- Neurourology and Urodynamics
- Pediatric Urology
- Robotic Urology
- Urinary Incontinence
Chair
Dana L Jacoby
BSM Consulting, USA
Session Introduction
Dana L Jacoby
BSM Consulting, USA
Title: Optimizing urology group partnerships: Collaboration, compensation, and centers of excellence
Time : 11:15-11:45
Biography:
Dana Jacoby has more than fifteen years of experience in healthcare with roles in sales, operations, consulting, and management.
Dana has been involved in change management, operations, and strategic planning in 30 of the 35 major medical markets in the United States. In addition she has conducted training and business development in European and Asian medical markets. She has been responsible for business planning with management, staff, and physicians at 17 top tier hospitals as ranked by U.S. News and World Report.
Ms. Jacoby holds a Bachelor of Science degree from Louisiana State University in Baton Rouge and a Master of Management from Tulane University in New Orleans. In addition, she holds a Master of Health Systems from the University of Medicine and Dentistry in Newark, NJ and is a Wharton Fellow at Wharton University in Philadelphia, PA.
Abstract:
Market forces in healthcare have created substantial regulatory, legislative, and reimbursement changes that have impacted urology group practices and health systems. Although group operations vary considerably, the majority of groups have struggled with the development of a strong culture, eff ective decision making, and consensus building around shared resources, income, and standardized care. Creating a sustainable business model requires urology group leaders to allocate appropriate time and resources to address these issues in a proactive manner. Th is presentation will outline collaboration strategies for creating eff ective culture, governance and leadership while providing practical suggestions on how to optimize urology group practice performance. Research suggests that successful urology groups and medical institutions have outstanding physician leaders who recognize the importance of creating a common culture built around a strong mission, vision, and set of values. Physicians must understand the value of developing a compensation plan and cultural structure that eff ectively aligns the incentives of the group in achieving long-term objectives. Principles of governance to be covered as a part of the discussion: • Trust, transparency, and communication. Proven methods to reduce the ineffi ciencies of stymied communication. • Physician-Hospital Interdependence. How to best achieve respective economic and clinical goals through collaboration and integration. • Aligning fi nancial incentives. Delivering cost-eff ective, high-quality care consistent with best practices to produce shared incentives • Quality-Identify and measure relevant indicators • Shared Leadership, Physician-driven and professionally managed clinical enterprise solutions
Mireia Olivan Riera
Vall d’Hebron Institute of Research, Spain
Title: Protein biomarkers in urinary exosome for the diagnosis of prostate cancer
Time : 11:45-12:15
Biography:
After her PhD based on therapeutic strategies for cancer cachexia (University of Barcelona), her first postdoctoral fellowship led her to work at the University of Sao Paulo (Brazil), where she studied the role of adipose tissue in inflammation during cachectic syndrome. When she returned to Barcelona, she obtained a postdoctoral position in the Group of Biomedical Research in Urology in the Research Institute of Vall Hebron Hospital. The last years, her main research has been in the field of biomarkers for the detection of aggressive prostate cancer. Recently, she spent a fruitful period at Mount Sinai Hospital (New York), where she studied the potential of miRNAs as therapeutic targets. The last year, she has also been focused in the study of urinary exosomes as a new source of biomarkers.
Abstract:
Background: Rapid and reliable diagnosis of prostate cancer (PCa) is highly desirable. Sensitivity and failure rate of current methods for diagnosis limit the success to early detect this type of cancer and consequently advanced disease is often encountered. Furthermore, the identification of PCa biomarkers that can classify patients into high- and low-risk groups of disease progression and therefore help in the treatment decision-making is a major area of ongoing research.
Objectives: Since the prostate is in direct contact with the urethra, desquamated cells and secreted products including exosomes like vesicles (ELV) are abundant in human urine and serve as potential source for PCa biomarkers. In this study we aimed to identify protein biomarkers in urinary exosomes for early non-invasive detection and stratification of PCa.
