Tag Archive for: AUA

Posts

#AUA15 bursts to life in New Orleans

CaptureCreole cuisine, bustling Bourbon street, beads and beignets and 16,000 urologists.  #AUA15 has just drawn to a close in the birthplace of Jazz; New Orleans, Louisiana #NOLA. With 2,598 abstracts being presented, over 2,500 speakers and representation from more than 100 countries it was undoubtedly an educational and action packed five days.

This was my first AUA and while I knew it was going to be a big conference I was stunned by the size of it all. There were urologists everywhere, so much so that jiving to jazz on Frenchman became a game of ‘spot the urologist’ by the signature urology dance moves and stylish….ish dress code!!!! The scientific programme was so extensive it was difficult to find the time to attend all the sessions I wanted to. However, the committee deserve huge credit for developing the AUA2015 app and Daily news snippets that were available throughout the centre which made it easy to optimise your time at the meeting.

AUA 15 1AUA 15 2

 

 

 

 

 

 

The French Quarter, NOLA

The conference got off to a heated beginning with the Crossfire: Controversies in Urology session sparking plenty of debate. Few topics have ignited as much argument as the question of focal ablation for prostate cancer and the discussion between Mark Emberton MD, UCL, London and Aaron E. Katz, MD,PhD, Winthrop University Hospital was no different. To call it a lively session is an understatement. The question of alpha blockers being sold over the counter for BPH was also discussed during this session. Although the drugs have proven safe over the last 25 years clinicians have concerns that the loss of patient contact as a result of this relabeling would causes a loss of control in the treatment of men with BPH.

Friday drew to a close with the urotwitterati enjoying the social media TweetUp encouraging newbie tweeters to get involved. It clearly worked because #AUA15 set a new record and almost trebled it’s tweeting volume since #AUA13.

Day two, Saturday saw the opening of the Science and Technology hall. A spectacle of testicular, penile devices and stalls I have never seen. I fear what one might have thought had they stumbled into the conference centre by accident!!

AUA 15 3AUA 15 4

AUA 15 5

 

 

 

 

 

 

 

 

 

 

 

 

The @BJUIJournal #SoMe awards took place on Saturday evening. @DrHWoo deservedly bagged The Social Media Award 2015 for #UROJC. A well chosen venue there were no issues with Wifi for tweeting!!! Read the #SoMe blog for all award details

AUA 15 6

Enjoying the @BJUIjournal cult #SoMe awards

AUA 15 7AUA 15 8AUA 15 9

 

 

 

 

 

 

 

 

 

 

A personal favourite of mine at the conference was the 4th annual Residents Bowl which took place over three days; with residents engaging in a battle of the brains! Northeastern claimed the trophy in the end and team members on the winning side included this year’s BAUS representative @DerekHennessey.

BAUS, BJUI and USANZ came together on Sunday afternoon for a stellar line-up of speakers and topics. The session was well attended and speakers outlined the most recent data but more importantly shared the experience of techniques and outcomes in their centres and countries. I think this combined society session is a fantastic arena for all to both learn and educate each other on what is working best, where and why? The superb line up included Dan Moon, Jeremy Grummet, Henry Woo, Declan Murphy, David Nicol, Damien Bolton, Stephen Boorjian and Philip D. Stricker who all shared their clinical expertise.
BJUI Guest speaker Ben Challacombe discussed the evidence base for management of RCC by partial nephrectomy. Lower intraoperative complications and WIT were observed at their centre at Guy’s Hospital London, which is similarly reflected by low complication rates in the BAUS mandatory UK national nephrectomy audit. Professor Prokar Dasgupta started his up and down journey for the evidence supporting robotic cystectomy for TCC bladder by reminiscing on where it all began; kite-flying in India as a young boy.

AUA 15 10

AUA 15 11

Much anticipated CORAL trial found that 90 day complication rates and oncological control were comparable in ORC v LRC/RARC.

AUA 15 12

Finally the session closed with the presentation of the Coffey-Krane award to Gopa Iyer; Phase III Study of  everolimus in metastatic urothelial cancer collected on Dr Gopa’s behalf by David Quinlan. This award is for trainees who are based in the Americas and judged by a panel as the best publication accepted to the BJUI.

 

Overall, some of the big points of the conference were the amendments to AUA guidelines including Castration-Resistant Prostate Cancer, which was updated from just last year. Perhaps, the most significant was the first ever draft of AUA Peyronie’s disease guidelines; outlining recommendations from medical therapy to surgery.

The huge rise in social media at urology conferences was demonstrated again by record-breaking figures via @symplur showing that the use of Twitter among the urology community continues to grow:

AUA 15 13AUA 15 14

 

#AUA15 was both an educational and social experience. I had a blast, learned loads and also got to experience the culinary delights of Muffuletta and Gumbo, take the trolley up St. Charles to the Garden district and simply encounter the warmth and friendliness of both the Louisiana folk and the huge family of Urology. The AUA Scientific Committee deserve a huge congratulations on the success of a stimulating, enjoyable and extensive scientific programme. I know I heard echoes of ‘best AUA yet’ in my company.

Áine Goggins

Medical Student; Queens University Belfast, Ireland

@gogsains

 

Guideline of Guidelines Poll Results

The recently published ‘guideline of guidelines’ attempts to bring together conflicting guidance from different authorities. But overall how often do you refer to AUA, EAU or other national urological guidelines in clinical practice?

At least weekly – 23%

At least once a month – 27%

Every 2-3 months – 15%

Less than 3 monthly – 23%

Never – 12 %

 

5 Questions with Per-Anders Abrahamsson and Gopal Badlani

Secretary Generals to the big Spring Meetings, European Association of Urology and the American Urological Association

Every Spring, thousands of urologists gather in big cities with mega-venues to attend one or both of the annual congresses of the EAU and the AUA. These are big events with respect to release of the latest scientific trials, instructional courses, plenary sessions, and of course multiple ways to see and interact with advances in industry partners. But who orchestrates these massive events occurring over multiple days? Of course it requires a full team of expert staff members, and in both groups, they employ an outstanding Urologist to a multi-year contract to serve as secretary and be a principle organizer of the annual meeting. We asked each secretary general to share their perspectives with 5 questions.

