Dr. Barry 2020 Meeting Take-Away’s

Meeting Abstract Take-Aways. Kimbrough 2020

CONTRIBUTED BY JOHN M. BARRY, MD

The principle of regenerative pharmacology is to stimulate the body to self-heal in situ. Local administration of the chemokine CXCL12 is being studied in a nonhuman primate male model of chronic post-prostatectomy erectile dysfunction and post-prostatectomy urinary incontinence. We hope it works.
The distribution of research papers presented at the Kimbrough has been stable for the past decade.
With machine learning, we are, at last, approaching a more reasonable definition of the level of microscopic hematuria to trigger a urologic evaluation.
Post-operative intraurethral lidocaine may not reduce dysuria after endourologic procedures in anesthetized patients.
Opioid-free ureteroscopy for stone disease is associated with less frequent post-procedure requests for opioids when compared with patients routinely prescribed post-procedure opioids. (A clinical science award winner.)
After uncomplicated ureteroscopy for ureteral and renal stones, ureteral stents are probably unnecessary.
Vasovasostomies by general urologists who did not complete fertility fellowships were usually successful.
Respect for clinical standards is necessary for the diagnosis and treatment of male hypogonadism.
Based on small numbers, erectile function and penis length after radical prostatectomy are not improved with sildenafil or pentoxifylline.
A multidisciplinary testicular torsion pathway was shown to decrease time from ER to OR.
Bicycling is the most common cause of pediatric renal hilum injuries.
Opioid prescriptions for minor pediatric urologic surgeries are not very common.
Referring pediatricians need to be educated in the preliminary assessment of primary monosymptomatic nocturnal eneuresis. Something as simple as a pre-referral voiding diary and urinalysis would be quite helpful.
Dual energy computerized tomography DECT) may be of use in the assessment of complex renal cysts because iodine uptake can be quantified, and iodine enhancement suggests malignancy.
Prolonged CT observation of Bosniak 2F renal cysts resulted in the development of contrast allergies three times as often as a malignancy diagnosis (6% vs 2%). (Check the 2019 update for Bosniak cyst classification and, if need be, modify your surveillance protocols.)
Stapling across a left renal vein tumor thrombus, removing the left kidney, and then addressing the IVC portion of the tumor thrombus is safe and gives one better exposure of the IVC for removal of the IVC portion of the thrombus.
Predictors for upstaging clinical T1 renal malignancy are evolving.
An enhanced recovery after surgery (ERAS) protocol with multimodal pain management resulted in a one-day improvement in the return of gastrointestinal continuity (P not quite significant), and an improvement in pain scores in the partial nephrectomy group (P barely significant).
Barrington’s reflexes were studied in rats. (First Prize, Basic Science.)
Male urethral slings were quite successful for the treatment of post-radical prostatectomy urinary incontinence.
Dyspareunia in women is common.
Annexin A1 enhanced the resolution of bladder inflammation following bladder de-obstruction in rats. It inhibits the NLRP3 inflammasome. (Another basic science award winner.)
After radical prostatectomy in the setting of equal access to and receipt of health care, there were no significant differences between African-American and Caucasian men with the long-term outcomes of risks of metastasis and overall death. (First Prize, Clinical Science.)
Not surprisingly, experience reduces surgical times and reduces complication rates for robotic-assisted laparoscopic retroperitoneal lymph node dissections.
Post-robotic-assisted laparoscopic prostatectomy pain management with local anesthetic wound injection and scheduled acetaminophen and ketorolac dosing significantly reduced the need for post-operative opioids.
The need for 3 incontinence pads per day 6 months after radical prostatectomy is a reasonable indication for surgical treatment of the leakage. The “3-pads/day-at-6-months” rule? (A clinical science winner.)
After minimally invasive radical prostatectomy, a single 14-hour postoperative hemoglobin evaluation seemed to be all that was necessary to recognize a bleeding event.
The diagnosis of hypogonadism in active duty men increased from 2006 to 2015. Were generally accepted diagnostic criteria for male hypogonadism met?
Al Squitieri’s “Name the Disease” prize at the 1970 Kimbrough meeting was a classic. It was for a goldfish swimming in a urine collection bag – AKA “Ictyuriosis” (fish in the urine)…
3-D reconstructive images may aid in surgical planning for minimally invasive surgery.
IgG-4-related inflammatory renal pseudotumor is rare.
Granulomatous prostatitis after BCG immunotherapy for non-muscle invasive bladder cancer may be associated with a lower grade of prostate cancer than that seen with other causes of prostatic inflammation.
Postmortem sperm retrieval is a controversial topic. Guidelines have been developed for deceased organ donors in the civilian community and the issue is being studied in the military.
Non-classical congenital adrenal hyperplasia (NCCAH) due to testicular adrenal rest tumors is rare.
Corporal thrombosis usually responds to anticoagulation.
The LRINEC Score (elevated C-reactive protein, elevated WBC, decreased hemoglobin, increased serum sodium, elevated plasma creatinine, elevated blood glucose) is a useful screening app to diagnose necrotizing fasciitis. It can be found in MDCalc as a cellphone app.
Late metastasis from a T1b renal cell carcinoma is rare.
A radical cystectomy ERAS algorithm was applied to renal surgery patients. It worked.
Plasma cell balanitis is rare; circumcision can be curative.
Automated flow cytometry will provide a new reference range for significant microscopic hematuria.
Extravesical common sheath ureteroneocystostomy for duplicated systems is successful.
Testosterone replacement therapy for organ-confined Gleason 6 and 7 prostate cancer with undetectable PSA after radical prostatectomy was safe.
There is a wide variance in opioid prescribing patterns after non-endoscopic urologic office procedures.
A standardized ERAS algorithm for renal surgery didn’t make a difference in hospital length-of-stay, 30-day readmission rate or complication rate. (See the disagreeing results from the ERAS study above.)
The teardrop meatoplasty modification of the urethral mobilization and advancement repair (UMAR) for hypospadias works.
Opioid prescribing patterns for robotic surgeries are variable among prescribers. This agrees with an earlier abstract about opioid prescribing practices.
In pre-clinical studies, the Thulium fiber laser seems to be a competitive alternative to the standard Holmium:YAG laser for lithotripsy. The fibers of the former are smaller, quite flexible, and operate from a standard 110-volt outlet.
A Renal Hereditary Syndrome Clinic (RHSC) was established to facilitate genetic counseling, provide accurate genetic testing, and improve imaging compliance rates. It was successful.
Late relapse following complete response to radiation or chemotherapy for clinical stage II germ cell testis tumors is rare. It is accompanied by high recurrence and mortality rates after retroperitoneal lymph node dissection.
Proper preoperative education is critical to ensure proper choice of urinary diversion after radical cystectomy. To find out if your team is doing a proper job with this task, periodically administer the Functional Assessment of Cancer Therapy – Bladder Cystectomy (FACT-BI-Cys) validated patient health survey to longitudinally assess the quality of life for these patients.
Compliance with dosing intervals for luteinizing hormone-releasing (LHRH) agonists injections isn’t very good. As expected, this resulted in ineffective testosterone suppression.
Men with high risk prostate cancer (HRPC) and low serum testosterone levels who were treated with testosterone had no higher rates or time to biochemical recurrence than men with HRPC and normal testosterone levels or low, untreated testosterone levels.
Different PSA reference ranges for Caucasian, African-American and Hispanic men may not be necessary.
Testosterone therapy doesn’t seem to result in significant PSA changes in men on active surveillance for prostate cancer.