Healthy debates
Clinical controversies take center stage at AUA2025.
AUA2025 delivered no shortage of spirited discussion, but three sessions in particular stood out for their debates, clinical nuance and real-world relevance. Whether you were in the room or catching up from afar, here’s a recap of the debates that pushed the field forward—and the questions that remain.
In “Positive Dipstick: Proceed or Postpone?”, panelists examined a common yet unclear clinical scenario: what to do when a patient scheduled for an office procedure has a positive urine dipstick. “Do we cancel, or do we go ahead?” asked moderator Dr. Stephanie Kielb. Drs. Kamran Sajadi and Siobhan Hartigan urged caution and postponement, while Dr. Yahir Santiago-Lastra said canceling the procedure goes against patient-centered medicine and Dr. Nitya Abraham warned that “half of patients with cancelled appointments never reschedule.” The session highlighted the delicate balance between guideline gaps and patient access.
Erectile dysfunction was the focus in “Shockwave Therapy for ED: Yea or Nay?”, where Dr. Stanton Honig described an evolving landscape: “There has been an evolution of practice from skepticism to some level of acceptance.” Despite increasing patient interest, experts emphasized the need for standardization and more robust evidence before shockwave therapy becomes mainstream.
Finally, “Exploring the Tradeoff of New Treatments for BCG-Unresponsive NMIBC” brought together Drs. Tullika Garg, Vignesh Packiam and Shreyas Joshi for a deep dive into emerging options to help patients with Bacillus Calmette-Guerin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) avoid or delay radical cystectomy. The session explored the pros and cons of double intravesical chemotherapy with Gemcitabine/Docetaxel (Gem/Doce) versus the new FDA-approved bladder-sparing treatments for BCG-unresponsive NMIBC. “With a full armamentarium of agents with multiple mechanisms of action, it’s a game-changing era to preserve bladder and quality of life,” said Dr. Garg. Discussion centered on balancing cost, effectiveness and long-term outcomes.