Gopal Badlani–Secretary to the AUA 2011-2015. The New Orleans AUA will be Prof. Badlani’s last as AUA and will certainly be an exciting meeting and fitting celebration to an excellent term of service and creative updates to the annual meeting.

1) What excites you about your meeting format and location?

PAA:  Stockholm of course is a major draw, but we don’t know if it will be Spring or Winter at the time. Forty percent of our draw is from beyond Europe—Latin America, China, and India. We know that Stockholm is an exotic city worth the trip, but hopefully they find the meeting and the quality of education worth the trip. Stockholm is recognized as one of the best venues, and our office staff knows venues across Europe. The problem here is that the Swedish economy is booming and its one of the most expensive cities in the world. We were able to downsize the hotel prices, but its very expensive. In addition, Pharma support for attendees has dropped from 80% to 60%. The weather has been rather decent.

GB:  We changed our format this year to incorporate Friday as the first official day of the AUA Annual Meeting, showcasing a full day of research programs and a highly successful Crossfires: Controversies in Urology program. It certainly generated “buzz” and continued discussions surrounding such controversies throughout the meeting.

 

2) What about high impact studies being presented?

PAA:  One coming up is the PREVAIL study with Enzalutamide “Pre-chemo”. We also have our own Swedish national cancer registry and there are some data coming out favoring early treatment of prostate cancer. This is one of the oldest in the world. Peter Wiklund will present this. Another that will be updated Tuesday is the European randomized screening trial. The principal investigator after Fritz Schroeder is Jonas Hugosson from Gothenberg. He got permission from Lancet to update the Swedish arm of that trial. You will find differences between centers and there will be an update with longer follow-up.

GB:  Our plenary sessions highlighted late-breaking news, new AUA clinical guidelines and the latest advances in urologic medicine. It was in this forum, we heard from Dr. Anthony Fauci on ending the HIV/AIDS pandemic and its lifecycle from scientific advances to public health implementation.

It was also where attendees heard from Dr. Ajay Nangia about the adverse effects of common medications on male fertility to outstanding sessions on benign disease, the challenges in managing spinal cord injury patients with neurogenic bladder as well as mesh use for urinary incontinence (Drs. Flynn and Rovner).

Our International Prostate Forum more than tripled anticipated attendance. Dr. Andrew Schally, a recipient of the Nobel Prize in Medicine, as well as a number of experts from around the world, provided global perspectives on prostate cancer.

Eight debates on today’s hottest topics in urology were showcased through our standing-room only Crossfire-Controversies in Urology event. Our Town Hall transported attendees into the future of simulated surgical training and imaging. This session included presentations from experts and pioneers in 3D and molecular imaging as well as surgical simulation.      

 

3) What are key metrics of the meeting?

PAA:  We have 120 countries represented. Registration is about 700 off from Milan last year, but are pleased overall given the expense noted, and sponsorship from Pharma continues to decrease.

GB:  Our meeting continues to attract over 15,000 attendees from over 120 countries. More than 2,200 abstracts were presented and more than 2,500 speakers. 

 

4) What are key trends important to Urologists attending your meeting? Why do they attend?

PAA: There is a need for meetings like this for people to meet and to start up multi-institutional trials, even trans-Atlantic. We hope to facilitate translational research. For example, we facilitated the first ever World Chinese meeting—Taiwan, Hong Kong, and Mainland—all together, and very difficult to organize from a political viewpoint. We were very pleased with this and left politics aside. 

GB:  There are a number of major concerns affecting American urologists, including issues affecting fair and appropriate payment (e.g., the sustainable growth rate, or SGR, the formula which is used to set Medicare payments for U.S. physicians), certain provisions under the Affordable Care Act (such as the 90-day grace period for recipients of advanced payments in the large group health insurance market places) and the impact that unfunded mandates such as prior authorizations, required accreditations, etc., have on our practices. All of these issues are compounded by the fact that our U.S. physician workforce is shrinking and, unless significant steps are taken to fundamentally reform graduate medical education, the country will have an insufficient supply of physicians to adequately meet patients’ needs in a timely manner. This shortage is of specific note to urology, since we have the second-oldest surgical subspecialty workforce, and limits on funding for urology residency programs make it extremely difficult to get more medical students into urology residencies.

 

5) What are your impressions of the venue and city?

PAA:  Honestly I was not involved in that decision-making. We have 70 people working full time in our office in Holland. We had our own congress consultants working, looking at new venues. We have mainly concentrated our annual congress to limited venues—Madrid, Barcelona, Paris, Vienna, Milan, London in the future, and in Germany Munich and Berlin. Scandinavia so far its only been Stockholm as we can take care of 15,000 people here and we have a good congress venue. In the future it will be Copenhagen as they have a new congress venue that is closer to Europe. So we are going to rotate between these venues. We have not been able to find a venue in Eastern Europe that accommodates that many people.

GB: We enjoyed being in sunny, warm Orlando in May. Orlando has a good mix of hotels to offer to our attendees – from an impressive full service Ritz Carlton to a few lower cost options such as the Days Inn and Marriott Courtyard. Overall, I think the Orlando Convention Center worked well for us. Looking forward, the excitement is in the air surrounding next year’s location, New Orleans May 15-20, 2015. Program planning begins this summer! 

 

So there you have it. While most of us run around these meetings trying to figure out which session suits our interest, or where we have to moderate/speak next, the secretaries have a very different perspective. They worry about meeting formats, costs, weather, who will show up, what will they think. I was also impressed that while most of us tend to network on the fly by just walking around the venue and bumping into colleagues, the secretaries have very tight schedules run by their staff. I appreciate the time both gave to us. Note that the answers may flow differently as Per-Anders did a sit down interview with an iPhone recorder running, while Gopal gave me typed answers after the meeting. 

