Leading Urologists Are Available for Expert Commentary on the Latest Research Findings
May 13, 2011
Among those presenting at this year's American Urological Association meeting are physician-scientists from NewYork-Presbyterian Hospital/Weill Cornell Medical Center. The meeting takes place May 14–19, at Walter E. Washington Convention Center, Washington, D.C.
The following are notable research studies:
Dr. Ashutosh Tewari
The Ronald P. Lynch Professor of Urologic Oncology at Weill Cornell Medical College, and director of the Prostate Cancer Institute and the LeFrak Robotic Surgery Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
Effectiveness of robotic prostatectomy.
There is no clear evidence that one approach (open prostatectomy vs. laparoscopic/robotic) is better than another for surgical treatment of prostate cancer. The aim of this meta-analysis was to analyze the literature available between 2002 and 2008 and compare positive surgical margin and complication rates for open retropubic, laparoscopic and robotic radical prostatectomy. Dr. Tewari and his co-investigators showed that robotic-assisted laparoscopic radical prostatectomy has overall lower perioperative morbidity and improved early oncologic outcomes compared with conventional laparoscopic or open approaches. The open and laparoscopic surgical groups had similar overall positive surgical margin rates, with the robotic group having lower rates. Both minimally invasive approaches showed significantly lower estimated blood loss and rate of blood transfusions, and a shorter length of hospital stay when compared with an open approach. A further decrease in these parameters was seen when robotic assistance was used. Total complication rates were highest for the open approach, intermediate for the laparoscopic cohort, and lowest for the robotic group. For the individual complication analysis, the rates for death; readmission; reoperation; ureteral, bladder, and rectal injury; ileus; pneumonia; fistula; and wound infection showed significant differences between groups.
"A Meta-Analysis Comparing Positive Surgical Margin and Complication Rates of 110,016 Patients Undergoing Open Retropubic, Laparoscopic and Robotic-Assisted Radical Prostatectomy." Sunday, May 15, 10:30 a.m–12:30 p.m.
Dr. Douglas S. Scherr
Associate professor of urology at Weill Cornell Medical College and a urologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
Especially for elderly, the less invasive technique of robotic cystectomy is safe and effective.
Because of the close relationships between age and incidence of bladder cancer, treatment of life-threatening, invasive bladder cancer has become an enormous challenge with the growth of our aging population. However, elderly patients are less likely to be treated with extirpative surgery (the standard, most effective treatment) compared with their younger counterparts. Dr. Scherr and his co-investigators evaluated the feasibility and safety of robot-assisted radical cystectomy (RARC) in octogenarians. They report that RARC is feasible and safe for octogenarians. Despite a higher prevalence of comorbidities in octogenarians, RARC can provide similar disease control and survival outcomes with risks of major perioperative morbidity comparable to those in younger patients. Further follow-up in large cohorts of patients is necessary to confirm these observations and discern long-term oncologic and survival outcomes, they report.
"Robotic Radical Cystectomy Is Feasible and Safe in The Treatment of Adequately Selected Octogenarians." Sunday, May 15, 1:00–3:00 p.m.
Dr. Shahrokh Shariat
Assistant professor of urology at Weill Cornell Medical College and a urologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
Use of a specialized urine test for patients with blood in the urine is very helpful to identify the presence of bladder cancer for these patients.
The ImmunoCyt immunocytology assay — a specialized urine test — detects cellular biomarkers for bladder cancer (BCa) in exfoliated urothelial cells. The role of ImmunoCyt for BCa detection remains controversial. Therefore, Dr. Shariat and his co-investigators assessed the performance of ImmunoCyt for detecting BCa in a large multi-institutional cohort of patients undergoing initial evaluation for asymptomatic hematuria. They report that ImmunoCyt is a strong, independent predictor of BCa presence in patients with hematuria; it outperforms cytology. Addition of ImmunoCyt into the clinical decision-making process may help with patient counseling, improve referral patterns (via increased awareness and prioritization), and possibly spare patients at extremely low risk of BCa from unnecessary hematuria workups.
"Immunocytology Is a Strong Predictor of Bladder Cancer Presence in Patients With Asymptomatic Hematuria." Monday, May 16, 3:30–5:30 p.m.
Dr. Alexis E. Te
Professor of urology at Weill Cornell Medical College and director of the Brady Prostate Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
Overweight men may not do as well after prostatectomy.
