|Articles|April 19, 2019
AUA 2019: Experts outline the must-see presentations in Chicago
Author(s)Richard R. Kerr
In advance of this year’s AUA annual meeting, Urology Times asked members of our editorial board to choose the top presentations in their subspecialty.
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In advance of this year’s AUA annual meeting, Urology Times asked members of our editorial board to choose the top presentations-instructional courses (IC), plenary sessions, forums, and video sessions (V), among others-in their subspecialty. They also commented on what’s hot and, in some cases what’s not, in their area of interest. Click on any topic below to see the board’s abstract picks for that category.
Urolithiasis/Endourology
Brian R. Matlaga, MD, MPH
Among the hot trends in stone disease: opioid use, high-power lasers, and single-use ureteroscopes.
“Due to the pain that accompanies a kidney stone event, opioids are commonly utilized. The urologic community is beginning to recognize this as an opportunity to improve practice patterns by decreasing reliance on opioids,” said Dr. Matlaga, professor of urology at Johns Hopkins, Baltimore.
A “dusting” approach to ureteroscopic laser lithotripsy has become increasingly popular, and among its purported benefits are shorter operative times and reduced complication rates. “We are now seeing increasing reports on the outcomes associated with this treatment approach, as well as better understanding of the physics of high-frequency laser lithotripsy,” Dr. Matlaga said.
The market for single-use ureteroscopes has evolved, and there are now multiple device companies providing single-use devices. “Concomitantly, the urologic community is working to better understand how these devices fit into present practice environments,” he said.
Dr. Matlaga's meeting picks:
- 031IC: Surgical & Medical Stone Guidelines Update: A Case-Based Approach
- 026IC: Dust or Bust: A Beginner’s Guide to Modern Day Laser Lithotripsy Strategies For Ureteroscopy
- 078IC: Catastrophies, Complications & Corrections of Percutaneous Stone Procedures
- 019IC: New Technology in the Management of Stone Disease: What’s New, What Works, & What to Buy
- 008IC: Advanced Ureteroscopy: Overcoming Challenging Problems
Next:
Prostate Cancer
J. Brantley Thrasher, MD
“Areas that are hot are covered by some of my choices, such as immunotherapy in many cancers-even prostate cancer,” said Dr. Thrasher, professor of urology at the University of Kansas, Kansas City. “Another area that continues to grow in prostate cancer is imaging and genetic markers-specifically their use in diagnosis and treatment planning. Continued advances in imaging, specifically PET scanning, have helped in the targeting of biochemically recurrent prostate cancer.”
Active surveillance for low-risk prostate cancer has significantly grown in popularity. “It has been widely accepted by urologists, and the only real question left is the standardization of the approach. It’s probably the fastest growing part of my practice,” he said.
Dr. Thrasher's meeting picks:
- 023IC: Chemotherapy and Immunotherapy Options for Genitourinary Malignancies: A Primer for Urologists and Advanced Practice Providers
- 024IC: Prostate Cancer Diagnostics: Biomarkers, MRI, & Biopsy Techniques
- 083IC: AUA Guideline 2019: Incontinence After Prostate Treatment
- 001IC: Active Surveillance for Prostate Cancer: 2019 Update
- Prostate Cancer Trends Over the Last Decade: Is the Disease Becoming More Advanced? Effect of the 2012 Task Force Recommendations (Società Italiana di Urologia lecture)
- Panel Discussion: Enhanced PET imaging for High Risk and Advanced Prostate Cancer: Ready for Prime Time?
- Panel Discussion: Biomarkers in Prostate Cancer
Next:
Kidney, Bladder, and Urothelial Cancer/Localized Prostate Cancer
Leonard G. Gomella, MD
“Nonmuscle-invasive bladder cancer is an area of intense interest due in part to the worldwide shortage of our gold-standard BCG,” said Dr. Gomella, professor and chairman of urology at Thomas Jefferson University, Philadelphia. “Newer intravesical agents are critically needed that may address the shortage. The concept that systemically administered immuno-oncology agents can impact nonmuscle-invasive bladder cancer is revolutionary and is being tested in a variety of clinical trials.
