AUA 2018

AUA 2018: Double-Blind Prospective Randomized Clinical Trial Comparing Regular and Moses Modes of Holmium Laser Lithotripsy: Preliminary Results

San Francisco, CA USA (UroToday.com) Ahmed Ibrahim, MD, a clinical urologist from Montreal, Canada, presented on a randomized double-blind prospective study that compares operative efficiency between Regular and Moses mode of Holmium laser lithotripsy. Currently, about 1 in 11 people are affected by kidney stones in the United States. According to the latest guidelines, Holmium laser lithotripsy is the gold standard for treatment of these stones because it is able to fragment most stone types with high stone free rates while maintaining a safety profile. Despite this, there are still challenges faced by Holmium laser lithotripsy such as energy absorbance by water, stone repulsion, and difficulty reaching certain locations (lower pole).

However, Moses technology provides a possible solution to these problems. With this new technology, the Holmium laser pulse is divided into two peaks. The first peak separates the fluid from the stone while the second peak is precisely delivered to the target, thus decreasing loss of energy compared to the Regular mode resulting in greater energy efficiency and less dependence on distance of stone.

In the study, a total of 66 patients were included and randomly assigned to two groups: Regular or Moses mode of Holmium laser lithotripsy. All patients and physicians were blinded and all procedures were performed by four urologists. Demographic data, stone parameters, peri-operative complications and success rates were compared. The primary objectives were to measure procedure time, fragmentation time, lasing time, total energy and degree of repulsion. Stone repulsion was graded on a Likert scale, which ranged from grade 0 (no repulsion) to grade 3 (migration to the kidney).

In the results, while demographic data and stone parameters were comparable in the two groups, a significant difference was found in fragmentation time and procedure time between the Regular and Moses groups. It was found that there was a 20%-25% reduction in both time measurements despite using the same total energy. Furthermore, there was also a significant reduction is retropulsion grade in the Moses group and stone free rates between the two groups were comparable at one month.

In conclusion, Moses technology was correlated with significantly lower fragmentation and procedural times. This reduction can be explained by the lower repulsion rate of the stone and enhanced energy delivery during laser lithotripsy, therefore improving efficiency. However, Dr. Ibrahim states that there were limitations to this study due to its preliminary nature, such as small sample size, short-term follow up (only about one month), the use of combined techniques of dusting and fragmentation, and no evaluation of the long pulse of Regular mode.

Presented by: Ahmed Ibrahim, MD

Written by: Whitney Zhang, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA

AUA 2018: High Intensity Focused Ultrasound Dose Escalation Leads to Fewer Recurrences in Following Focal HIFU in Prostate Cancer

San Francisco, CA (UroToday.com) Dr. Huber and colleagues evaluated retrospective data to analyze optimal techniques used for high intensity focused ultrasound (HIFU) in prostate cancer. Their database contained 190 men, 131 of whom were treated with 2 HIFU ablation zones, and 59 of whom were treated with 3 ablation zones. This led to 37 matched pairs that were compared with regard to prostate cancer recurrence. The pairs were matched for exact Gleason score and tumor volume as assessed via mpMRI.

AUA 2018: Systematic Review and Meta-Analysis of Adjuvant Therapy After Nephrectomy for High-risk, Non-metastatic Renal Cell Carcinoma

San Francisco, CA USA (UroToday.com) The current treatment for non-metastatic renal cell carcinoma (nmRCC) is either a partial or radical nephrectomy. However, many adjuvant therapies have been examined such as radiotherapy, vaccines, immunotherapy, Vascular Endothelial Growth Factor (VEGF)-TKI, and checkpoint inhibitors. Five trials, ASSURE, S-TRAC, PROTECT, SORCE, ATLAS, have been designed to evaluate the effect of adjuvant VEGF-based therapy in patients with nmRCC, who underwent either partial or radical nephrectomy. The ASSURE, S-TRAC and the PROTECT trials published their results.

AUA 2018: Two Year Oncological Outcomes Following Focal Laser Ablation

San Francisco, CA (UroToday.com) Brian Chao and Dr. Lepor presented the NYU experience using focal laser ablation (FLA) now that they have 2 years’ worth of oncologic data and 1 year of functional outcomes data. They recruited 34 men undergoing in-bore FLA with clinically localized disease, PSA <10, Gleason <8, and MRI findings demonstrating index lesions.

Functionally, there was no significant change from baseline in standardized measurements for erectile function and lower urinary tract function. The AUA symptom score, SHIM erectile function score, incontinence pad number, and self-reported incontinence rates were all the same at 12 months as at baseline prior to FLA.

AUA 2018: Rapid Patient Derived Xenografts that Consider Tumor Heterogeneity for Prediction of Cancer Immunotherapy Responses in Metastatic Renal Cell Carcinoma

San Francisco, CA USA (UroToday.com) Metastatic renal cell carcinoma is one of the most lethal of all genitourinary cancers due to its resistant nature to both chemotherapy and radiotherapy. The currently available clinical treatment options for this patient population is a cytoreductive nephrectomy followed by either surgery, systemic anti-angiogenic agents or immunotherapy. This particular cancer subtype is a good candidate for personalized medicine as around 30% of patients are de novo resistant to their selective frontline anti-angiogenic and a long term durable response is only seen in a subpopulation of patients undergoing immunotherapy. Specifically, patient responses to cancer immunotherapy such as checkpoint inhibitor drugs (PD-1 and PD-L1) vary greatly between patients and between disease sites.

AUA 2018: Robotic Prostatectomy- Setbacks and Operative Solutions

San Francisco, CA (UroToday.com) The introduction of robotic assisted technology has had a tremendous impact in the care of patient with prostate cancer allowing surgeons to operate on the prostate with enhanced vision, control and precision. To date, robotic assisted laparoscopic radical prostatectomy (RALP) is the most common intervention for the care of patients with localized prostate cancer due to its minimal invasive approach and decreased complications compared to open radical prostatectomy. Although, robotic technology has improved the safety and reproducibility of the radical prostatectomy, complication due occur and early recognition and management of these complications is essential. Dr. Sotelo, from the University of Southern California, has assembled an all-star panel of robotic surgeons to discuss the common complication associated with robotic prostatectomy and their management. 

AUA 2018: Medium Size Bladder Tumors En-block Bipolar Resection on Put to the Test

San Francisco, CA (UroToday.com) The conventional transurethral resection of bladder tumor (TURBT) technique involves piecemeal resection of the tumor, which is contrary to the established oncological principles of cancer surgery. En-block TURBT has been championed as a superior technique since the tumor is left intact during resection which leads to improved pathological evaluation and improved recurrence rates.  Dr. Geavlete, from Bucharest Romania, presents a long-term, prospective, randomized-controlled trial aimed at comparing the clinical outcomes of patients with medium size papillary non-muscle invasive bladder tumors (NMIBT) treated with either standard or en-block bipolar resection TURBT.