AUA virtual meeting preview: BPH, stones, and incontinence

In this video, Urology Times® Co-Editor-in-Chief Gopal H. Badlani, MD, breaks down the key presentations and research in the areas of BPH, stone disease, and incontinence to be presented at the 2021 American Urological Association annual meeting. Badlani is professor and vice chair of urology at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.

The 2021 AUA annual meeting, much to my disappointment, was converted to a virtual-only meeting. This represents a lost opportunity to interact with colleagues in person, and it means that catching up with all the new research will have to be done on your own. On behalf of Urology Times®, let me make it a bit easier by sharing what I thought was interesting in the submitted abstracts as well as what I look forward to hearing during the plenary. I reviewed the podium presentations, posters, and late-breaking abstracts in the field of technology for treating benign prostate hyperplasia and managing lower urinary tract symptoms. I also looked at stone disease, voiding dysfunction, incontinence in women and men, as well as hot topics in benign urology.

In the plenary, there are 3 guideline presentations on benign disease. These include BPH/male LUTS, to be presented by Dr Lori Lerner; priapism; to be presented by Dr Trinity Bivalacqua; and male infertility, to be presented by Dr Peter Schlegel. There are a number of abstracts on the treatment of BPH-related symptoms and outcomes. These include sponsored multicenter trials with data collected by manufacturers. There are single-center or investigator-initiated data. What is new this year is the real-world perspective and/or retrospective pooled data about technologies.

Benign prostatic hyperplasia

Noteworthy abstracts from AUA 2021 in BPH can be found in moderated poster sessions 1 and 9, as well as podium sessions 18 and 23. Devices covered in this year's abstracts include the prostatic urethral lift, or UroLift, and Rezum, as well as the newer office-based removable devices iTind and the Optilume balloon. In addition, research will be presented on the new "Butterfly" and ZenFlow Spring System devices.

On the opposite spectrum are treatment strategies for large glands with traditional holmium laser being improved upon with MOSES technology or switching to a thulium laser fiber. Aquablation is evaluated in multiple abstracts regarding its long-term results and ways to reduce bleeding in large glands. Once again, the learning curve and efficiency, as with other techniques, were improved by a single center with a large-volume experience.

Of course, adverse events and posttreatment need for a catheter also play roles in patient satisfaction. But the biggest buzz phrase this year is "retreatment rate." "Retreatment" is ill defined as it can mean a second treatment, continued use, or need for medication. As treatments stretch their indications from the initial approval indication, the success rate drops. Examples of this include Rezum experience with large glands beyond 80 grams, and an abstract evaluating the prostatic urethral lift for radiated patients. Rezum was evaluated by an academic group, comparing prostates larger than 80 grams vs prostates smaller than 80 grams in an abstract in moderated poster session nine. Overall, the large glands required longer catheter duration and required more treatment. In the late-breaking abstracts, there was a comparison of UroLift, Rezum, TURP, and GreenLight that showed that Rezum had more complications and/or retreatment, compared with the other treatments. Of course, these are data assisted by a large-scale registry in the real world.

Aquablation and other BPH treatments were notable for duration of results in 3- and 4-year data presented by a multicenter study. There were also studies that showed minimized bleeding by use of cautery. In general, it was exciting to see technology keep evolving for the prostate, in terms of newer devices coming on the market, as well as a focus on office-based treatment.

Stone disease

Moving on to the field of stone disease, 1 highlight will be the John K. Lattimer Lecture from Dr Glenn Preminger titled, "Kidney stones: Is prevention possible?" "How can I prevent these stones?" is a question we hear frequently from patients. The information on the Urology Care Foundation website for this is quite invaluable. In fact, they have a recipe book to help prevent stones. I look forward to Dr Preminger's lecture on this.

There are many "semi live" procedures to highlight advances in endourology, which will be presented during the plenary. An abstract from Desai et al compares an indigenous disposable flexible ureteroscope made in India to one made in China. One exciting late-breaking abstract reported on a randomized controlled trial of ultrasonic propulsion to facilitate clearance of chronic residual fragments. The investigators were able to reposition fragments with external ultrasonic propulsion...to non-invasively facilitate the passage of stone fragments aligned in the distal ureter. They also had an abstract on the feasibility of this technology.

Incontinence

In the world of incontinence, unfortunately, the SUFU session at the AUA has been cancelled. The plenary highlights include a crossfire debate on the controversies in management of neurogenic bladder. Competing options include suprapubic cystotomy, onabotulinumtoxinA, and augmentation cystoplasty. The use of slings at the time of prolapse repair is another debate in the era of mesh controversy. A panel discussion on the nuances in selection of candidates for sacred neuromodulation will be good to watch. Among the abstracts, Dr Michael Chancellor has 2 studies of autologous muscle derived cells for urinary sphincter repair, or AMDC-USR, with comparison to placebo in women with stress incontinence. On the flip side, the use of regenerative pharmacology or so-called secretome by Damaser et al to achieve sphincteric continence in small animals replicates results shown in primates by investigators at Wake Forest. In the late-breaking plenary is a presentation by Dr Curtis Nickel, who shares a Canadian experience with a novel sublingual vaccine that will dramatically alter the clinical management of recurrent urinary tract infection in women. This is a huge clinical problem, and Dr Nickel shared the experience of using his sublingual vaccine spray MV140 to prevent recurrent UTI. This vaccine is apparently available in 18 countries, and it's something exciting to look forward to. Thank you.