State of Urology: Our experts' top picks for AUA 2015

As a urologist, regardless of your practice setting or area of subspecialization, the AUA annual meeting has something for everyone, as our exclusive look at this year’s gathering attests.

As always, this year’s meeting promises a rich assortment of clinical research as well as practical forums and courses to help you stay on top of today’s hot-button health policy issues.

The AUA meeting is massive in scope, as shown with everything from the exhibitors’ elaborate booths to the phone-book-sized collection of abstracts produced every year. With so much research being presented, the task of choosing which presentations to catch can be daunting. To help you maximize your AUA experience, Urology Times’ editorial board and other thought leaders have pored over hundreds of abstracts to identify the key trends and can’t-miss research from this year’s meeting.

Jump to a topic:

Sexual Dysfunction

Health Policy

Localized Prostate Cancer

Advanced Prostate Cancer

Pediatric Urology

Interstitial Cystitis/Bladder Pain Syndrome

Laparoscopy/Robotics

Infertility

Infection

Female Urology

Stone Disease

BPH/LUTS

Trauma/Reconstruction

Sexual Dysfunction

Dr. BurnettIf you attended last year’s AUA meeting, chances are you heard about (and perhaps participated in) the ongoing debate over testosterone replacement therapy and cardiovascular risk, which culminated recently with the FDA ordering a labeling update for approved testosterone products. Look for further discussion on TRT at this year’s meeting; the topic is the subject of this year’s “AUA Town Hall,” moderated by Gregory A. Broderick, MD, Ajay K. Nangia, MD, and Ridwan Shabsigh, MD, and will also be discussed in multiple research presentations.

“In line with recent attention given to the role of testosterone replacement therapy, some abstracts will importantly focus on safety, indications, and new options for managing the hypogonadal male,” said Arthur L. Burnett, II, MD, MBA, professor of urology at Johns Hopkins University, Baltimore.

There will also be TRT research centered on treatment indications in different hypogonadal populations, as well as novel treatment formulations, Dr. Burnett added.

In the area of penile prosthesis surgery, look for abstracts on surgical modifications and innovative techniques to address penile deformity and length problems, management of device infections, and sources of patient dissatisfaction. For those interested in Peyronie’s disease, watch for research examining expanded indications and outcomes for intralesional collagenase, surgical options, and national trends in treatment, Dr. Burnett says.

Here are Dr. Burnett's top abstract picks for sexual dysfunction from AUA 2015:

PD37-08: Efficacy and Pharmacokinetics of LPCN 1021, a Novel Oral Testosterone Replacement Therapy (TRT), in Hypogonadal Men: Study of Androgen Replacement (SOAR)
Jed C. Kaminetsky

PD48-05: Trends in the Treatment of Peyronie’s Disease: An Analysis of Case Logs from American Urologists
Daniel T. Oberlin

PD26-02: A Review of Microorganisms Isolated at Salvage or Explant of IPPs: Are we Covering the Correct Bugs?
Martin Gross

PD40-10: Penile Implants – Why are Men Dissatisfied?
Tobias Kohler

PD45-04: Incidence of prostate cancer and effects on prostate-related parameters under long-term therapy with testosterone undecanoate injections (TU) in hypogonadal men for up to 84 months: real-life experience from an observational registry study
Ahmad Haider

PD45-10: The Safety and Efficacy of Li-ESWT in 604 patients for Erectile Dysfunction: Summary of Current and Evolving Evidence
Robert Feldman

NEXT: Health Policy

Health Policy

Dr. GeeThis year’s meeting promises courses and talks on a variety of health policy/socioeconomics-related topics. One forum William F. Gee, MD, says urologists would do well to attend covers the AUA’s Quality (AQUA) Registry (Monday, May 18).

“The collection of outcomes data is becoming more and more important to urologists, patients, and insurers. The AQUA Registry currently focuses on prostate cancer, but it will gradually expand to include other urologic conditions. Many large group practices are already participating in the AQUA Registry,” said Dr. Gee, who is in private practice in Lexington, KY.

Dr. Gee also pointed out courses on preventing and defending malpractice lawsuits (Sunday, May 17), coding and reimbursement (May 18), and telemedicine (May 18) as being of particular use for practicing urologists.