In kidney cancer, Dr. Gomella said robot-assisted surgery for partial nephrectomy has entered the mainstream of surgical care, but the same cannot be said for muscle-invasive bladder cancer. “We continue to be conflicted concerning the risks and benefits of robotic surgery in the management of muscle-invasive bladder cancer compared to traditional open surgery,” he said.
Dr. Gomella's meeting picks:
- 010IC: Renal Cell Carcinoma: Surgical & Medical Management of High-Risk Renal Cell Carcinoma: New Paradigms for Treatment
- 077IC: Integrating Care for Oncology Patients: Establishing a Multidisciplinary Oncology Clinic with Advanced Therapeutics
- Crowdsourcing: Transurethral Resection of Bladder Tumor
- 023IC: Chemotherapy and Immunotherapy Options for Genitourinary Malignancies: A Primer for Urologists and Advanced Practice Providers
- 072IC: Management of NMIBC: Practical Solutions for Common Problems
- Crossfire:Controversies in Urology: Cytoreductive Radical Therapy still has a Role in the Era of Targeted Therapy for Metastatic RCC
Next:
Sexual Function/Dysfunction
Key trends in sexual function/dysfunction include the emergence of men’s health clinics, new non-drug treatments for erectile dysfunction, new testosterone replacement guidelines, and management of female sexual dysfunction, said Dr. Burnett, professor of urology at Johns Hopkins, Baltimore.
“Certainly as we continue to make strides in female sexual dysfunction and consider what approaches we may bring to those presenting with female sexual dysfunction problems, we need to be more versed in the area,” he said.
Dr. Burnett was particularly enthusiastic about a panel discussion on novel therapies for ED and Peyronie’s disease. “I think it’s important that we do have a good discussion from experts highlighting what’s new but also help urologists be guided on what is proper therapy, what is effective therapy, what is therapy that they should know is likely to be of benefit to patients. This is all the more important in the past year or so with therapies that are getting a lot of attention, such as stem cell therapy and shock wave therapy, that at this time remain incompletely understood.
“The other trend that I see is that urology practices are trying to not let some of their potential practice and revenue go out to [non-urologists]. They’re sensing that this is their source of revenue and their domain [and that] if we don’t do it, these other will do it, so we better do it.”
Dr. Burnett's meeting picks:
- 043IC: How to Start, Build & Run A Successful Andrology/Men’s Health Practice
- 036IC: What the Urologist Needs to Know to Manage Female Sexual Dysfunction
- Panel Discussion: Novel Therapies for Erectile Dysfunction and Peyronie’s Disease
- Complex Cases: Androgens: Charting the Course through the sea of Guidelines
- V04: ED, Infertility & Transgender
Next:
Health Policy
Jeffrey E. Kaufman, MD
“In general, the Practice Management Conference provides an up-to-date, cutting-edge, nuts-and-bolts summary of what practitioners need to know to successfully bill in 2019,” said Dr. Kaufman, who is in private practice in Santa Ana, CA. “If members attended one health policy course at the conference, this would be it.
“The AUA has an agenda according to which we lobby and educate Congress and private payers on our patients’ behalf to get appropriate coverage. Understanding why we hold the opinions we do weaponizes individual urologists to argue locally or get involved in national advocacy. Every AUA member-in private practice, academia, or training-should attend.”
Dr. Kaufman's meeting picks:
- 16th Annual AUA Urology Practice Management Conference (2-day event)
- AUA Public Policy Council Liaison Update
Next:
Trauma/Reconstruction/Diversion
Bradley A. Erickson, MD, MS
“The armamentarium of the reconstructive urologist continues to expand. Many centers around the country have begun to offer gender-affirming genital surgery for our transgender patients and this year’s AUA will offer a course, co-sponsored by the Genitourinary Reconstruction Society (GURS), on how to incorporate transgender care into your practice,” said Dr. Erickson, associate professor of urology at the University of Iowa, Iowa City.
“Cancer survivorship continues to be a popular topic at the meeting, especially after the treatment of prostate cancer. We continue to get better at prolonging the life of genitourinary cancer patients; the focus now turns to how improve their quality of life after treatment.
“The benefits of robot-assisted surgery for reconstruction of the urinary tract continue to be explored, with the ureter being the most obvious organ of benefit, but also in the management of post-prostatectomy anastomotic strictures,” Dr. Erickson said.
