Best of the 2008 AUA Annual Meeting

Meeting Review

RIU0415_08-13.qxd 8/13/08 6:09 PM Page 227 MEETING REVIEW Best of the 2008 AUA Annual Meeting Highlights from the 2008 Annual Meeting of the American Urological Association, May 17-22, 2008, Orlando, FL [Rev Urol. 2008;10(3):227-228] © 2008 MedReviews, LLC Key words: Prepubertal testis biopsy • Vesicoureteral reflux • Endocrine disrupters ver 2100 posters, abstracts, and videos were presented at the 2008 annual meeting of the American Urological Association (AUA), held this year in Orlando, Florida, from May 17 through 22. Reviews in Urology continues its coverage with contributing editor Dr. Ellen Shapiro’s report on the work she found most clinically relevant to the field of pediatric urology. For additional reports, see Brawer MK, Makarov MD, Partin AW, et al. Best of the 2008 AUA Annual Meeting: Highlights from the 2008 Annual Meeting of the American Urological Association, May 17-22, 2008, Orlando, FL. Rev Urol. 2008;10:136-156. O Pediatric Urology Testis Kim and colleagues1 reported the positive predictive value (PPV) of prepubertal testis biopsies obtained at the Reviewed by Ellen Shapiro, MD, FACS, FAAP, New York University School of Medicine, New York, NY. time of bilateral orchiopexy with sperm density in 24 adult patients. A sperm density (SD) of greater than 20 million/mL was defined as the threshold value in accordance with established World Health Organization reference values for oligospermia. The investigators found that adults with a history of bilateral undescended testes (UDT) have an average SD of 18 million/mL, but 29% have an SD of more than 20 million/mL. A biopsy of either testis having a germ cell/tubule ratio less than 0.2 and associated with an SD of less than 20 million/mL has a PPV of 93% (14 patients). A biopsy with no adult dark spermatogonia in either testis is associated with SD of less than 20 million/mL and has a PPV of 93%. They concluded that the testis biopsies obtained at orchiopexy may be highly predictive of poor sperm density in adulthood, which would be useful in counseling parents. Makari and coworkers2 examined the rate of testicular salvage in 45 of 51 patients following surgical exploration for presumed testis torsion. Intraoperative salvage was defined as a viable testis worthy of fixation and postoperative salvage was defined as symmetric testes on postoperative sonogram or physical examination. Of the 45 boys who were found to have testicular torsion on exploration, 67% (30) underwent orchidectomy and 33% (15) had intraoperative salvage. Of those with salvage, the mean age was 14 years and only 11 patients were available for follow-up. Of those 11 patients, 7 (64%) had postoperative salvage (3 sonographic evidence, 4 physical examination only) and 4 had asymmetry or atrophy (1 sonographic evidence, 3 physical examination only). Importantly, 3 of the 4 with asymmetry or atrophy were surgically explored in less than 6 hours. These findings suggest that intervention prior to 6 hours does not always guarantee postoperative salvage and should be used in perioperative counseling of patients and their parents. Vesicoureteral Reflux An important study by Lee and associates,3 from Kansas City, MO, examined VOL. 10 NO. 3 2008 REVIEWS IN UROLOGY 227 RIU0415_08-13.qxd 8/13/08 6:09 PM Page 228 2008 AUA Annual Meeting continued long-term follow-up of endoscopic therapy with dextranomer/hyaluronic acid for reflux. They report on their total success rate at first voiding cystourethrogram (VCUG) and subsequent follow-up. The first VCUG performed on 248 of 333 total ureters had a success of 74.4%. The success rate decreased with increasing grade of reflux and was lower (66%) in the earlier part of the series and improved (81%) in the later half of their experience, which they attribute to their learning curve. Patients with negative VCUGs were restudied at 1 year and were found to have an overall success rate of 132 of 182 patients (72.5%) with 50 patient failures. The total success rate in patients with 1-year data was 132 of 267 ureters (49.4%). The authors concluded that although initial success at 3 months appears to be good, there is a significant failure rate at 1 year. This study supports the finding of other groups, including investigators at the University of Iowa and the National Children’s Medical Center, and further suggests that long-term follow-up is warranted. Cerwinka and colleagues4 from Atlanta