Thank you to both secretaries on strong annual congresses.

John W. Davis, MD, FACS
Associate Editor, BJUI

 

AUA 2014 – Monday, Tuesday, Wednesday: “The Tweeter’s Congress”

Thanks to @rmehrazin and @uroncdoc for a great summary of the first three days of #AUA14. This year’s meeting has been a phenomenal success, especially with regards to Twitter use during the Congress and the dissemination of content surrounding the meeting. You know how it goes – ‘sorry I can’t catch your session because I have to be somewhere else’. Well not anymore. Keep the #AUA14 search feed on your Twitter app, and the stream of information on posters/podiums or plenary was tremendous! One could be at multiple sessions at the same time. Indeed, Twitter use compared to last year’s meeting has increased by over 100%. Just as Tony Blair coined the term ‘the people’s Princess’ for Princess Diana – I am calling #AUA14 ‘the Tweeter’s congress’. In honour of that, I have created ‘Twitter-grams’ around themes. As the conference has too much to cover, I will concentrate on the big plenary sessions.

Twitter-gram 2: PCNL

Further plenary included the EAU lecture by Mr Marcus Drake on the management of LUTS. He announced the protocol of a European RCT enrolling 800 patients assessing invasive urodynamics versus noninvasive tests in men undergoing surgery for bladder outlet obstruction. This was followed by Dr Quentin Clemens, from @umichurology and Chair of the multidisciplinary approach to the study of chronic pelvic pain (MAPP) network. The objectives of this impressive multi-institutional study are to address underlying disease pathophysiology and natural history utilizing patient cohorts, biospecimens and animal models, as well as provide new information to inform patient management and future clinical trial design. More details can be found here.

The plenary then wrapped up with a discussion of the new AUA guidelines from Dr Morey on urotrauma and Dr Pearle on medical management of stone disease. Both can be viewed here:

Urotrauma
Medical management of kidney stones

Some important points from the urotrauma guidelines:

  1. Imaging is necessary – immediate and delayed
  2. Indications for renal trauma imaging include gross hematuria, microscopic hematuria and systolic blood pressure <90, or mechanism of injury suggest high index of suspicion.
  3. Stable patients be managed non-invasively
  4. For renal injuries Grade 4 or greater – follow-up imaging is advised
  5. For ureteral trauma, immediate repair is indicated if complete injury and recognized in the operating room
  6. In unstable patients, ureteral trauma can be managed with temporary urinary drainage
  7. In presence of gross hematuria and pelvic fracture – patient must have cystography

Some important points from the medical management guidelines:

  1. Thiazides are indicated in patients with recurrent calcium stones and hypercalciuria
  2. Potassium-citrate therapy should be offered to patients with hypocitraturia and recurrent calcium stones
  3. In patients with recurrent calcium stones and absence of metabolic abnormalities, both thiazides and potassium citrate should be offered
  4. Allopurinol should be prescribed to patients with recurrent calcium stones elevated urinary uric acid and normal urinary calcium. It should not routinely be prescribed as first line therapy for patients with uric acid stones
  5. In terms of follow-up, a 24 hour urine collection should be performed within 6 months of initiating treatment and at least annually thereafter

Monday – Townhall session

The ‘townhall’ session this year contained urology and non-urology experts who were questioned by the audience via text messages (but not Twitter! @AmerUrological). This session was moderated by Dr Inderbir Gill, and included experts from Hollywood on 3D imaging, a neuroscientist, molecular imaging scientists and surgical simulation pioneers. The session began with a talk on tissue level imaging in 3D, followed by Dr Tewari (@nycrobotics) introducing us to his research on visualizing nerves during robot-assisted radical prostatectomy. Dr Narula, Editor of the Journal of Cardiovascular Imaging, then gave a fascinating talk on “Who gets the Heart Attack? Imaging from Bench to Bedside and from Mummies to Population”. At the end of his talk, I had a strong urge to get my cholesterol checked as well as demand a CT angiogram. The simulation debate was entitled – “The giants of the past don’t need no stinkin’ simulators” – and was between Dr Carl Olsson (Against simulation) and Dr Robert Sweet (For). Dr Olsson was the man with all the right jokes, while Dr Sweet’s slides malfunctioned; although it was clear to the audience that in this era of reduced hours training, simulated surgical training is becoming the norm. Finally, only at the AUA meeting can you get the team behind 3D rendering for Hollywood provide an insight into the methodology of rendering. We all put on 3D glasses and watched a short clip of the film “Need for speed” in glorious 3D.

Tuesday – plenary

The morning began with a panel discussion between some very well known urologists on robotic vs. open robotic cystectomy. First on, Dr Hautmann argued against robotic cystectomy: “Optimal function was more important than the length of the incision or time to flatus”. He also argued there was a selection bias in robotic series, with healthier patients tending to be selected for robotic surgery. He closed by quoting Einstein: “make things as simple as possible but not simpler than that”.

Next was Dr Pruthi, an expert on robotic cystectomy. He felt the benefit of a robotic intracorporeal diversion was fewer GI complications, readmissions, and the potential to reduce ureteral stricture because of less ureteral mobilization with the robotic approach. While the ileal conduit robotically was simple and straightforward, he admitted he was unsure of robotic neobladders as this was more complex. The session closed with a frank statement by Dr Jay Smith, “It is unlikely any substantial difference in outcome will emerge between robotic vs open cystectomy”. However, he felt robotics was here to stay, as it was doubtful if the next generation of urologists would have the skills to obtain high-level open cystectomy results.

The plenary then resumed with the theme on PSA testing, and started with a panel discussion on tests to distinguish aggressive from non-aggressive prostate cancer before biopsy. Dr John Wei (@jtwei88) from @umichurology, spoke about the Michigan Prostate Score (MiPS) – a composite score consisting of three tests: PSA, urine T2:ERG gene fusion, and urine PCA3 level. Later on, to a jam jam-packed hall, Dr Penson (@urogeek), from Vanderbilt, delivered a state-of-the-art lecture on PSA testing guidelines. This excellent talk generated lots of Twitter traffic, which is illustrated in the Twitter-gram.

