Desai Sethi Urology Institute Makes Impressive Showing at 2022 AUA Annual Meeting

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Nearly 30 faculty and students from the Desai Sethi Urology Institute at the University of Miami Miller School of Medicine were featured speakers at the 117th Annual Scientific Meeting of the American Urological Association (AUA), held May 13 to 16 in New Orleans.

The Desai Sethi Urology Institute stood out not only for its participation during multiple in-person sessions and presentations but also digitally. The institute was highlighted during the AUA Thought Leadership Video Series, in which meeting attendees viewed the latest updates in Miller School research, advanced technology, collaborations with engineering and other disciplines, and medical education.

Dipen Parekh, M.D., spoke at a plenary on focal therapy and Gleason Grade 2 prostate cancer.

“This year was a banner year for the Department of Urology, as we had well over 40 presentations by our outstanding faculty, staff, and students,” said Ranjith Ramasamy, M.D., associate professor and director of the Miller School’s Reproductive Urology Program. Dr. Ramasamy spoke during seven AUA sessions, including the plenary “State-of-the-art Lecture: Shockwave Therapy for Erectile Dysfunction and Peyronie’s Disease: Legitimacy, Efficacy, and Regulatory Commentary,” which had more than 200 attendees.

The AUA annual meeting is a premier event for advancing the specialty, according to Dipen J. Parekh, M.D., founding director of the Desai Sethi Urology Institute and chair of urology at the Miller School.

"Being able to attend conferences where we network and learn from our peers is an invaluable experience. And having such a strong presence at this year's AUA conference from Miller School of Medicine faculty and our medical students confirms our commitment to evolving and growing the field of urology," said Dr. Parekh, who was one of two experts to debate during the AUA plenary “Controversies in Urology Debate: Focal Ablation versus Active Surveillance in a65M with GGG2, MRI Concordant Unilateral Prostate Cancer.”

Ranjith Ramasamy, M.D., receiving The Journal of Urology Best Reviewers Award

Miller School faculty were experts on a range of topics, including men’s health. Leslie A. Deane M.D., M.S., professor of endourology, minimally invasive and robotic urological surgery in the Department of Urology, participated in a plenary session entitled “Urologic Pain Management in the Non-narcotic Era.”

Dr. Deane was invited to the panel because of his experience in the area, including a recently published paper in the Journal of Robotic Surgery detailing the safe transition to opioid-free pathways after robotic-assisted laparoscopic prostatectomy at the Miami VA Medical Center and UHealth.

“I discussed the specific techniques I have implemented in practice over the years to achieve the goals of optimized pain management and patient satisfaction, with a focus on getting to zero pain after surgery,” Dr. Deane said.

Bruce R. Kava, M.D., professor of urology and director of men's health at the Desai Sethi Urology Institute, chaired the American Society for Men’s Health (ASMH) program, presenting “Cancer Screenings Decade by Decade: What Urologists and Men’s Health Experts Need to Know.”

Dr. Kava also presented data confirming the safety of the Direct Vision Transfascial (DVT) approach to placement of multicomponent penile implants in patients following prostate and bladder cancer surgery. This technique fulfills a critical need in patients who desire the return of normal sexual function following treatment for these and other pelvic malignancies. Using post-implant imaging that was taken as part of routine cancer surveillance, Dr. Kava showed that this technique is more precise than historical techniques by placing the reservoir of multicomponent penile implants in a safe and reliable location.

“While all surgical procedures may entail some degree of risk, we have made a substantial contribution to minimize these risks for this particular group of cancer survivors," Dr. Kava said.

Representing Diversity

Raveen Syan, M.D., assistant professor of clinical urology at the Miller School, co-chaired the Indian American Urological Association half-day event, in which various dilemmas in clinical management of urologic patients were debated. During the event, Dr. Syan debated on the topic of “Transvaginal Repair of Apical Prolapse: Is Hysterectomy Necessary?”

“The uterus has a meaningful impact on a woman’s sense of self and femininity. With emerging evidence supporting that uterine preserving prolapse surgery is safe and effective, clinicians can better support patient’s wishes by offering this surgical approach,” said Dr. Syan, who was also honored at the Urology Care Foundation’s 2022 Research Honors Program and Reception for her grant-funded work on “Pelvic Floor Disorders Among Minority Women: Identifying Prevalence, Barriers to Care, and Perceptions Towards Symptoms and Treatments."

Raveen Syan, M.D., presented on differences that persist in prevalence of urinary incontinence between various Hispanic/Latina groups.

Dr. Syan’s podium presentation, “Predictors of Urinary Incontinence among Hispanic/Latina Women in the United States: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL),” highlighted that differences persist in prevalence of urinary incontinence (UI) and subtypes of UI between various Hispanic/Latina background groups, suggesting that grouping this geographically and culturally diverse group as a single entity to understand urinary incontinence is flawed.