Methods: Protein biomarker candidates for PCa were initially identified from a discovery phasedone in urinary exosomes isolated by ultracentrifugation from urine obtained after digital rectal examination. Specifically, label-free LC-MS/MS protein quantitation was performed on 24 samples: 8 benign samples, 8 low-risk PCa samples (Gleason=7(3+4)) and 8 high-risk PCa samples (Gleason>7). Proteins significantly changing in abundance were selected for further selected reaction monitoring (SRM) validation in 53 urinary exosomes samples from PCa patients and 54 from benign counterparts.
Results & Discussion: We identified 1673 proteins including PSA, PSMA and ACPP and selected a panel of 64 candidates for validation by SRM. Ultimately we identified a profile of 2 novel urinary exosome-associated protein biomarkers after the comparison between benign and PCa patients and a promising profile of 5 proteins able to significantly distinguish between high (Gleason ≥7 (4+3)) and low (Gleason ≤7 (3+4)) risk patients. The presence of the candidates was confirmed in urinary exosomes of PCa and benign prostate pathologies patients by western blot and analyzed in TMA PCa samples. In summary, our proteomic studies identified a list of markers which are very good candidates for evaluation of their clinical utility in future studies in order to reduce PCa related over-diagnosis and over-treatment.
Sibel Silici
Erciyes University, Turkey
Title: In vivo nephroprotective efficacy of propolis against contrast-induced nephropathy
Time : 12:15-12:45
Biography:
Sibel Silici is a professor from Erciyes University, Turkey
Abstract:
Objective: Contrast-induced nephrophaty (CIN) is a common cause of hospital-acquired renal failures following the administration of computer tomography contrast agent Diatrizoate, but can be prevented using pretreatment with pharmaceutical compounds, such as N-acetylcystein (NAC) and Calpain. Th is paper explores the value of natural antioxidant compound Propolis with demonstrated benefi ts in health care as a potential nephroprotector. Materials &Methods: In vivo experiments were performed with a total of 35 male rats divided equally into 5 groups: Control, Diatrizoate administered (6 mg/kg/bw i.v.) and pretreatment with either propolis (100 mg/kg/bw), NAC (300 mg/kg/bw) or Calpain (10 mg/kg/bw) 1 hr before the Diatrizoate administration (6 mg/kg/bw i.v.). Th ree days later, blood, urine and renal tissue samples were collected and quantitatively processed for critical biomarkers sensitive to the indicated manipulations. Specifi cally, Malondialdehyde (MDA), glutathione (GSH), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and catalase (CAT) activities in renal tissue in addition to plasma urea and serum creatinine levels were measured and statistically analyzed to determine the response and effi cacy of each of the selected pretreatment approach. Results: Overall, pretreatment with Propolis was consistently proven to be more eff ective in restoring the values of the measured parameters to within their normal ranges compared to NAC and Calpain. Conclusion: With its robust power to eliminate free radicals and other adverse eff ects induced by Diatrizoate, Propolis plays an important protective role in preventing kidney from getting CIN.
Mireia Las Heras Alonso
Hospital Universitario de Getafe, Madrid Universidad Europea
Title: Penile low-intensity shock wave therapy: A promising novel modality for erectile dysfunction
Time : 12:45-13:15
Biography:
Mireia Las Heras is an urologist, and did her andrology training in the Fundación Puigvert (Barcelona) in 2005. She obtained his Doctorate degree from the Universidad Autónoma de Barcelona in 2010, and developed the Fellow of European Board of Sexology in Amsterdan in 2012. She currently works at the Hospital Universitario de Getafe (Madrid), where she developed her work as andrologist and conducting research.
