Five Sessions to See at #AUA2019

The American Urological Association (AUA) is hosting its Annual Meeting in Chicago, IL from May 3-6, 2019. Specialists from the Massachusetts General Hospital Department of Urology will present on leading research and innovative treatment approaches. Mass General doctors will participate in sessions covering the full spectrum of urologic care, including bladder, prostate, urologic oncology and more.

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Here are five highlights from this year’s meeting:

0615C: Prostate Cancer Update

Douglas M. Dahl, MD

Sunday, May 5, 4-6:00 pm | WEST: W183c

This course will offer a review of what faculty believe are the most important articles in the English-speaking literature on prostate cancer from May 2018 to May 2019. Focus will be placed on articles that have relevance to clinical practice, including both research and clinical articles.

005IC: Urolithiasis: Metabolic Evaluation & Medical Treatment

Brian Eisner, MD      

Friday, May 3, 7:30-9:30 am | MCP: W186abc

This course will review the pathophysiology of stone disease in order to understand the metabolic and environmental risk factors that lead to stone formation. Additionally, it will guide the practitioner in obtaining a pertinent and directed medical history relating to stone disease that will facilitate identification of high risk patients who warrant metabolic evaluation. The role of diet in stone prevention will be reviewed. Finally, this course will offer a simplified diagnostic protocol and treatment algorithm, consisting of dietary measures and medication, for the prevention of recurrent stones.

051IC: Opioid-Sparing Analgesia for Enhanced Recovery After Urological Surgery

Francis McGovern, MD

Sunday, May 5, 7:30-9:30 am | MCP: W187a

Traditionally, opioids are used perioperatively for the prevention and treatment of pain. However, opioid analgesics are often limited by opioid-related adverse events, including nausea and vomiting, sedation, respiratory depression, ileus, urinary retention and pruritus. Additionally, the early prescription of opioids postoperatively is associated with chronic opioid use. Up to 8.2% of opioid naive, adult patients who have surgery may become chronic opioid users. Thus, reducing patient exposure to opioids should be imperative for all physicians. The authors of one study conclude, “Long-term postoperative analgesic use may best be addressed by preventing its initiation.” When less opioid analgesics are used perioperatively, opioid-related adverse events and recovery time both decrease. However, it can be challenging to provide good pain control with minimal use of opioids. Over this two hour instructional course, we will outline strategies to provide exceptional perioperative pain control while dramatically reducing perioperative opioid use. These methods include regional anesthesia techniques as well as preoperative, intraoperative and postoperative non-opioid medications in order to decrease postoperative pain, reduce opioid use, hasten recovery and improve patient safety.

014IC: Trimodality Therapy for Management of Muscle-invasive Bladder Cancer

Adam Feldman, MD, MPH   

Friday, May 3, 1:30-3:30 pm | MCP: W187a

This course is a comprehensive review of trimodal therapy for muscularis propria invasive urothelial carcinoma of the bladder with a multidisciplinary faculty including urology, radiation oncology and medical oncology. The course will focus on the urologist’s critical role in patient selection for this approach vs. radical cystectomy. We will discuss the technique and importance of aggressive transurethral resection and repeat resection prior to proceeding to chemotherapy and radiation, as well as the continued role of the urologist in repeat cystoscopic assessments of tumor response and ongoing surveillance of the bladder. We will review the coordinated multidisciplinary approach for bladder preservation, including radiation fields, role of concurrent chemotherapy, need for early salvage cystectomy when indicated and management of non-muscle invasive recurrences. We will review potential toxicities and quality of life associated with bladder sparing therapy versus cystectomy, and will address emerging topics such as novel biomarkers and the potential role of combining radiation with immunotherapy and other targeted therapies.

029IC: Surgical Approach to the Management of Post-prostatectomy Incontinence - Initial and Revision Procedures

Ajay Singla, MD, FACS, FRCS

Saturday, May 4, 7:30-9:30 am | MCP: W186abc

There are currently no approved guidelines regarding the management of post-prostatectomy urinary incontinence. However, given the increased use of robotic assisted laparoscopic radical prostatectomy, the prevalence of post-prostatectomy incontinence continues to rise. We propose an evidence-based course that recommends a logical and straightforward evaluation of the incontinent male, including history, physical examination, radiographic evaluation and urodynamic testing. Once the pathophysiology is determined, then the patient and urologist can arrive at a treatment plan that may include physical therapy, pharmacotherapy and/or surgery. When conservative management fails, depending on the bladder and outlet function and dysfunction, the urologist can offer surgical intervention. There are a plethora of surgical devices, including a variety of male slings and the artificial sphincter, each with their own advantages and disadvantages. We will give an evidence-based recommendation regarding the ideal evaluation and best surgical options for a particular type of patient, based on bladder activity (detrusor overactivity versus stable, normal versus weak contractility), sphincteric function (mobile versus fixed, present versus absent residual sphincter function) and urethral integrity (radiated versus non-radiated). We will give a case-based discussion regarding best practices, trouble-shooting postoperative complications, managing persistent or recurrent incontinence and indications for and techniques for surgical re-intervention.

 Teaching techniques will include didactic lectures, surgical videos, and display of various devices.

Learn more about the Mass General Department of Urology

Contact the Mass General Department of Urology