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AUA 2018 highlights days 3 and 4

AUA 2018

As a first-timer to the AUA, I did not know what to expect from this meeting but one thing for sure was that San Francisco would put on a show. I have always been told that everything is big in America so let’s see: plenty of big names present (check), big conference centre (check), big smiles everywhere (check), big news (check)! (but a diminutive author, to put this all together).

It may have been half-way across the world but the royal wedding brought a buzz of excitement, since they prepare everything for this event, including the use of red table linen for decoration on this special day. They are some special things, which kept secret due to royal family. The most important excited thing which is kept secret from media is hens nights of the Meghan Markle, As per sources from the royal house then hens party was arranged with the special hens packages, arranged by the wedding planner by hiring world’s best hens party company.

On Sunday, we were treated to one of the city’s quintessential experiences: The Bay to Breakers race. Getting to the Moscone centre may have been a bit difficult as a result of all the road closures but the runners offered plenty of entertainment on the commute.

Some of the male runners decided to bare it all and one wonders whether their boldness comes from having read the ‘biggest paper” at AUA2018!

At the conference centre, there was no shortage of excitement with the annual AUA residents bowl challenge happening over the weekend culminating in the final between South Central – Pirates of the Perineum vs Western – California Streamin’. This was a tense battle that went into overtime with the Western – California Streamin’ taking out the overall prize.

A recurring theme at the meeting was ‘the rise of the machines’. A few abstracts presented suggested the role of artificial intelligence (A.I) to not only interpret MRI but also to determine who needs an MRI! Should clinicians be worried about losing their jobs to machines? The hope is that A.I does not replace clinicians but aids in improving the diagnostic accuracy. Ralph Clayman also mentioned the potential use technology in surgical rehearsal and even true automation!

A Japanese group also presented their work on the potential role of A.I in screening for STI’s – the possibilities are truly endless!

On Sunday, we were treated to the BAUS-BJUI-USANZ joint session at Marriott Marquis. This was a great session with talks ranging from prostate cancer genomics to tissue engineering for reconstruction. During the session, Dr Ballentine Carter paid tribute to Donald Coffey before presenting the Coffey-Krane prize to Dr Xiaosong Meng.

I should also point out that Dr Bal Carter himself won an award at AUA2018 and the legitimacy of this award cannot be questioned as this was voted for by one of the top social media influencers! I shall say no more…

Dr Caroline Moore presented the results of their landmark PRECISION trial. However, following on from the spine-tingling “Court is in session” case on post-TRUS biopsy sepsis and the comment earlier in the meeting on the superiority of a well done ultrasound over MRI, it was not surprising that the crowd here was still a bit sceptic about the benefits of MRI.

The issue of gender diversity in leadership positions also came up at the meeting. The presidents’ reception photo only showed two female presidents and there was a call for improvement in this regard. It was encouraging to note that there were sessions at the meeting that focussed on how to bridge the gender gap and a few articles have been published recently in the literature looking at exactly this issue.

Away from the conference, I got to experience a bit of what San Francisco had to offer including the NBA Western conference finals (Go Warriors!!!), Napa wine region, a ride across the bridge, Alcatraz island, Tiburon, drowned in the shopping experience at the Livermore outlets. San Francisco has some great restaurants showcasing food from all around the world which I got to enjoy. Overall, this was a great meeting in a great host city and my first AUA experience definitely lived up to the hype and am already looking at what Chicago 2019 has in store!

Dr. Tatenda Nzenza,University of Melbourne, Department of Surgery, Austin Hospital, Melbourne; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne; and Young Urology Researchers Organisation (YURO), Australia

Twitter: @DrTNzenza

AUA 2018 highlights days 1 and 2

The American Urological Association meetings always offer a plethora of stimulating sessions. Forget about the flowers in your hair, if you were going to San Francisco for the 2018 AUA meeting, an early morning coffee and good walking shoes were your best shot at getting to as much of the action as possible.  As best that I tried, I could not make it to all of the places that I wanted to be, so apologies must be made in advance if I fail to mention some of the great work that is being done in our field.

After registration and carefully dissecting the daily content in the phone book sized program, the day kicked off as early as 7am. Poster and video presentations touted new technologies and put forward ideas that met critical peer review and applause in several concurrent sessions. Also flourishing in number was the amount of instructional courses that were offered to attendees. From nocturia management to business models in medicine, the AUA courses added some active involvement to the osmotic learning process.