Wednesday – take home messages and wrap-up

The final day was not as busy as the other days as most delegates and all exhibitors had left. I too had to get back to work, but I was still able to catch up with #AUA14 via the twittersphere (thanks @chrisfilson). The best of the tweets from this last day are depicted in the final twitter-gram. I also recommend @cbayneMD for his top 5 conference highlights.

[caption id=”attachment_15430″ align=”alignnone” width=”1024′ label=’ Twitter-gram 4: final day

Overall, #AUA14 has been a fantastic conference, where records were set for Twitter participation and engagement in a urological meeting. I am still recovering!

Khurshid Ghani
University of Michigan, Ann Arbor, USA

@peepeeDoctor

Social media traffic broke all records at #AUA14 with over 1100 participants sending over 10,000 tweets and making almost 14 million digital impressions.

 

AUA 2014 – Friday, Saturday, Sunday: Orlando, FL

As my flight descends into the home of Walt Disney and make believe in sunny Borelando, I can’t help wonder how #AUA14 will compare to the outstanding #EAU14 meeting held just one month ago.  A great meeting requires equal parts place and content, and although Stockholm is without peer, there must be a reason Orlando is the third most visited city in the U.S., right? The solution to that mystery is for another day; ask elsewhere, as I have no idea. Review of the agenda on the #AUA14 app gives hope for this meeting. There is more quality scientific content than one can possibly absorb, and highlights include the new “Crossfire” program to address controversies in urology, the John K. Lattimer Lecture by Dr. Anthony Fauci (director of the National Institute of Allergy and Infectious Diseases), the Town Hall on imaging, simulation and animation (with speakers from Hollywood who make make-believe a reality and a living), #SUO14, and the release of three new AUA Guidelines on urotrauma, medical management of stones, and cryptorchidism.  

Friday afternoon kicked off with the new “Crossfire” section featuring debates on a number of heated urology controversies. Debate topics included the use of synthetic slings for stress urinary incontinence (SUI), the role of urologists in administration of therapy for advanced and metastatic prostate cancer, and the probably overly discussed topic of open versus robotic surgery (for both partial nephrectomy and radical prostatectomy). In favor of synthetic mid-urethral slings for SUI, Drs. Kennelly and Rovner presented a wealth of data showing the efficacy of slings in both the short and long term. Drs. O’Connell and Blaivas countered that the pubovaginal fascial sling provides a safer alternative, with less potentially significant complications that far outweigh the benefits of having the operation. 

Drs. Nelson and Lepor then argued in favor of open prostatectomy, which drew some colorful tweets:

Drs. Tewari and Menon presented compelling arguments for robotic prostatectomy, and while it is hard to declare a winner, the majority of urologists in the U.S. perform robotic assisted prostatectomy; the panelists stressed that outcomes depend more upon the surgeon than the technique, and people should perform whichever approach they are most comfortable with. 

The robotic versus open debate then shifted to kidney surgery, with distinguished faculty Drs. Gill and Uzzo debating “minimally invasive partial nephrectomy is the new gold standard for renal cancer”, while Drs. Blute and Libertino argued in favor of open surgery. Although both sides had thought provoking arguments, presented data were all limited by their retrospective designs, institutional experience, or lack of validation. In my opinion, even with high volume surgeons, most patients with highly complex tumors or a renal mass in a solitary kidney undergo open surgery, which implies selection bias that limits the generalizability of robotic or laparoscopic partial nephrectomy. As contemporary experience with robotic surgery grows, we can anticipate that more complex lesions will be approached via MIS techniques in the future. We always love to throw in “randomized clinical trials are needed”… although I do think that IDEALLY prospective evidence would be great, however a clinical trial comparing MIS partial Nx to open techniques will be fraught with accrual challenges and are most likely not expected in the near future. Until more definitive prospective evidence is available, decisions regarding the optimal surgical approach for the renal mass should be determined by individual patient and surgeon preference, experience and comfort level.

Following the debate, Dr. Todd Morgan nicely summarized audience sentiment:

Dr. Declan Murphy provided perhaps the best sage advice regarding robotic versus open surgery:

Social Media continues to grow in urology, and Friday evening concluded with a wonderful party hosted by the AUA (@Americanurol) for the “UroTwitterati”. There was a great turnout, and #SoMe heavy hitters: @daviesbj, @declangmurphy, @dr_coop, @qdtrinh, @TheUrologist, @LoebStacy, and @Tdave attended along with “wannabe” youngsters (your current bloggers, @UROncDoc and @RMehrazin). The beauty of #SoMe is that it even allows members to participate in the meeting from home, including @uretericbud and @dytcmd. Urologists should sign up for a Twitter account and join. It is very engaging and addictive!

The jam-packed schedule continued on Saturday morning with the annual residents forum, during which the resident teaching award was awarded to Dr. Robert Uzzo from Fox Chase Cancer Center. 

A variety of sections and societies also held meetings on Saturday. At the Association of American-Iranian Urologists, panelists Drs. Ghavamian and Samadi discussed the role of focal therapy in prostate cancer. 

The remainder of Saturday was largely filled by the Society for Basic Urological Research and Society for Urological Oncology annual meetings. One highlight of the #SUO meeting was Dr. McDermott’s presentation on anti-PD-1 agents in kidney cancer. In a phase 1 RCT, Nivolumab (anti PD-L1 agent) showed efficacy for patients with metastatic RCC (n=34). There was a 29% objective response rate with a median progression-free survival time of 7.3 months. The drug was well tolerated with minimal severe adverse events, and remarkably, treatment free survival was achieved in a few patients. Immunotherapy represents an exciting and novel way target kidney cancer, and may well help usher in the era of personalized targeted therapy.