Dr. Erickson's meeting picks:
- Forum: Gender-Affirming Genital Surgery
- 032IC: Management of Complicated Urinary Dysfunction after Prostate Cancer Treatment
- 002IC: Robotic Upper Urinary Tract Reconstruction: A Top to Bottom Approach
Next:
Infertility
James M. Hotaling, MD, MS
“Research examining surgical or medical outcomes in male infertility prospectively from multi-institution databases will continue to drive the field forward,” said Dr. Hotaling, assistant professor of surgery (urology) at the University of Utah, Salt Lake City. “Translational work that allows refinement of the male infertility phenotype through molecular diagnostics in order to provide personalized care will also be a key theme. Finally, work that begins to apply the tools of health services research to male infertility will also be featured.”
What’s not hot? “Single-surgeon case series, work that further validates existing series in varicocele repair, and work that looks at the impact of single genes on male infertility is fading in importance,” Dr. Hotaling said.
Dr. Hotaling's meeting picks:
- 049IC: Infertility Update 2019: A Comprehensive Approach to Understanding & Treating Male Infertility in the Era of IVF
- 069IC: Emerging Concepts in Hormone Replacement Therapy for Men and Women
- Crossfire: Controversies in Urology: Vasectomy Reversal should be done even if the Spouse is 42 years old
Next:
Voiding Dysfunction (male)/BPH
Steven A. Kaplan, MD
“This year’s meeting will continue to highlight an association between metabolic factors and the onset of lower urinary tract symptoms secondary to BPH. In addition, data on maturing technologies as well as new investigational methods to treat BPH will be presented,” said Dr. Kaplan, professor of urology at Icahn School of Medicine at Mount Sinai, New York.
“Finally, updated data on surgical therapies for BPH will be presented as well.”
Dr. Kaplan's meeting picks:
- 044IC: AUA BPH Guidelines: How to Best Diagnose & How to Most Effectively & Safely Treat
- 060IC: Understanding The Evidence: New Technologies For Treating BPH & LUTS
- V02: BPH & Transplantation
MP01-01:
WATER VS WATER II: AQUABLATION THERAPY FOR BENIGN PROSTATIC HYPERPLASIA
MP01-05:
THE RESULTS OF ONE ARM MULTICENTER PROSPECTIVE STUDY ON AN INNOVATIVE MINIMALLY INVASIVE SURGICAL TECHNIQUE FOR LUTS MANAGEMENT: THE SECOND GENERATION TEMPORARY IMPLANTABLE NITINOL DEVICE (I-TIND) MEDITATE®
MP01-06:
EFFECTS OF POLOXAMER-BASED THERMO-SENSITIVE SOL-GEL ON URETHRAL STRICTURE AFTER TRANSURETHRAL RESECTIONS OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA : A MULTICENTER, SINGLE BLINDED, RANDOMIZED CONTROLLED STUDY
MP01-07:
PROSTACARE: WATER ELECTROLYSIS SYSTEM FOR THE TREATMENT OF BENIGN PROSTATE HYPERPLASIA
MP01-11:
LONG-TERM REOPERATION RATES FOLLOWING SURGERY FOR BPH: VARIATION BASED ON SURGICAL MODALITY
MP01-19:
EFFECT OF INDEX SURGICAL CARE SETTING ON 30-DAY REVISIT RATES AND ASSOCIATED COSTS FOLLOWING OUTLET PROCEDURE FOR SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA
PD10-01:
THE IMPACT OF TRAINING ERA ON THE OUTCOMES OF TRANSURETHRAL PROSTATECTOMY
PD10-07:
MULTI-INSTITUTIONAL PROPENSITY MATCHED COMPARISON OF ROBOTIC-ASSISTED SIMPLE PROSTATECTOMY AND THULIUM LASER ENUCLEATION OF THE PROSTATE
PD24-05:
PROSTATIC ARTERY EMBOLIZATION TO TREAT LOWER URINARY TRACT SYMPTOMS ATTRIBUTABLE TO BENIGN PROSTATIC HYPERPLASIA: A SINGLE CENTER ANALYSIS OF 2-YEAR OUTCOMES
MP45-08:
PROSTATIC URETHRAL LIFT (PUL) AND MAGNETIC RESONANCE IMAGING (MRI): DEFINING ARTEFACT AND RISK OF OBSCURING SIGNIFICANT CANCER.