Abstract:
Penile extracorporeal low-intensity shock wave therapy (LIST) to thepenis has recently emerged as a novel and promising modality in the treatment of erectile dysfunction (ED). LIST has angiogenic properties and stimulates neovascularization. If applied to the corpora cavernosa, LIST can improve penile blood fl ow and endothelial function. In a series of clinical trials, including randomized double-blind sham-controlled studies, LIST has been shown to have a substantial eff ect on penile hemodynamics and erectile function in patients with vasculogenic ED. LIST is eff ective in patients who are responsive to phosphodiesterase 5 inhibitors (PDE5i) and can also convert PDE5i non-responders to responders. Th e response to LIST wanes gradually over time, and aft er 2 years, about half of the patients manintain their function. Extensive research is needed to understand the eff ect of LIST on erectile tissue, to modify the treatment protocol to maximize its outcomes, and to identify the patients who will benefi t the most from this treatment.
Suzi Demirbag
Gulhane Military Medical Academy, Turkey
Title: Indications and effectiveness of the open surgery in vesicoureteral reflux
Time : 14:00-14:30
Biography:
Suzi Demirbag has completed his MD at the age of 23 years from Gulhane Military Medical School and Postdoctoral studies from same center. He has published more than 36 papers in reputed journals.
Abstract:
Vesicoureteral reflux (VUR) is retrograde flow of urine from the bladder into the ureters and is still one of the most common causes of end-stage renal disease in infancy and childhood. In this abstract we will discuss indications and effectiveness of the open surgery in VUR. The prevalence of VUR in healthy children is around 1-3% and varies depending on sex, age and race. There are two treatment options for patients with VUR: Medical and surgical. The main goal in the management of vesicoureteral reflux in children is to protect renal function. There is a still disagreement regarding the optimal management of the VUR.
Chetan Mehndiratta
Ranbaxy Laboratories Limited, India
Title: Silodosin improves low urinary tract symptoms associated with benign prostatic hyperplasia
Time : 14:30-15:00
Biography:
Chetan Mehndiratta is a researcher from Ranbaxy Laboratories Limited, India
Abstract:
Introduction & Objective: Benign prostatic hyperplasia (BPH) is a globally prevalent histological condition with approximately 80% to 90% men aff ected in their 70s and 80s. Th e present study was a pan-India survey conducted among 655 urologists for highlighting the role of silodosin, a highly selective α1A-AR antagonist in the management of lower urinary tract symptoms (LUTS) associated with BPH. Methods: Th e survey consisted of an objective, time based questionnaire to be completed by the urologists to obtain their opinion on the best drug choice for LUTS management. Th e response to silodosin on the relevance scale (scores of 1-5) was categorized as average-1, above average-2, good-3, very good-4 and excellent-5. Th e results were expressed as mean scores and percentage values. Results: According to approximately 85% of urologists, silodosin has a good to excellent relevance in patients suff ering from moderate to severe nocturia. Silodosin was also eff ective in the group of LUTS patients who were concomitantly treated with antihypertensive medications and PDE5 inhibitors as well as patients who were not satisfi ed with previous therapy of alpha blockers. Conclusions: Silodosin might prove a potent agent in the improvement of the clinical symptoms related to LUTS with BPH, especially in elderly patients
- Urologic Oncology
- Genitourinary Medicine
Session Introduction
Amal Fawzy Said
Cairo University, Egypt
Title: Increased Cell-Free Circulating Plasma DNA in cancer Prostate
Biography:
Amal Fawzy Said is an assistant professor from Cairo University, Egypt
Abstract:
BACKGROUND: Prostate Cancer is the most common cancer overall after breast cancer, and is the most common cancer affecting men, who have a lifetime risk 10% of developing the disease and 3% chance of dying. DNA is normally released from an apoptotic source which generates small fragments of cell-free DNA, whereas cancer patients have cell- free circulating DNA that originated from necrosis, autophagy, or mitotic catastrophe..
Aim of work: to determine the role of total plasma cell-free DNA levels in newly diagnosed cancer prostate.
Methodology: The amount of DNA was determined by a quantitative real-time PCR technique, using two sets of primers to amplify the consensus ALU sequence. ALU 115-bp amplicons were representing the total amount of free cell-free circulating DNA. While ALU 247-bp amplicons representing the DNA released from non-apoptotic cells. DNA integrity was calculated as the ratio of concentrations in each assay.
