2020 Meeting “Take-Aways” from Dr. Joe Clark (must read)

Research on stem cell therapy for treating post prostatectomy incontinence has focused on both injecting stem cells as well as targeting in-situ regeneration of tissue with small molecules.
Despite changes to government service urology, there continues to be similar types of research presented at the SGSU meetings.
It is possible to not place a ureteral stent after uncomplicated ureteroscopy for proximal ureteral and renal stones.
Using machine learning based on risk factors and real-world results can help predict those who would most benefit from undergoing a microscopic hematuria workup.
Intraurethral lidocaine instillation after endourology procedures under anesthesia did not improve postop dysuria.
It is possible to avoid routine opioid prescriptions after ureteroscopy without increasing patient morbidity.
Xtandi (enzalutamide) is FDA approved for metastatic castrate sensitive prostate cancer (new indication as of December 2019), metastatic castrate resistant prostate cancer and nonmetastatic castrate resistant prostate cancer (sponsored symposium).
A retrospective review showed that in appropriately selected patients, a general urologist can obtain patency rate approaching 90% after vasovasostomy
Incidence data from the Defense Medical Epidemiology Database from 2006-2015 showed that rates of hypogonadism increased significantly among active duty males.
Interim results of treatment with placebo, sildenafil, and pentoxifylline after RALP showed no difference in IIEF between the treatment arms after one year, and that IIEF scores were worse 1 year after RALP across all interventions.
We saw how a testicular torsion care pathway was created that may decrease time from presentation to the emergency department to the operating room.
In the pediatric population, renal vascular injuries are managed differently depending on age group (mostly nonoperatively), but outcomes do not significantly vary with age.
A single institution retrospective chart review of pediatric patients who underwent minor urological surgeries showed that opioid prescribing rates are low and that older patients were more likely to be prescribed opioids.
Referral patterns for pediatric monosymptomatic nocturnal enuresis (PMNE) had not changed over a 9-year period, with similar percentages of patients having undergone behavioral modification, alarms, and pharmacotherapy before referral to pediatric urology.
A dual energy CT scan may help stratify risk in patient with complex renal cysts.
Surveillance of indeterminate renal cysts is costly and progression over time can aid in clinical decision making.
A multi-center retrospective review showed that in patients with cT1 renal cancer, tumor size, male sex, diabetes, advanced age, and those treated with radical nephrectomy were statistically more likely to be upstaged.
An enhanced recovery after surgery (ERAS) protocol for nephrectomy showed improvements in time to bowel function and pain control, particularly with open nephrectomy.
Electrical stimulation of the proximal urethra in rats with and without supraspinal spinal cord injury showed that urethra to bladder reflexes require suprasacral involvement (Basic Science winner).
Male slings have low rates of complication at 30 days with the most common being urinary retention and wound dehiscence.
A survey of women presenting to a general urology clinic showed that almost half of the sexually active women had dyspareunia.
In a rat bladder model of bladder outlet obstruction, annexin A1 can inhibit the effect of NLRP3 dependent caspase-1 activity and improve bladder recovery after deobstruction.

A query of the Center for Prostate Disease Research database showed that despite younger age at diagnosis of prostate cancer and higher initial PSA, African American men who undergo radical prostatectomy have similar metastasis rate and overall survival when treated in an equal access healthcare system (Clinical Research winner).

