in Percutaneous Nephrolithotomy in the United States: 1998-2011
MP33-11: Anatomical Variations Between Vertical and Horizontal Bolster Placement and the Implications for Percutaneous Nephrolithotomy (PCNL) Access
MP33-20: A PROSPECTIVE RANDOMIZED COMPARISON AMONG SWL, PCNL AND RIRS FOR LOWER CALYCEAL STONES LESS THAN 2 CM: A MULTICENTER EXPERIENCE
MP51-09: Primary versus Deferred Ureteroscopy for Management of Calculus Anuria: A prospective randomized trial
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:
Here are Dr. Nakada's can't-miss stone disease abstracts from the 2016 annual meeting:
PD31-10: Statin Intake Reduces Kidney Stone Formation
PD47-02: Global Trends in Urolithiasis Morbidity and Mortality from 1990-2010
MP54-05: Extracorporeal Shockwave Lithotripsy and the Risk of Diabetes Mellitus: A Population-Based Cohort Study
MP54-13: Detection and Assessment of Hemorrhagic Kidney Injury Caused by Burst Wave Lithotripsy using Ultrasound and Magnetic Resonance Imaging
MP82-09: Metabolic Stone Center Effectively Decreases Emergency Department Visits in High-Risk Patients
George Turini, III
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:
PD50-02: Effects of long-term testosterone undecanoate injections (TU) on urinary and sexual function in hypogonadal men: real-life data from a controlled registry study
PD50-03: Cardiovascular events and prostate cancer diagnoses in men treated with testosterone replacement therapy
PD45-02: Impact of number of cycles of Collagenase Clostridium Histolyticum on outcomes in patients with Peyronie’s disease
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:
PD20-02: Chronic Prostate Inflammation Predicts Symptom Progression in Chronic Prostatitis/Chronic Pelvic Pain Patients
J. Curtis Nickel
PD21-03: Convective Water Vapor Energy (WAVE) Ablation: Two-Year Results Following Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia
PD21-06: Mid-term Results using Aquablation, an image guided robot-assisted water jet ablation of the prostate, for the treatment of Benign Prostatic Hyperplasia (BPH).
MP35-03: Lower urinary tract symptoms as risk factor for cardiovascular events in men: a systematic review and meta-analysis of five longitudinal trials
MP35-17: Underactive bladder (UAB) symptoms and voiding parameters in elderly community-dwelling males with 5 year followup
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:
MP41-10: Renal Tumor Enucleation Maximally Preserves Renal Parenchymal Volume Compared to Standard Partial Nephrectomy
Robert H. Blackwell
MP41-18: PATHOGENESIS, FEATURES AND PROGNOSIS OF RENAL RELAPSE AFTER PARTIAL NEPHRECTOMY
MP64-05: Surgical Salvage of Thermal Ablation Failures for Renal Cell Carcinoma
PD41-08: Patients Who Maintain Normal Glomerular Filtration Rate (GFR) Despite Coronary Artery Disease Appear Resistant to Marked GFR Decline Following Radical Nephrectomy
MP75-08: Could perirenal fat be more important than the tumor itself? The MAP score better predicts perioperative morbidity than the RENAL score.
PD48-10: Examination of perioperative outcomes following partial nephrectomy performed on patients remaining on antiplatelet therapy
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 Pediatrics: Testis, Varicocele & Stones:
MP43-02: Insights into Pediatric Stone Disease from a Comparative Functional Analysis of the Urinary Proteome in Children and Adults
MP43-06: 24 Hour Urinary Parameters in Overweight and Obese Pediatric Patients - A Single Institution Cohort
MP43-16: How many semen analyses are needed to evaluate the adolescent with a varicocele?
MP43-18: Does varicocele repair improve total motile sperm count (TMSC) in adolescents? A Pilot Study
The next four abstracts are from Pediatrics: Urinary Tract Infection and Vesicoureteral Reflux:
MP55-05: Parental Preference Assessment for Vesicoureteral Reflux Management in Children
MP55-08: Prevalence and risk factors of symptomatic urinary tract infection after endoscopic incision for the treatment of ureterocele in children.