Results: The levels of plasma cell-free DNA in the cancer group were significantly higher in comparison with the benign tumor group (P < 0.001) and the healthy control group (P < 0.001). There was statistically significant association with some prognostic parameters
Xiaotian Yuan
Karolinska University Hospital, Sweden
Title: Differential frequencies in TERT promoter and FGFR3 mutations between Chinese and western patients with urothelial bladder cancer
Biography:
Xiaotian Yuan is an PhD student from Karolinska University Hospital, Sweden
Abstract:
The TERT promoter and FGFR3 gene mutations are two most common genetic events in urothelial bladder cancer (UBC) and these mutation assays in patient urine have been shown promising biomarkers for UBC diagnosis and surveillance based on analyses of UBC patients from western countries. However, we observed TERT promoter and FGFR3 mutations in 87 of 182 (47.8%) and 7 of 102 (6.7%) Han Chinese patients with UBC, respectively, which were lower than those in UBC patients from western countries. In 46 urine samples from patients with TERT-promoter mutation-carrying tumors, the mutant promoter was detected in 24 (52%) prior to operation and disappeared in 80% urine samples one week post-operation. TERT mRNA was detected in urine derived from 46 of 49 (94%) of patients determined before operation independently of TERT promoter mutations. Collectively, FGFR3 mutations occur at a very low rate in Han Chinese UBC patients compared with western patients, indicating a different aetiology between Chinese and western UBCs. Han Chinese UBC patients have a relatively lower TERT promoter mutation frequency, and simultaneous detection of both mutant TERT promoter and TERT mRNA improves sensitivity and specificity of urine-based diagnosis.
Emanuele Corongiu
University of Rome, Italy
Title: Role of percutaneous tibial nerve stimulation in the treatment of neurogenic overactive bladder syndrome.
Time : 12:40-13:10
Biography:
Emauele Corongiu is an professor from University of Rome, Italy
Abstract:
Overactive bladder syndrome (OAB) is characterized by a series of urinary symptoms such as incontinence, urgency, frequency, nocturia and it is nowadays differentiated in OAB, due to an involuntary urodynamic detrusor contraction, responsible of the symtoms and Neurogenic Detrusor overactivity (NDO). Many neurologic pathologies can be responsible of NDO such as Parkinson disease, multiple sclerosis, spinal cord injury, cerebral palsy, brain tumors, cerebrovascular pathologies, and meningomyelocele and the lower urinary tract disfunction depend on the site and the completeness of the associated neurological lesions. Aim of the study is to evaluate preliminary results on symptoms and urodynamic findings of posterior tibial nerve stimulation (PTNS) in patients with NDO.
METHODS:
Twelve patients (pts.), 9 men and 3 females, age ranged from 25 and 76 years with clinical and urodynamic diagnosis of NDO were included in the study. Electrical stimulations were applied unilaterally from the medial malleolus and posterior to the edge of the tibia twice a week for a total of 6 weeks. Urodynamic parameters were evaluated before and after treatment. Overactive bladder questionnaire (AOB-q) and voiding diary were performed in all pts. before treatment after 6 elettrical stimulations and at the end of treatment.
RESULTS:
PTNS was found to be effective on OAB symtoms in all pts., according to the data of the questionnaires and voiding diary. Mean 1st involuntary detrusor contraction (IDC) and mean maximum cistometric capacity(MCC) were significantly improved on standard cystometry. 8 pts. (66,6%) showed a complete disappearance of IDC and the other 4pts.(33,3%) showed an increased filling volume to IDC. No complications have been reported and pts. compliance to treatment was very high.
CONCLUSIONS:
PTNS is an effective and safe option to treat pts. with symptoms from NDO. Further studies are needed to assess the role of this technique, and to establish the length of treatment in order to maintain the results obtained.