On Sunday, multiple poster and podium sessions were occurring simultaneously, which makes it hard to attend and see everything. The discussion on Twitter via #AUA14 made it possible to capture highlights from simultaneous sessions. During the Plenary session on Sunday, Dr. Fauci, Director of the National Institute of Health, Allergy and Infectious Disease Division, gave the annual Lattimer lecture. AIDS is an important topic for urologists because several aspects of the disease are specific to urology. “For example, the role of STD’s in increasing the transmissibility as well as the vulnerability of getting infected with HIV, the potential role of HPV vaccine in preventing HIV infection, and the importance of urologist issues associated with the drugs HIV patients are taking, including stones, renal insufficiency, voiding dysfunction, and erectile dysfunction,” remarked Dr. Fauci. 

John P. Mulhall, Director of Male Sexual Health and Reproductive Medicine at Memorial Sloan Kettering Cancer Center, delivered the plenary state of the art lecture on radiation induced erectile dysfunction. It is an important topic, because “there are an increasing number of urologists who have hired a radiation oncologist or have a stake in an IMRT unit or do brachytherapy in their practices”, remarked Dr. Mulhall. “The pathophysiology of ED after pelvic radiation is very similar to that after radical prostatectomy based on three factors: nerve injury, arterial injury, and smooth muscle injury”. 

The new AUA clinical guideline for cryptorchidism was also presented at the plenary session on Sunday. The highlights of the guideline:

  1. Orhiopexy is the gold standard treatment for cryptorchidism in 2014
  2. Initial radiographic studies are not necessary for the child with cryptorchidism
  3. Surgery should be performed from 6 to 18 months after birth
  4. Hormonal therapy should not be used as primary therapy to attempt to reposition the testis in the scrotum

Your bloggers,

Reza Mehrazin, M.D. and Jeffrey J. Tomaszewski, M.D.
Fox Chase Cancer Center, Philadephia, PA
Twitter @rmehrazin and @UROncDoc

 

You are Not Connected to the Internet: Seeking Stable WiFi at the Modern Conference

Urologists the world over have at last settled back into their rhythms after congregating en masse in San Diego, California for the American Urological Association Annual Meeting. While I hadn’t expected to escape balmy Ontario for crisp breezes in Southern California, the setting was an excellent one.

This year’s AUA meeting had all the hallmarks of years past – heaving throngs of AUA-branded-faux-leather-bagged urologists speed-walking between sessions in the enormous SD Convention Centre, bleary-eyed sufferers burning away their respective fogs with espresso in the cavernous Exhibit Hall, and plenary sessions packed to the gills to hear the latest and greatest. One pernicious tradition was unfortunately manifest again, however, in the form of unreliable wireless internet access in the conference hall and ancillary venues.

Modern conferences and conference centres (where (ironically) the latest technologies and scientific advances are presented) seem to have barricaded themselves from the digital world the modern conference-goer inhabits. This may at first seem inconsequential, as the sequestration and forced attention might keep the focus on the presented data. In truth, an entire communication meta-layer, that of the conversations, opinions and dissemination created by social media activity, are needlessly compromised.

As has been stated repeatedly in social media circles, this year’s annual meeting was a bonanza of twitter activity at the #aua13 hashtag, with over 4000 tweets sent from 468 users during the meeting proper. The recent European Association of Urology meeting in Milan was similarly well subscribed, with almost 1800 tweets from 251 users.

It seems universal at urology (and doubtless other disciplines’) meetings that some of the earliest twitter activity centers around the pain of spotty or absent wifi. To wit:

 – from #uro12 (AUA Atlanta):

 

 – from #eau13 (EAU Milan):

 

 – from #aua13 (AUA San Diego):

These are but a few of the dozens of agonized tweets based on weak, spotty or absent wifi, and for each there is doubtless a dozen, fifty, a hundred more people in the same building steaming with the same frustrations. International delegates, loathe to “roam” outside their home data plans, are perhaps the most handicapped. One imagines the conference centre tech team testing their seemingly robust signal in an empty room, devoid of the hundreds or thousands of devices queuing for bandwidth space once the meeting is in full swing. And let’s not forgive the conference-adjacent hotels that host dozens of ancillary meetings, such as the well-attended Society of Urologic Oncology meeting, each year in advance of the AUA proper. Typically there is a total absence of available wifi in these conference halls. In 2013, the mind boggles at this omission (on the part of organizers as well as the hotels).

Certainly the modern conference centre and the modern meeting must see beyond their own walls, and address the modern realities of communication. The reach of social media, and indeed the basic need of busy attendees to connect with their practices, lives and colleagues make this all the more imperative. Relative to all the other logistic feats that underpin a conference, building in extra bandwidth (with redundancy to avoid catastrophe) should be a simple infrastructure and expenditure issue, well within the means of the centre to predict and to deploy.

 A brief set of expectations for the modern conference centre’s wireless internet:

  1. Conference wifi must be available to all who wish to access it, when and where they wish to do so. Hotels are not exempt if they host parts of the meeting. Wifi is no longer a perk or a luxury.
  2. Login should be simple and able to be performed in the native settings of the users’ devices, rather than the agonizing experience of web- or browser-based login.
  3. Requiring repeated logins when re-entering rooms or buildings is excruciating and anathema to the speed of communication and discussion that define social media. One formal login per device per meeting.
  4. The ubiquity of mobile devices may require a building retrofit or construction of stations to facilitate the ability of delegates to charge these devices.

Until these conditions are met, associations, conferences and conference centres will be forced by their own inertia to stifle the full potential of the meetings they host. Here’s hoping that the volume of our discontent is heard by organizers, and suitable guarantees are established and met as conditions of hosting our meetings.

Mike Leveridge is an Assistant Professor in the Departments of Urology and Oncology at Queen’s University, Kingston, ON, Canada. @_theurologist_

 

Comments on this blog are now closed.

