Mark Sigman, MD

The Board of Directors and the Treasurer have a kept a close eye on Section finances. With much of the worst economic news behind us, the Section remains in a strong position. At the recent mid-winter Board of Directors meeting, a Long Range Planning Committee was reactivated and charged with formulating suggestions for the long-term success of the Section. The Committee consists of David Green (Chair), Steven Schiff, Bob Eyre and Treasurer, Mark Plante, as an Advisor to the Committee.

The New England Ophthalmological Society has been in contact with us about concerns over an increasing prevalence of Intraoperative Floppy Iris Syndrome (IFIS) which is more common in patients on alpha blockers. Please see the article in this issue of the Highlighter.

The fall 2010 NE Section meeting is shaping up to be an interesting an enjoyable meeting. The Scientific Program Chairs, Lori Lerner and Gyan Pareek, and the Program Committee are in the process of finalizing the program. Steven Schiff, the Local Arrangements Chair, is working with our Executive Director and Meeting Manager and has arranged for a variety of interesting social activities emphasizing the character and history of Providence and the Ocean State.

I look forward to seeing all of you at this meeting this fall.

E. Ann Gormley, MD

79th Annual Meeting
Plans are underway for the 79th Annual Meeting of the New England Section of the AUA in Providence, RI. October 21-23, 2010. Drs. Lori Lerner and Gyan Pareek, Scientific Program Committee Co-Chairs are planning the program, which will be finalized shortly. Dr. Stephen Schiff is planning an exciting social program. Please check the NEAUA website for updates and information on the meeting as it becomes available.

Section News
At our September Board Meeting, we voted to post the Highlighter electronically and to stop printing the membership roster and Section By-Laws in the Annual Meeting Program Book. These “green” initiatives will also result in a cost saving for the Section. Increasingly, we are trying to use email rather than regular mail. This year your dues statements were delivered electronically. We are gauging the response to this and all business communicated electronically so that in the future, we can consider conducting more business via email and web with less paper mailings. Please let us know what you think of receiving notices via email instead of through regular mail or fax.

Town Meetings
Our Section Town Meetings resumed in January 2010. The New Hampshire Town Meeting was held in Manchester on January 13th, 2010. Dr. John Seigne presented “Decision Making and Prostate Cancer: Helping Our Patients to Make Good Choices in the Face of Conflicting Medical Advice.” On February 9, 2010 the Massachusetts Town meeting was held at the Boston Newton Marriott. Dr. Jim Hu spoke on the “Controversies Concerning the Surgical Treatment of Prostate Cancer.” The Maine Town Meeting was held on May 12th in Augusta. Dr. Craig Hawkins spoke on “Bladder Cancer in Maine: Can We Improve Outcomes?” Plans are also being made to hold a Western Massachusetts Town Meeting. Town Meetings are complimentary and open to all Section members. Please see the postings on our web site.

Additional Town Meetings are also being planned and announcements will be sent via e-mail. If there is a topic or speaker that you would like to hear at your state’s Town Meeting please let me know. In the past we have offered the AUA Ultrasound Training Course as a Town Meeting and we can organize this again if there is enough interest. The Town Meetings are a wonderful way to maintain your involvement in the Section. I encourage our newest Section members to attend a Town Meeting. These meetings are a great way to be involved if you are unable to take time off to participate in our fall Section meeting.

AUA Leadership Program
This year we had a number of excellent young urologists apply to the AUA Leadership Program. At the March Board Meeting, Drs. Gregory Adey from Maine and Dianne Sacco from Massachusetts were chosen to represent our Section. Graduates of the AUA Leadership Program in the past have all been active participants in the Section and we look forward to Greg and Dianne’s continued involvement.

It was wonderful to see some of you at the AUA National Meeting in San Francisco and I hope to see others at an upcoming Town Meetings or at the Sectional Meeting in October. Please share your thoughts and ideas for the Section by sending me an email: ann.gormley@hitchcock.org.

The Section is pleased to report that Kevin R. Loughlin, MD of Boston Massachusetts has been selected to represent the New England Section as Alternate Representative to the AUA Board of Directors. Dr. Loughlin joins David F. Green, MD who serves as the Section’s Representative to the AUA Board. Dr. Loughlin will serve as Alternate Representative from 2011-2013, succeeding Dr. Green in 2013 to serve a four year term as Representative. Congratulations!

Alpha-blockers have long been prescribed to treat benign prostatic hypertrophy (BPH). In the quest for reduced systemic side effects and increased potency, “selective” alpha-blockers have grown in popularity. One of the most commonly prescribed BPH treatments today is the selective alpha-blocker tamsulosin (Flomax). Several years ago tamsulosin use was linked to a newly described condition called Intraoperative Floppy Iris Syndrome (IFIS). Increases in complications during cataract surgery were associated with IFIS, and the ophthalmic community has been trying to find ways to both educate physicians and provide the best solution to this dilemma.

Since the urology community often sets the standards for appropriate treatment of BPH, it is especially important they know the facts about IFIS.

Although there have been reports of IFIS with both selective and nonselective alpha-blockers, the selective alpha-blockers, particularly tamsulosin, are much more strongly associated with IFIS. A recent JAMA article by Bell et al highlights the concern from ophthalmologists regarding cataract surgery complications and selective alpha-blockers used to treat BPH. This study looked at only at the most serious complications requiring repeat trips to the OR or other invasive measures and found a strong link to exposure to tamsulosin prior to the surgery.