MP55-14: Surgical Scar Location Preference for Pediatric Kidney and Bladder Surgery: A Crowd-Sourced Population-Based Survey
MP55-18: Can We Rely on Pyuria as a Marker for UTI in the Neurogenic Bladder?: An 11 year Longitudinal Analysis
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:
MP72-01: Urine levels of Macrophage Migration Inhibitory Factor are increased in patients with bladder inflammation
MP72-02: Frequent expansion of clonal B-cells suggestive of specific immune responses in Hunner type interstitial cystitis
MP72-03: Urinary chemokines as predictors of interstitial cystitis/bladder pain syndrome in patients with lower urinary tract symptoms
MP72-06: Quantitative analysis of mast cell infiltration in interstitial cystitis-Is it still specific to interstitial cystitis?
MP72-12: Natural history and predictive factors for hospitalization in patients with radiation cystitis. Results from a large retrospective study
MP72-14: Oral Cyclosporine For Interstitial Cystitis: Efficacy, Side Effects and Impact of Clinical Phenotype on Outcome
MP72-15: Gene Expression in the Blood of Interstitial Cystitis Patients and Controls Distinguishes Pathways Associated with Interstitial Cystitis and Predicts Clinical Response to Cyclosporine Therapy
MP72-16: Safety, Tolerability, and Preliminary Efficacy of LiRIS® 400 mg in Women with Ulcerative Interstitial Cystitis
MP24-01: A microfiltration device for urogenital schistosomiasis diagnostics
MP24-03: Direct detection of urinary tract infection from urine samples using Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry
MP24-14: Radiation Therapy Attenuates Regeneration of the Urothelium in Novel Cell Culture Radiation Model
MP26-20: Intravesical instillation of Liposomal-Tacrolimus (LP-10) is an effective treatment for chronic radiation cystitis
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:
Dr. Hotaling also advised AUA attendees to watch for:
Here are Dr. Hotaling's can't-miss abstracts from this year's meeting:
PD07-02: COMPARISON OF PATERNITY RATES AND TIME TO CONCEPTION BETWEEN ADOLESCENTS WITH VARICOCELE WHO UNDERWENT MICROSURGICAL VARICOCELE REPAIR OR HAD OBSERVATION ONLY: A SINGLE INSTITUTE EXPERIENCE WITH 408 CASES
The below abstracts are all from Infertility: Epidemiology & Evaluation:
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
MP91-09: Do testicles involved with germ-cell tumors contribute to fertility?
MP91-12: Vasectomy and Risk of Prostate Cancer in a Screening Trial
MP91-16: First Report from the Andrology Research Consortium
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:
MP17-09: Trends in Supraspinal Variation in Patients with Multiple Sclerosis and Detrusor Sphincter Dyssenergia
MP17-12: SERIAL BOTULINUM TOXIN INJECTIONS OFFER DURABLE RESULTS FOR NEUROGENIC BLADDER: 4 YEAR URODYNAMIC OUTCOMES
PD36-03: URGE 1 study - randomized clinical trial to compare solifenacin and bilateral mesh replacement of the uterosacral ligaments in the treatment of urgency urinary incontinence in women
PD36-12: Mid-term outcomes following sub-urethral synthetic sling removal in women
MP74-15: Bladder Outlet Procedures are an Effective Treatment Option for Patients with Urodynamically-Confirmed Detrusor Underactivity without Bladder Outlet Obstruction
MP77-15: Quality of Life After Sacral Neuromodulation: Does it Differ in Subjects Across Different Overactive Bladder Diagnoses?
MP77-17: The Outcomes In Women With None Obstructive Urinary Retention and Detrusor Underactivity Treated By Sacral Neuromodulation.
MP77-20: Is detrusor contraction really necessary for female micturition?
The below abstracts are from Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II:
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
MP65-17: Low-frequency transcutaneous electrical stimulation of foot can be a novel home-based treatment for refractory OAB
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:
PD16-04: Factors Affecting Feasibility of Same Day Anterior Urethroplasty
PD16-08: FOLEY OR FIX: COMPARATIVE ANALYSIS OF FOLEY, ABBREVIATED URETHROPLASTY, AND MOBILIZATION WITH PRIMARY URETHRAL ANASTOMOSIS AT THE TIME OF AUS EXPLANTATION FOR CUFF EROSION
PD16-09: HYPOGONADISM IS A RISK FACTOR FOR ARTIFICIAL URINARY SPHINCTER CUFF EROSION
Matthias D Hofer
MP52-08: Excision and Primary Anastomosis vs. Dorsal Buccal Grafting for Bulbar Urethral Strictures: Comparison of Outcomes and Quality of Life
PD44-09: What’s the best way to prepare a buccal mucosa graft for urethroplasty? A histologic based study.
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