Finally, Dr. Gee highlighted the AUA/American Association of Clinical Urologists Health Policy Forum, slated for May 17. This year’s featured speakers are Relative Value Scale Update Committee (RUC) Chair Barbara Levy, MD, who will discuss the RUC and physician reimbursement, and Rep. John Fleming, MD (R-LA), who serves as vice chairman of the GOP Doctors Caucus, a group that includes 14 physicians.

NEXT: Localized Prostate Cancer

Dr. GomellaNew research on active surveillance, including the role of MRI-guided fusion biopsy to detect disease progression in men being observed, will take the spotlight during the localized prostate cancer sessions at this year’s AUA meeting.

Also look for a prospective comparison of two forms of focal therapy-cryotherapy and high-intensity focused ultrasound-in localized disease and a long-term comparison of current surgical approaches to radical prostatectomy, advises Leonard G. Gomella, MD, professor and chairman of urology at Thomas Jefferson University, Philadelphia.

Here are Dr. Gomella’s top abstract selections in localized prostate cancer:

MP42-04: Active Surveillance: When Can Patients Stop Worrying?
Ridwan Alam

PD30-01: MR-US fusion biopsy to diagnose prostate cancer: First 1000 men at UCLA
Christopher Filson

PD30-02: MRI-TRUS guided fusion biopsy to detect progression on active surveillance for low and intermediate risk prostate cancer.
Thomas P. Frye

PD34-07: Can Gleason 7 Prostate Cancer Ever be Low-Risk? Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) Database
Kathleen McGinley

PD34-09: Comparison of Pathologic Outcomes in Men with Favorable-Risk Prostate Cancer Undergoing Delayed Surgery After Active Surveillance versus Immediate Surgery
Jeffrey Tosoian

MP62-19: Focal Cryotherapy Delivers Similar Oncological Control with Significantly Improved Erectile Function Recovery Rates Over a Whole Gland Approach
Melissa Mendez

PD43-02: Comparative effectiveness of surgery and radiation therapy for high risk prostate cancer patients
Ravishankar Jayadevappa

PD47-05: Prospective comparison of oncological outcomes between Focal cryotherapy versus Focal High-Intensity Focused Ultrasound in localized prostate cancer
Youness Ahallal

MP78-03: Association between number of prostate biopsies and patient-reported functional outcomes after radical prostatectomy: implications for active surveillance protocols
Christopher Anderson

MP83-08: Thirty years of radical prostatectomies at a single tertiary care referral center
Paolo Dell'Oglio

MP83-11: Long-term Patient-reported Functional Outcomes Following Open, Laparoscopic, and Robotic-assisted Radical Prostatectomy Performed by High Volume Surgeons
Boris Gershman

Next: Advanced Prostate Cancer

Advanced Prostate Cancer

Dr. ThrasherResearchers continue to explore the possibilities of new treatments for castration-resistant prostate cancer, so look for studies on the timing and sequencing of these therapies, says J. Brantley Thrasher, MD, professor and chair of urology at the University of Kansas, Kansas City.

“Also this year, we are seeing several studies on imaging and how it might change the approach to prostate cancer or direct surgery for localized metastatic lesions-specifically multi-parametric MRI and PET,” Dr. Thrasher told Urology Times.

Dr. Thrasher says also to look for research bolstering evidence on the benefits of statins-“but interestingly, in a patient with advanced disease on ADT.”

“I was also interested to hear about the new anti androgen ARN-509,” Dr. Thrasher said.

Specifically, here are the abstracts Dr. Thrasher says to watch for at this year's meeting:

MP73-04: The association between statin use and outcomes in patients initiating androgen deprivation therapy
Robert Hamilton

MP82-10: PSMA-radioguided surgery: Introducing molecular surgery in patients with recurrent prostate cancer
Tobias Maurer

MP82-15: Does early androgen deprivation therapy after biochemical recurrence following radical prostatectomy increase overall survival? Results from SEARCH
Stephen Freedland

MP82-19: Can Multiparametric Magnetic Resonance Imaging Predict Biochemical Recurrence After Radical Prostatectomy? Implications for Preoperative Staging and Surgical Planning
Richard Ho