Recent studies have shown that obese men have an increased risk of developing benign prostate hyperplasia (BPH) and lower urinary tract symptoms. However, data is lacking to explore the effect of body mass index (BMI) on surgical outcomes following treatment of bladder outlet obstruction due to BPH. Dr. Te and his co-investigators compared outcomes in men with normal versus elevated BMI following transurethral laser prostatectomy. They report that men with an elevated BMI had significantly less improvement in maximum flow rate following laser prostatectomy than men with normal BMI. However, BMI had no influence on improvement in International Prostate Symptom Score or post-void residual. This data may assist urologists when counseling overweight men regarding their expectations of symptom relief following laser prostatectomy.
"A Comparison of Clinical Outcomes Following Transurethral Laser Prostatectomy in Men With Normal Versus Elevated Body Mass Index." Tuesday, May 17, 1:00–3:00 p.m.
Dr. Peter Schlegel
Chairman of Department of Urology and professor of urology and reproductive medicine at Weill Cornell Medical College and urologist-in-chief at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
A novel imaging technique (multiphoton microscopy), developed in conjunction with Cornell University engineers in Ithaca, may provide the ability to help men with severe infertility who require surgical treatment to extract sperm for IVF.
Successful microdissection testicular sperm extraction (micro-TESE) depends on the ability to identify tubules that harbor sperm. Multiphoton microscopy (MPM), is a novel technique to image intact, unprocessed tissue in real time, and could significantly improve physicians' ability to identify sites of sperm production during surgical treatment of patients with severely impaired sperm production (who have no sperm in the ejaculate). Dr. Schlegel and his co-investigators report that MPM can be used to identify spermatogenesis in the testis in ex vivo tissue of healthy rats. This study in rodents suggests that MPM may also be applied during surgery on humans to aid in their treatment. A unique advantage of this technique, they say, is the real-time acquisition of high-resolution images without necessitating any extrinsic labeling agent.
"Multiphoton Microscopy of Rat Testis for Real-Time Spermatogenesis Identification." Wednesday, May 18, 8:00–10:00 a.m.
Dr. Marc Goldstein
The Matthew P. Hardy Distinguished Professor of Reproductive Medicine and a professor of urology at Weill Cornell Medical College, and surgeon-in-chief of male reproductive medicine and surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
Men may have low testosterone levels because of varicoceles, a surgically curable condition.
Men with clinically palpable varicoceles are at high risk for progressive decline in fertility, and more recent evidence suggests that these men are also at greater risk for androgen deficiency. Repair of a higher-grade (larger) varicocele has been shown to result in greater improvement in sperm count and quality than repairing a lower-grade varicocele. In this study, Dr. Goldstein and his co-investigators sought to determine whether grade (varicocele size) is related to degree of improvement in serum testosterone levels after varicocelectomy. They report that microsurgical varicocelectomy results in significant increases in testosterone independent of varicocele grade. Microsurgical varicocelectomy should be offered to hypogonadal men regardless of varicocele grade.
"Varicocelectomy Is Associated With Increases in Serum Testosterone Regardless of Clinical Grade." Wednesday, May 18, 1:00–3:00 p.m.
For more information on the American Urological Association meeting, visit www.aua2011.org.
NewYork-Presbyterian Hospital/Weill Cornell Medical Center
NewYork-Presbyterian Hospital/Weill Cornell Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and Weill Cornell Medical College, the medical school of Cornell University. NewYork-Presbyterian/Weill Cornell provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, education, research and community service. Weill Cornell physician-scientists have been responsible for many medical advances — including the development of the Pap test for cervical cancer; the synthesis of penicillin; the first successful embryo-biopsy pregnancy and birth in the U.S.; the first clinical trial for gene therapy for Parkinson's disease; the first indication of bone marrow's critical role in tumor growth; and, most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. NewYork-Presbyterian Hospital also comprises NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian/Morgan Stanley Children's Hospital, NewYork-Presbyterian Hospital/Westchester Division and NewYork-Presbyterian/The Allen Hospital. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. Weill Cornell Medical College is the first U.S. medical college to offer a medical degree overseas and maintains a strong global presence in Austria, Brazil, Haiti, Tanzania, Turkey and Qatar. For more information, visit www.nyp.org and weill.cornell.edu.