So often the term “defensive medicine” is used in describing practice that protects a practitioner from punitive or litigious claims. As uncomfortable an idea as this is, the AUA stage show titled “Court is in Session” was a great portrayal of the risk management process that occurs in clinical decision making for all of our patients. The brutal cross examination of on stage “witnesses” delivered by close colleagues (given away by a wry smile or two) had a few people shuffling in their seats and pulling at their collars. All in all, this was a great example of the use of best current evidence base for common choices made in urological care. Interestingly, when debating the case of a post-TRUS biopsy sepsis patient, transperineal biopsy did not even score a mention from the prosecution!

 

A complex case discussion of Prostate cancer was to follow with John Davis doing an excellent job at moderating and driving the discussion. A common theme in the court cases and case studies was the increasing relevance of pre-biopsy multiparametric MRI, with an argument being made by many that it is the evolving standard of care to image before biopsy.

To break up the day, a stroll around the science and trades hall is always welcome. The new devices and systems on offer surely raised some questions and some eyebrows! Some of the virtual reality simulators gave a great feeling for being actually present in the OT as seen in the picture below of me performing a prone PCNL puncture with my arm over the shoulder of my virtual consultant.

 

An interesting presentation was to follow called “The survivor debate” in which a case was made for different treatment options in a male patient with low- intermediate risk prostate cancer. The showdown of cases presented by Klotz’ 13 – each a passionate experts in the field – revealed some convincing arguments for therapies that I would not have previously considered. If anything, it was a lovely chance for the salesmanship of senior clinicians to come out!

AUA President Brantley Thrasher delivered an address with some future insight. The issue of clinician burnout was addressed, being particularly high in the US. This was tied in with the rise of artificial intelligence, technology in medicine and the need for future proofing of the electronic medical record and data systems to help us better care for patients and ourselves. A slide and brief description on each new technology had my head swimming after learning about Bluetooth urinalysis chips to put in patient’s underwear to beam UTI info straight to your smartphone and electromagnetically driven “sperm-bots” that delivered a genetic payload to an ova.

Just when I thought I couldn’t be more impressed, a presentation from Dr. Atul Butte blew the lid off the plenary. In an engaging oration, he described the access that already exists to large data sets such as genomic and tissue samples and how easily these kinds of sets can be used to create innovative solutions to current healthcare dilemmas. To cap it off, a very effective visual “patient illness moving-map” was displayed showing data from tens of thousands of patients who had suffered myocardial infarction. By finding the end point of these patient journeys (most likely to die of sepsis years down the track) this can lead to the creation of a truly accountable model for healthcare outcome prediction and improved patient care. Definitely a lecture to re-visit if you get the chance!

After the lecture on clinician burnout, I thought it best to heed the advice regarding taking some time out for you. Luckily, only a 10min walk from the convention center, you could find yourself amidst the Seal Docks and waterside. If you were lucky enough to jump in to the baseball game at AT&T Park, you may have enjoyed some ballpark American classics (hotdogs, nuts and crackerjacks) as well as a sea of black and orange clad SF Giants fans cheering their home team to victory.

Other stress relief events throughout the conference were a great chance for peers to mix and mingle, old alumni to catch up and for new relationships to be forged. The Urological Society of Australia and New Zealand’s annual AUA reception is a great event on the calendar that performed this role perfectly. With attendees encouraged to bring international guests, it was as multi-national as Australia’s home population.

It seems that an overarching theme for our future directions is one of large-scale change. The sheer size of the AUA 2018 meeting was enough to out that idea into our heads initially, but considering the global impact of the growing population and the limitation to our resourcing, we will need to start to consider some changes to future proof our systems of care. A quote that stuck with me that I had caught along the conference: Progress is impossible without change, and those who cannot their minds, cannot change anything. This meeting definitely changed presented enough to change my mind about quite a few things!

For my first AUA it was a fantastic experience! It is always a great chance to catch up with peers and mentors and also to meet international experts in the field to gain exposure to their work. Looking forward to Chicago! #AUA19

 

Dr. Daniel Christidis, Peter MacCallum Cancer Centre, Melbourne, Australia

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