AUA 2018

AUA 2018: Trends in Renal Surgery from the National Inpatient Sample: Implications for Resident Education

San Francisco, CA USA (UroToday.com) In accordance with the increased diagnosis of renal cancer in the past two decades, urologists have become more comfortable with minimally invasive surgery. However, there is yet no established impact of these observations on resident exposure and case mix. The objective of this study was to examine trends in utilization of open and minimally invasive approaches for radical and partial nephrectomies, in training and nonteaching institutions.

AUA 2018: Comparison of Two Digital, Single Use Flexible Ureterorenoscopes (Boston Scientific Lithovue And Pusen Pu3022) - A Prospective Study

San Francisco, CA USA (UroToday.com) The number and availability of single-use flexible ureteroscopes has currently been on the rise as more companies begin to develop scopes in this novel area. There have currently been no in vivo studies to compare the performance of different single use scopes. In lieu of this, Dr. Kam and colleagues sought to compare the Pusen single-use scope vs the LithoVue (Boston Scientific) single-use scope. The reusable Olympus URF-V2 was used as a standard for this comparison.

AUA 2018: Portable Digital Endoscopy Using Laptop Adaptor Device

San Francisco, CA USA (UroToday.com)  Brian Calio, MD presented his institution’s experience using a portable, digital ureteroscope that uses a laptop as its video monitoring system. As an introduction to his talk, Dr. Calio explained the importance of ureteroscopy in urology today. However, he also explained that ureteroscopy presents a financial obstacle to many countries. These high costs can exceed $30,000 and includes the cost of a reusable rigid and/or flexible scope. CCD/CMOS video camera with coupler, halogen light source, video recorder.

AUA 2018: 3D Printed Virtual Models for Planning and Counseling of Robot-assisted Radical Prostatectomy and Partial Nephrectomy

San Francisco, CA USA (UroToday.com) Riccardo Bertolo, MD, presented data on the use of 3D printed and Virtual models for planning and patient counseling for robot-assisted radical prostatectomy (RARP) and robot-assisted partial nephrectomy cases. As an introduction to his talk, Dr. Bertol stated that a surgeon may not have the right perception of the real anatomical details with the standard imaging and that Fluorescece-based imaging and image guidance have been explored, but their use remains under scrutiny.

AUA 2018: Radical Nephrectomy for Recurrent Renal Cell Carcinoma: Patient Selection for Laparoscopic Approach

San Francisco, CA USA (UroToday.com) Zachary Kozel, MD of the Arthur Smith Institute for Urology at Northwell Health presented a moderated poster of their experience with laparoscopic completion nephrectomy following locoregional renal cell carcinoma (RCC) recurrence.

AUA 2018: The Utility of Emergently Placed Interventional Radiology Nephrostomy Tube Tracts for Subsequent Percutaneous Nephrolithotomy

San Francisco, CA USA (UroToday.com) Patients undergoing percutaneous nephrolithotomies require optimal percutaneous access to remove kidney stones larger than 2 cm. The primary goal for this access is to safely drain urine, usually completed by interventional radiology. Dr. Kaitlan Cobb of George Washington University and her research team observed the efficiency of nephrostomy tubes placed by IR to obtain percutaneous access in acute settings.

AUA 2018: ELOC-Mutated Renal Cell Carcinoma: A Distinct Clinical Entity with Unclear Disease Course

San Francisco, CA USA (UroToday.com) Renzo DiNatale, MD, a urology research fellow at Memorial Sloan Cancer Center, presented on hotspot mutations in ELOC and the hypothesis of how clear-cell renal cell carcinomas (RCC) with certain mutations in the ELOC gene may have an indolent disease course. He began by noting that RCC frequently has many of the same genomic mutations, but some cases of RCC, does not show the mutations typically associated with clear cell (ccRCC) or papillary RCC and instead have variations within the ELOC gene.

