Innovative research, novel therapies take center stage this week

"It's an exciting year, with a lot of good presentations and interesting panel discussions," J. Brantley Thrasher, MD, chair of AUA's Public Media Committee, told members of the media at a briefing here yesterday, and to illustrate his point, he guided them on a whirlwind summary of the highlights of the 101st AUA annual meeting.

Incontinence and overactive bladder
"A few years ago, we were talking about how the use of genetic engineering and stem cells was 5 to 7 years out - and it's here now," Dr. Thrasher said.

He was referring to promising research on the use of stem cells to regenerate tissues in treating a number of urologic indications, among them, incontinence. See Monday's Daily Meeting Report for more on this research.

In addition, therapies for incontinence that drew considerable attention last year will do so again this year in terms of outcomes. Key presentations include an evaluation of the long-term efficacy of botulinum toxin injections in treating overactive bladder and complications attached to the use of sling surgery for pelvic prolapse and stress incontinence in older women. Other studies will explore the prevalence of overactive bladder and lower urinary tract symptoms in specific populations of older men.

Lifestyle and urologic disease
How do your patients' decisions about their lifestyle influence the development of urologic disease? Presentations range from the effect of dietary habits and drinking on prostate cancer development to the effects of cigarette smoking on sexual dysfunction and development of bladder cancer, and how environmental pollutants in water may affect urologic health.

Prostate cancer
The debate over watchful waiting versus immediate treatment with radical prostatectomy continues. A new study provides an argument for surgery in lowering cancer-related mortality. Prostatectomy also appears to offer excellent long-term cancer control, and the vast majority of biochemical recurrences occur within 10 years of surgery, research shows.

Positive surgical margins in prostatectomy patients are a slightly bigger problem in Europe than in North America, according to new data.

Surgeon experience, and more importantly, surgeon skill, are key factors in maintaining postoperative erectile function following radical prostatectomy, data suggest.

Long-term (16-year) outcomes for brachytherapy show interesting trends in the severity and persistency of side effects from this treatment approach.

Erectile dysfunction
Evidence continues to mount that ED is a predictor of cardiovascular disease. One study shows that ED is as important a risk factor for heart disease as smoking and a family history of myocardial infarction. Another group of researchers has found that ED is a sign of diffuse coronary and systemic atherosclerotic disease.

Does combining an alpha-blocker with a phosphodiesterase type-5 inhibitor improve both sexual dysfunction and lower urinary tract symptoms better than monotherapy? Look for researchers' answer in the Thursday edition of our Daily Meeting Report.

Tissue engineering has entered the realm of ED. Researchers have engineered corporal tissue from autologous cells and have attached the constructed corporal tissue in rabbits.

Whether treatment with PDE-5 inhibitors is a cause of nonarteritic anterior ischemic optic neuropathy has become a source of controversy. New data shed light on this current controversy.

Gene therapy may be a safe, effective approach to ED treatment, according to the authors of the first human gene trial for gene transfer therapy used to treat the condition.

BPH/LUTS
Results to date on the use of botulinum toxin (Botox) to treat BPH have been unconvincing, but new study results suggest that the treatment may be safe and effective.

Primary care physicians and urologists show some interesting differences in how they evaluate and treat BPH, according to data from a BPH registry.

Interstitial cystitis
Innovative research on the causes of interstitial cystitis assumes a prominent place in this year's program. What role do abusive and sexual relationships and nutritional choices play in the manifestation of IC in men and women? Does previous pelvic surgery predispose women to IC? Presentations will analyze the economics of treating IC and will examine the safety and efficacy of particular therapies (including hyperbaric oxygen) for it.

Kidney cancer

Are more people developing kidney cancer, or are diagnostic techniques catching more early-stage cases of the disease? Should small renal masses be treated immediately, or is surveillance the best medicine? How durable are the outcomes of cryotherapy in treating kidney cancer? Presenters will offer compelling answers to these questions and others, such as whether medications for controlling blood pressure protect some patients from developing renal masses and what effect transfusions during nephrectomies have on the immune system of patients.

Finally, welcome to the age of cybersurgery: Presenters will discuss their use of the Internet to enable expert surgeons to perform a nephrectomy with robotics at a site thousands of miles away.