Global Connections Fall 2013

GLOBAL CONNECTIONS A PUBLICATION OF THE AMERICAN UROLOGICAL ASSOCIATION

Global Unification for

VOLUME 6

Interstitial Cystitis More Research, Education and Answers

Popular Worldwide Program Offers Rewarding Ways to Share the AUA There are many opportunities for American Urological Association (AUA) members to share what they value most about their AUA membership with colleagues.

Through the AUA’s Member Get-A-Member (MGM) program, members have a direct way to communicate this value, gain unlimited “AUA reward dollars” that can be used toward select AUA products and subscriptions, and earn a chance to win a travel stipend to the AUA’s Annual Meeting.

Given its host of advantages, the MGM program has been very popular within the AUA community, both inside and outside the United States. The program began in 2007. Brazil has been the most active country outside the United States, with 190 member referrals. Canada and India have been passionately involved in the program as well, with 87 new referrals from Canada and 74 from India.

To participate, an AUA member makes sure that the colleague or friend they have referred has listed them in the “referral field” on the new member’s application for membership. Once that name has been submitted with the application, the member who made the referral receives 10 AUA Reward Dollars for each member who applies.

When the applicant completes the membership application process, the nominator will also be entered into a grand prize drawing for a chance to win a $1,000, $500 or $250 travel stipend to the AUA Annual Meeting.

“With the MGM Rewards, I have been able to purchase items from the AUA product store, including teaching videos for my residents,” said Ganesh Gopalakrishnan, MD, a longtime MGM participant and consultant urologist at Vedanayagam Hospital in Coimbatore, Tamilnadu, India.

Two additional ways to participate in the MGM program include the online Colleague Referral and Share with a Colleague options available through AUAnet.org/MGM. These systems automatically record that a referral has been made, and send a personalized email outlining the benefits of AUA membership to an interested friend or colleague with the purpose of encouraging them to apply.

“As the residency program director for a large academic program with over 20 residents, the MGM rewards go back to our division,” said Robert J. Stewart, MD, a dedicated MGM participant from the University of Toronto in Canada.

Dr. Stewart described the program as “very simple to participate.”

Dr. Gopalakrishnan has expressed to his colleagues the importance of AUA membership for several reasons. “I think it is important for urologists to be part of some global association apart from their own societies,” he said. “Such an association allows one to see and hear about global urological issues, cuttingedge technology and, of course, meet and discuss various issues (both urological and non-urological) with fellow urologists across the world.”

To learn more about the benefits of AUA membership and to earn AUA Reward Dollars, visit AUAnet.org/MGM. top ten countries (outside the United States)

= 10 referrals

brazil 190

canada 87

india 74

japan 70

mexico 52

germany 32

egypt 28

australia 25

united kingdom 23

philippines 19

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Global Unification for Interstitial Cystitis: More Research, Education and Answers

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Up Close & Personal: AUA/EAU Academic Exchange Program

Global Connections is published twice-yearly by the American Urological Association Education and Research, Inc. (AUA). The AUA believes that the information in this newsletter is as authoritative and accurate as is reasonably possible and that sources of information used in preparation are reliable, but no assurance or warranty of completeness or accuracy is intended or given, and all warranties of any kind are disclaimed. This newsletter is not intended as legal advice, nor is the AUA engaged in rendering legal or other professional services.

For comments or questions email us at communications@AUAnet.org.

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Advancing Urology through Innovation

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co l l a b o r at i o n s

AUA’s Annual Meeting: A Global Forum Advancing Urology Around the World

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Global Unification for

Interstitial Cystitis

More Research, Education and Answers

By William D. Steers, MD, and Jennifer Larche Imagine having the urge to urinate more than 20 times per day and enduring constant discomfort. This is real for men and women living with interstitial cystitis/bladder pain syndrome (IC/BPS or just IC). Many with severe cases of IC may urinate up to 60 times a day. IC is known as a condition that consists of recurring pelvic pain, pressure or discomfort in the bladder and pelvic region, often associated with urinary frequency and urgency. Unspoken is the pain that may occur during intercourse and its impact on sexual partners. The effects of IC on psychosocial functioning and quality of life (QoL) are pervasive and insidious, damaging work life, psychological well-being, personal relationships and general health. Lasting longer than six weeks in the absence of infection or other identifiable causes, the symptoms can vary between individuals and even for the same person.

