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Needs & Objectives

Rocky Mountain Urological Society
2020 Annual Meeting

August 7 - 8, 2020
DoubleTree By Hilton Denver
Denver, CO

Educational Needs

Kidney cancer is among the most common cancers in both men and women. Overall, the lifetime risk for developing kidney cancer in men is about 1 in 48. The lifetime risk for women is 1 in 83. A number of other factors also affect a person's risk.

For reasons that are not totally clear, the rate of new kidney cancers has been rising since the 1990s, although this seems to have leveled off in the past few years. Part of this rise was probably due to the use of newer imaging tests such as CT scans, which picked up some cancers that might never have been found otherwise. The death rates for these cancers have gone down slightly since the middle of the 1990s.

Renal cell carcinoma (RCC), also known as renal cell cancer or renal cell adenocarcinoma, is by far the most common type of kidney cancer. About 9 out of 10 kidney cancers are renal cell carcinomas.

There are several subtypes of renal cell carcinoma. Amongst the most common are clear cell carcinoma and papillary renal cell carcinoma. A less common variant is known as sarcomatoid renal cell carcinoma.

There are many uncertainties regarding the appropriate approach to metastatic renal cell carcinoma. In addition the role of neoadjuvant chemotherapy and renal cell carcinoma has not been completely defined. Limited research on tumors with sarcomatoid change has led to minimal progress in the understanding and treatment of these tumors. Because the sarcomatoid variant of renal cell carcinoma can account for approximately one in six cases of advanced kidney cancer, we hope to familiarize clinicians with these tumors by describing the historic background, histologic features, molecular characterization, diagnosis, prognosis, treatment strategies, and active clinical trials of this aggressive type of tumor. Our speakers will present and critically reviewed data regarding management of renal cell carcinoma with regard to neoadjuvant chemotherapy as well as cytoreductive nephrectomy for metastatic disease. In addition we will discuss the sarcomatoid variant with regard to its biology ,clinical course, and management.

There has been significant discussion and debate regarding the optimal treatment of small renal masses. Local experts will discuss their experience in the appropriate management of these lesions, including open versus laparoscopic partial nephrectomy, active surveillance, or ablative therapy using interventional radiology techniques.

Burn injury to the genitalia is among the most disabling and challenging type of injury. Our expert speaker will discuss his experience in the basics of burn care to the genitalia along with identifying key decisions for timing and grafting to repair the burn area. In addition numerous various reconstruction techniques for genital wounds will be discussed with the conference members.

Urinary incontinence, also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geriatric health care. Pelvic surgery, pregnancy, childbirth, and menopause are major risk factors. Urinary incontinence is often a result of an underlying medical condition but is under-reported to medical practitioners. The main types of urinary incontinence are urge incontinence, stress incontinence, and overflow incontinence.

Urinary incontinence can result from both urologic and non-urologic causes. Urologic causes can be classified as either bladder or urethral dysfunction and may include detrusor overactivity, poor bladder compliance, urethral hypermobility, or intrinsic sphincter deficiency. Non-urologic causes may include infection, medication or drugs, psychological factors, polyuria, stool impaction, and restricted mobility.

The most common types of urinary incontinence in women are stress urinary incontinence and urge urinary incontinence. Women with both problems have mixed urinary incontinence. After menopause, estrogen production decreases and in some women urethral tissue will demonstrate atrophy with the tissue of the urethra becoming weaker and thinner. Stress urinary incontinence is caused by loss of support of the urethra which is usually a consequence of damage to pelvic support structures as a result of childbirth. It is characterized by leaking of small amounts of urine with activities which increase abdominal pressure such as coughing, sneezing and lifting. Men tend to experience incontinence less often than women, and the structure of the male urinary tract accounts for this difference. It is common with prostate cancer treatments.

Given the significant role the community urologist play in the diagnosis and treatment of urinary incontinence it is felt that a comprehensive update of diagnosis work-up and treatment is needed at this meeting. Our speakers will discuss options for vaginal vault suspension including various pros and cons of the approach to this malady. They will also educate our members on the appropriate management of patients with persistent incontinence after a prior surgery. We also will review relevant complications of slings and prolapse repair, and how these complications can be properly managed. National as well as local experts in the field of bladder instability will discussed various evaluation techniques as well as management strategies for this extremely common malady.

The management of female and male pelvic pain can be an extremely challenging aspect of the urologic care. There are numerous factors including clinical and psychological issues which affect patient's perception of pelvic pain. A myriad of treatment options are available for this frustrating malady. Our local expert will discuss appropriate evaluation and various management strategies for this complex and difficult patient population.

