The 2023 Mid-Atlantic Section of the AUA held its annual meeting at the Williamsburg Lodge from October 19 to 21, 2023. President Dr Costas Lallas and the entire planning committee (led by Paul Chung, MD) put together an outstanding and well-balanced program that focused on all aspects of urology. Two highly regarded programs were “Hot Topics in FPMRS” (Female Pelvic Medicine and Reconstructive Surgery) and the resident program.

The “Hot Topics in FPMRS” plenary was held in the afternoon on Thursday, October 19, and focused on what is new and up and coming in the FPMRS triad: overactive bladder, stress urinary incontinence, and pelvic organ prolapse. The esteemed panel members included Dr Laura Giusto (Chesapeake Urology), Dr Jacqueline Zillioux (University of Virginia), and moderator Dr Whitney Smith (Thomas Jefferson University; Figure 1).

Key takeaways:

• Acronyms are beloved in our field, and Dr Zillioux cleverly reminded us of the upcoming transition from FPMRS to URPS (Urogynecology and Reconstructive Pelvic Surgery). She says, “Just think URPS! I did it again!” The name change officially took effect on January 1, 2024.¹
• We all are very familiar with sacral neuromodulation and peripheral tibial nerve stimulation. Dr Giusto described new targets of neuromodulation for the management of overactive bladder.
• Dr Smith discussed maturing data on single incision slings and urethral bulking which shows some promising results compared to standard midurethral slings. She also discussed the current status of laser energy, artificial urinary sphincter, and stem cells for treatment of stress urinary incontinence, which currently remain without enough data to support widespread use.
• Dr Zillioux discussed that uterine-sparing prolapse repairs are likely noninferior to hysterectomy (patient selection and shared decision making are key!), and thoughtful concerns about the prophylactic midurethral sling at the time of prolapse repair (mesh litigation, complications, cost, and a staged approach with bulking agents). To engage our oncology colleagues, she discussed challenges associated with post-cystectomy prolapse, and we need more data on preventative strategies.
• The panel provided its input on optimizing urethral bulking in the office under local or the operating room/ambulatory surgery center under anesthesia. Tips included efficient techniques for minimizing bladder distension, setting pain/discomfort expectations, use of topical and periurethral anesthetics, and standardizing void trial protocols.

On Friday afternoon, audiences heard from 4 groups of speakers during the resident lecture hour in the plenary session. First, Dr Brad Lerner (Chesapeake Urology) and Dr Katharina Mitchell (West Virginia University) discussed “Business and Practice Models” within urology. Specific focus was given to how these practice models could impact residents as they transition into their careers and consider negotiating their first contracts. Next, Dr Mohit Gupta (MedStar Health) and Dr J. Bradley Mason (Eastern Virginia Medical School) presented “Principles of Communication in the Operating Room.” Using memorable examples, Drs Gupta and Mason highlighted how effective, closed-loop communication can prevent unintentional errors in the operating room and produce more efficient teams. By drawing on concepts developed by the US military, audience members left the talk with concrete strategies to improve communication within operating rooms at their home institution. Following this, Dr Nathan Shaw (MedStar Health) and Dr Joanna Marantidis (MedStar Health) presented “Surgical Ergonomics for Urologists.” The presenters highlighted the physical challenges presented to trainees and attendings by the operating room environment. With engaging clinical examples, Dr Marantidis highlighted work at Georgetown where urology residents worked with occupational therapists to optimize the operating room environment and reduce physical strain. Thoughtful commentary from Dr Edouard Trabulsi (Einstein Medical Center) prompted the audience to consider if education on surgical ergonomics should be added to the resident training curriculum. Lastly, Dr Andrea Correa (Fox Chase Cancer Center) and Dr Jeffrey Wei (Temple University Medical Center; Figure 2) presented “Research Training: Non-Technical Skillset for Learners.” Using a case-based approach, the presenters gave the audience challenging cases from which they could draw important lessons in operating room leadership.

The final portion of the day was the Resident Prize Essay Podium Session. Audiences heard from 6 urology residents within the Mid-Atlantic section.

Key takeaways:

• The first presenter, Dr Matthew Buck (Thomas Jefferson University Hospitals; Figure 3) presented “A Propensity-Score Matched Analysis of Patients Receiving Inflatable Penile Prosthesis and the Risk of Complications, Infections, and Re-Interventions.” Using a large, multi-institutional database, Dr Buck presented work highlighting the risk of re-intervention given certain comorbidities, and the average time from implantation to need for device reintervention.
• Next, Dr Conor McPartland (Temple University Medical Center) presented “Evaluation of Intravesical Gemcitabine Plus Docetaxel and BCG [bacille Calmette-Guérin] from the Treatment of Non-Muscle Invasive Bladder Cancer.” In the era of BCG shortage, Dr McPartland provided thoughtful and timely data finding that BCG, gemcitabine plus docetaxel, and combination BCG plus gemcitabine and docetaxel conferred similar survival benefits at 24 months for intermediate and high-risk patients.
• Dr Ahmad Haffar (Johns Hopkins) next presented “Classic Bladder Extrophy Closure without Osteotomy or Immobilization: An Exercise in Futility?” Using a prospective institutional database, Dr Haffar’s results highlighted the role of osteotomy and postoperative immobilization in primary and secondary extrophy closure.
• Dr Sean Fletcher (Johns Hopkins) presented his work entitled “Does Tumor Volume Assessed by Cumulative Cancer Location Predict Grade Reclassification on Active Surveillance in the MRI Era?” Building on work with the cumulative cancer location (CCLO), Dr Fletcher’s work examined the ability of CCLO to predict grade reclassification in men on active surveillance in the MRI era, developing an MRI-informed version of the CCLO, dubbed mCCLO. In their work, they found the mCCLO comparable to traditional biopsy metrics on predicting grade reclassification, offering potential greater reproducibility and less variability.
• Dr Tyler Gaines (Albert Einstein Medical Center) presented on “Racial Differences in New-Onset Cardiovascular Disease in Men with Prostate Cancer Treated with Hormone Therapy.” Dr Gaines’s work focused on the relationship between Black men at elevated risk of cardiovascular disease mortality in the setting of androgen deprivation therapy. In her work, she found a higher incidence of cardiovascular morbidity in Black men on androgen deprivation therapy, which may translate to a higher risk of cardiovascular mortality. This has important implications for the provision of care and warrants further investigation on these outcomes for these men.
• Dr Tina Chen (University of Virginia) presented her work on “Cost-Effectiveness Analysis of the Clear Cell Likelihood Score Against Renal Mass Biopsy for Evaluating Small Renal Masses.” Given the rising use of cross-sectional imaging and an associated increase in incidental identification of small renal masses, she highlighted the need for more cost-effective approaches to patient workup. Using a grading system based on multiparametric MRI clear cell likelihood score, Dr Chen used decision-tree analysis and institutional costs combined with literature-based probabilities to identify ccLS as a more cost-effective option than renal mass biopsy alone to evaluate small renal masses for clear cell renal carcinoma.

All speakers provided thoughtful, timely, and engaging material relevant to all attendees. Kudos to Dr Lallas and the organizers for recognizing the importance of these topics and showcasing our residents’ contributions. We sincerely appreciate the leadership and planning, and we look forward to the 2024 meeting at the Greenbrier in White Sulphur Springs, West Virginia.