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#AUA17: Highlights from Boston part 2

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The #AUA17 meeting was starting to hot up with the anticipation of the crossfire sessions controversy in urology,  second opinion cases and surgical technique plenary session. The early crossfire session was looking at adult onset hypogonadism. The  debaters  gave convincing arguments on both sides of the discussion but we were left in no doubt that adult-onset hypogonadism is a true medical condition and urologists need to recognise the symptoms and treat when appropriate.

 

There was a lively crossfire debate on the use off transperineal biopsy  vs TRUS biopsy for the detection of prostate cancer. There we some moral arguments in favour of  transperineal biopsy stated. Laurence Klotz presented the AUA MRI targeted biopsy consensus statement.

 

 

 

 

 

The results of the 24 months follow-up of the aquablation study was presented. The mean operative time was 45 mins with a aquablation time of 5 mins!  There was a 34% prostate volume reduction. There were no cases of urinary innocence , ejection or erectile dysfunction. The WATER study was presented comparing aquablation vs TURP.  The study found aqua ablation superior to TURP in terms of safety, Q max and IPSS reduction. We look forward to long term data but the initial results presented look promising

 

 

 

 

In a packed breakfast session we were given an excellent overview of the role of Immune checkpoint inhibitors in bladder cancer. The audience was treated to a state-of-the-art update on the newer drugs on the horizon, their indications, side effects and early clinical trial data. Watch his space for the new check point inhibitors for treatment of metastatic bladder cancer.

 

 

Burnout was a main theme across many of the sessions at the AUA. The poster by Nash et al. looked at results from the AUA census. They found that 41% of urologist surveyed  between the ages of 29-65 experienced burnout. Other risk factors included working in a multi speciality practise. Paediatric  urologists and urologist older than 65 were least likely to suffer from burnout. Very important issues have been highlighted at this meeting and gives food for thought for us all.

 

 

 

 

 

 

The eagerly awaited results of the randomised open verses robotic cystectomy (RAZOR) trial was announced at the AUA. the findings of the study showed that robotic cystectomy is not inferior to open cystectomy with respect to 2 year progression free and overall survival. As expected blood loss, length  to stay favoured the robotic cystectomy group but complication rates, overall surgical margins and lymph node yield were similar.

 

 

Bladder cancer diagnosis cost effectiveness was highlighted in a plenary session. Cost-effectiveness of ultrasound vs CT with cystoscopy was presented. The study found that the use of CT rather than ultrasound increased costs by $65 million / 1 cancer detected. This study highlights the need to risk stratify the use of CT in investigation of patients with non visible heamaturia.

 

 

One of the major announcements was the much anticipated phase 3 trial results looking at immediate post-TURBT instillation of gemcitabine vs saline in patients with newly diagnosed or occasionally recurring low grade non-muscle invasive bladder cancer,  SWOG S0337. The study shows reduced recurrence by 34% with little toxicity. There was a lot of excitement regarding gemcitabine as it 5-10 times cheaper than the widely used mytomycin C.

 

 

 

 

 

baus-bjui-usanz17The BAUS-BJUI-USANZ joint session was a fantastic overview from some of the top UK, US and Australian urologists. The highlights of the session included the talks on personalised medicine. The president of the British Association of Urological Surgeons Mr Kieran O’Flynn gave an insightful talk on training and inspiring the next generation of urologists. This was followed up by the Australian perceptive on urological training for the future. Khurshid Guru, Director of Robotic Surgery at Roswell Park Cancer Institute, gave an overview of cognitive training in surger . Finally the Coffey-Krane Award – the BJUI Journal prize for trainees based in The Americas – was awarded to Drs. Ranjith Ramasamy and Jason Kovac on their paper titled ‘Hypogonadal symptoms in young men are associated with a serum total testosterone threshold of 400 ng/dL’.

ckprize17Dr Ramasamy receives the 2017 Coffey-Krane prize from Prof Dasgupta

The Christchurch Medal was awarded to  Dr. Catherine deVries for her work on developing urological training programs in Asia, Africa, and Latin America. Congratulations to all the award winners and the BJUI team on an  exceptional programme.

