10th CEM: common problems in office urology, key messages

October 2010 - Common problems in office urology were taken up in the second-day plenary session of the 10th Central European Meeting (CEM) held today in Bratislava, Slovakia. The topics covered during the session included management strategies for pelvic pain, overactive bladder, recurrent cystitis and the current trends in preventing nephrolithiasis.

P. Radziszewski (Poland) discussed the various treatment options for managing pelvic pain including the work-up or evaluation of patients with CP/CPPS, namely: a mandatory history taking, physical examination, urinalysis, urine culture and LUT/Pelvic imaging. He also spoke on the current treatment options such as the use of analgesics, antibiotics, anticholinergics, aplpha-adrenolytics and antidepressants, amongst others.

Regarding general treatment, Radziszewski said this includes psychologic support and treatment, stress reduction and patient counseling. He briefly noted intravesical treatments including echopractic WCS-go, silver nitrate, Botulinum toxin and lidocaine. "Efficacy of Botox in suppressing sensory signaling has been documented," noted Radziszewski.

Meanwhile, tackling the challenges in overactive bladder (OAB), Peter Zvara (Slovakia) spoke on the incidence and the current treatment interventions for OAB. He said dietary modifications in stone formers are important. For instance, on the issue of caffeine and OAB, high caffeine intake is associated with a modest increase in incident urgency incontinence.

In his concluding remarks Zvara said that despite "intense research antimuscarinics remain the only class of OAB medication with clearly proven efficacy." He added that the identification of bladder sensation as a key target would hopefully lead to new discoveries, and that there are significant advances in the assessment methods.

In his take home message, Zvara underscored the crucial importance of treatment follow-up. "The urologist needs to know that it is not only a matter of giving the patient his medications and letting him go, but, more importantly he needs to monitor his symptoms, and properly conduct and follow up the treatment outcomes."

Tomasz Borkowski (Poland) lectured on recurrent cystitis, discussing the prevalence of urinary tract infections and the management of recurrent cystitis. "In the US, UTIs account for over seven million physician visits annually, including the more than two million visits for cystitis," said Borkowski, adding that in the US alone the disease accounts for an estimated annual cost of over US$1 billion. He also mentioned that recurrent cystitis are rare in healthy men but are more common in women and are licked to considerable morbidity and expense.

"Women are 30 times more likely to have UTIs than men and every year 15% of sexually active women have at least one such infection," he said. Borkowski also noted the following:

• Non-antimicrobial prevention strategies are desirable given the adverse effects associated with antibiotics and the increasing problem with antimicrobial resistance; and
• Antimicrobial prophylaxis is highly effective in reducing the risk of recurrent cystitis.

Petrisor Geavlete discussed the prevention of stone formation and gave an overview on general metaphylaxis such as drinking habits, diet and lifestyle. In his take-home messages, Geavlete underscored the following points:

• Stone disease diagnosis must identify stone and the potential anatomical abnormalities and evaluate the risk of recurrencwe;
• High prevalence and recurrence of urinary lithiasis justify medical treatment and metaphylaxis;
• The composition of all stones must be determined;
• Complexity of metabolic assessment must be tailored in regards to risk evaluation;
• In low-risk stone formers, diet and lifestyle changes are sufficient to increase stone-free rates;
• In high-stone formers, pharmacological measures must complete metaphylaxis;
• New agents like probiotics or methods like nanocrystallites manipulation are emerging with promising perspectives.