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Currently, there is no cure for IC, and the exact cause is unknown.

However, there is a combination of treatments, including diet, drugs, procedures and behavioral interventions, that can improve symptoms. A wide array of factors may contribute to this disorder, such as a defect in the urothelium (a layer that lines much of the urinary bladder), histamine-releasing cells or other immune cells, and changes in nerves that carry bladder sensations. What is known is who IC affects, as it can effect anyone, including children, teens, and the elderly. Although IC has been traditionally considered a women’s disorder, men can also have the disorder but are likely to be diagnosed with prostate conditions such as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) or benign prostatic hyperplasia (BPH); and because IC symptoms are similar to those of other diseases, diagnosis can be very difficult.

Images courtesy of TARIS Biomedical, Inc.

“IC/BPS has earlier been referred to as a ‘headache in the pelvis.’

This alias has stuck on, but with the excellent contribution by organizations like the Interstitial Cystitis Database Study and the Interstitial Cystitis Clinical Trials Group, there seems to be light at the end of the tunnel toward a unified approach to combat this disorder,” says Dr. John S. Banerji, Associate Professor, Department of Urology Christian Medical College in Vellore, India.

It’s not just urologists who diagnose, manage and treat IC. IC is known as a challenging disorder, one that requires the patient and his or her physician and consulting specialists, such as gynecologists, pain clinics, and physical therapists, to work as a team to identify effective therapies. Urologists, while very familiar with the disorder, are often not trained in chronic pain, behavioral therapies or emotional disorders associated with IC. “There appears to be somewhat of a knowledge gap the

‘...there seems to be light at the end of the tunnel toward a unified approach to combat this disorder’ condition even exists, and frequently the condition is not diagnosed or the physician feels uncomfortable with available, effective management strategies,” said New York urologist Dr. Robert Moldwin, a well-known IC specialist. “I see patients every day who are in need of more receptive medical systems when caring for this condition.”

In 2011, the AUA released the first consensus-based guideline for the diagnosis and treatment of IC in the United States aimed at providing insights for both health care providers and patients about managing the chronic condition. The Guideline outlines principles of clinical care with the ultimate goal of improving the quality of life for IC patients, and provides a treatment algorithm.

Education for health care providers Dr. J Curtis Nickel, Professor of Urology at Queens University in Kingston, Canada, considers IC “the black sheep of urological conditions which has led to a lack of educational opportunities for urologists.”

Fortunately, educational opportunities for physicians to learn more about the condition are developing throughout the world and have been popular in Asia, Canada, Europe and the United States. In partnership with the American Urogynecologic Society and The France Foundation, the Interstitial Cystitis Association (ICA) has released a new continuing medical education (CME) program, titled Conquering IC: Identification and Management Strategies. This educational program provides an interdisciplinary audience with comprehensive continuing education on identification and management of patients with IC. The 2013 AUA Annual Meeting was host to an IC/BPS course, Interstitial Cystitis/Bladder Pain Syndrome: A Primer and a WorldView, which was presented from an international viewpoint and included information regarding the history of the syndrome, epidemiology, associated disorders, confusable diseases, treatment, etc. The course discussed why there have been various challenges associated with diagnosis and management, and the remarkable progress in harmonization around the world during the last decade, which continues. It also covered where this disorder is situated in new classification schemes of chronic pain syndromes, as well as the comparing and contrasting of treatment guidelines from Asia, Europe and the United States.

Highlights, including handouts from the course, are available on the AUA’s Annual Meeting website. Additionally, educational offerings such as the ICA and AUA CME assist health care providers in learning the most current approaches in diagnosis, treatment and management of IC, which may translate to better symptom control and improved outcomes for IC patients. co n t i n u e d o n p g 6 ▼ g lo b a l co n n ec t i o n s • vo l u m e 6

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▼ co n t i n u e d f r o m p g 5 IC/BS: An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symp-toms of more than six weeks duration, in the ab-sence of infection or other identifiable causes

BASIC ASSESSMENT History Frequency/Volume Chart Post-void residual Physical examination

The guideline, treatment algorithm, and a webinar are available at

Urinalysis, culture Cytology if smoking hx Symptom questionnaire Pain evaluation

FIRST-LINE TREATMENTS

General Relaxation/ Stress Management Pain Management Patient Education Self-care/Behavioral Modification

