CUA 2018: The Opioid Epidemic and Testosterone Dysfunction – Current Challenges and a Future Roadmap for the Practicing Clinician

Halifax, Nova Scotia ( Hossein Sadeghi-Nejad, MD, from New Jersey provided a State-of-the-Art lecture at the CUA 2018 annual meeting discussing the opioid epidemic and its relation to testosterone dysfunction. Dr. Sadeghi-Nejad started with several important facts from the National Governor’s Association:

CUA 2018: The WATER Study Clinical Results: A Subgroup Analysis of Larger Prostates from the Phase 3, Blinded, Randomized Trial of Aquablation vs. Transurethral Resection of the Prostate

Halifax, Nova Scotia ( Benign prostate hyperplasia (BPH) is one of the most common diseases treated by urologists. While the introduction of medical therapy with alpha-blockers and 5-alpha reductase inhibitors in the 1990s significantly changed the management of BPH, there remains a large and important role of surgical intervention. Endoscopic resection via transurethral resection of the prostate (TURP) remains the gold standard for surgical treatment of BPH despite numerous other treatments being introduced over the past few decades. A newly introduced treatment option for BPH is aquablation.

CUA 2018: Do Common Urological Procedures Increase the Risk of an Infected Joint Prosthesis?

Halifax, Nova Scotia ( There has been concern of transient bacteremia during the course of urological procedures. Previously, on account of this concern, antibiotic prophylaxis was advocated for patients with structural heart disease and value replacements. However, guidelines have recently suggested that such prophylaxis is unnecessary. Similar concerns have also been raised regarding bacterial seeding of artificial joints. Notably, revision of knee and hip arthroplasty rates have been rising. In a podium presentation today at the Canadian Urologic Association Annual Meeting, Nahid Punjani, MD, and colleagues assessed the association between a prior cystoscopy or transurethral resection of the prostate (TURP) and the risk of infection of an infected total hip arthroplasty (THA) or total knee arthroplasty (TKA).

CUA 2018: The Early Canadian Experience with ATOMS for Post–Prostatectomy Incontinence

Halifax, Nova Scotia ( Urinary incontinence is a common and bothersome complication of radical prostatectomy in the treatment of prostate cancer. While many patients recover continence in the year following surgery, a significant proportion (likely approximately 5%) continue to have bothersome urinary incontinence. The artificial urinary sphincter has traditionally been considered the gold standard surgical intervention among these patients.

CUA 2018: Twenty-Two Year Population-Level Trends in the Surgical Management of Female Stress Urinary Incontinence in Ontario, Canada

Halifax, Nova Scotia ( Stress urinary incontinence (SUI) is one of the more common reasons why women may present to a urologist. Medications have, to date, proven ineffective in treating SUI, thus, surgery has remained the mainstay of management for women with bothersome symptoms. Historically, patients underwent relatively morbid operations requiring prolonged operations and hospital admission. However, in 1999, transvaginal sling (TVS) procedures were introduced in Canada and have since become the gold standard treatment. Complications associated with transvaginal mesh led to warnings from the U.S. Food and Drug Administration (FDA) and Health Canada in 2008 and 2010, respectively.

CUA 2018: A Pilot Randomized–Controlled Trial of the Urodynamic Efficacy of Mirabegron for Patients with Neurogenic Lower Urinary Tract Dysfunction

Halifax, Nova Scotia ( Mirabegron has been used for many years in patients with overactive bladder. In a podium presentation at the Canadian Urologic Association Annual Meeting, Blayne Welk, MD, and colleagues presented results of a randomized-controlled trial of this agent in patients with neurogenic lower urinary tract dysfunction.

CUA 2018: Efficacy and Tolerability of First-Line Abiraterone + Prednisone vs. Enzalutamide for Metastatic Castration-Resistant Prostate Cancer in Men ≥80 Years: A Retrospective Study

Halifax, Nova Scotia ( Abiraterone, and enzalutamide, both androgen-receptor axis targeted therapies (ARATs), have drastically changed the management of advanced prostate cancer, and are now routinely used in the setting of metastatic castration-resistant prostate cancer (mCRPC). However, as can be expected, they are not without their downsides – side effects vary between the agents, but in general, the adverse event profile is worse in elderly patients. 

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