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GU Cancers See More Minimally Invasive Procedures and Personalized Treatment at AUA19

Op-Med is a collection of original articles contributed by Doximity members.

At the recent American Urological Association (AUA) 2019 Annual Meeting (May 3-6), the safety question and the ongoing litigation of vaginal mesh continued. The issue of vaginal mesh affects only the mesh used in procedures for bladder prolapse. The meshes used for USI remain approved and in use.

Minimally invasive treatments for benign prostatic hyperplasia (BPH) took the front seat at AUA19. Specifically, the Urolift procedure was highlighted and Rezume was a big draw at the Boston Scientific BPH booth. A steam-based, office procedure, Rezume can be performed under local anesthesia for ablating obstructive prostatic tissue. 

Some of the less-noted yet significant advancements include SRS’s introduction of a new device, which can revolutionize treatment decision-making in lower UTIs due to BPH. The NNUC (Noninvasive No-touch Urethral Cuff) is used for measuring bladder pressure non-invasively, as a way to best determine the timing of treatment intervention to prevent the insidious effects of increased bladder pressures due to silent BPH-related obstruction. This can be likened to an “urologic sphygmomanometer”. Bladder pressure determination can only be measured invasively with a catheter or the old penile cuff, which is a touch technique. Current users have been trying to improve due to some patient complaints related to side effects. This new device is anticipated to attract attention from urologists who have found current methods to measure bladder pressure onerous, time-consuming, and labor-intensive.

PercuVision has developed a new way to improve patient care: the only visually-guided Foley is now available. This device is expected to help improve CAUTI (National Quality Forum) scores, decrease complications when catheters are placed by ancillary personnel, and reduce the pain and injuries due to blind insertions. This device also lends itself to be used in tele-medical intervention, as it can connect to the internet for off-site specialist input. The device works well with the Urethrotome introduced by Uramix, which can be introduced over a guide wire and used to treat urethral strictures by physicians or physician assistants and even RN’s under the supervision of a qualified MD.

Zenflow is introducing the “spring-system” to treat BPH non-invasively. The Spring Implant is formed from a superelastic shape-memory material and is tailored to fit the unique geometry of the prostatic urethra. It is easily and reliably deployed in the urologist’s office through a thin flexible cystoscope under direct visualization.

Urotronic has found a way to break the stricture cycle by coating a balloon with the drug paclitaxel, which is released when the balloon inflates to break the stricture. This drug is an anti proliferative agent, which is hoped to decrease collagen deposition and decrease stricture recurrence, which is a common problem in endoscopic stricture treatment.

Uromedica has an ingenious implant for the treatment of both male and female incontinence. ProAct Adjustable Continence Therapy for Men is indicated for the treatment of adult men who have streps incontinence arising from sphincter deficiency of at least twelve months duration following radical prostatectomy or transurethral resection of the prostate (TURP) and who have failed to respond adequately to conservative management. The device is minimally invasive and consists of two adjustable silicone balloon implants planed via perineal approach in a periurethral position at the bladder neck. Titanium ports attached via tubing to the balloons are placed in the scrotum, allowing for transcutenous, post-operative volume adjustment. This maneuverer increases coaptation of the urethra and lifts the bladder neck, to improve continence.

Urethrotec has developed a Urethral Catheterisation Device (UCD), which is a Foley with an integrated guide wire to provide a safer urethral catheterization solution in complicated insertions. The catheter is placed over the guide wire to guide it into the bladder in stenotic urethras, men with enlarged prostates or men with difficulty relaxing the sphincter during insertion.

Last, but not least, kudos to Steve Chung, MD, a urologist in clinical practice who founded the IT company Healthereum, which introduced a patient engagement platform in health care based on bitcoin technology. Healthereum has been receiving a good bit of press lately for its innovative and secure approach in connecting with patients to incentivize healthy behavior. The app, called Helio, is a health care rewards platform to engage patients with their medical practices and receive rewards for compliance. The company has figured out a solution to improve engagement of patients, increase compliance, and improve the administrative frustrations of medical practice. When health care tasks are completed, such as attending an appointment or filling out forms, patients earn reward points in the form of digital tokens. The tokens are given out by doctors and the patients exchange them for predetermined health care benefits.

Overall, the research at AUA19 showed promise for improving treatment decisions based on personalized molecular landscapes, particularly in the treatment of genitourinary cancers.

Michael Mooreville, MD is a private practice urologist in the Philadelphia area, as well as an inventor and entrepreneur. He has designed and distributed urologic instruments used in the U.S. as well as internationally. He is co-founder of Uramix, Inc. He has been involved in clinical research about bladder defense mechanisms.

Disclosure: The author reports no other conflicts of interest aside from founding a device included in the op-ed. He does not receive any financial incentives, however, connection with the use of the urethrotome and the PercuVision device.

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