SAN DIEGO -- Controversy, crossfire, clinical guidance, and courtroom drama all found a place in a full schedule of activities at the American Urological Association (AUA) meeting, which begins here today.
The program includes multiple sessions on controversial issues in urology, beginning with the timing of the meeting itself, which includes Mother's Day. In a (and their mothers), AUA President , and secretary , acknowledged the unfortunate timing of the meeting and the difficult decision to spend Mother's Day away from home.
"It was a conflict we were aware of even before we started getting feedback about it," said Monga, of the Cleveland Clinic. "Unfortunately, with Mother's Day and Memorial Day falling in May, it limits our options in terms of when to hold the meeting. That, coupled with the size of the meeting (an estimated 16,000 participants this year), that limits the number of cities that are potential venues and unfortunately leads to these conflicts."
AUA members and other attendees will face similar difficult decisions a year from now, as the dates of the 2017 meeting also include Mother's Day. The AUA books the venue for its annual meeting about 8 years in advance, said Monga. Moving forward, the organization will take a "more proactive view" toward dates and site selection.
"We certainly appreciate that it is an important matter for mothers, fathers, and kids," he told MedPage Today.
Controversies
Aside from the scheduling issue, controversy will figure prominently in scientific and educational programming. The Crossfire Controversies, introduced 2 years ago, has expanded to two sessions because of the interest generated. A session today will focus on malignant conditions, and one on Saturday will revolve around benign conditions.
The Crossfire sessions focus on unresolved issues in urology. For each issue, two or more authorities will pitch opposing viewpoints -- including rebuttals -- to the audience, which will eventually vote on who made the stronger case.
Introduced last year, Second Opinion also will expand to two sessions, one each devoted to malignant and benign diseases. As the name suggests, an authority will present a case and his or her clinical judgment about it, followed by another authority who will review the same case and offer a second opinion.
New this year is SOS -- Stepback from Operative Solutions. Monga said the session will make use of clinical videos and animation to illustrate "how thing may go wrong during surgery and how to anticipate them, prevent them, recognize them when they occur, and how best to manage them when they do occur."
Also new this year are three sessions known collectively as Three Surgeons, Three Days, Three Ways. The objective is to demonstrate how a clinical situation may have more than one solution. During each session, three surgeons will discuss how they would approach the same clinical case, including an explanation about why they think their individual approaches may lead to better outcomes. The three topics are partial nephrectomy, robotic prostatectomy, and percutaneous kidney stone removal.
Yet another new program is Court's in Session, which employs a mock trial format toward a hypothetical malpractice case in urology. Two practicing attorneys will lead the program, one serving as the plaintiff's attorney and the other as the defendant's lawyer.
"The goal is to capture some of the challenges that patients and urologists face in terms of unanticipated outcomes," said Monga.
The three unanticipated outcomes are avulsion of the ureter during ureteroscopy, pregnancy following vasectomy, and prostate cancer progression during active surveillance.
Keynote Presentations
Two featured panel discussions will focus on issues that have professional and personal implications for clinicians. During one discussion, panelists will address various aspects of improving surgical skill. The objective will be to encourage surgeons to ask themselves, "Can you do better or are you already as good as you can be?" said Monga. The panelists will also discuss tools that surgeons can use to hone their skills.
The second panel will address physician wellness and burnout, which a growing number of urologists face, according to recent data on the topic said Monga. Three specialists will discuss how to recognize and prevent burnout.
Featured lectures include a presentation by , the South African surgeon who performed the world's first successful penis transplantation. A pioneer in the management of erectile dysfunction (ED), , of the University of California San Francisco, will present the John K. Lattimer Lecture, during which he will discuss his experiences with a variety of novel strategies to treat ED.
New Science
Plenary sessions on Monday and Tuesday will provide a forum for new science in urology in the form of late-breaking abstracts. Presentations include the initial report from a randomized trial of sacral neuromodulation and botulinum toxin injections to treat medication-refractory overactive bladder.
"This trial had a goal of trying to help patients and practitioners understand 'the next step,' when medication fails," said Monga. "I think this will become a landmark study, and the results will help guide therapy in the future."
Several late-breaking abstracts relate to the use of biomarkers to streamline care and optimize patient selection for various treatments. One study evaluated the potential of a urinary biomarker to reduce the use of surveillance cystoscopy for transitional cell bladder cancer. Two other studies evaluated biomarkers -- one serum, one urinary -- for risk stratification in prostate cancer.
The meeting also includes an entire session on late-breaking science surrounding high-intensity focused ultrasound (HIFU). Late last year the FDA granted a first-ever approval of a HIFU device for prostate ablation -- but not prostate cancer treatment. Authorities from several countries where HIFU does have a prostate cancer indication will discuss their experience with the technology. Additionally, an FDA representative will be on hand to discuss the agency's decision.
New clinical recommendations and standards will come in the form of three new guidelines that will be introduced and discussed in various forums -- including education sessions and plenaries. The guidelines address surgical management of kidney stones, non-invasive bladder cancer, and urethral stricture.
"Our theme this year is 'Your AUA,'" said Monga. "By that we mean that no matter where you come from, what kind of practice you have, what kind of role you have in the delivery of healthcare to urology patients, there's a rich amount of material for you to engage in, learn, and enhance your practice by coming to the annual meeting."
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