MP82-20: Preoperative Multiparametric Prostate MRI Identifies Patients at Risk for Lymph Node Involvement at Radical Prostatectomy
Annerleim Walton Diaz

MP87-16: Novel Antiandrogen ARN-509 in High-Risk Nonmetastatic Castration-Resistant Prostate Cancer
Neal D. Shore

MP87-17: Exploring the Incidence of Abiraterone Acetate Withdrawal Responses
Rajasree Pia Chowdry

MP87-19: Effect of abiraterone acetate and low dose prednisone on prostate-specific antigen in patients with non-metastatic castration-resistant prostate cancer: the results from Impact of Abiraterone Acetate in Prostate-specific Antigen Core study
Charles J. Ryan

NEXT: Pediatric Urology

Pediatric Urology

Dr. SnyderOnce again, the Society for Pediatric Urology will hold its annual meeting concurrently with the first 3 days of the AUA meeting.

The problem of antibiotic resistance and infection remains a concern for urology and is a topic urologists can expect to see brought out in this year’s pediatrics research, says Howard M. Snyder, III, MD, professor of surgery in urology at the University of Pennsylvania School of Medicine, Philadelphia.

“Pediatric urologists seem to be more aware of the benign nature of asymptomatic bacteriuria and the harm that comes from excessive use of antibiotics,” Dr. Snyder told Urology Times.

The increasing prevalence of pediatric stones is another trend to watch for, says Dr. Snyder.

“The incidence of stones in kids continues to grow, and we are realizing that they can be treated by the same techniques as in adults,” he said.

Finally, for this year’s John Duckett Memorial Lecture (May 17), Chung Kwong Yeung, MD, PhD, will present, “Minimally invasive surgery in pediatric urology: Present and future.”

NEXT: Interstitial Cystitis/Bladder Pain Syndrome

Interstitial Cystitis/Bladder Pain Syndrome

Dr. HannoPlenary and podium sessions will feature noteworthy research on interstitial cystitis/bladder pain syndrome, says Philip M. Hanno, MD, MPH, professor of urology at the University of Pennsylvania.

On May 18, the results of the 4-year update to the Interstitial Cystitis/Bladder Pain Syndrome guideline will be presented.

“While the amendment largely validates the original published guideline based upon review of subsequently published literature from July 2009 through July 2013, there are some changes in the treatment algorithm and classification of therapies that the treating physician will want to be aware of,” Dr. Hanno said.

One abstract singled out by Dr. Hanno will highlight the characteristics of women testing positive for Mycoplasma hominis and Ureaplasma urealyticum in the urinary tract.

“Symptoms of urgency and pelvic pain will be discussed along with management of this infection that is one of the ‘confusable diseases’ in the diagnosis of IC/BPS,” Dr. Hanno said.

Dr. Hanno says there are many interesting presentations at this year’s meeting, including a randomized, multicenter, double-blind, placebo-controlled trial of intravesical botulinum toxin and a look at an alternative delivery system for botulinum toxin in the bladder. Another randomized clinical trial compares the effect of hydrodistention versus transurethral fulguration of Hunner’s lesions. In addition, the latest abstracts from the Multi-Disciplinary Approach to Chronic Pelvic Pain 10-year NIDDK research effort will be presented.

“All in all, it looks like a very interesting and potentially useful trove of new information that will help clinicians and researchers as they continue to make advances in diagnosis and treatment,” Dr. Hanno said.

Here are the top abstract picks for IC/BPS from this year's AUA annual meeting:

PD20-02: Intravesical botulinum toxin A single injections can reduce bladder pain in treatmetn of interstitial cystitis/bladder pain syndrome refractory to conventional treatment - a prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial
Jia-Fong Jhang

PD20-03: Pilot study evaluating safety and feasibility of intravesical instillation of botulinum toxin in hydrogel-based slow release delivery system in PBS/IC patients
Kobi Stav

PD20-10: Prospective, multicenter, randomized clinical trial comparing the effect of hydrodistention and transurthral fulguration of bladder in interstitial cystitis/bladder pain syndrome patients
Jang Hwan Kim

PD8-11: The characteristics of women testing positive for mycoplasma hominis and ureaplasma urealyticum in the urinary tract
Jessie Liang

NEXT: Laparoscopy/Robotics

Laparoscopy/Robotics

Dr. WolfRobotic surgery is firmly part of urologic practice. Now we are trying to determine nuances that make a difference (such as the role of assistant),” said J. Stuart Wolf, Jr., MD, professor of urology at the University of Michigan, Ann Arbor.

