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Turf battles appear to be heating up between urologists and two specialist groups.
To start, researchers provided evidence for the use of a single medication or procedure for a range of urologic conditions. Generating the most interest on this front is botulinum toxin A (Botox). While studies continue to show positive results with this agent in patients with refractory overactive bladder, intriguing data now also provide a potential rationale for its use in men with BPH. An Italian group found intraprostatic injections of the agent reduced prostate symptom scores significantly, but a U.S. group, while finding the injections fast and easy to perform, was unable to show a benefit. Look for more research to clarify this agent's role in both neurogenic bladder and BPH.
Alpha-blockers, a traditional mainstay of medical treatment for BPH, now appear to offer benefit in stone disease, with studies showing their efficacy in aiding the passage of ureteral stones, and to provide relief in chronic prostatitis, with one study showing a modest improvement in symptoms. Similarly, the indications for robotic-assisted laparoscopy continue to widen, as surgeons showed promising initial results with this technology in procedures ranging from sacrocolpopexy to pediatric antireflux surgery.
Finally, on the socioeconomic front, turf battles appear to be heating up between urologists and two specialist groups. Issues over who should perform imaging tests and in what setting came to the forefront during a debate between urologist Martin Resnick, MD, and radiologist James P. Borgstede, MD. While urologists undoubtedly should be afforded the opportunity to perform ultrasound and other imaging studies in the office, they need to guard against overusing these tests. Meanwhile, some urologists privately expressed concern that the introduction of minimally invasive sling procedures for stress incontinence using such materials as transvaginal tape (TVT) and transobturator tape (ObTape) may invite increased competition from obstetrician-gynecologists.
This is by no means a comprehensive list of the AUA annual meeting's highlights. See our "Best of AUA" article for a recap of the meeting's take-home messages, and watch for our Aug. 15 issue for "AUA Take-Homes In-Depth," which includes critical analyses from members of the Urology Times editorial board.