AUA 2018: Concomitant Hysterectomy Lowers the Rate of Repeat Surgery for All Vaginal Pelvic Organ Prolapse in Nearly 100,000 Women
San Francisco, CA USA (UroToday.com) This session explored the role of hysterectomy in pelvic organ prolapse (POP) repair in two different, conflicting studies. Many surgeons perform hysterectomy in the treatment of POP, but some advocate for uterine-sparing procedures. The contribution of the uterus in prolapse recurrence is debated, with some arguing that the weight of the uterus increases the risk for prolapse recurrence. Those who advocate for uterine preservation argue that it improves sexual function and prevents the early onset of menopause that is though to occur with hysterectomy, even when the ovaries are spared. The authors of this study explored the risk of recurrence after POP repair with and without hysterectomy using a large database analysis.
AUA 2018: Impact of Lifetime Obesity on Urinary Incontinence in the Women’s Health Initiative
San Francisco, CA USA (UroToday.com) Several studies in this session addressed the association of obesity and the metabolic syndrome with urinary incontinence. Obesity is a known risk factor for developing urinary incontinence (UI), and some studies have suggested that obese women have worse outcomes in the treatment of urinary incontinence. Recently there has been an emphasis on research into the prevention of pelvic floor disorders, and obesity prevention may be a target for urinary incontinence prevention. However, this is a difficult field to study as it requires long-term, longitudinal data on weight and urinary incontinence, as well as other patient factors. The Women’s Health Initiative (WHI) data allows for the long-term study of multiple factors affecting women and their health over time.
AUA 2018: Recurrent UTI Prevention: Fact vs Fiction
San Francisco, CA USA (UroToday.com) This session presented an in-depth discussion on the nature of recurrent urinary tract infections (rUTIs), and challenged the classic thinking on their etiology and treatment. Recurrent UTIs are a common problem seen by nearly all urologists, but to date, there is no consensus on their management or even their definition. However, rUTI guidelines are in development and expected to be released in 2019. Here Melissa Kaufman, MD distinguishes myth from fact in rUTIs.
AUA 2018: Variability in Partial Nephrectomy Outcomes: Does Your Surgeon Matter?
San Francisco, CA USA (UroToday.com) Recently, there have been many publications citing the difference amongst surgeon skill and technique in partial nephrectomy. Julien Dagenais, MD emphasized these articles in the beginning of his talk by mentioning fifteen articles surrounding this topic. Understanding discrepancies between surgeons is increasingly important in the pursuit of quality-based healthcare in the United States.
AUA 2018: Open, Laparoscopic and Robotic Partial and Radical Nephrectomy: Practice Patterns and the New Standard of Care
San Francisco, CA USA (UroToday.com) During recent years, robot-assisted surgery has become increasingly available as more hospitals have found funds and reason to acquire a daVinci. Michael Palsae, MD and colleagues set out to determine practice patterns and dissemination of robotic partial nephrectomy and radical nephrectomy. The study team compared these to their open and laparoscopic counterparts. Dr. Palsae and colleagues performed a retrospective chart review of 26152 patients who underwent robotic partial nephrectomy between 2008 and 2016, using the Statewide Planning and Research Cooperative database.
AUA 2018: The Utility of Urodynamic Evaluation in Clinical Practice
San Francisco, CA USA (UroToday.com) This moderated poster session included several studies regarding the quality of urodynamic studies (UDS) and whether they add to treatment planning in patient management. The publication of the VALUE trial in 2012 caused many clinicians to question the utility of urodynamics. However, many urologists have argued that the patient population in this trial was of minimal complexity and the results of this landmark trial do not apply to the general clinical population. Rena Malik, MD and colleagues sought to evaluate the value of urodynamic studies in their patient population, a tertiary referral center.
AUA 2018: Does Partial Nephrectomy for Biopsy Proven Fuhrman Grade 3/4 Renal Cell Carcinoma Confer Worse Outcomes Compared to Radical Nephrectomy?
San Francisco, CA (UroToday.com) To date, no evidence exists on whether the treatment with radical nephrectomy (RN) for non-metastatic grade 3/4 renal cell carcinoma (RCC) tumors confers better overall outcomes than treatment with partial nephrectomy (PN). In this study the authors aimed to analyze and compare results of patients with biopsy proven grade 3 / 4 RCC treated with either PN or RN.