AUA 2018: Active Surveillance of T1a Renal Masses: Results from National Cancer Database

San Francisco, CA USA (UroToday.com) Dave Jiang, MD, currently a second year resident at Oregon Health and Science University, presented data comparing results on the active surveillance (AS) and other intervention of T1a renal masses based on the National Cancer Database (NCDB). He focused on determining the contemporary use and results of AS in SRMs in the United States. He introduced T1a kidney cancer as a small renal mass (SRMs, ≤ 4 cm) in which 20% are benign. Active surveillance (AS) has been a management strategy since 2010 because such tumors have a low rate of metastases in the first 3 years (<5%).

AUA 2018: State-of-the-Art Lecture - Disparities in Urology: Renal Transplant

San Francisco, CA USA (UroToday.com) Charles S. Modlin, MD, from the Cleveland Clinic provided a video presentation on the disparities of renal transplants, focusing on the African American (AA) population group. He indicated that the incidence of end-stage renal disease is 4 times higher in AAs compared to European Americans (EU). The causes behind kidney failure are primarily due to hypertension and diabetes. The AA group has worse renal transplant outcomes compared to EAs and the causes for this disparity tends to be multifactorial.

AUA 2018: Crossfire: Controversies in Urology: Kidney Cancer

San Francisco, CA USA (UroToday.com) Ralph V. Clayman, MD opened the debate by proposing the use of thermal ablation in the case of a 62 year-old healthy man with a 3 cm posterolateral renal mass. This is of relevance as the rising use of computed tomography has lead to the increased discovery of renal masses of 3 cm of less.

First up in the debate was Dr. Jaime Landman, who argued for the “Pro” side of thermal ablation. Dr. Landman began by showing data on the sensitivity, specificity, and complication rates for renal, breast, lung, pancreas, thyroid, liver, and prostate biopsies. He argued that renal biopsies have a more favorable sensitivity, specificity, and complications profile than most other biopsies. Furthermore, Dr. Landman emphasized how 70% of renal masses biopsies reveal benign disease, not requiring surgical intervention.

AUA 2018: Tips and Tricks: Dissection of the Renal Mass with Hilar Fat Invasion

San Francisco, CA USA (UroToday.com) Monish Aron, MD, presented on the “enucleo-resection” of pT3a renal masses. Dr. Aron explained that pT3a renal masses are difficult to predict on pre-operative imaging and have the potential to lead to tumor violation and/or positive surgical margins with subsequent implications for prognosis.

AUA 2018: How Surgical Factors Influence Renal Functional Preservation in Healthy and "At-Risk" Kidneys after Partial Nephrectomy

San Francisco, CA USA (UroToday.com) Dr. Dagenais of the Cleveland Clinic presented a moderated poster of their study looking at the incidence and predictors of chronic kidney disease (CKD) upstaging after partial nephrectomy.

The authors retrospectively reviewed the charts of 778 patients from their single institutional database of patients who underwent partial nephrectomy. Of these patients, 634 had healthy, normal kidneys and 144 either had CKD or were at risk for developing CKD. “At risk” was defined as those patients with hypertension, diabetes, and/or a smoking history. Upstaging of CKD was determined using the estimated glomerular filtration rate (eGFR) calculated using the MDRD equation and postoperative creatinine values between 3 to 12 months.

AUA 2018: Holmium Laser Lithotripsy for Ureteral and Renal Stones: Is Dusting Equivalent to Fragmenting?

San Francisco, CA USA (UroToday.com) Dr. Thomas Knoll, from University of Tuebingen, presented research comparing two commonly used holmium laser lithotripsy settings for ureteroscopic stone treatment. The variables of frequency, energy, pulse length and shape impact the laser’s effect on the stone and therefore the outcomes of dusting and fragmentation. As ureteroscopy has become the primary treatment of choice for upper tract stones, this prospective study of 177 patients aimed to determine the optimum laser settings to improve stone management.

AUA 2018: 3-Dimensional, Virtual Reality Planning for Robotic Partial Nephrectomy

San Francisco, CA USA (UroToday.com) Dr. Joseph Shirk from UCLA Medical Center presented data on using 3-dimensional, virtual reality models of patient-specific anatomy to plan for patients undergoing robotic partial nephrectomy. He foremost introduced that surgeons have mainly been using 2-dimensional CT or MRI images for the initial planning of complex surgeries such as the robotic partial nephrectomy. Contarily, he also found that previous optical and neuroscience research associated accuracy of memory with the encounter of 3-dimensional objects.