Interstitial Cystitis/Bladder Pain Syndrome 96

SECOND-LINE TREATMENTS

TREAT AND REASSESS

Signs/Symptoms of Complicated IC/BS

CLINICAL MANAGEMENT PRINCIPLES

- Treatments are ordered from most to least conservative; surgical treatment is appropriate only after other treatment options have been found to be ineffective (except for treatment of Hunner’s lesions if detected) - Initial treatment level depends on symptom severity, clinician judgment, and patient preferences - Multiple, simultaneous treatments may be considered if in best interests of patient - Ineffective treatments should be stopped - Pain management should be considered throughout course of therapy with goal of maximizing function and minimizing pain and side effects - Diagnosis should be reconsidered if no improvement w/in clinically-meaningful time-frame

Appropriate manual physical therapy techniques

THIRD-LINE TREATMENTS

Oral: amitriptyline, ci-metidine, hydroxyzine, PPS

Cystoscopy under anesthesia w/ hydrodistension

FOURTH-LINE TREATMENTS

Pain Management

Pain Management

Intravesical: DMSO, hepa-rin, Lidocaine Pain Management

Neuromodulation

Tx of Hunner’s lesions if found

RESEARCH TRIALS Patient enrollment as appropriate at any point in treatment process

Making a Difference with Research IC research continues to engage the world’s premier researchers to discover more about this condition and, in turn, find a cure.

Early research suggests IC prevalence can range anywhere from 1 in 100,000 to 5.1 in 1,000. More recently, the scientific community has achieved a much deeper understanding of the epidemiology of IC. A few landmark IC studies include the RAND Interstitial Cystitis Epidemiology (RICE), Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) and the Boston Area Community Health (BACH) survey.

RICE The RICE studies have provided astonishing data on the

Incontinence/OAB

CONSIDER:

GI signs/symptoms

- Urine cytology

- Laparoscopy

Microscopic/gross hematuria/sterile pyuria

- Imaging

- Specialist referral (urologic or nonurologic as appropriate)

Gynecologic signs/ symptoms

- Cystoscopy - Urodynamics

NORMAL

ABNORMAL TREAT AS INDICATED

SIXTH-LINE TREATMENTS

Copyright © 2010 American Urological Association Education and Research, Inc.®

Several new studies providing new insights for the cause, diagnosis and treatment of IC were also presented at the 2013 AUA Annual Meeting. According to some urologists, considerable advancements are being made in pathogenesis (disease cause) and new biomarkers (biological indicators), and the relationship between genetic and environmental factors has recently been explored. Urologic researchers are uniquely poised to take advantage of very recent, exciting discoveries regarding the human microbiome (collection of microorganisms), interplay of environment through epigenomics (study of genetic cells) and epithelial cells and nerves, or the sharing of microbial DNA fragments and sensory nerves to alter the pain threshold.

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Dx Urinary Tract Infection

FIFTH-LINE TREATMENTS

Diversion w/ or w/out cystectomy Pain Management

Cyclosporine A

Substitution cystoplasty

Intradetrusor BTX

NOTE: For patients with end-stage structurally small bladders, diversion is indicated at any time clinician and patient believe ap-propriate

Pain Management

Interstitial Cystitis/Bladder Pain Syndrome

www.AUAnet.org / ClinicalPracticeGuidelines

The evidence supporting the use of Neuromodulation, Cyclosporine A, and BTX for IC/ BPS is lim-ited by many factors including study quality, small sample sizes, and lack of durable follow up. None of these therapies have been approved by the U.S. Food and Drug Administration for this indication. The panel believes that none of these interventions can be recommended for general-ized use for this disorder, but rather should be limited to practitioners with experience managing this syndrome and willingness to provide long term care of these patients post intervention.

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prevalence of IC in the United States. This study, funded by the National Institutes of Health (NIH), estimated 3.4 to 7.8 million women in the United States have symptoms of interstitial cystitis, much higher than was previously thought. Moreover, approximately 1 to 4 million men appear to have IC, though the true rate has yet to be determined because men are often diagnosed with CP/CPPS instead.