 

The BJUI Social Media Awards 2013

The BJUI has been very pleased with the large amount of social media activity we have seen across our various platforms since January 2013 when the new-look Journal was introduced. Editor-in-Chief, Prokar Dasgupta, has decreed that he wants the BJUI to be “the most-read surgical journal on the web”, and has recognised the key role that social media plays in realizing this ambition. At the same time, the social media revolution that has engrossed Gen Y and Gen Z and which has transformed the way in which news is communicated, has now taken a foothold in scientific publishing and is evolving.

To recognise the rapidly growing interest in social media in urology, and also to acknowledge those who have played a major role in advancing social media in urology at the BJUI and elsewhere, we this year inaugurated the BJUI Social Media Awards, presented for the first time at the AUA recently. Individuals and organisations were recognised across 20 categories including the top gong, The BJUI Social Media Award 2013, awarded to an individual or organization who has made an outstanding contribution to social media in urology in the preceding year.

This year’s Awards Ceremony was held in the Dublin Square Irish Bar in San Diego during the AUA Annual Meeting. Sixty of the World’s leading social media enthusiasts (the “Uro-Twitterati”), gathered to meet up in person and to see who would be recognised. Sort of like the Oscars but without the wardrobe malfunctions. Yours truly played the role of MC. While most of the awards recognised genuine achievements in social media, there were a few “special” categories which recognised some reasonably strange activity propagated through social media channels!

Todd Morgan and Alex Kutikov, the brains behind Draw MD Urology and Urology Match who won the top award of the evening.

We were delighted to have recipients from all categories present at the ceremony including representatives from the AUA and EAU. The BJUI Social Media Awards Ceremony was competing with the European Urology Cocktail Reception a couple of blocks away but in the spirit of conviviality which we encourage, we welcomed European Urology Editor-in-Chief elect, Dr Jim Catto, and managing editor Cathy Pierce, who popped in for a drink and to collect the EAU awards.

A special thanks to my research fellow Dr Marni Basto who organised this year’s awards, and to Scott Millar and Helena Kasprowicz at BJUI in London who manage our social media and website activity.

For more pictures from the evening, please visit BJUI Associate Editor John Davies Flickr page.

 

Declan Murphy is Associate Editor for Social Media at BJUI. He is a uro-oncologist in Melbourne, Australia

Follow Declan on Twitter @declangmurphy 

 

Comments on this blog are now closed.

 

 

 

The BJUI and BAUS join forces at AUA in San Diego

For the first time, the BJUI and our friends at the British Association of Urological Surgeons (BAUS), joined forces at the Annual Meeting of the American Urological Association to stage a satellite session focusing on some interesting areas of urology. While both BAUS and BJUI have long had strong relations and have worked together on many occasions, this was the first time we had an opportunity to present a full afternoon of plenary content at the AUA.

This year’s AUA took place in beautiful San Diego, a very popular destination for delegates, even those travelling all the way from the UK. The convention centre is very conveniently located and is state-of-the-art. The adjoining Marriott hotel hosts many of the satellite events and it was here on Sunday 5th May 2013 that the joint BAUS/BJUI session took place. We attracted over 200 delegates in the face of tremendous competition from parallel sessions and had a wonderful atmosphere all afternoon.

Prokar Dasgupta excited about this session at AUA Annual Meeting 2013

Part one was chaired by BAUS President Adrian Joyce and featured state-of-the-art lectures from Prof Tony Mundy, Dr Tamsin Greenwell, Dr Craig Rogers, Mr Ben Challacombe, Mr Simon Brewster , Dr Philippa Cheetham and Prof Mark Emberton.

The second session was opened by BJUI Chairman Dr David Quinlan who gave a great introduction before handing over to BJUI Editor-in-Chief Prokar Dasgupta who Chaired the session. This was a fascinating session which combined state-of-the-art addresses from well known BJUI editors/contributors Dr John Davis, Dr Peter Gilling and Dr David Ralph, along with an exciting overview of social media and digital publishing by Prokar Dasgupta, Casey Ng and myself. The future of publishing is certainly not in paper and attendees at this session were given a wonderful preview of how urology publishing might look in the future.

The joint session finished with the presentation of the BJUI Coffey–Krane Prize, which was accepted by Dr Christian Pavlovich on behalf of his team for their paper Impact of surgical technique (open vs laparoscopic vs robotic-assisted) on pathological and biochemical outcomes following radical prostatectomy: an analysis using propensity score matching. The Prize was presented by the great Dr Coffey who gave a humorous overview after his warm introduction by Dr Quinlan.

Dr Christian Pavlovich receives the CoffeyKrane Prize 2013 from Dr Donald Coffey,
Prof Prokar Dasgupta and Mr David Quinlan

Attendees enjoyed socializing over drinks following the session and toasted the strong relationship between BAUS, the BJUI and the AUA.

We look forward to similar conjoined events in the future and are particularly looking forward to the BJUI supporting the forthcoming BAUS Annual Meeting in Manchester from 17–20th June 2013.

 

Declan Murphy BJUI Associate Editor

Follow Declan on Twitter @declangmurphy

 

Comments on this blog are now closed.

 

AUA Blog – Day 3 and 4 – Monday and Tuesday

The American Urological Association (AUA) 2013 national meeting remains in full swing in beautiful San Diego. Not sure what is going on with the weather (two days in a row of rain?), but plenty of great things going on inside the convention center.

The “main event” on Monday was Dr. Ballentine Carter’s presentation of the AUA’s new Guidelines on the Early Detection of Prostate Cancer . Dr. Carter spoke to a packed house (the Fire Marshall was turning people away!).

For those who missed the talk, the AUA added a second session on Tuesday. Further comments from the AUA can be found here. Whatever your opinion regarding the new guidelines, and there were many prominent urologists who voiced their concerns about the guidelines, urologists will need to be able to speak intelligently to patients and primary care physicians. In the same session, Dr. Michael Cookson gave the AUA Guideline presentation on castration resistant prostate cancer which seemed better received than the PSA Guidance which certainly got many urologists hot and bothered.

