Naslund (Baltimore, MA, USA) presented a speech on supply and demand of urology during the Charles Hoffman Memorial Lecture. There's good news for US urologists who feel they have given away too much in fee negotiations with insurers. In some areas of the country the demand for urology is increasing as the polpulation ages. Physician's fees have been ratcheted down over the past 10-15 years, fueled by an excess of physicians and the reaction of most to accept lower fees and see more patients per unit of time. The surplus of urologists is dwindling. 'If your group is busy, and every other group around you is busy, you can say 'no' when the insurance company wants you to discount your fees further'. Urologists can negotiate both fees and contract terms more aggressively.
After Urologix took over Prostatron from the French company EDAP, Prostate thermotherapy for BPH (TUMT) has been in the hands of two major players: Urologix' Targis and the ProstaLund device from Sweden. Now, Urologix is trying to defeat the Swedes with legal arms and is suing them for patent infringement. A third company, Thermatrx, has now entered the arena. Contrary to Targis and ProstaLund, that typically use up to 50-70 Watts, the Thermatrx device uses only 5-20 Watts, obliviating the need for cooling. While the trend is towards higher power delivery to the prostate to increase the volume of necrosis, it seems a strange 'backwards innovation' to aim for such low power applications. We will await the results.

Pantuck, (Los Angeles, CA, USA) demonstrated in an in vitro human bladder cancer model that Green Tea extract inhibits cell proliferation, induces differentiation, and has a modulateable effect on cellular F/G-actin ratios in both PC and MTC I I cells. These findings provide direct, though preliminary, support for the use of Green Tea as a chemoprevention strategy in patients with smoking related bladder cancers, since the cell line used in the test is transformed into cancer by the carcinogen 4-Aminobiphenol (4-ABP), the major carcinogenic derivative found in cigarette smoke. Green tea counteracts the effects of 4-ABP on cellular differentiation.
Botulinum toxin A (BTX), commonly known as Botox, shows promise as a treatment for a variety of lower urinary tract dysfunctions, according to Chancellor (Pittsburgh, USA). Forty-one of 50 patients, suffering from spinal cord injury, overactive bladder, interstitial cystitis and multiple sclerosis, resulting in various types of dysfunction, reacted well to intravesical Botox and ended up having less incontinence.
Hopkins (Madison, WI, USA) showed a placebo-controlled study into the effect of a vaginal mucosal vaccine in vaginal suppository form to reduce recurrent urinary tract infections in adult women. of 54 women enrolled in the study, 55% of the vaccine group had no infection, vs. 89% of the placebo group for a period of 4.5 months.

In a nice study by Fleshner (Toronto, Canada), about the anlytical precision and reliability of commonly used nutritional supplements, which are offered on several booths during this AUA, samples of vitamin E (n=7) and selenium (n=5) fell within a range of -41% to +57% and -19% to +23% of the stated dosage, respectively. Vitamin D brands (n=4) all fell within 15% of the stated dose. Saw palmetto samples (n=6) fell within a range -97% to +140% of the stated dosages with 3 containing less than 20% of the stated dosages. Lycopene brands were between -38% and +143% of stated dosages. Among the reliability assays, one of three brands of vitamin E, one of two brands of selenium, and one of two brands of saw palmetto demonstrated statistical differences in interlot dosage (p<. 0055, approximate 20-25% differences in dose). The one assayed form of Vitamin D was reliable between lots. Therefore, commonly used nutritional supplements for prostate disease can vary widely in their measured dose. The more regulated substances such as vitamins and minerals demonstrated less variation whereas the herbal product Saw Palmetto demonstrated tremendous variability with some samples containing virtually no active ingredients. These data suggest that non-responders to Saw Palmetto may benefit from a trial of an alternative brand, while regulation is required to improve the manufacturing standards of nutritional supplements.

Saad (Montreal, QC, Canada) presented a multicenter, randomized, placebo-controlled trial of zoledronic acid conducted in 643 patients with hormone-refractory prostate cancer (HRPC) and at least 1 bone metastasis. Patients were randomized to zoledronic acid (4 or 8/4 mg via 15-minute infusion) or placebo every 3 weeks for 15 months. Zoledronic acid provides significant clinical benefit in patients with HRPC, particularly with respect to reducing the risk of pathologic fracture and other skeletal-related events (SREs), including radiation needed. In general, the time to first SRE and time to first pathologic fracture was doubled, and the incidence of long-bone and vertbral fractures halved. Patients on 8 mg zoledronic acid fare no better that those on 4 mg.