MAPP The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is sponsoring a unique research study known as the MAPP Research Network. The research is aimed to help better understand the underlying causes of IC and CP/CPPS. MAPP embraces a systemic approach by investigating potential relationships between these two urological syndromes and other overlapping conditions, such as irritable bowel syndrome, fibromyalgia, vulvodynia and chronic fatigue syndrome.

Researchers are wrapping up data analysis on Phase I of the study and are in the planning stages for Phase II, which is set to begin next year.

BACH In 2002, the NIDDK began the BACH survey of Bostonmetropolitan residents, which intended to discover more about the community’s urologic symptoms and how those symptoms affected their daily lives. The NIDDK also intended to estimate the prevalence of other health problems, such as urinary

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incontinence, impaired sexual function and prostatitis (infection of the prostate). Study results were published in The Journal of Urology® in 2008, indicating the proportion of men with IC was much higher than previously thought. IC symptoms were only two-to-three times more common in women than in men.

Supplemental Studies Other smaller studies from these larger research inquiries also show impactful results — one in particular comes from AUA Member, MAPP Chair and ICA Medical Advisory Board Member J. Quentin Clemens at the University of Michigan Medical Center.

Due to the overlapping conditions associated with IC, they wanted to know whether one type of disease tends to occur before the other. More than 3,000 women from the RICE study were surveyed, and results indicated 2,185 who had IC had a diagnosis of at least one non-bladder condition (chronic fatigue syndrome, migraines, panic attacks or depression).

Newer research studies being conducted are aimed at discovering IC treatment options. For example, in the United States and Canada, a promising study involving lidocaine as a form of treatment is underway. The product is designed to continuously provide lidocaine, over an extended period, directly to the bladder. The Massachusetts biomedical company who introduced the therapeutic system announced in April the dosing of the first patient in the second Phase 2 clinical study. The trial’s principal investigator, Dr. J. Curtis Nickel, says, “The first Phase 2 study provided important insights into both the disease and the benefit of this treatment option, relative to placebo in this patient

population. This new study incorporates these learnings.” The research is active in 12 study centers across the United States and will ultimately include up to 20 study centers around the United States and Canada.

The NIH Pain Consortium recently held its 8th annual symposium, which highlighted advances in NIH-funded pain research. This year’s theme was “Integrated Self-Management Strategies for Chronic Pain,” based on the recent Institute of Medicine report that recommends using self-management techniques for chronic pain — a condition estimated to cost the United States about $600 billion per year. The research presented at the meeting demonstrated the importance of self-management in successfully living with chronic pain conditions. Because self-management is so important in IC, ICA is in the process of developing the program ICHope Self Management Module – A Staged Approach to Managing IC Pain.

A wide range of IC clinical trials are also being conducted on issues such as efficacy, safety and genetics, which are recruiting patients. Physicians are encouraged to take an active part in referring their IC patients to these studies, as well as to forums like ResearchMatch, where patients can sign up for various projects, surveys and trials.

“Recent advances in human genetic variation are bringing new perspective on the syndrome. In the future, genetic understanding may provide consistent information about the mechanisms involved in IC/BPS activity,” says Dr. Marcos Lucon, co n t i n u e d o n p g 8 ▼

“...patients are the best advocates in r aising both awareness and funding for IC, and continue to pl ay an enormous role in increasing awareness for the medical communit y and public.”

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Hospital das Clinicas, University of Sao Paulo Medical School in Sao Paulo, Brazil.

More information on Interstitial Cystitis can be found here:

The World Health Organization maintains the International Clinical Trials Registry Platform, a database of clinical trials happening all over the world. There are currently 20 international studies being conducted in countries such as Canada, China, Finland, India, the United States and many others — 13 of which are actively recruiting IC/BPS patients.

IC Network

Advocating for Answers

Interstitial Cystitis Association

More so than any other urologic condition, patients are the best advocates in raising both awareness and funding for IC, and continue to play an enormous role in increasing awareness for the medical community and public. In fact, IC has a strong, global network of patient-based groups – such as the ICA, the Multinational Interstitial Cystitis Association, and the IC Network – who are dedicated to helping men and women receive the care they need and to researchers to obtain funds to continue critical research into this complex condition.

www.ichelp.org

“I was a young orthopedic surgeon when I began to suffer from IC symptoms that threatened to take over my life,” says Vicki Ratner, ICA founder. “That’s why I started the ICA – to make sure patients had reliable information on their condition and to lobby the U.S. government to ensure health care funds were allocated toward research for this condition.”