Cataract surgery is such a common procedure and selective alpha-blockers are such commonly used agents that the overall impact of IFIS-related surgical complications may be significant. Over the past few years, several surgical techniques have been described for management of IFIS and there is no doubt that the ophthalmologist’s ability to deal with the syndrome has improved. Nevertheless, serious negative outcomes do occur and lesser complications such as prolonged post-operative inflammation, cystoid macular edema, and exacerbation of glaucoma are not infrequent.

Unfortunately, cessation of the selective alpha-blocker prior to cataract surgery does not appear to eliminate the possibility of IFIS. There have been reports of cases many months after a relatively short exposure to tamsulosin, presumably related to a permanent change in iris smooth muscle.

So what can be done to minimize IFIS-related cataract surgery complications and at the same time adequately and safely treat symptoms of BPH?

In the short term, communication between ophthalmologists and those prescribing medicines for BPH is important for protecting patients well being. If possible, we would recommend asking patients if they have been diagnosed with cataracts and if they are having vision problems before prescribing a selective alpha-blocker. This might help avoid the all too common occurrence of patients being started on selective alpha-blockers just prior to cataract surgery. For patients on a non-selective or other agent in whom BPH therapy is being advanced, a comprehensive eye exam by an ophthalmologist can help determine the time frame for cataract surgery if indicated.

Today, primary care providers are involved in the treatment of BPH and are often the ones initiating medical therapy with selective alpha-blockers. We are hoping that the urology community can help set a standard where by many patients may be adequately treated with less expensive, non-selective alpha-blocker agents if medically appropriate. Ophthalmologists and most importantly their patients will be thankful to reduce the incidence of intra-operative floppy iris syndrome to an occasional occurrence rather than a growing epidemic.

A helpful link from the American Society of Cataract and Refractive Surgery: http://www.ascrs.org/press_releases/Patient-Advisory-on-Flomax-and-Cataract-Surgery.cfm

Dr. Hu was selected by the AUA Foundation Research Council to showcase his urologic research project along with other elite young investigators from around the country. Dr. Hu’s work entitled “Comparative Effectiveness of Minimally Invasive vs. Open Radical Prostatectomy” was presented on Sunday, May 30 at the Moscone Convention Center, as part of the AUA Annual Meeting.

The AUA Leadership Program provides a year-long experience of activities and opportunities to develop core leadership competencies and valuable relationships with peers who also share the desire to become future leaders of the AUA. Included in the year’s activities is a Kickoff Weekend at the AUA Headquarters which encompasses an overview of the AUA's structure, governance, strategic goals, key program areas and services, along with the identification of key competencies for tomorrow's urology leaders. A leadership skills development program provided by The Institute for Medical Leadership will also be included. There will be an introduction to the concept of mentoring with a discussion about what makes mentoring most effective and mentors and their assigned Leadership Class participants will be given the opportunity to meet and set goals for their mentor/mentee relationship.

In March of 2011, the Leadership Class will participate in the an Advocacy Conference, jointly sponsored by the AUA and the American Association of Clinical Urologists (AACU) in Washington, DC. AUA government relations and advocacy staff will provide an overview of the political process and review the AUA's current positions on key political issues. Leadership Class participants will have a special session which will teach the nuts and bolts of the political process (e.g., how a bill becomes a law, the role of the Political Action Committee (PAC), how to get politically involved, how to set up a meeting with elected representatives). Leadership Class participants will also be given the chance to visit "the Hill" to meet with a member of Congress.

Gregory S. Adey, MD

Dr. Adey received his medical degree from Jefferson Medical College in Philadelphia. He then completed his surgery and urology training at the Harvard Program in Urology (Longwood). Dr. Adey is a founding member of Fore River Urology in Portland, Maine. He serves as the Cancer Liaison Physician at Mercy Hospital, along with positions on the Quality, Strategic Management, and Cancer Committees. Dr. Adey’s clinical interests are urologic oncology, BPH and erectile dysfunction. He is a Diplomate of the American Board of Urology, and a Fellow of the American College of Surgeons.

Dianne Sacco, MD

Dr. Sacco is currently an Assistant Professor of Surgery at Massachusetts General Hospital and Director of the Kidney Stone Program. After completing her medical education at University of Vermont College of Medicine, she completed a residency in urology at Massachusetts General Hospital. Presently, she is on the Board of Directors for the New England Section of the AUA and Massachusetts Association of Practicing Urologists, as well as the Associate Director of the Residency Program at Massachusetts General Hospital. She specializes in endourology with an emphasis on stone disease. Her current research is focusing on the development of tools to enhance ureteroscopic management of stones and assist in resident training. She is a member of the AUA and the Endourological Society.

We wish Drs. Adey and Sacco good luck in their leadership pursuits in the coming year and we look forward to the lessons they will bring back to the Section.

The AUA Young Urologists (YU) Committee considers issues of concern to young urologists; its mission to address the needs of urologists 10 years or less out of training. In an effort to provide more information to young AUA and Section members, the YU Committee has recently launched a web site containing information and links on topics of interest to young urologists. Please visit www.AUAnet.org/YoungUrologists.

A Young Urologists Forum Reception will be held at the NEAUA Annual Meeting on Thursday, October 21, 2010, 5:30 – 7:00 PM in Providence, Rhode Island. This reception is open to all urologists.

To cut down on the amount of paper generated by the Section, many NE AUA publications and communications, including the NEAUA Highlighter and Annual Meeting Preliminary Program, have gone electronic and are distributed to members via email communication.

In an effort to continue and develop new eco-friendly initiatives, please share your ideas with the Section. Is your office cutting down on paper or committed to some other eco-friendly practice? Please send your ideas to the NEAUA administrative office.