NYU Urology Research at the 2009 AUA Annual Meeting
NYU Urology was well represented at the 2009 Annual Meeting of the American Urological Association (AUA), held April 25-30 in Chicago, Illinois. NYU Urology faculty, residents and fellows contributed close to 50 abstracts to the conference's peer-reviewed research volume.
This conference, attended by over 20,000 urologists annually, provides an opportunity for practicing and academic urologists to share their most recent medical research findings. Highlights of some of this year's departmental research are below.
Urologic oncology
Patient satisfaction after prostate surgery
An abstract and poster by Dr. Herbert Lepor and resident Nitya E. Abraham examined the factors contributing to patient satisfaction after surgery for prostate cancer. Using interviews and questionnaires, the researchers tracked the health and quality of life of more than 1,500 men for 7 years after their radical retropubic prostatectomy. Patient satisfaction with the decision to have surgery consistently exceeded 93% over the course of the follow-up period. The factors that predicted long-term satisfaction were potency, continence and disease-free survival. The study objectively confirms that ‘open’ surgery remains a highly successful means of treating prostate cancer with high rates of patient satisfaction.
Bladder cancer
Dr. Xue-Ru Wu, Professor of Urology and Pathology and Director of Urological Research, presented his research on the role of E-cadherin deficiency in the development of bladder cancer. E-cadherin is an important molecule adjoining neighboring cells that line the inside of healthy bladders. But in patients with bladder cancer, this molecule is frequently present at much lower levels than normal.
The researchers in Dr. Wu’s laboratory used a mouse model of bladder cancer to test how reducing the levels of E-cadherin in the bladder would affect the development of bladder cancer. One test group of mice had very low inherent levels of normal E-cadherin in their bladders, and another group had normal levels of E-cadherin. Over time, the test group of mice developed symptoms of the early stages of bladder cancer.
In addition, when both groups of mice were exposed to a chemical known to cause bladder cancer, the test group deficient in E-cadherin was more likely to develop high-grade, muscle-invasive bladder cancer compared with the normal mice.
These are the first results demonstrating that lack of E-cadherin can promote the growth and progression of bladder cancer. Dr. Yan Liu, Senior Research Associate in Dr. Wu’s group, Dr. Tung-Tien Sun, Professor of Cell Biology and Urology and Dr. Herbert Lepor, Professor and Chairman of Urology also participated in this study. The investigators received a 2009 AUA “Best Poster in Bladder Cancer Basic Research” award, a top honor recognizing excellence in urologic research.
MRI, prostate cancer diagnosis and focal therapy
An abstract and podium presentation by Dr. Samir Taneja, resident Timothy Ito and former Bruce Sherman Fellow Basir Tareen examined the ability of MRI to detect localized prostate cancer confined to one side of the gland.
The rationale for this study was to explore if MRI can be used to improve the selection of patients for focal therapy. Focal therapy destroys the cancerous portion of the prostate, rather than removing the entire gland. When considering focal therapy for the treatment of prostate cancer, it is important to have an accurate assessment of whether the cancer is confined to one side of the prostate. Previous studies have shown that traditional prostate biopsy alone is not very accurate at determining which men have cancer on only one side of the prostate.
Dr. Taneja and colleagues compared the results of biopsy, MRI and final surgical pathology in 41 men who underwent prostatectomy for prostate cancer. The researchers found that, compared with biopsy, MRI was more accurate at determining that one side of the prostate was free of cancer. In addition, the results indicated that using biopsy and MRI together can lead to 100% accuracy and sensitivity in determining which cancers were confined to one side of the prostate.
Localized prostate cancer
Dr. Samir Taneja delivered the take-home message on localized prostate cancer for the plenary session of the meeting. This talk summarized the most important data presented at the meeting in the area of localized prostate cancer therapy.
Male sexual health
Drs. Andrew McCullough, Herbert Lepor and Samir Taneja reported the results of a clinical trial that studied the effectiveness of two medications, intraurethral alprostadil (MUSE) and sildenafil citrate (Viagra), administered after radical prostatectomy. Previous studies have looked at these two drugs, but results have been mostly observational. This study was the first large randomized trial to prospectively examine the effectiveness of both medications.
The investigators found that men who took MUSE reported substantially better erectile function and success at intercourse than men who took Viagra during the first six months after prostatectomy. This study has important implications for sexual rehabilitation protocols in the early months after prostate surgery.
Endourology and stone disease
An abstract by Dr. Ojas Shah and resident Eli Hyams compared the cost and clinical outcomes for two types of treatments for kidney stones: percutaneous nephrolithotomy and ureteroscopy with Holmium laser lithotripsy. In percutaneous nephrolithotomy, the surgeon extracts or breaks up the stone through a surgical incision in the back. In ureteroscopy with laser lithotripsy, the urologist breaks up the stone using a laser passed through a small scope that is navigated into the kidney through the urinary tract. Percutaneous nephrolithotomy typically requires a hospital stay, whereas ureteroscopy with laser lithotripsy is an outpatient procedure.
Over the course of 14 months, the researchers found that the two methods achieved comparable success rates. However, ureteroscopy with laser lithotripsy did so at a significantly lower cost than percutaneous nephrolithotomy. In addition, ureteroscopy with laser lithotripsy did not routinely require a second-stage procedure.
This finding could be encouraging for patients who do not wish to undergo hospitalization or who are unable to undergo more invasive surgery because of other health problems. The significant difference in cost could also have implications for urologists in developing standardized guidelines for treatment of kidney stones.
Shah and Hyams’ results will also be published in an upcoming issue of the Journal of Urology.
Robotic surgery
An abstract by Dr. Michael Stifelman and residents Lori Dulabon and Michael Lipkin reported the results of a multi-institutional comparison of robotic partial nephrectomy and laparoscopic partial nephrectomy. Partial nephrectomy, which is used to treat diseases such as kidney cancer and renal cysts, involves removing the diseased portion of the kidney while allowing patients to retain part of their functioning kidney.
The investigators found that both blood loss and length of hospital stay were decreased for patients who underwent robotic surgery compared with those who underwent laparoscopic surgery. In addition, the time during which the kidney was cut off from blood flow was also significantly shorter for patients undergoing robotic surgery. The two surgical methods produced similar overall operating times, and were equally good at removing tumors in the hands of experienced surgeons.
This study illustrates that robotic partial nephrectomy may hold several advantages over laparoscopic surgery. Additional studies will be needed to confirm these findings.
Overactive bladder
In patients with overactive bladder who do not respond to anticholinergic medications, surgery has traditionally been the only option for treatment. Previous studies have indicated that Botox® may be an effective therapy for these individuals. Doctors are permitted to use FDA-approved drugs such as Botox for "off-label" uses at their discretion.
An abstract by Dr. Victor Nitti and colleagues reported the results of a multi-center, randomized, placebo-controlled Phase 2 clinical trial studying the use of Botox® for patients with overactive bladder and urgency urinary incontinence. The researchers found that patients who received Botox had fewer episodes of incontinence per week compared with those who received a placebo. They also found that urinary symptoms improved with increasing dosage of Botox, up to a dose of 150U.
This report is a key step in the study of Botox as a treatment for overactive bladder and urinary continence.