Catherine Horine, an IC patient and volunteer advocate, teamed up with the ICA to help raise global awareness about the condition. With almost 60 countries represented in the IC community, Facebook, Twitter and her blog also provide the ability to connect with these patients worldwide and offer support, information and resources. “I’m constantly looking for ways to raise awareness about IC,” explains Horine. “IC needs the help of the medical community to further education, and to help with awareness and fundraising.” Catherine has a local support group for IC patients in her area, which has grown to be a great success in the last six years. She works with the ICA on fundraising; she personally raised $3,000 for IC research and has her Congressional Representative following her on Twitter — he is supporting increased IC research funding.

Physicians can help raise awareness in the same manner they would any other urological disease or condition. Write to your representative and encourage your patients to do the same. The impact of IC on QoL is as severe as that of rheumatoid arthritis and end-stage renal disease. It is imperative that patient groups and the urology community continue to advocate and strive to improve the awareness surrounding this disease. ●

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www.ic-network.com

Annual Meeting IC course information : 071PG: Interstitial Cystitis/ Bladder Pain Syndrome: A Primer and a World-View Visit www.AUA2013.org and login to view handouts

William D. Steers, MD, is a Paul Mellon professor and Chair of the Department of Urology at the School of Medicine of the University of Virginia, Past President of the American Board of Urology and Editor at the American Urological Association’s Journal of Urology.

references Interstitial Cystitis Association, Retrieved August 12, 2013, from http://www.ichelp.org/ClinicalTrials IC Network, Retrieved August 12, 2013, from https://www.ic-network.com/ic-research/

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2013 AUA/EAU Academic Exchange Program Participants: Johannes Huber, MD, PhD University Hospital Carl Gustav Carus Dresden, Germany

Altaf Mangera, MD Royal Hallamshire Hospital Sheffield, United Kingdom

Maria Merce Pascual Queralt, MD Hospital Santa Maria Lleida, Spain

AUA /EAU Academic Exchange Program In 1993, the American Urological Association (AUA) and the European Association of Urology (EAU) began an exchange program designed to provide young urology faculty with an international perspective on urologic medicine. Since then, more than 80 European and North American urologists have participated in the AUA/EAU Academic Exchange Program.

The program not only allows the sharing of knowledge and experience, but it assists in identifying future leaders within both the AUA and EAU organizations. The AUA/EAU Academic Exchange Program has served as the cornerstone of the AUA’s international exchange programs. Because of the success of this program, the AUA has expanded its international academic exchange programs to include Brazil, China, India, Japan, Mexico and South America.

The 21st annual AUA/EAU Academic Exchange Program occurred in April 2013 with three European urologists and one Senior Advisor traveling to North America to visit three U.S. institutions, followed by participation in the AUA’s Annual Meeting in San Diego, California. Their journey began at the University of Minnesota, continued with a visit to University of California, Los Angeles, and University of California, Irvine, before ending at the Annual Meeting in San Diego. We interviewed this year’s European scholars to gain a more in depth look at the exchange program from their unique points of view.

AUA: Huber:

Are you still in contact with colleagues that you met during your exchange experience? If so, in what capacity (i.e., friendly emails, journal club, exchanging medical cases, etc.)?

Occasionally some of the colleagues exchange emails with me. Moreover, we connected through scientific social media (www.researchgate.net).

Professor Paul Van Cangh (Senior Advisor) Univerité Catholique de Louvain Brussels, Belgium

“I do believe that this program is the most valuable investment for the future: selecting and promoting the best people and bringing them together for a global interaction.”

– Professor Paul Van Cangh, Senior Advisor for the 2013 AUA/EAU Academic Exchange Program

Mangera: It has only been a few months since the trip, and we’ve shared regular friendly emails and have had updates and meetings at congresses.

Pascual Queralt: I think in the future we are going to have more chances of exchanging other kind of information.

Also, I exchanged some friendly emails with some American urologists.

AUA:

How has or will your academic exchange experience affect your daily practice (if at all)?

Have you or do you plan to implement any techniques or skills that you learned during the exchange into your everyday practice?

Huber:

From witnessing the many complications after TOT and TVT procedures during my experience at UCLA, I am much more aware of that problem in clinical practice.

