During Monday morning’s Plenary I program, representatives from the Society of Genitourinary Reconstructive Surgeons (GURS), the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) and the Society of Urologic Oncology (SUO) shared highlights from their specialty programs held in conjunction with AUA2016.
Bryan Voelzke, MD, associate professor in the Department of Urology at the University of Washington School of Medicine, summarized advances in penile reconstructive surgery that were reported during the GURS program.
“Over the past century there has been a progression of advances, from incorporation of penile skin to the use of penile skin flaps and then to the use of free grafts, such as buccal mucosa,” Dr. Voelzke said. “There have also been major advances with improved antibiotics, use of fine monofilament suture and new catheter materials, as well as better perioperative care. In the future we’ll need to use tissue engineering to take that next leap to successful urethral reconstruction.”
Nirit Rosenblum, MD, assistant professor of Urology at NYU Langone Medical Center, followed with a summary of SUFU’s program, which included several presentations on neurogenic lower urinary tract dysfunction.
“The congenital population of neurogenic bladder is a unique population with both anatomic and physiologic differences that require lifelong care from urologists and primary care physicians,” Dr. Rosenblum said. “Unfortunately, in the spina bifida population, for example, there is a significant loss of care as they enter adulthood and there is a need for multidisciplinary adult clinics to provide both urologic and primary care. We must partner with our pediatric urology colleagues to offer this transitional care. There is currently an AUA working group to establish these guidelines.”
Leonard G. Gomella, MD, professor and Chair of the Department of Urology at Thomas Jefferson University, presented highlights from the SUO program, which included presentations on balancing the risk of overtreatment versus undertreatment of prostate cancer, bladder cancer and kidney cancer.
“In the area of prostate cancer, we discussed the issue of undertreating patients with high risk prostate cancer, including active surveillance in patients with what is traditionally considered to be high risk disease, which is becoming more commonplace,” Dr. Gomella said. “We looked at some very interesting data on African Americans undergoing active surveillance suggesting that these men require closer discussion and observation because of the likelihood that they would harbor higher risk disease compared to their Caucasian counterparts.”
The bladder cancer presentations at SUO’s program included analysis of the role of radical cystectomy in patients with high grade T1 disease. “An important, evolving concept is how many nodes need to be taken out during radical cystectomy. There are important, ongoing trials attempting to address that issue,” Dr. Gomella said.
Dr. Gomella also reported data indicating that ischemia times in partial nephrectomy greater than 20 to 25 minutes will adversely impact rates of acute kidney injury and long-term impact on the estimated glomular filtraton rate, suggesting that clamping should be limited when possible during partial nephrectomy.