On Monday, the Young Urologists Forum focused on the business aspect of urology (something I heard very little about in training), with informative talks by Dr. Raju Thomas, Dr. Koushik Shaw and Dr. Neil Baum. Thanks to Dr. Mike Ost and the YU Committee for putting together a great program.

Speaking of young urologists, the Southeastern section took home first prize in the Second Annual Residents Bowl, besting the Western section in the finals on Monday.

Southeastern Section of AUA claim the honours in the Annual Residents Bowl

The Monday plenary session included discussions on the contemporary uses of neuromodulation and the management of iatrogenic ureteral injury. BJUI Editor-in-Chief Dr. Prokar Dasgupta, gave an informative lecture on the current applications of botulinum toxin in the lower urinary tract. Prostate cancer made it into the Endocrine Forum on Monday, with Dr. Scardino and Dr. Klotz debating the treatment of men with low risk prostate cancer. Jumping ahead, a similar debate was held during the Tuesday plenary between Dr. Carroll and Dr. Tewari with roles reversing somewhat as Dr Tewari argued the case for surveillance while Dr Carroll took us through some of the pitfalls.

Also on Monday, Dr. Vincent Laudone gave late-breaking news regarding the randomized trial between open and robotic radical cystectomy at MSKCC. Bottom line – no difference was found regarding oncologic or perioperative outcomes. In particular, the robotic approach did not reduce the complication rate which remained at about 60% in both arms. Cost difference, which seems to be on everyone’s mind, was not addressed. Other trials between open and robotic cystectomy remain ongoing and the jury appears out here.

Dr. Christopher Kane moderated a session debating the use of simulation in robotic surgery between Drs. Sundaram (pro) and Nadler (con). Dr. Kane concluded the debate by stating that basic robotic training is important but limited by cost and duty hour restrictions. In addition, further studies are needed to determine if virtual robotic training actually helps performance.

One of the more contentious areas of prostate cancer, HIFU and focal therapy, received much attention during various poster sessions this year. Abstract #553 reported five-year oncological outcomes following HIFU in the UK in over 500 patients. Disappointingly, 38% of men who had a biopsy had residual cancer. About one third of patients had androgen deprivation therapy upfront with a further 30% requiring salvage treatment. The authors described the disease-free outcomes as “reasonable”. Abstract #1356 from the same authors reported outcomes in 110 patients undergoing focal therapy using the same HIFU technology. Again, 38% of patients had a positive biopsy. Both of these papers provoked much reaction from the floor and across social media. These are experimental interventions which should only be undertaken in appropriate trials.

The aging US population (10,000 people turn 65 every day and will for the next 15 years) coupled with the average age of urologists (mid-50’s!) will create a serious manpower shortage over the next several years. As an illustration, abstract #153 reported that 14 counties in Oregon have zero urologists and men in those counties are more likely to get bladder cancer.

From Monday, abstract #1041 (awarded best poster for MP40), confirmed what habitual coffee drinkers already know – that high dosage coffee increases LUTS and urine volume compared to decaffeinated coffee or water. Dr. Tom Walsh and colleagues were awarded best poster (abstract #1241) for MP46 for evaluating a smartphone application to assess the penile deformity in men with Peyronie’s disease. Another best of session – Dr. Penson (@urogeek) and colleagues reported that men with prostate cancer today (CAESER) have more baseline dysfunction that men 20 years ago (PCOS) – abstract #449. There were many more great abstracts out there…too many to list in this blog.

The Urological Society of Australia and New Zealand hosted a great reception on Monday night. Several prominent uro-twitterati (including yours truly) and other urologic “heavy hitters” were in attendance.

Thanks to the Aussies and Kiwis for a wonderful event. Strangely, they were not serving Foster’s at the event.

Tuesday’s plenary included several sessions on the management of both low and high-risk prostate cancer. The main auditorium was absolutely packed for what was one of the best sessions of the week.

Dr Hein Van Poppel, Secretary-General Adjunct of the European Association of Urology (EAU), delivered an outstanding plenary on the management of high-risk localised prostate cancer. His clear message – surgery should always be considered first with radiotherapy and androgen deprivation therapy later if required – was very well received. Dr Ed Messing introduced a fantastic session on molecular markers in prostate cancer led by Dr’s Alan Partin, Dan Lin and Theo Van der Kwast. Key messages here were that the Phi test already has a role in clinical practice; PCA3/TEMPRSS2ERG fusion is emerging; and for sure, we will see genetic markers in clinical practice very soon. In fact the UCSF group generated a lot of media headlines on Tuesday evening when the commercialization of their genetic test was announced ahead of its presentation by Dr Cooperberg on Wednesday am.

So many other sessions it’s hard to know what to choose from. A mention of Dr Joel Nelson’s Critical Discussion session where he led Dr Reiter and Dr Brooks through the options for patients with progressive prostate cancer. This was a good way to present the key data in an engaging manner.

The AUA Guideline presentations on follow-up care for renal cancer and radiation after prostatectomy were given by Dr. Sherri Donat and Dr. Richard Valicenti, respectively. In addition, Drs. McVary and Kaplan debated the use of alpha blockers versus PDE5 inhibitors for BPH/LUTS.

Other highlights from Tuesday from the land of stones included abstract #1816 – people are 67% less likely to file short-term disability when treated with medical expulsive therapy versus ureteroscopy. A higher physical activity level improves the results of lithotripsy (#1824). In an earlier abstract (#67), physical activity was protected against stones in women. SO…get moving people! Lastly, 2 groups developed nomograms to predict stone-free rates after PCNL (abstracts #1526 and 1532). Thanks to Peter Steinberg and Michelle Semins (my stone peeps) for vetting abstracts.

Social media and twitter continued to have a significant impact at the meeting, with an increasing number of tweets every day. With so much going on at the AUA (seemingly at the same time), twitter provides an easy way for urologists to digitally multitask and get more out of the conference. Check out the metrics via Symplur.com which show huge social media activity (5.7m digital impressions) and also shows the BJUI and its team/contributors are among the top influencers once again.