Mangera: I will be looking for more collaboration with the co n t i n u e d o n p g 10 ▼ g lo b a l co n n ec t i o n s • vo l u m e 6

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▼ co n t i n u e d f r o m p g 9

U.S. and looking at adopting the U.S. research model of how clinical research ties in with the university.

area can help others.

Pascual Queralt: I still do more or less the same in my

from other countries it’s easier for you to work with them, exchange information, collaborate on research projects, and so on.

current practice, but the exchange has opened my mind to be more flexible to different ways of doing the same thing. I am thinking about introducing some new procedures to my practice.

AUA:

What are the biggest differences you saw between your current practice and those that you observed in the U.S.?

Huber:

The massive dominance of robotic surgery, e.g., for radical prostatectomy.

Pascual Queralt: Yes, because when you meet people

AUA:

Have you been asked to present to a group about your exchange experience? If so, where and to whom did you present your experience?

Huber:

Yes, I presented at the Grand Rounds of my home institution, and we wrote an article for “European Urology Today.”

Mangera: The centres in the U.S. are very well -funded and have good facilities for operations and post-operative care.

Mangera: In my hospital I presented at the Grand Rounds

Pascual Queralt: The biggest difference is money.

With more money, you can have more technology for your daily practice, and also you have more people working in very specialized areas (e.g., research projects). These are things that we don’t have in Spain right now.

Pascual Queralt: I presented my experience to my team

AUA:

Do you think the exchange will inspire international research collaborations? Will the exchange affect how you conduct research in the future (i.e., more of an international approach?)

Huber:

Certainly. I already advised a younger colleague to apply for a scientific rotation at one of the institutions we visited. Personally, I learned about several new aspects of shared decision-making and will stay in contact with some colleagues with the same research focus.

about my experiences and take-home messages.

in my hospital. I also wrote a report for the News Journal of the Spanish Association of Urology, which was published in June 2013.

AUA:

How has the exchange program changed your perception of the practice of urology? How has it affected your perception of the world in general?

Huber: I am very grateful for all the efforts and friendly caring we received. I got to know the strong and cooperative relationship of the AUA and the EAU, and realized the importance of these organizations for fruitful cooperation.

Mangera: There are differences in the way people do things

Mangera: I hope so. I saw how we are all working globally on the same problems, and using ideas and research from one

in different parts of the world, and these are due to differences in culture and health economics but the ultimate goal of helping patients remains the same.

Observing in the OR at University of Minnesota.

Dr. Mark Litwin and the scholars during their visit to UCLA.

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The scholars present a plaque to Dr. Jaime Landman, their host at UC Irvine.

Pascual Queralt: You see that everywhere the same things happen; we have the same problems, and everywhere we solve them in a similar way. It makes you feel more confident in what you do. This exchange program has demonstrated to me that in my country (Spain) we have a very good level of Urology.

Sometimes we think that in small countries we do things “worse” and that’s not the case. This program opens your mind, makes you more capable to adapt to any media, and teaches you how to interact with different kinds of people.

AUA:

How will participating in this program influence your participation in other international activities? For instance, will you be more likely to host an international scholar at your institution?

Have you been involved in other international exchanges or meetings because of your participation in the exchange program?

Huber: It was helpful to get this view, because I will be even

Scholars practice laparoscopic surgery through simulation at UC Irvine.

AUA:

What moment or experience did you find to be the most impactful during your exchange?

Huber: That is difficult to say. There were so many! Maybe the social events, when the head of departments welcomed us at their private home.

Mangera: I found meeting people with new interests and insights into topics I have studied in great depth to be very special. This experience allows you to see other people looking at the same problems with a different lens.

Pascual Queralt: The first day of every hospital, because you were expecting how should be the people, what we would do. The things that impacted me the most were the research centers that we visited in Minneapolis and Irvine.

AUA:

Would you recommend participation in this program to your colleagues?

more caring for visiting guests at our institution than before.

As the exchange was only some months ago, there was no opportunity for another program since then.

Huber: Yes, absolutely.

Mangera: I would feel privileged to host an international scholar. I would also be able to appreciate their perspective after having participated in the program. This gave me a good insight of what scholars are looking for when they visit other institutions.

Pascual Queralt: Yes

Pascual Queralt: After this program, I have learned to not be afraid of talking in front of a big audience in English (a foreign language for me). Now I am planning to do a conference in London next October, and I am planning to present something for the next European Congress.

