AUA 2018: Comparative Effectiveness of Neoadjuvant and Adjuvant Chemotherapy in the Medicare Bladder Cancer Population

San Francisco, CA (UroToday.com) Neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) prior to radical cystectomy (RC) is supported by Level 1 evidence; yet utilization is not as high as it should be, due to multiple concerns – specifically, delay to RC, complications from chemotherapy, concern for renal function deterioration, etc. On the other hand, there is no strong data to support adjuvant therapy (AC), as of yet – though, there are indicators to suggest it may be effective. 

AUA 2018: Bipolar Transurethral Resection of Bladder Tumor Provides Better Tissue for Histopathology but Has No Superior Efficacy and Safety

San Francisco, CA (UroToday.com) Bipolar TURBT technology has become increasingly used, particularly for longer procedures, in the hopes of reducing TUR syndrome – long procedures using hypotonic fluids (such as glycine or water) for monopolar TUR procedures (TURP or TURBT) puts the patient at risk of developing severe hyponatremia. Bipolar technology, which utilizes saline instead, helps reduce that risk and enables longer procedures. While very useful for TURP procedures, its utility in relatively shorter TURBT procedures has been of clinical interest.

AUA 2018: Early Opioid Use in ERAS Pathway in Radical Cystectomy Correlates with Increased Length of Stay and Cost

San Francisco, CA (UroToday.com) ERAS (Early recovery after surgery) pathways have been helping to drastically change historical post-operative recovery norms. With a better understanding of pre-operative, intra-operative and post-operative factors that affect recovery times, we can make modifications to help patients recover sooner. 

AUA 2018: Frequency of Low Grade T1 Bladder Cancer Has Decreased but Continues to Vary by Institution

San Francisco, CA (UroToday.com) Non-muscle invasive bladder cancer (NMIBC) encompasses approximately 70% of new bladder cancer diagnoses. The 2004 WHO classification system classifies tumors into low and high grade disease on the basis of microscopic characteristics. In contrast, the TNM staging classifies NMIBC by depth of invasion. In general, these two correlate to some degree in that most low grade (LG) disease is Ta (involving urothelium but not into lamina propria) disease and HG disease can be either Ta or T1 (into lamina propria). LG T1 disease is very uncommon, and to many urologists, is a flag for requiring pathology re-review. True LG T1 disease is quite uncommon and a management conundrum.

AUA 2018: FDG-Positron Emission Tomography for Assessing the Response to Neo-Adjuvant Chemotherapy in Bladder Cancer Patients

San Francisco, CA (UroToday.com) Neoadjuvant chemotherapy (NAC) is a standard of care for muscle-invasive bladder cancer (MIBC), though the overall survival benefit is modest. Though it is not without its adverse effects, it is still recommended for all eligible patients prior to radical cystectomy. Yet, many medical oncologists will consider imaging during NAC or at the end of NAC to assess chemotherapy response and re-stage patients. Unfortunately, there is no consensus on the utilization or modality of this repeat imaging – and the interpretation of the anatomic information provided by CT scan or MRI is challenging post NAC because any hemorrhagic inflammation and necrosis can mimic a residual tumor. 

AUA 2018: Risk of Bone Fractures Following Urinary Intestinal Diversion: A Population-Based Study

San Francisco, CA (UroToday.com) Urinary diversion is an integral part of the management of muscle-invasive bladder cancer; often, the removal of the bladder is the less involved portion of the case. Urinary diversion comes in many forms, and while different segments of bowel can be used, ileum is used most often as it has been shown to have the least consequences from a post-operative metabolic standpoint. Even in patients with an incontinent ileal conduit, metabolic complications still occur – most often, metabolic acidosis. These metabolic changes can have theoretical implications for patient care, independent of cancer outcomes. One such theoretical risk is that of bone fractures due to calcium resorption, yet this has never been demonstrated – indeed, bone fractures may also occur due to disease progression instead.

AUA 2018: Predicting Chemo Sensitivity in Urothelial Malignancy: Nanotech and Precision Medicine

San Francisco, CA (UroToday.com) Chong-xian Pan, MD, a leading medical oncologist focused on bladder cancer, gave a State of the Art Lecture on his work. He focused on two areas: microdosing approach to identify chemoresistance prior to chemotherapy and cancer-specific nanoparticles to improve chemotherapy, photodynamic therapy, and immunotherapy.