AUA Annual Meeting Recap
June 19, 2014
What is the American Urological Association meeting all about?
The American Urological Association (AUA) held its annual meeting recently in Orlando, FL. It was a great opportunity to hear speakers from around the country (and even other countries) discuss the standard guidelines, changes, and new research in the urology field. This is done through lectures, live surgical videos, debates, and poster presentations on new research. The AUA puts out publications, holds conferences, and has several resources that keep urologists informed and up to date. While enjoying the beautiful weather in Orlando, I was also able to learn about the updates on some of the most common urology problems we encounter in our practice.
Cardiovascular risks and testosterone supplementation
Cardiac risks and testosterone treatment have recently become a hot topic, not only in the urology world, but we now are seeing it in the news, advertisements, and other media. Many of our patients also have questions and concerns regarding these risks. The AUA held a debate with both views of whether or not testosterone treatment is safe for the male patient with low testosterone. The main conclusions were that cardiovascular risk is dependent on underlying risk factors such as obesity, smoking, diet, family history, alcoholism, and age. It has also been determined that the paper arguing against testosterone supplementation did not have sufficient research or solid evidence making this claim. Testosterone is also protective against certain cardiac and metabolic diseases when at a normal level. In our practice, we keep patients on treatment within a normal testosterone range. Any hormone that is too high or too low will certainly have its risks and detrimental side effects.
Varicoceles are varicose veins in the scrotum. They are usually noticeable to the patient and also on ultrasound. Varicoceles not only cause discomfort, however can also impair fertility by affected temperature of the testicle and thereby sperm production. The latest research at AUA showed that surgical repair of varicocele can increase pregnancy rates with IUI (intrauterine insemination) and IVF (in vitro fertilization). On a semen analysis , there is an increase in sperm concentration, motility, and morphology. Some patients require sperm retrieval directly from the testicle, and the varicocele repair has also shown to increase those numbers.
Peyronie’s Disease is when scar tissue forms within the penis, and the penis curves a result of it. Until recently there have not been many effective options for treatment other than surgery. Xiaflex is an injectable treatment that slowly breaks up the plaque or scar tissue, and was recently approved for use in Peyronie’s Disease. This is an appropriate treatment option for patients who have been experiencing symptoms for at least 12-18 months and/or have at least a 30 degree or greater curvature. Patients that have a contracture of the palm (called Dupuytren’s Contracture) are at risk of Peyronie’s Disease also since both are connective tissue disorders. At Austin Urology Institute, we are in the process of receiving Xiaflex for administration for Peyronie’s Disease, which should be available soon. Please contact our clinic if you would like an evaluation or discuss this new treatment option. You can also visit www.peyroniesassociation.org for more information.
Overactive bladder affects mostly women, however some men may experience it as well. Typical symptoms include frequency, urgency, and leakage of urine. Keeping a bladder diary helps your provider to assess how severe your symptoms are and prescribe the appropriate treatment. It is advised to void with increasing intervals each week (1h → 1.5h → 2h, etc). Extended release tablets of certain medications are also preferentially used, with less side effects. Other treatment options, if medications fail, include Botox for the bladder. Botox is completed either in the office or operating room (with light sedation). We use a local anesthetic to numb the areas of injection and inject Botox to help relax the bladder muscle. As a results, patients have less frequency and urgency. Vaginal estrogen has also been proven to be effective against overactive bladder symptoms. This may be applied as a cream or a ring inserted into the vagina.
Prostate cancer, genetic testing
Thankfully there are a number of new genetic tests available that assess the aggressive nature of individual prostate cancers. These tests help us to determine what type of treatment would be appropriate. They are also very useful for patients who have already had prostate cancer treatment, and would like to know the risk of recurrence of the cancer. Some genetic tests look at how cells replicate (cell cycle progression), others evaluate specific tumor markers for prostate cancer, and some tests evaluate down to level of DNA and chromosomes that can activate or silence genes (DNA methylation). These tests are always used in correlation with the PSA blood test, patient’s health, and medical/family history. They do not decide treatment for us, however help the provider plan for future management and outcomes.
Benign Prostatic Hypertrophy (or prostate enlargement) is a natural occurrence in most men > 50 years of age. Many men will exhibit symptoms of BPH that include weak stream, pushing to urinate, incomplete emptying, increased frequency and urgency. Research has shown that these BPH symptoms can decrease by 25% by increasing your physical activity. This is recommended for patients both on and off medications. Some treatments relax the prostate, while others relax the bladder. Combination medications have been shown to decrease symptoms if you are both pushing to urinate, and go very frequently or urgently. There are also medications that may be used that actually shrink the prostate.
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