Many thanks to Dr. Barry for his thoughtful capturing and sharing of these pearls during the virtual meeting on Oct. 24-29, 2020.

WSAUA 2020 Take-Aways – By John M. Barry, MD, Past President, 12/05/20

  • Virtual professional meetings are successful, but in-person meetings are better.
  • Precision oncology is coming of age.
  • The basic question for a tumor marker is “How does it improve patient care?”
  • BRCA2, PALB2, and ATM are associated with bad prostate cancers.
  • Circulating prostate cancer DNA had good concordance with that of metastatic tissue biopsies.
  • Martin Gleave looks like Brad Pitt.
  • LHRH agonist/antagonist dosing is often delayed, and castrate levels of testosterone are not maintained. Perhaps we should re-discover bilateral orchiectomies. Perhaps estrogen patches instead of LHRH agonists/antagonists injections should become a treatment option.
  • A low PSA + visceral metastatic disease predicts a poor response to androgen deprivation therapy for prostate cancer.
  • Radium-223 is effective treatment for patients with castrate-resistant prostate cancer who have symptomatic bone metastases.
  • Sensitivity to enfortumab vedotin (EV) is mediated by expression of NECTIN4, which is enriched in luminal subtypes of bladder cancer. It may prove to be a tumor marker that predicts response to EV.
  • The concept of the CAPRA Score has been applied to bladder cancer, and a Cancer of the Bladder Risk Assessment (COBRA) Score has been developed to estimate mortality in patients with urothelial carcinoma of the bladder after cystectomy. The COBRA Score included age, tumor stage, and lymph node density. It is being fine-tuned.
  • Virtual tumor boards will probably become the norm after the COVID pandemic.
  • Oncologists continue to count Charlson Comorbidities and call the total a “Charlson Comorbidity Index” which it is not. For example, simply being 71 years-old results in a Charlson Comorbidity Index (or Score) of 3, and CAD and COPD add two more points.
  • Mitomycin C gel is being used for treatment of upper tract urothelial cancers.
  • Percutaneous needle biopsy of cT1a renal masses before management assignment is becoming more widely accepted,
  • “Stone-free” seems to have a rather loose definition among endourologists.
  • If percutaneous nephrostomy tube placement results in pus, leave the tube and do the nephrostolithotomy at a later date.
  • Ureteroscopy pressure >30 mm Hg results in pyelovenous backflow. Avoid it. Why aren’t pressure monitors standard on ureteropyeloscopes?
  • Thulium laser + a 14 Fr access sheath is a good combination for PCNL.
  • The thulium fiber laser is gaining in popularity for both lithotripsy and BPH treatment.
  • Perhaps shockwave lithotripsy (SWL) is underused. For example, a lower pole stone + SWL + mechanical percussion + inversion can be quite effective.
  • The criteria for successful SWL seem to be <2cm stone diameter, <10cm skin-to-stone distance, and <1000 Hounsfield units.
  • Too bad the HM3 is no longer available.
  • Where is our urine dipstick for the urines of stone formers that includes the usual + calcium, citrate, oxalate, phosphate, uric acid, sodium, sulfates and whatever else we think important? Perhaps we could reduce or eliminate the need for the often less-than-accurate 24-hour urine collections.
  • Train emergency department and PCPs to send patients whom they suspect of passing a stone home with a strainer. If no strainer, they can substitute the toe of a woman’s nylon stocking.
  • For overactive bladder patients, adherence seems better with beta-3 agonists than with antimuscarinics because of fewer side effects, including cognitive impairment, with the former.
  • Let’s become familiar with the American Spinal Injury Association (ASIA) Score System (A = bad; E = normal).
  • Blood pressure monitoring is important because of silent autonomic dysreflexia (AD) in T6 or higher spinal cord injured patients. Botox can reduce silent AD.
  • What works for UTI prevention? Cranberry products, D-mannose, and probiotics all have proponents; the first two probably work. Post-menopausal women benefit from topical estrogen cream.
  • Shock wave therapy for ED is investigational. There seems to be no standardized protocol, and questionnaires, rather than nocturnal penile tumescence monitoring, are used as assessment tools.
  • Colored sutures help orient a surgeon when doing reconstructive procedures, like robotic urinary diversions and open end-to-end urethroplasties.
  • MiGuts is a clever acronym for a developing GU trauma tool.
  • Line drawings would enhance the videos of surgical procedures.
  • The Round Table is a great way to wrap up the meeting.
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