CUA 2018: Assessing the Relationship Between Obstructive Sleep Apnea and Stone Disease

Halifax, Nova Scotia ( Obstructive sleep apnea (OSA) is an important clinical problem in the chronic kidney disease population. OSA is associated with induction of hypoxemia and sleep fragmentation, which activates the patient's sympathetic nervous system, the renin-angiotensin-aldosterone system, changes cardiovascular hemodynamics, and results in a free radical generation. This, in turn, causes a variety of inflammatory processes, platelet aggregation, atherosclerosis, predisposing patients to metabolic syndrome and abnormalities.

CUA 2018: Metabolic Evaluation Guidelines in Patients With Nephrolithiasis: Are They Being Followed? Results of a National, Multi-Institutional Quality Assessment Study

Halifax, Nova Scotia ( As Naeem Bhojani, MD, opened his presentation, he began by discussing the current state of kidney stone disease and how its morbidity, recurrent nature, and the significant cost is a burden to society. Therefore, he stressed that clinical endourologist focus more heavily on kidney stone prevention rather than treatment. Bhojani reminded the audience in regard to the AUA’s guidelines and how it recommended metabolic evaluation for high-risk stone formers as well as interested stone formers. Though this is highly recommended, these procedures are seldom carried out. Therefore, Bhojani and his team at the University of Montreal set out to determine the efficacy of metabolic evaluation prescription patterns in stone formers and to assess the patient’s understanding of the disease and their willingness to diet to prevent recurrence. 

CUA 2018: Are Lead Glasses Necessary? A Prospective, Multicentre Cohort Study on Radiation Exposure to the Operator’s Eyes During Urological Surgery

Halifax, Nova Scotia ( Through several urologic surgeries, there is a very high demand for fluoroscopy during the procedure. Though it is invaluable in identifying anatomical structures in real time, this aberrant ionizing radiation could cause significant detriment to the surgeon, particularly in their eyes. It has been shown that lens radiation is sufficient to cause cataracts. Additionally, few urologists use X-ray protective eyewear and the risk to urologists is incompletely known.

CUA 2018: Medical Expulsive Therapy in Pregnancy: A Retrospective Study

Halifax, Nova Scotia ( The management of urolithiasis during pregnancy is a challenge. The use of medical expulsive therapy (MET) is increasingly common in the symptomatic management of urolithiasis. The use of MET during pregnancy is very controversial due to lack of safety and efficacy data. When pregnant women are presented with renal colic, selection of management strategy is dependent on the trimester. Common and first line recommendation is active observation. With proper management of pain symptoms, observation is a viable option to let the stone pass without any further intervention. In these cases, MET can hypothetically facilitate and improve the stone passage. 

CUA 2018: What Every Urologist Should Know About Neurogenic Bladder

Halifax, Nova Scotia ( Anne Pelletier-Cameron, MD, provided a State-of-the-Art lecture at CUA 2018, discussing what every urologist should know about neurogenic bladder. Dr. Pelletier-Cameron notes that her top 5 lists for every patient with neurogenic bladder is:
  1. Keep the patient safe (protect the kidneys) and dry
  2. Manage their catheters
  3. Know when not to panic
  4. Keep the patient infection free
  5. Know when to “throw in the towel”

CUA 2018: Integrating Immune-Oncology with the Current Treatment of Advanced Urothelial Carcinoma

Halifax, Nova Scotia ( As part of the CUA 2018 education forum, Bobby Shayegan, MD, served as moderator for the immunotherapy in urothelial carcinoma session. Shayegan started by noting that bladder cancer therapies have historically lagged behind other malignancies, until the advent of immunotherapy. Secondary to bladder cancer’s somatic mutational burden, immunotherapy is attractive for bladder cancer and has been one of the first significant advancements regarding systemic therapy in several decades.

CUA 2018: Canadian Urology Workforce Study — The Graduating Cohort of 2014–2016

Halifax, Nova Scotia ( For many years, and across many surgical specialties, there has been the perception among medical students, residents, and in fact the general public that it is difficult for newly trained surgeons to find employment in Canada. This has led some to conclude that residency programs are training too many surgical residents. Urology is not immune to these perceptions.

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