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AUA Convention Orlando - 2002
- Tuesday 28 May, Day 3 -
Orlando
    There isn't much to tell about Orlando. For an outsider, the city is made up of amusement parks, outlet stores and golf courses. Florida seems to be entirely devoted to elderly couples living off their pension and families with young children leaving their money in amusement parks and tourist shops. And delegates of big conventions offcourse, who can be devided into three groups. Those arriving each morning at the convention empty handed and leaving again with bags full of pens, taperecorders and all kinds of handed out commercial material. Those who arrive empty handed and do not see the beautiful blue sky (with an occasional big splash of rain) for the rest of the day, since they try to follow more sessions than is good for them. Those who don't arrive at the convention at all, but instead can be found at the pool side or in the parks, etcetera, which are mentioned above.
 A very well visited afternoon session dealt with many aspects of PSA, screening and biopsies. Since 1993, Rotterdam, the Netherlands, is the focal point of a big European screening trial, in which 34,000 men between 55 and 74 are followed up, 17,000 of which have now been included in the study. The detection rate for prostate cancer was 4.9% in the first go in 1993. In 14% of previously negative biopsies, a second biopsy yielded cancer. The number of biopsies per patient may play a role here. See also the data of last sunday. In the screeningsarm (17,636 men), 816 cancers were found vs. 149 in the control group (17,513 men). Tumor grade in the screening group was also lower. The answer to questions, like whether this all means that more men can be succefully treated in an early stage or that too many men are treated, will have to wait until the end of the trial at around 2008.
The overactive bladder is part of the number of symptoms of BPH. The more obstructive the prostate, the more chance on bladder instability, going up from 16 to 60%. Common sense dictates that one should be cautious about treating an overactive bladder in these cases.
More tomorrow.
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Today, Patrick Walsh climbed the podium to present a State-of-the-Art lecture on the treatment of prostate cancer. A nicely illustrated introduction into the anatomic aspects of the radical retropubic prostatectomy (RRP) was followed by statistical information, like the rise in the number of RRP's in men between the ages of 55 and 70 from 20 to 50% between 1983 and 1993. Ten years after surgery, 80% remains disease free, although Walsh admits that definitions on that term can be quite different. The same goes for the number of complications that are often either over- or underrated. He illustrates this with studies, some by welknown urologists, in which the percentage of incontinence is as high as 39%. He states that RRP's should be concentrated in big centres where enough experience can be accumulated. In Johns Hopkins, 2700 RRP's have been performed between 1985 and 2000. The number that has been done by Walsh himself remained undisclosed. Neither does he comment on the role of laparoscopic RRP's.
Winfield presented a State-of-the-Art about laparoscopic complications. The complication rate has risen from .84% in 1990 to 7-14% today, together with a change from diagnostic to interventional procedures. High up on the chart of causes is the Verress needle with trocar. Thirty-two deaths have been recorded now, all of them because of bowel lesions that have been missed initially, or vascular lesions. In cases of bowel lesions, symptoms are not very specific, like pain near the former trocar insertion, slight elevation of temperature and leucopenia. Should these symptoms exist and not improve, a laparotomy is indicated. A second cause of complications is the CO2-insufflation, that may lead to metabolic acidosis, hypercapnia and CO2 emboli. Swift action in case of acute hypotension, tachycardia and hypoxia is mandatory. The patient should be put in Trendelenburg position, the abdomen desufflated and 100% oxygen administered, after which the anesthetist hopefully takes over.
Abrahams showed in a large study, however, that caution may not be necessary. Tolterodine could very well be used to alleviate symptoms only one retention was found in each group.
A study by Raya-Rivera (Boston, MA, USA) demonstrated the use of engineered testicular prostheses, made out of polymer scaffolds of manufactured bovine articular cartilage and filled with testosterone enanthate, that, when implanted, can release a physiologic level of testosterone for a prolonged period. Periodic reinjection may potentially provide permanent hormonal replacement. Melman (Bronx, NY, USA) showed a trick of genetic engineering in rats in which is was possible to transfect the hSlo/pcDNA gene via intravenous injections into the corporal bodies in aging animals and thus rejuvenate the penis and normalize penile erection for a follow-up of 6 months. 
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