AUA 2018: Panel Discussion: Catheter-Associated UTIs

San Francisco, CA USA (UroToday.com) Brian S. Schwartz, MD (UCSF) moderated the Plenary session on “Catheter-Associated UTIs” with Dr. Tomas Griebling (University of Kansas), Dr. Timothy Averch (University of Pittsburg), and Dr. Ben Chew (University of British Columbia) as the panelists.

Dr. Averch started off the discussion by defining the scope of the problem. The incidence of catheter associated urinary tract infections (CAUTIs) was 9.4 per 1000 catheterizations in 2001. This led to 13,000 attributable deaths/year, excess length of stay and increased costs. In 2008, the Center for Medicare & Medicaid Services made it a never event and no longer provided reimbursement for hospital acquired CAUTIs. Following this the CAUTI rate dropped to 5.3 cases in 2010. Risk factors for CAUTIs are female gender, emergency hospital admission, transfer patients and Medicare patients.

AUA 2018: Distribution of M0 Renal Cell Carcinoma Metastases Stratified by Pathologic Nodal Status

San Francisco, CA USA (UroToday.com) David Y Yang, from the Mayo Clinic, Rochester, MN presented an evaluation of the timing and anatomic distribution of first metastasis in treated RCC patients stratified by nodal status. Yang began by identifying that brain metastases are frequently diagnosed among patients with renal cell carcinoma (RCC) and are associated with a poor prognosis. These patients have historically been excluded from clinical trials and aggressive treatment regimens. There are limited guidelines on screening and surveillance for brain involvement.

AUA 2018: Comparison of Robotic and Open Techniques in Patients Undergoing Radical Nephrectomy and Level II Inferior Vena Cava Thrombectomy

San Francisco, CA USA (UroToday.com) Alp Tuna Beksac from the Icahn School of Medicine at Mount Sinai, New York, NY, presented an evaluation of the safety and feasibility of robot assisted laparoscopic radical nephrectomy for patients with clinical T3 renal masses, level II IVC thrombus. As an introduction to his talk, Beksac stated that inferior vena cava (IVC) thrombectomy is a technically challenging procedure that is a relative indication for open surgery.

AUA 2018: Perioperative Outcomes of Flexible Ureteroscopy for Urolithiasis using the Sheathless Technique: A Comparative Study

Dr. Benjamin Pradere, the Chief of Clinic at Chru Hôpitaux De Tours, presented on the perioperative outcomes using a sheathless method for flexible ureteroscopy (fURS). As a result of advancing capabilities of flexible ureteroscopes, the interest in sheathless and wireless approaches to fURS has increased. The author opened by explaining current literature that correlates ureteral access sheaths (UAS) deployment to a possible increase ureteral damage and ureteral lesions formation during standard fURS.

AUA 2018: Carcinomas Of The Renal Medulla: A Comprehensive Genomic Profiling (Cgp) Study

San Francisco, CA USA (UroToday.com) Stephanie Gleicher, MD, urology resident at the State University of New York Upstate Medical University, presented on the genomic profiling (Cgp) of renal medullar carcinoma (RMC) and collecting duct carcinoma (CDC). The author opened by describing RMC and CDC as being extremely rare but aggressive subtypes of renal cancer, making up less than 1% of renal cancer cases, but also being associate with high probability of metastasis. Current treatment guidelines of both RMC and CDC are primarily chemotherapy, while preforming a debunking nephrectomy in conjunction to chemotherapy has shown to increase survival rates.

AUA 2018: Effect of Ketogenic Diet on the Clear Cell Renal Cell Carcinoma Cell Growth

San Francisco, CA USA (UroToday.com) In recent years, lifestyle intervention via diet and exercise has become an increasingly popular prevention and therapy mechanism for patients suffering from diseases known to be exacerbated by metabolic syndromes. In this regard, clear cell renal cell carcinoma (ccRCC) has been of no exception.
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