Other themes to expect at the meeting include application of adjunctive technologies and patient safety with robotic surgery, Dr. Wolf said.

Abstracts evaluating primary versus salvage laparoscopic pyeloplasty, a tactile-feedback-driven pelvic floor muscle training smartphone app, and use of a hyaluronic acid-carboxymethylcellulose adhesion barrier on the neurovascular bundle during robot-assisted radical prostatectomy are among the key research to watch for, Dr. Wolf said.

Specifically, here are the abstracts Dr. Wolf singled out from this year's meeting:

PD21-02: Surgical crisis: Is the robot friend or foe?
Courtney K. Rowe

PD21-04: Matched comparison of primary versus salvage laparoscopic pyeloplasty (LP)
Sapan Ambani

PD21-06: Perioperative outcomes, complications, and efficacy of robotic assisted prolapse repair
Michael Ehlert

PD15-12: Design and early clinical experience with a tactile feedback driven pelvic floor muscle training smartphone app
Maurice Garcia

PD18-09: The Role of the Assistant During Robot-Assisted Partial Nephrectomy: Does Experience Matter?
John A. Brockman

PD18-12: Use of Hyaluronic Acid-Carboxymethylcellulose Adhesion Barrier on the Neurovascular Bundle during Robot-Assisted Radical Prostatectomy: Long term outcomes
Rutveej Patel

NEXT: Infertility

Infertility

Dr. HotalingInfertility research being presented at this year’s meeting is centered on practice patterns in the care of infertile males, says James M. Hotaling, MD, MS, assistant professor of surgery (urology) at the Center for Reconstructive Urology and Men’s Health, University of Utah Health Care, Salt Lake City.

“Specifically, authors examined vasovasostomy and epididymovasostomy-new techniques to make these procedures easier and characterizing current practice patterns. Likewise, new techniques for optimizing varicocelectomy and microTESE, and selecting optimal patients for these procedures, are also a focus of the work presented this year,” Dr. Hotaling said.

Another notable trend is re-examination of the concept that infertile men with poor sperm parameters and recurrent pregnancy loss have significantly higher rates of sperm aneuploidy.

“Although this concept was first demonstrated over 20 years ago, many authors have proposed refining the cut-offs for testing for sperm aneuploidy,” Dr. Hotaling said.

He says urologists interested in infertility should also be on the lookout for the following:

• several studies on new techniques such as chromosomal and genetic analysis in the evaluation of infertility

• several abstracts exploring novel intra-operative techniques for testicular sperm extraction and varicoceletectomy, “which will be of great interest to urologists performing these procedures”

• research on pregnancy rates for fresh versus frozen testicular sperm for intracystoplasmic sperm injection.

Here are Dr. Hotaling's infertility abstract picks:

PD52-07: Time for public health action on infertility: Updates from the Centers for Disease Control and Prevention
Lee Warner

PD52-08: Inequity between male and female infertility coverage in state insurance laws
James Dupree

MP74-13: Predictors of success after microscopic subinguinal varicocelectomy
Dane Johnson

MP74-14: Efficacy of microsurgical subinguinal varicocelectomy using indocyanine green fluoresence angiography
Yasuhiro Shibata

NEXT: Infection

Infection

Dr. ChaiThis year’s infection program features many relevant topics to the practicing urologist, says Toby C. Chai, MD, professor of urology at Yale School of Medicine, New Haven, CT.

One such area is post-urologic procedure infections, where several presentations will suggest potential methods to prevent these infections.

Other studies will investigate the concept of the “bladder microbiome”-the theorized population of multiple unculturable microorganisms in the normal bladder.

“The relationships between the bladder microbiome and asymptomatic bacteriuria will be presented. The concept of an existence of a microbiome in the bladder may change the way we manage several different bladder conditions and redefine how we understand host-pathogen interaction in the bladder,” Dr. Chai said.