 

 

 

In a busy trauma symposium the management of grade 4 renal injuries was presented. A multi centre study  looking at  safety in early mobilisation after renal trauma examined the benefits. The study concluded that the advantages for early mobilisation included increase in return of bowel function, reduced length of hospital stay, but acknowledged the increased risk of early mobilisation in higher grade traumas. One study looking specifically at outcomes in grade 4 renal injuries found 14% of the patients were unstable on  presentation, 52% required a blood transfusion with 24 hours and 74% of those with grade 4 renal injury had associated injuries.

 

 

 

 

 

The medical expulsive therapy (MET) debate rumbled on in 2017 at the AUA. Results of the late breaking abstract the Study of Tamsuolsin for Urolithiasis in the Emergency department (STONE) was presented.  The end point was stone passage at 28 days, with CT used to confirm stone passage. The study found no difference for stone passage rates for stones less than 9 mm compared to placebo.

 

 

 

At the ROCK session UK urologist Matthew Bultitude (@MattBultitude) gave an excellent case against  MET has he debated with John Hollingsworth. It is safe to say now ‘MET IS DEAD’

 

 

 

The NBA playoff final were on the Monday evening with the Boston Celtics beating the  Washington Wizards 115-105 in Game 7 of the Eastern Conference semi-finals. Many of the conference attendee took time out to watch the game live and support their adopted team the Boston Celtics.

 

 

 

 

 

It has been another excellent AUA in Boston. It was good to catch up with old friends and urologists from across the globe to debate and update on the latest management in urology. It was another record breaking year for the #AUA17 on twitter. It surpassed the stats for #AUA16 with over 52 million impressions, 20,530 tweets 3,591 participants. See you all in San Fransisco  for AUA 2018.

 

 

 

By Jonathan Makanjuola (@jonmakurology) and Nicholas Raison (@NicholasRaison)

 

 

#AUA17: Highlights from Boston part 1

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It was a cold and wet Boston that welcomed the thousands of delegates from around the world for the start of #AUA17. Being home to such pre-eminent centres of learning and academia as Harvard, MIT and Fenway Park, we looked forward to a productive and enjoyable meeting. Set on the South Boston Waterfront, the Boston Convention and Exhibition Centre offered an elegant home to us for the next 5 days and provided all the necessary tools for scientific discussion: numerous coffee shops and speedy wi-fi.

Friday morning started off with a fascinating plenary session hosted by Prof Prokar Dasgupta (@prokarurol) on surgical techniques in radical prostatectomy. Three great “as live” demonstrations of open perineal, laparoscopic and robotic single site prostatectomy thrilled the packed room and once again demonstrated that it really isn’t the technique but the surgeon that really counts.

Following on in the plenary hall, the Tumour Boards offered informative panel discussions on all the major tumours. Of note the multidisciplinary discussion on prostate cancer highlighted some important key messages. Use of risk calculators was emphasised as well as the importance of reducing our reliance on PSA and the number of biopsies. Dr Stacey Loeb (@staceyloeb) gave some helpful reasons for the greater incorporation of the prostate cancer biomarkers into the clinical decision making process. But Dr Kibel made the excellent point that especially with all these new tests, the key is that we and, more importantly, the patients believe the results.

Similarly, the bladder cancer panel offered a number of points for discussion. Interestingly Dr Ashish Kamat(@UroDocAsh) highlighted the discrepancies between the EAU and AUA in risk stratification of high grade tumours which prompted extensive discussion in the twitter-sphere.

The potential for the new urinary markers to aid prostate cancer risk stratification featured prominently throughout the conference. The clear message was for their greater integration with other diagnostic tests such as MRI.

But worrying evidence that urologists in the States are already having to fight with insurance companies for an mpMRI, how easy this will be remains to be seen.