 

#aua13 was the #1 trending conference over the past few days! The use of social media will only expand over the coming years, and urologists need to stay “ahead of the curve”. Perhaps the @Americanurol will offer a Plenary session on Social Media next year? I can honestly say that I got more out of the meeting this year, largely thanks to the use of twitter.

The AUA responded to a social media campaign and installed twitter-boards around the convention centre. Great to see the AUA engaging so well in social media.

Thanks to the AUA and San Diego for a great meeting! Looking forward to seeing everyone next year in Orlando. Until then, I encourage everyone to participate in the International Journal club on twitter (@iurojc) and to bring a friend!

 

Dr. Matthew Hayn

Follow Matt on Twitter @matthayn

 

Comments on this blog are now closed.

 

The new AUA PSA Testing Guidelines leave me scratching my head

The fact that Otis Brawley describes the new PSA testing guidelines of the American Urological Association (AUA) as “wonderful”, should immediately raise a red flag at AUA headquarters. Dr Brawley, Chief Medical Officer of the American Cancer Society, and the most vocal anti-prostate cancer screening voice in the USA over the past decade, has enthusiastically welcomed the new document and “commended” the AUA for bringing its policy closer to that of his Society. The Guidelines have also been compared to those of the United States Preventative Services Task Force (USPSTF) which completely opposes PSA testing in any situation – a position which the AUA called “inappropriate and irresponsible” just a few months ago. Oh dear – where has it all gone wrong? ?

For those who haven’t yet seen the document, here are the five statements issued by the Guideline committee at the Annual Meeting of the AUA in San Diego this week along with some of my thoughts in italics:

  1. The Panel recommends against PSA screening in men under age 40 years. This appears reasonable.
  2. The Panel does not recommend routine screening in men between ages 40 to 54 years at average risk. I have some problems with this (as do many others). In addition to this statement, the AUA highlights its view that the likelihood of causing harm is high and that any benefit is marginal. It appears to have completely dismissed evidence (and its own previous view), that a baseline PSA in men in this age group is highly predictive of future prostate cancer, metastasis and death. In my view, there is considerable value in having a baseline PSA in this age group and I am disappointed that the AUA has not recognised the evidence to support this.
  3. For men ages 55 to 69 years the Panel recognizes that the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, the Panel strongly recommends shared decision-making for men age 55 to 69 years that are considering PSA screening, and proceeding based on a man’s values and preferences. I agree with the emphasis here on shared decision-making, although the concept can be somewhat nebulous and difficult to achieve in real-life. However, I think that this statement somewhat over-emphasises the harms associated with PSA testing in this group. Rather than portray the reduction in prostate cancer mortality as being very minor (1 in 1000), men should know that when compared with a man who chooses not to have PSA testing in this age group, those who do have regular PSA testing have a 44% reduction in prostate-cancer mortality over a 14 year period. Furthermore, the numbers needed to screen (293) and number needed to treat (12) to save one life stack up very well when compared with other screening modalities such as mammography (Hugosson et al). Why has the AUA instead chosen to over-emphasise the harms? This is disappointing.  
  4. To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce over-diagnosis and false positives. This appears reasonable.
  5. The Panel does not recommend routine PSA screening in men over age 70 years or any man with less than a 10 to 15 year life expectancy. Yes, but this strong advice not to offer PSA testing in men greater than 70 belies the fact that many men in this age group have a long life expectancy (eg in Australia a male who reaches 70 has a 15 year life expectancy (www.abs.gov.au), and an early diagnosis of prostate cancer may prevent their untimely death from this disease. Clearly, not all men in their 70’s are the same but following this advice to the letter could deny many men the option of avoiding death from prostate cancer in later life.

Therefore, it appears that the only circumstances under which the AUA currently recommend a PSA test be performed is for men between the age of 55 and 69 following a weekend seminar so they can be adequately informed (or thoroughly confused).

These statements have led to headlines such as these in the mass media today:

  • Urology Group Stops Recommending Routine PSA Test (USA Today)
  • Looser Guidelines Issued on Prostate Cancer Screening (New York Times)
  • Urologists No Longer Support Routine Prostate Cancer Screening (Minn Post)
  • Most men don’t need PSA test (Arizona Star)
  • AUA No Longer Recommend Routine PSA Testing For Prostate Cancer (Huff Post)

I think it is reasonable to say that this AUA document adds more confusion than clarity to the debate around prostate cancer testing. It has certainly provoked some anger among prominent members of the AUA who voiced their displeasure to the Committee during the plenary and also through social media. Dr Catalona was first to the microphone asking why AUA members were not more widely consulted prior to publication and in particular, challenging the guidance around men aged 40-54 (reported on Twitter):

 

 

Dr Stacy Loeb also voiced her concerns at various sessions during the day:

 

Much progress has been made in the last few decades with a 30% reduction in prostate cancer-specific mortality since the introduction of PSA testing. And while we accept that this has led to a large amount of over-treatment of less aggressive disease, it is clear that (at least outside the USA), active surveillance is being enthusiastically embraced for appropriate patients. Any return towards the pre-PSA era would likely lead to a reversal in these mortality gains and we would again see many more men presenting to our rooms with incurable disease.

As Dr Smith editorialized in the Journal of Urology following the publication of the ERSPC and PLCO trials in 2009, “Treatment or non-treatment decisions can be made once a cancer is found, but not knowing about it in the first place surely burns bridges”. It is clear that many urologists consider these new AUA PSA Guidelines to be in danger of burning these bridges. However, rather than burn bridges, it is likely that urologists and others will ignore these guidelines and continue to counsel men in a more balanced fashion about the pros and cons of PSA testing. The AUA will then need to consider whether ignored guidelines are failed guidelines.

 

Prof Tony Costello is a Director and Professor of Urology at the Royal Melbourne Hospital, Melbourne, Australia.

Twitter: @proftcostello

 

Comments on this blog are now closed.