Additionally, watch for several presentations on newer diagnostic approaches, as well as utility of currently used imaging modalities, to assess for urinary tract infections.

“The current urine culture test takes at least 48 hours to get results, and newer technologies may bridge this time delay,” Dr. Chai told UT.

Finally, abstracts will review the management of radiation hemorrhagic cystitis.

“These patients are usually difficult to manage, and these abstracts will give the urologist additional insights,” he said.

Here are the abstracts Dr. Chai says to watch for:

MP20-08: Pyuria and Asymptomatic Bacteriuria is Associated with Novel and Specific Urine Microbiomes
Suzanne Groah

MP20-10: A biosensor for rapid and simultaneous uropathogen identification and ciprofloxacin minimum inhibitory concentration determination
Emanuela Altobelli

MP20-12: Recent antibiotic treatment and the risk of post-outpatient cystoscopy urinary tract infection
Justin R. Gregg

MP20-18: Grade 4 hemorrhage radiation cystitis treated by early transurethral fulguration versus conservative observation strategy: outcome comparison from 283 cases
Toru Sugiahra

MP25-17: Rapid qPCR to Identify Multi-Drug Resistant E. Coli Prior to Prostate Biopsy
Michael Liss

NEXT: Female Urology

Female Urology

Dr. RazStudies with long-term follow-up are among the highlights of the sessions on female urology at this year’s meeting, according to Shlomo Raz, MD, professor of surgery/urology at UCLA.

Those studies examine the use of urethral bulking injections for stress urinary incontinence (SUI), sling surgery for SUI in a high-volume referral center, intradetrusor onabotulinumtoxinA (Botox) in patients with neurogenic detrusor overactivity, and sacral nerve stimulation (InterStim) in those with non-obstructive urinary retention.

Researchers will also discuss the risk of surgical revision or removal of incontinence mesh and gentamicin instillations for symptomatic UTI episodes in patients with neurogenic bladder.

Here are Dr. Raz’s top choices for female urology abstracts to watch for in New Orleans:

PD27-05: The use of onabotulinumtoxinA for treatment of overactive bladder in older patients
Anne Sammarco

PD27-07: Evaluation of Quality of Life Improvements at 36 Months in Subjects with Overactive Bladder Treated with Sacral Neuromodulation Using the InterStim System
Steven Siegel

PD28-01: Still dry! Longevity of Deflux urethral bulking injections for urinary stress incontinence
Catherine Hobbs

PD28-05: Long-term outcomes of mid-urethral and pubovaginal slings for stress urinary incontinence in a tertiary referral setting
Kevin Gioia

PD28-08: The effect of time to revision of an obstructing synthetic mid-urethral sling on reoperation for stress urinary incontinence
Nitya Abraham

PD28-09: A population based assessment of the risk factors for mesh removal or revision after female incontinence procedures
Blayne Welk

PD28-11: Changes in urinary storage symptoms following surgical treatment for female stress urinary incontinence
Zachary Panfili

MP81-06: Changes in Female Urologic Case Distribution with New Subspecialty Certification and Surgeon Gender
Joceline S. Liu

MP81-14: Female Urethral Stricture: More Common Than You Think
Marco Spilotros

PD1-01: Long-term Efficacy and Safety of OnabotulinumtoxinA in Patients With Neurogenic Detrusor Overactivity: Analysis Among Patients Who Completed 4 Years of Treatment
Eric Rovner

PD10-09: Gentamicin intravesical instillations decrease symptomatic urinary tract infections and oral antibiotic use in patients with neurogenic bladder on intermittent catheterization
Lindsey Cox

MP89-04: Long-term Efficacy of Sacral Nerve Stimulation Implantation for Non-Obstructive Urinary Retention Refractory to Medical Therapy
Charles Snyder

NEXT: Stone Disease

Dr. AssimosStone Disease

Two abstract headliners in the area of stone disease management are a new look at the use of ultrasound to reposition kidney stones and an examination of the consequences of non-adherence to medical therapy in stone patients.

Those are among the top choices of Dean G. Assimos, MD, professor and chair of urology at the University of Alabama, Birmingham. Here is Dr. Assimos’ list of can’t miss stone abstracts at this year’s meeting.