MP45-16:
PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE: FAVOURABILITY OF STUDY RESULTS AS A FUNCTION OF CONFLICTS OF INTEREST AND INDUSTRIAL SPONSORSHIP
Next:
Female Urology
Female Urology
Priya Padmanabhan, MD, MPH
"Past meetings have had much focus on the implications of mesh complications in female pelvic medicine and reconstructive surgery [FPMRS], robotic apical prolapse repairs, and the role of obesity in incontinence management,” said Dr. Padmanabhan, associate professor of urology at the University of Kansas, Kansas City. “Tertiary OAB treatment is now abuzz with applications in atypical populations, trending of alternative and future options of neuromodulation (ie, implantable tibial nerve stimulation and improved batteries).
“Some other hot topics include: gender disparity patterns in FPMRS, the questioning of our practices in screening and prevention of UTIs, the clinical significance of vaginal lasers, and basic research advances in stress urinary incontinence.”
Dr. Padmanabhan's meeting picks:
- 036IC: What the Urologist Needs to Know to Manage Female Sexual Dysfunction
- 054IC: The Indications for Vaginal Thermotherapy: What is (and is there) a Role for Laser Treatment
- Journal of Urology: Top Papers: Female Urology and Urodynamics
- Highlights: Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU)
- Complex Cases: Pelvic Floor Medicine
Next:
Pediatrics
Barry A. Kogan, MD
“Reconstructive and robot surgery remain of great interest this year in the presentations. On the other hand, diagnosis and treatment of reflux is of lesser interest, as is (surprisingly) antenatal hydronephrosis,” said Dr. Kogan, chief of urology at Albany, Albany, NY.
“The older generation of pediatric urologists keep trying to bury robotic procedures that seem to have few benefits over open surgery, but they keep coming back. [The Crossfire session] should be a great debate.
“There is also a session on whose hypospadias repair is better. There is constant evolution in this area, so this should be an informative and fun session,” Dr. Kogan said.
Dr. Kogan's meeting picks:
- 073IC: Common Problems in Pediatric Urology
- Crossfire: Controversies in Urology: Ureteral Reimplantation should be Robotic
- Debate: Hypospadias: My Way is Best
- John Duckett Memorial Lecture: How Urodynamics Influenced Pediatric Urology
Next:
Late-breaking abstracts
Neal D. Shore, MD
Clinical practice, Myrtle Beach, SC
Next:
J. Stuart Wolf, Jr., MD
"Awareness of the opioid crisis has been growing for several years now. At this AUA annual meeting there will be many presentations on important aspects of the opioid crisis, including the general over-prescription of opioids after urologic surgery, the association of post-surgical opioid prescribing with chronic opioid use, alternatives to post-operative opioids, and the impact of interventions to decrease post-surgical opioid prescribing," said Dr. Wolf, professor of urology at Dell Medical School at The University of Texas, Austin.
Dr. Wolf's meeting picks:
Next:
Peter C. Albertsen, MD
In surveying the area of epidemiologic trends/socioeconomics, “measuring and describing practice variation is clearly a major theme this year,” said Dr. Albertsen, chief of urology at the University of Connecticut Health Center, Farmington. “As this type of analysis forms the basis for any quality improvement project. The use of electronic medical records and large databases that derive from them become more ubiquitous, these types of studies will become more important. Equally important, urologists need to pay attention to these reports because their own practice patterns may be evaluated and compared against evolving norms.”
Dr. Albertsen also highlighted several abstracts that utilized social media for collecting data and evaluating trends.
“I suspect this new method of conducting urologic research will increase in the future,” he said.
Among other trends to watch for at this year’s meeting, Dr. Albertsen pointed out, are: the growing use of nonphysician providers and telemedicine to address the urologist shortage, the opioid crisis, and the wide variability in acceptance of active surveillance for prostate cancer among community urologists.
Dr. Albertsen's meeting picks:
Next:
Gopal H. Badlani, MD
Professor of urology, Wake Forest Baptist Medical Center, Winston-Salem, NC
Dr. Badlani's meeting picks:
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