The management of preoperative as well as postoperative patient pain has become an increasingly important issue given the recent concern regarding Americas opioid crisis. Given the fact that surgeons are responsible for managing these pain issues, we are constantly seeking improved modalities to provide the patient comfort required while minimizing addictive medications and avoiding numerous complications. Our local expert will provide detailed information regarding ideal pain management strategies following various surgical procedures.

Health care is a major issue in American politics, with important debates related to health care coverage and the underlying cost of health care. The role of health care coverage is to insulate people from high health care spending burdens and facilitate access to health care. Policies related to coverage include those affecting how Americans get health insurance, how that insurance is paid for, and what insurance does and does not cover. Debates about how to reduce the number of people without health insurance, whether Americans should continue to get coverage through their jobs, if health insurance deductibles are too high, or how to change the premiums required under federal coverage programs all fall into this category. Our speaker will provide updated information regarding critical healthcare policies specifically related to the Rocky Mountain region.

Educational Objectives

At the conclusion of the 2020 RMUS Annual Meeting, attendees will be able to:

  1. Review published studies on cytoreductive nephrectomy in the previous immnunotherapy era.
  2. Review published studies on cytoreductive nephrectomy in the targeted therapy era.
  3. Discuss preoperative criteria/factors that can be used to select patients for cytoreductive nephrectomy.
  4. Discuss ongoing clinical trials of cytoreductive nephrectomy in the current immunotherapy era.
  5. Describe keys to a successful robotic urologic surgery program.
  6. Demonstrate patient positioning for robotic renal surgery.
  7. Describe robotic renal surgery port placement.
  8. Demonstrate techniques for kidney exposure.
  9. Demonstrate techniques for renal hilar dissection.
  10. Describe techniques for renorrhaphy.
  11. Define sRCC.
  12. Discuss biology of sRCC (at the RNA, DNA, and protein level).
  13. Discuss diagnostics in sRCC (radiology and biopsy).
  14. Discuss the natural history of surgically treated sRCC.
  15. Discuss novel therapies in sRCC.
  16. Define neoadjuvant therapy in RCC
  17. Review published studies of neoadjuvant therapy in RCC.
  18. Discuss the safety of neoadjuvant therapy in RCC.
  19. Discuss ongoing clinical trials of neoadjuvant therapy in RCC, along with rationale, potential benefits, and pitfalls.
  20. Review national trends of partial nephrectomy for renal masses.
  21. Discuss opportunities to develop a state-based initiative to improve our understanding of surgical treatments for renal masses.
  22. Identify ways to use deep-learning to better integrate prediction tools for renal masses.
  23. Discuss different ablative techniques, RFA, microwave, cryoablation.
  24. Discuss the role of embolization in the treatment of renal masses.
  25. Discuss outcomes and follow-up protocols after ablation of small renal masses following NCCN guidelines.
  26. Discuss the MSKCC and IMDC risk models for metastatic RCC (mRCC).
  27. Evaluate the first-line options for management of metastatic RCC.
  28. Identify the second- and subsequent- line options for management of metastatic RCC.
  29. Identify symptoms and physical exam findings consistent with the diagnosis of interstitial cystitis.
  30. Identify symptoms and physical exam findings consistent with muscle tension
  31. Identify symptoms and physical exam findings consistent with pudendal neuralgia.
  32. Discuss relevant complications of slings and prolapse repairs.
  33. Discuss options for management of mesh related complication.
  34. Describe how to evaluate and when to manage a patient with bladder outlet obstruction.
  35. Recognize non-neurogenic OAB.
  36. Develop a treatment plan for the patient with non-neurogenic OAB with the goals of maximizing symptom control and patient quality of life while minimizing adverse events and patient burden.
  37. Summarize advanced therapies for OAB.
  38. Identify patient selection for surgical treatment.
  39. Discuss the changes in male sling technology.
  40. Describe the role of the artificial urinary sphincter.
  41. Discuss the management of AUS complications: infection, erosion.
  42. Discuss management of the recurrent SUI following surgery.
  43. Discuss options for vaginal apical prolapse.
  44. Describe pros and cons of various approaches to vaginal vault prolapsed.
  45. Discuss emerging complications concerns of sacrocolpopexy.
  46. Describe the evaluation of a patient who has persistent or recurrent stress incontinence after a prior sling.
  47. Discuss options for management of recurrent stress incontinence.
  48. Discuss areas that are higher risk for patient safety and how to reduce this risk.
  49. Recognize when you are in a situation that warrants heightened vigilance.
  50. Explain how you can improve patient safety.
  51. Review current state of opioid epidemic.
  52. Review data on opioid utilization in urology.
  53. Review evidence and best practices for post operative pain management as urologists.
  54. Review recent local and federal legislation with a particular focus on potential impact to the physician’s practice of medicine.