PD42-01: Report on the feasibility of ultrasound to reposition kidney stones in humans
Jonathan Harper

PD42-02: A preclinical image-guided therapy system for burst wave lithotripsy
Adam Maxwell

MP41-04: Consequences of non-adherence to selective therapy among patients with kidney stones
Casey Dauw

MP41-05: Perinatal Outcomes with Tamsulosin Therapy for Symptomatic Urolithiasis
George Bailey

MP41-10: Quality of Acute Care for Patients with Upper Tract Stones in the United States
Charles Scales

PD13-01: Dusting vs Basketing During Ureteroscopic Lithotripsy-What is More Efficacious? Interim Analysis from a Multi-Centre Prospective Trial from the EDGE Research Consortium
Ben H. Chew

MP30-03: Is preoperative antibiotic prophylaxis for high-risk patients necessary before percutaneous nephrolithotomy? A retrospective review of 7 vs 2 vs 0 day therapy
Jeffrey Larson

NEXT: BPH/LUTS

BPH/LUTS

Dr. KaplanSteven A. Kaplan, MD, professor of urology at Weill Cornell Medical College, New York, says this year's BPH research will examine "metabolic parameters associated with indices of BPH including prostate volume, urinary symptoms and risks of progression. This will include Vitamin D levels  and waist circumference."

Attendees interested in BPH/lower urinary tract symptoms should also take note of surveys of both the incidence of LUTS in men as well as the use of medications.

"There has been a renaissance in new technologies designed to treat male lower urinary tract symptoms secondary to BPH," Dr. Kaplan commented.

Finally, the meeting will feature long-term data and outcomes with laser prostatectomy, maturing data on the Prostatic Urethral Lift (UroLift, Neotract, Inc.), and emerging data on the use of image-guided water jet ablative technologies.

Here are Dr. Kaplan's picks from this year's podium and poster sessions:

MP71-01: Serum Vitamin D Levels and Prostate Volume
Yaw Nyame

MP71-03: Waist circumference can be predictive of postoperative storage LUTS after surgery for benign prostatic hyperplasia
Mauro Gacci

MP71-11: Urinary Symptoms and Medications Used in Men Attending a National Health Screening Program
Nelson Stone

PD16-01: New Insight of PSA Reduction during Finasteride Therapy
Ding Xu

MP3-01: BPH6 Randomized Study of Prostatic Urethral Lift (PUL) vs Transurethral Resection of the Prostate (TURP): Outcomes and Patient Satisfaction
Neil Barber

MP3-08: Bipolar vaporization causes higher complication rates compared to bipolar loop resection: A randomized prospective trial
Osama Abdelwahab

PD5-01: Three Year Durability of the Prostatic Urethral Lift for BPH: Results of a Prospective, Multi-center, Randomized Study
Claus Roehrborn

PD5-02: Multicenter Experience of a Novel Treatment for BPH: Aquablation – Image Guided Robot-assisted Water jet Ablation of the Prostate
Peter Gilling

NEXT: Trauma/Reconstruction

Trauma/Reconstruction

Dr. MoreyRobotic buccal mucosa graft ureteroplasty, changing practice patterns in the treatment of urethral stricture, and research indicating that male anterior urethral strictures are commonly treated without imaging or being offered urethroplasty are among this year's high-interest trauma/reconstruction abstracts, according to Allen F. Morey, MD, professor of urology at UT Southwestern Medical Center, Dallas.

Here are Dr. Morey's abstract picks from this year's meeting:

MP18-19: Delay of Surgical Treatment of Penile Fracture Results in Poor Functional Outcome: Results from a Large Retrospective Multicenter European Study.
Giorgio Bozzini

MP29-01: Multi-institutional Study of Robotic Buccal Mucosa Graft Ureteroplasty: Inital Results
Lee C Zhao

MP29-08: Indications and timing of revision surgery in patients having had multiple artificial urinary sphincters
Anastasia Frost

MP15-01: Changing Practice Patterns in the Treatment of Urethral Stricture Amongst American Urologists
Joceline S. Liu

PD22-08: Male anterior urethral strictures are commonly treated without imaging or being offered urethroplasty
Justin De Grado

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