Surgeon experience contributes to decreased operative time and overall complication rate for robotic assisted RPLND, and therefore can be safely performed by experienced robotic surgeons.
Surgeon administered TAP block and scheduled acetaminophen and ketorolac can decrease opioid use in patients undergoing robotic assisted radical prostatectomy.
Patients requiring greater than 3 pads per day and extremely bothered one month after radical prostatectomy are less likely to recover continence and should be appropriately counseled.
Routine postoperative hemoglobin checks poorly predicts need for blood transfusion after minimally invasive radical prostatectomy.
Removing the reservoir in revision penile prosthesis surgery can be challenging; however, always remove the reservoir if there is an infection.
ExoDx is a urine-based genomic test that can be used to assess risk of high-grade prostate cancer in men with PSA of 2-10 who are considering prostate biopsy (sponsored symposium).
PD-1 pathway inhibitors, antibody-drug conjugates (enfortumab vedotin), and molecularly targeted agents such as FGFR3 inhibitors (erdafitinib) have revolutionized advanced bladder cancer management and how we think about the disease (sponsored symposium).
Low-intensity shockwave, stem cell therapy, and platelet rich plasma should be considered experimental therapies for treating ED until appropriate RCTs have demonstrated proven efficacy and safety.
Dr. Al Squitieri reflected on memorable events over the past 50 years of Kimbrough Urological Seminars – some things have definitely changed.
There has been a lot of progress in the management of castrate resistant prostate cancer with newer agents, although the optimal sequencing has yet to be defined.
The VA healthcare system offers many opportunities for urologists in terms of leadership, career and helping to train urology residents; there are pros, cons, and many benefits in working as a urologist in the VA system.
Many urologists fantasize about being NASCAR drivers.
There are big changes ahead for military medicine as the Defense Health Agency (DHA) takes over health care delivery functions, although the readiness functions will remain with the military departments. Individual Critical Task Lists (ICTLs) will define what a urologist must maintain proficiency on for readiness. Knowledge, Skills and Abilities (KSAs) are specialty-specific skills utilized by the expeditionary clinician and will “help Commanders make decisions regarding deployment by optimizing the readiness of their clinicians, MTF, and address gaps prior to deployment.”
There is wide variance between urologist prescribing patterns of opioids for pain control following similar clinic procedures.
In a retrospective study, there was no significant improvement in length of stay, complications rates or 30-day readmission rates after implementation of an enhanced recovery clinical care pathway for nephrectomy.
Teardrop Urethral Mobilization Advancement Repair (T-UMAR) improved cosmesis, reduced meatal stenosis and adhesion formation compared to UMAR.
Pelvic fracture associated urethral injury is challenging to treat and the optimal management is not certain; there is significant morbidity if not reconstructed properly and one should consider referring these patients to high volume centers.
There is no clear evidence on optimal sequencing of drug treatment for metastatic castrate resistant prostate cancer and there are many ongoing and planned clinical trials for prostate cancer patients (sponsored symposia).
A retrospective review of robotic assisted laparoscopic surgery showed that prescribing patterns for opioids are variable despite similar surgery and similar patient populations and provide evidence for establishment of local standardized prescribing guidelines.
Thulium Fiber Laser (TFL) is a viable alternative to conventional holmium laser for lithotripsy and clinical studies are in progress.
As percent seminoma in the orchiectomy specimen increased, the incidence of necrosis, surgical complexity, and the need for concurrent ancillary procedures at the time of post-chemotherapy RPLND increased.
Evaluating patients with suspected hereditary renal cancer in a multidisciplinary clinic may increase imaging and follow-up compliance rates while better identifying at-risk patients with a strong family history.
Late relapse after chemotherapy for stage II germ cell tumor is rare and the primary therapy should be surgical.
In patients undergoing radical cystectomy, proper preoperative counseling is critical to ensure understanding of the benefits of the type of urinary diversion.
Clinicians prescribing LHRH agonists for prostate cancer should following dosing instructions and schedules, and routinely check testosterone levels.
Men with high risk prostate cancer after prostatectomy have no higher rates of biochemical recurrence on testosterone therapy.
There is an apparent difference in prostate cancer behavior after RP in Hispanic men compared to AA and Caucasian men in an equal access setting – higher PSAs in Hispanic males appears less predictive for BCR.
Testosterone therapy can be safe in men on active surveillance for prostate cancer.
Aquablation therapy for BPH shows promising results and may be especially beneficial for patients with very large prostates as there is significantly reduced tissue removal time (sponsored symposia).