AUA Convention Chicago - 2003
- Saturday 26 April, Prologue -
The Windy City
The AUA reporting has become a wellknown topic and seems to be a succesful concept. The AUA pressroom staff now and is being watched: 'Hey, your application was pretty late this year', 'we really liked the daily reports last year'. Well, at least two people seem to read these pages.
Although many websites, even the AUA's now have webcasts of the plenary sessions, the concept of the UROlog Congress Reporter has not been copied.
Together with Philip Weijerman and sponsored by Pharmacia, Joop Noordzij, now in his fifth AUA reporting year, will try to get you up-to-date on a variety of urological subjects.
'What a way to go: Chicago'.
Chicago, 'The Windy City', is the third biggest city of the USA: 'The city that moves too fast to be pinned down'. First impression is that of a ransackle conglomerate of nearly skyscraping but still impressing tall buildings at the shores of Lake Michigan. Indeed the place is windy, which can make the town really chilly at this time of year, although the sunns shines brightly. Incidentally, the term 'windy'was coined in 1893 by New York Sun editor Charles Dana who was fed up with the longwinded arrogant behaviour of local politicians - has something changed over the years? - over a world expo. On the other hand, Chicago os also the city of Nobel Prize winner Charles B. Huggins; Therefore Chicago constitutes an ideal location for the mother of all urological congresses.
News from the AUA frontline:
There is an impressive and rather bulky abstract book containing 1877 abstracts. It is surprising that of all abstracts (abs) only 38% are being published in a peer-reviewed journal (USA, abs 135).
Traditionally, saturday is filled with preliminaries like the Scieties meetings, which count 15 in all now. Newcomers are the Geriatric Urology Society and theSociety for Inflammation and Infection.
But also a few postersessions containing the first scientific titbits.
The remove the ureter in a nephroureterectomy session, a second incision is not mandatory, according to Takashi Saida (Japan, abs 6), since the ureter can be transurethrally stripped (as is done with varcose veins). This is not a new approach. However, chances on vesical recurrence is higher (36% versus 22% with the two-incision technique).
It will not surprise you that antibiotics given at cystoscopy will lower the chance on a post-cystoscopy urinary infection and that ciprofloxacin works as well as trimethoprim (UK, abs 22). The same goes for the new once-daily Ciproxin by Bayer, which is as effective as the twice-daily variety (USA, abs 23). Maybe it will surprise you that 48 hours of antibiotics given after catheter removal (after being in for >48 hours) has no effect on bacteriuria found at follow-up, while it will certainly interest you that nearly all bacteria found were resistant to ciprofloxacin (UK, abs 34).
Chronic prostatitis and the pelvic pain syndrome (CP/CPPS, the cold war revisited) seem to interest more researchers. In a randomized study in 65 men with negative cultures, Curtis Nickel (Canada, abs 104) found that levofloxacin leads to an 'early and significant improvement in symptoms', that persisted after 6 weeks of antibiotics, but unfortunately was not significantly different from the placebo group. Other placebo-controlled studies (Finland, abs 106 and USA, abs 109) showed alpha-blockers to be somewhat effective and statistically significantly better than controls. Because the differences are minimal, the question remains whether these results have any clinical relevance. It seems too early to prescribe long-term alpha-blockers for this group of patients. On the other hand, one has to ask whether chronic prostatitis indeed has a bacterial origin. The Italian Guercini (abs 114), on the contrary, postulated the inexistence of abacterial prostatitis. In 56 patients with CP/CPPS, he found evidence of infection in all prostate biopsies, while cultures were positive in nearly 80 percent. In short: 'further studies are needed …'.
Of all treatments, TUMT seems to get the best results (UK, abs 118), which is not surprising since this type of thermotherapy has been shown to have alpha-blocking, antibacterial, and (through damage to the nerve endings) local anaethetic effects.
An analysis of 31,240 patients with prostate cancer revealed an unusual percentage of metastasis (abs 58, USA). See the table below from this Ann Arbor study.
Because of the Partin tables, staging in low risk patients is often limited or absent. Maybe these data should be re-analysed in view of the above results.
The convention has yet to pick up steam and nothing more substantial comes to mind while the late afternoon sun is not cooled down anymore by the cold Canadian wind.
Your reporter team decided to spend the evening at 'Buddy Guy's Legend' starring Carl Weathersby and Lonny Brooks. A fantastic and ear shattering blues night, which has probably cost us a couple of Db's of a inner ear sensitivity. But alas ...
It was again a day of science and promises.