Samileh Noorbaksh
Research Center of Pediatric Infectious Diseases, Iran
Title: Dynamic magnetic resonance urography vs DMSA scan, IVP, Ultrasonography in children with urinary tract infection
Time : 14:00-14:30
Biography:
Samileh Noorbaksh is an Professor Research Center of Pediatric Infectious Diseases, Iran
Abstract:
Background: Urinary tract infection 0 in children causes renal scarring and permanent
damage to the organ. In this study, we compared the diagnostic value of magnetic
resonance urogram for urinary tract anomalies with other conventional imaging
methods in children with UTI.
Methods: In this case-control study, 190 children (mean age 3.23±3.59 yrs) with UTI
were recruited from the Pediatric Ward of Rasul-e-Akram Hospital during 2007-2009.
The patients were divided into two groups based on the applied imaging technique:
MRU (cases) and conventional imaging groups (controls).
Results: Abnormal imaging detection rates for Ultrasonography were 32%, X-ray of
kidneys, ureters and bladder (KUB) 9%, Intravenous Pyelogram (IVP) 26%, Voiding
Cystoure therogram (VCUG) 54%, Dimercaptosuccinic Acid scan (DMSA) indicating
non-obstructive (reflux) uropathy in 76% (mean age 3.5 yrs) and MRU 43% (mean age
1.6 yrs), respectively. A meaningful correlation was observed between MRU and DMSA
scan with IVP results (Kappa=0.75). KUB and Ultrasonography had similar results in
cases with abnormal MRU and DMSA scan (P=0.121). MRU had strong agreement with
VCUG and IVP for the detection of obstructive uropathy and scar due to congenital
malformation even during intrauterine life but not with sonography results.
Conclusion: Sonography had poor results for the diagnosis of urinary tract anomalies in
comparison with MRU. Use of dynamic MRU for the diagnosis of congenital anomalies
(hydronephrosis, obstruction, pyelonephritis, renal scar) in children with UTI seems to
be of better help, although higher costs and the need for sedation during MRU still are
its disadvantages.
Chetan Mehndiratta
Ranbaxy Laboratories Ltd., India
Title: Effect of silodosin and dutasteride combination treatment in Indian patients of benign prostate hyperplasia with an enlarged prostate and co-morbid condition
Time : 11:40-12:10
Biography:
Chetan Mehndiratta is an researcher from Ranbaxy Laboratories Ltd., India
Abstract:
Introduction: Benign prostate hyperplasia can occur up to about 50% of men by age 50 with an increase in incidence with age. Th e International Prostate Symptom Score (IPSS) questionnaire can help in the diagnosis and determine patient outcome. Th e addition of dutasteride, a 5-alpha-reductase inhibitor to silodosin can be benefi cial in cases of benign prostate hyperplasia with an enlarged prostate especially in patients with co-morbid conditions like hypertension, obesity and dyslipidemia. Objective: Th is study has evaluated the eff ectiveness and safety of combination treatment of silodosin and dutasteride in Indian patients with mild to severe benign prostatic hyperplasia symptoms. Methods: Th e study was a non-interventional observational study, conducted in 1695 Indian male patients with benign prostatic symptoms between 45-75 years of age. All the patients received a combination of silodosin and dutasteride for benign prostatic hyperplasia with enlarged prostate. Th e study results were the treating physician’s observations based on which descriptive analysis was carried out. Results: Around 71% of the patients in this study were of more than 55 years of age. Th e study observed that at baseline, majority (57%) of patients had moderate prostatic hyperplasia whereas at the end of the study aft er receiving combination of silodosin and dutasteride, 70% of patients had mild prostatic hyperplasia. Th e combination of silodosin and dutasteride brought an overall improvement in symptoms and symptom in 79% patient and prevented aggravation of symptoms in 20% patients. Th e patients with co-morbid conditions in the study were 36% with hypertension, 15% with obesity, and 10% with dyslipidemia. Less than 2% patients reported adverse events with the treatment. Conclusion: Th e combination of silodosin and dutasteride was found to be effi cacious and safe by improving the symptoms in patients of benign prostate hyperplasia with enlarged prostate, especially in comorbid conditions like hypertension, obesity and dyslipidemia.
