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) Sero Andonian, 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).
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.