AUA Convention Chicago - 2003

Directly opposite the convention center (McCormick Place/Lakeside Center), on a peninsula, Meigs airfield can be found. For those among you that have ever try to digitally fly an airplane using MS Flightsimulater, Meigs airfield is the first landingstrip you encounter. The digital sea at the start of the strip must be littered with thousands of airplane wreckages.
But Meigs is no longer: the intentionally destroyed strip lies wounded before you with big yellow crosses to prevent anyone from ever landing there.
Another national heritage gone.

An early busride was followed by a short introduction and the traditional invocation. Somehow, all local presidents seem to have a friend of the family who is either reverent, priest or rabbi. This was followed by a memorable John Duckett Lecture by Judah Folkman. Over the years, angiogenesis has definitively found a place in oncogenesis and tumorgrowth. Every day new studies on the subject are published. However, the year 1971 was dominated by only three articles, two from the Folkman lab and one as a comment on the other two. Now, oncology cannot do without angiogenesis. In 1992, Folkman got a standing ovation on the AUA meeting in Washington.
In the mean time, the mechanisms of tumor angiogenesisare have been and are being unraveled step by step. Many blocking agents have been discovered, one of the most important being endostatin. Interestingly, the endostatin gene is located on chromosome 21, while relatively high concentrations of endostatin can be measured in patients with Down syndrome who have an extra copy of the gene. Cancer in Down patients is rare, with the exception of testicular cancer, which was later shown to take care of its own angiogenesis.
Different medications are being developed that can have an effect on tumor angiogenesis through different pathways and which will probably address different types of cancer since the underlying oncogenesis is essentially is the same.

Folkman's 'take home message':
If you happen to drain the pacific ocean you will find that the islands are connected

A pediatric urology panel on the timing of surgery in cryptorchidism advused to do that early, but not before 3 months to allow for a chance on spontaneous resolution of the problem. So their advice is to do an orchidopexy somewhere between 6 and 18 months.

What everyone suspected and some among you knew: the overactive bladder is a chronic feature. Paul Abrams and his co-workers (abs 362, UK) concluded that the disease is there to stay in a majority of patients after a follow-up of 10 years. When urodynamics were performed, detrusor instability was found in 91 percent.
Neuromodulation through sacral root S3 stimulation proves to be ineffective in the treatment of the pelvic pain syndrome (abs 365, USA), although, depending on the interpretation, the effect has also been described as effective (abs 263, USA)

The results of new incontinence treatments are suffering from positive anthousiasm. The magnetic chair (also, erroneously, called electric chair) can be called slightly effective with a succesrate of 35-54 percent in various domains (abs 364, Brazil), but 47% of the initially dry patients have again become wet after three months. Apart from that, the treatment study was not controlled and could also be attributed to placebo.
Placebo controlled studies are very important, which was shown by a study into the effect of vaginal electrostimulation (abs 363, Brasil): the sham treatment was equally good.

Something about lifestyle en prostate cancer:
A group of 87 men with low risk prostate cancer was randomized between watchful waiting with lifestyle factors (low fat vegan diet, soj, antioxidants, aerobics, stressmanagement, psychosocial group therapy) or watchful waiting and plain normal living (abs 286, USA). After one year, the lifestyle group PSA was 3% lower, while in the normal group PSA was up 7%, which proved to be statistically significant. Does this translate into clinical effects? Do we choose a lower PSA or a better life? What is the meaning of Quality of Life in this respect?
There is sufficient evidence, even in animal experiments, to support dietary measures in prostate cancer. Vitamin E and Lycopene have an effect, i.e. tumor necrosis, in Copenhagen rats (Switserland, abs 349). In 28 male beige mice an isocaloric high fat diet was correlated with more tumor growth than the low fat version (USA, abs 338).

The postersession on interstitial cystitis indicates that more researchers are interested in the subject, although one study showed urologists worldwide to differ considerable on definition, diagnosis and treatment options. Most presented studies get stuck into animal studies ('the results can not be applied to humans') or non-statistical pilots.

More tomorrow.

ENGLISH version 26 April 2003 27 April 2003 28 April 2003 29 April 2003 30 April 2003

DUTCH version 26 April 2003 27 April 2003 28 April 2003 29 April 2003 30 April 2003