Jacques Choucair
Saint Joseph University, Lebanon
Title: Ertapenem as treatment for ESBL producing E. coli prostatitis
Time : 12:10-12:40
Biography:
Jacques Choucair is an professor from Saint Joseph University, Lebanon
Abstract:
Introduction: Prostatitis presents one of the most common entities encountered in urologic practice. Treating ESBL producing enterobacteriaecea urinary tract infections is a major problem especially in prostatitis because of the absence of active transporters for antibiotics and a relatively low prostate penetration of these drugs. Th us, therapeutic options are limited in infections with such resistant bacteria and require the use of carbapenems in the majority of the cases. Ertapenem is used in acute bacterial prostatitis yet not been approved by the FDA for this indication. Th e goal of this study is to compare the effi cacy of ertapenemas to other antibiotics in the treatment of prostatitis with ESBL producing E. coli. Methods: It is a comparative retrospective study of the fi les of patients admitted in Hotel Dieu de France between 1st July 2008 and 1st July 2014 treated for acute bacterial prostatitis caused by E. coli producing ESBL with ertapenem and other antibiotics. Results: Th e mean age of the 110 patients of this study was 69.58 years. Ertapenem was administered without previous effi cient antibiotic treatment in 34 cases. 18.18% recurred in a period of three months. 85% of recurrences were caused by ESBL producing E. coli (15.45%). 17% and 19% of patients treated with meropenem and imipenem respectively recurred in a 3 months period. Conclusion: Ertapenem is as eff ective as other carbapenems in treatment of E. coli producing ESBL and is not associated with a higher recurrence rate.
Ahmed Hashim
Ain Shams University School of Medicine, Egypt
Title: The coagulation depth of bipolar plasma vaporization of the prostate vs bipolar resection of the prostate vs transurethral resection of the prostate
Time : 12:40-13:10
Biography:
Ahmed Ezat Hashim has completed his Ph.D at the age of 23 years from Ain-Shams University and M.Sc. in Urology in 2012 from Ain-Shams University. He had been a resident of Urology in K. El-Koba Military hospital for 2 years and then Ahmed Maher Educational Hospital for 2 years. He is a Specialist of Urology in Wady El-Nile General Intelligence Hospital and in Manshyet El-Bakry Governmental Hospital since 2013 in parallel with working as a doctor (Medical Guidance and Insurance) for a Petroleum Company PetroDara since 2010.
Abstract:
In aim of comparing the coagulation depth in tissue specimen following Bipolar plasma vaporization of the prostate (BPVP), Bipolar resection of the prostate and Transurethral resection of the prostate (TURP) procedures. Because of the conventional transurethral resection of the prostate (TURP) is regarded as the gold standard in surgical treatment of benign prostatic hyperplasia (BPH) because of its immediate and enduring effi cacy. However, problems that have not yet been overcome for TURP include absorption of irrigation fl uid and bleeding. For this reason, alternative surgical options, such as bipolar transurethral resection of the prostate (BTURP) and bipolar transurethral vaporization of the prostate (BPVP) have been developed. In our study which done on 10 patient’s prostate, taking a diff erent 3 chips aft er the diff erent 3 techniques; bipolar plasma vaporization of the prostate, bipolar trans urethral resection of the prostate and the classic trans urethral resection of the prostate, were applied for a diff erent 3 areas of the prostate, comparing the coagulation depth of it pathologicaly. In our study the coagulation depth induced by BPVP was greater than that induced by BTURP and TURP, with no signifi cant diff erence between BPVP and BTURP (p > 0.05), while with a signifi cant diff erence between BPVP and TURP (p < 0.05). And the coagulation depth induced by BTURP was greater than that induced by TURP but with no signifi cant diff erence (p > 0.05). What prove that there is slight signifi cant diff erence in the coagulation depth of novo BPVP and the coagulation depth of the classic TURP.