 

The morning in the plenary hall was nicely rounded off by the presentation of the latest AUA guidelines for managing RCC. In particular, the emphasis on biopsy and active surveillance of the small renal mass was strongly promoted.

 

Friday ended with a great evening session on robotic surgery organised by Mount Sinai Hospital. A panel of experts discussed and critiqued a trio of robotic procedures performed by Dr Tewari (Prostatectomy), Dr Badani (Kidney) and Dr Wiklund (Bladder). Despite the lengthy queues for the free snacks, Mount Sinai Hospital put on a great evening with some truly incredible 4K 3d video courtesy of Sony.

 

And for those urologists that have managed to resist the alluring charms of the Da Vinci Robot, an AUA trip to Fenway park offered the chance to enjoy something some top-level baseball as well as the classic Boston snack of the Fenway Frank (Hotdog). Even if the precise rules of baseball remained somewhat of an enigma, the great atmosphere inside the ground, not to mention the Jumbotron proposal, meant a fantastic evening was had by all.

 

Saturday morning kicked off with another strong programme. Dr Robert Sweet’s Journal of Urology lecture gave us some pause for thought. Entitled “Staying Relevant in the Modern Age”, Dr Sweet set out a very persuasive case why it is up to us as urologists to take charge of training and accreditation. Especially since device manufacturers wash their hands of any responsibility, before adopting any new technology it is vital that we recognise the learning curve and ensure the correct systems are in place.

 

The journal of urology top papers of 2016 provided a handy summary of the new hot topics and points of interests. In particular recognition of the worryingly aggressive but also MRI-invisible cribiform subtype of prostate cancer caught the audience’s’ attention.

 

The AUA further supported the importance of education and training with an extensive presentation programme. The benefits of crowdsourcing where endorsed by a number of presentations led by a plenary presentation by Dr Khurshid Ghani (@peepeeDoctor). Crowdsourced reviews of videos of robotic prostatectomies performed by expert surgeons were again shown to be effective, this time correlating closely with patient outcomes.

 

Similarly, Dr Tom Lendvay (@LendvayT) presented even more surprising data that when compared to expert reviewers, the Mechanical Turks (as the crowdsource workers on Amazon are known) gave more reliable and consistent evaluations! Given the growing calls for ongoing technical assessment of surgeons together with the time and financial expense of recruiting expert surgeon appraisers, the somewhat unpalatable option of crowdsourced assessment of surgeons continues to grow.

 

The highly popular crossfire debates returned with Dr Gerhard Fuchs (@GerhardFuchs9) leading a lively debate on dusting vs basketing. Dr Olivier Traxer and Dr Khurshid Ghani (@peepeedoctor) made a strong case for dusting in front of a packed crowed. But the “basketeers” championed by Dr Sara Best (@BestSaraMD) and Dr Jodi Antonelli defended well. Backed up by a strong SoMe debate, the final opinion was that as with everything the key is selecting the right technique for the right patient although the definition of dust was still hotly contested.

 

SoMe was of course a critical component of the conference, with some lively debates really helping to create the feeling of a very inclusive and connected conference despite the thousands of delegates. SoMe also featured strongly in the presentations with interesting studies showing both a relationship between social media presence on online ratings and surgical volume.

 

The highlight of the Saturday evening was the highly popular annual BJUI Social Media Awards. The city bar of the Westin Waterfront quickly filled and Prof Prokar Dasgupta kicked off the evening with a boisterous but nevertheless very warm welcome. A/Prof Declan Murphy, compère for the night, presented the many awards for the organisations and individuals that had done most to promote SoMe in urology. Best urology journal for social media was awarded to the Journal of Urology – recognising the significant steps they have made recently in this field. Other winners included Dr Stacey Loeb for best social media paper, the EAU for the best app and Christopher Wallis for the most read blog.

 

By Jonathan Makanjuola (@jonmakurology) and Nicholas Raison (@NicholasRaison)

 

 

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