had the opportunity to examine the appearance of Deflux® (Q-Med Scandinavia, Inc., Princeton, NJ) on computed tomography (CT) scans. Nine patients of 340 with a history of Deflux injection underwent CT scans for primarily abdominal pain at an average of 24 months postinjection. Eight of the 9 patients had bilateral injections. A tissue density of 21 (HU range, 19-22) bilaterally was observed in the blebs of 4 patients, whereas a calcific density (HU mean, 203; HU range, 126-262) bilaterally was seen in 3 patients. Two patients had blebs demonstrating tissue density on 1 side and calcific density on the other. Small injections volumes (mean, 0.87 mL) and shorter time since the injection (15 months) were associated with noncalcified blebs versus the calcified blebs (1.1 cc, 31 months). This 228 VOL. 10 NO. 3 2008 study is important because the CT scan may be performed in more patients in the future and blebs should not be mistaken for ureteral calculi when the calcified material is found outside the ureteral lumen. Endocrine Disrupters DeCaro and colleagues5 studied the relationship between maternal pregnancy levels of polybrominated biphenyl (PBB), thought to be an endocrine disrupting agent, and genitourinary (GU) anomalies in offspring. This prospective study of the Michigan Long-Term PBB cohort, who were exposed to PBB during 1973-1974, included males whose mothers had in male infants and whether persistent maternal levels are associated with UDT. Forty boys (27 UDT and 13 controls; ages 8-18 months) were included. Serum and fat tissue samples were obtained at the time of surgery. Compounds that were measured included polychlorinated biphenyls (PCBs). Specifically, PCB congeners 153 and 180 showed significantly elevated levels in mothers of cryptorchid boys versus controls. The total PCB level in these mothers were also statistically increased versus control mothers. The serum PCB levels correlated well with the fat tissue levels in the boys and maternal OCC levels correlated well with the serum levels in The computed tomography scan may be performed in more patients in the future and blebs should not be mistaken for ureteral calculi when the calcified material is found outside the ureteral lumen. known serum levels of PBB at the time of conception. Initial median maternal PBB levels at study entrance were 3.0 parts per billion (ppb) in the younger male offspring (ages 5-18 years) and 2.5 ppb in older male offspring (ages 18-30 years). Thirty-five of 464 sons of mothers with known PBB levels had GU anomalies including 13 hernias, 10 hydroceles, 9 undescended testis, 5 hypospadias, 2 phimosis, and 1 varicocele. Of the younger sons, 9.3% had a GU anomaly, whereas 5.6% of older sons reported any GU problem. Mothers with higher levels of PBB ( 5 ppb) reported more GU anomalies than those mothers with the lowest levels (12.2% vs 5.5%). This prospective cohort investigation on the GU effects of PBB exposure on male offspring is the first study to lend support to the endocrine disrupter hypothesis. Chen and researchers6 determined whether maternal serum levels of organochoro-compounds (OCCs) correlate with tissue fat and serum levels REVIEWS IN UROLOGY their sons. This study of maternal and male offspring OCC levels further supports the hypothesis that testicular maldescent derives from maternal levels of these chemical endocrine disruptors. References 1. 2. 3. 4. 5. 6. Kim SS, Kolon TF, Casale P, et al. The positive predictive value of prepubertal testis biopsy on adult sperm density in patients with bilateral undescended testes. J Urol. 2008;179:144. Abstract 405. Makari JH, Pope JC, Adams MC, et al. Defining salvage after testicular torsion impacts counseling and follow-up. J Urol. 2008;179:146. Abstract 411. Lee EK, Gatti J, Murphy JP. Long term follow-up of dextranomer/hyaluronic acid for reflux: late failure warrants continued follow-up. J Urol. 2008;179:202. Abstract 577. Cerwinka WH, Scherz HC, Kirsch AJ. Long-term appearance of dextranomer implants on computed tomography scan after endoscopic treatment of vesicoureteral reflux in children. J Urol. 2008;179:202. Abstract 578. DeCaro JJ, Small CM, Terrell ML,et al. Maternal exposure to polybrominated biphenyls and genitourinary conditions in male offspring. J Urol. 2008;179:97. Abstract 277. Chen JJ, Zhang G, Wasnick R, et al. Maternal burden of organochloro-compounds associated with undescended testes. J Urol. 2008;179:97. Abstract 276.