Prostate Cancer Detection

Sanoj Punnen, M.D., associate professor and vice chair of research in urology at the Miller School, was part of the moderated case-based discussion, “Ga-PSMA PET: Its Utilization in Urologic Practice.”

“One of the major advances in prostate cancer over the last year has been the FDA approval of prostate-specific membrane antigen (PSMA) PET tracers that have been shown to be more accurate for detecting metastatic prostate cancer compared to current standards of care. In addition, PSMA-based treatments have been recently approved for the treatment of advanced prostate cancer that has failed standard therapies” Dr. Punnen said.

The panel of multi-disciplinary experts discussed the clinical utility of PSMA-PET, study findings, current access to the technology, and pending approvals. The discussion took place in what AUA called an "ICU theater," which Dr. Punnen said was conducive to real-world dialogue and exchange with the audience.

Bladder Cancer Treatment

Chad R. Ritch, M.D., M.B.A., associate professor of urology and associate director of UHealth International, was faculty for the AUA instructional course "Bladder Cancer Treatment Dilemmas: The Cases You Face and What to Do About Them," which had more than 80 attendees. Dr. Ritch, who has been involved in this course at AUA since 2016, presented an overview of current AUA non-muscle invasive guidelines and discussed challenging clinical cases.

Treating Peyronie’s Disease in Veterans

Thomas A. Masterson, M.D., assistant professor of urology at the Miller School, presented during an AUA sub-meeting for the Urological Society for American Veterans. One of Dr. Masterson’s presentations, “Rates of Penile Fracture in Patients Treated with Collagenase Clostridium Histolyticum within the Veterans Health Administration,” looked at rates of penile fracture and found that only six occurred in over 1,500 men after injection of the brand-name collagenase clostridium histolyticum, Xiaflex.

Xiaflex has a black box warning recommending four weeks of abstinence after injection. Dr. Masterson and colleagues found that all six fractures happened within seven days of injection, and all occurred with sexual activity.

The researchers also found that after the FDA approval of Xiaflex, fewer patients elected for penile plication, a surgical intervention to straighten penile curvature.

Thomas Masterson, M.D., presenting on restorative therapies for erectile dysfunction

“These findings suggest that Xiaflex is being increasingly used as first-line therapy for Peyronie’s disease,” Dr. Masterson said.

Tadalafil’s Cardiovascular Effects, and Cranberry’s Potential in UTIs

Miller School urology resident Ruben Blachman-Braun, M.D., M.Sc., presented “Is tadalafil associated with decreased risk of major adverse cardiac events or venous thromboembolism in men with lower urinary tract symptoms?”

In this study, Dr. Blachman-Braun and colleagues evaluated whether men taking phosphodiesterase type 5 inhibitor tadalafil for lower urinary tract symptoms had a decreased risk of major adverse cardiac events or venous thromboembolism. The study, which included data on nearly 1,160,700 men, found that tadalafil was associated with decreased risk of cardiac events and venous thromboembolism in men with lower urinary tract symptoms (LUTS) with and without a history of alpha-blocker use.

While prospective trials are needed to confirm the results, the authors concluded that “Tadalafil for the treatment of LUTS might provide a cardiovascular benefit due to its beneficial effects on vasodilation and endothelial function.”

Katherine Amin, M.D., assistant professor of urology at the Miller School, was among the moderators during a general program session for the Society of Female Urology and Urodynamics. She participated with experts nationwide in the panel discussion “Recurrent UTI in Women: 40-Year-Old with Recurrent UTI's Treated — Is There a Role for Cranberry or Other Non-Antibiotic Solutions?” Dr. Amin discussed the positive effects of cranberry as a natural, evidence-based treatment option for preventing recurrent UTIs.

COVID-19 Vaccines and Fertility Concerns

Miller School medical student researcher Parris Diaz presented findings from a study he co-authored, “Concerns about fertility: a major cause of COVID-19 vaccine hesitancy in the United States.” The study by Miller School urology researchers surveyed more than 900 unvaccinated adults and demonstrated that fertility concerns are a significant barrier to vaccine uptake among unvaccinated Americans.

Nearly 60% of those surveyed indicated they were worried about the vaccines’ unknown long-term adverse effects, including 41% who said they believed the COVID-19 vaccines can negatively impact reproductive health and or fertility.

Working As a Team with APPs

Libert Ramos, DNP, who works in the Men’s Health Program at the Miller School, took part in the panel discussion, “How to Establish a Successful Men's Health and Andrology Practice.” Dr. Ramos shared best practices for how to incorporate advanced practice providers within the men's health practice.

“The course was a complete success. Participants were very engaged and involved asking many questions about topics presented,” Dr. Ramos said.