Mangera: Yes. For more information about AUA’s Academic Exchange Programs, go to www.AUAnet.org/International or email international@AUAnet.org. ●

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Virtual education, commonly referred to as e-learning, continues to advance the way physicians and health care professionals teach, study and share experiences across the globe. Urologists are known for being early adopters of new technologies so it is no surprise urology has embraced virtual education. Urologic health remains an area of focus transcending geographic borders, and the opportunity to improve the quality and scope of urologic education exists through virtual learning. Organizations such as the American Urological Association (AUA), the International Continence Society (ICS) and the Societe Internationale D’Urologie (SIU) are using remote learning as an option for their members to stay abreast of the newest information and provide continued education. vo l um e 5 • g lo b a l co n n ec t i o n s

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E-learning in the Urologic Community E-learning in the medical field continues to gain global acceptance as learners recognize the benefit of accessing a solution to meet their educational needs while supporting their demanding schedules. The convenience and power of online technology combined with content developed by expert clinicians, urologists and academia provides a robust e-learning environment that promotes lifelong learning, maintenance of certification, teaching resources and improved patient care.

The AUA provides several e-learning options, including its International Academy (IA), which is designed to advance international exchange of urologic skills and expertise. This virtual learning environment offers physicians the opportunity to receive direct “anytime, anywhere” instruction from urologic experts around the world. The International Academy promotes discussion and learning among the world’s diverse urologic communities through its educational offerings that include webcasts, surgical videos, online courses, abstracts and posters, and foreign language offerings, as well as the “Case-of-theMonth” series. The “Case-of-the-Month” was established as a resource for residents, urologists and urologic health professionals that highlights a routine patient scenario with evaluation and management illustrations in a think-first format.

“One of the greatest advantages of virtual learning technology is the ability to share information — it is critical to the AUA and to advancing urology worldwide,” says Dr. Gopal H. Badlani, AUA Secretary.

‘One of the greatest advantages of virtual learning technology is the abilit y to share information...’

In addition to IA educational offerings, there are also several options for physicians to achieve continuing medical education (CME) from the AUA. For example, the online Urology Core Curriculum is a collection of educational content and study material that serves as a living resource and ever-expanding learning tool for health care professionals practicing in the field of urology.

“U.S.- and European-based core curriculum in medical education is now being implemented in Africa, Latin America and South

America,” explains Dr. Hiep Nguyen, Associate Professor, Harvard Medical School Urology, Boston Children’s Hospital Director, Robotic Surgery, Research and Training Director. “Collaboration between organizations such as IVUMed, the College of Surgeons in East, Central and Southern Africa, and other African urology organizations use virtual education to develop similar core competencies for their residents and trainees.”

Other urological organizations offering similar e-learning opportunities include the European Association of Urology (EAU), ICS and SIU. The EAU provides online CME activities and training courses; and the ICS has introduced a new e-learning portal, the ICS eLearning Centre, offering ICS accredited online educational courses pertaining to brain and bladder, pelvic pain, overactive bladder and urodynamic equipment. In recent months, the SIU launched its SIU Academy, an e-learning portal for urologists, which includes surgical videos, clinical case studies, publications and congress materials.

“The SIU Academy provides urologists with a dynamic and innovative platform,” said Dr. Simon Tanguay, SIU General Secretary, Professor of Surgery at McGill University and Head of Urologic Oncology at McGill University Medical Center in Montreal, Quebec, Canada. “It is a result of our vision to promote continuing medical education and share best practices with the ultimate goal of improving urological care worldwide.”

Collaboration is crucial to improving the quality of urologic health care and education around the world. The SIU and iClinics.org — a free, urology-specific surgical video website — have teamed up to enhance online educational experiences for both established urologists and urologists-in-training in such countries as China, Egypt, India and Turkey. Together, U.S. urologist Dr. Richard Santucci and German urologist Dr. Markus Hohenfellner founded the site “to continue the tradition of classical paper journals in facilitating the discovery of the unknown and the search for the truth.” co n t i n u e d o n p g 14 ▼

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“Coll abor ation is crucial to improving the qualit y of urologic health care and education around the world.”

“Video sites such as iClinics.org can be extremely helpful to international surgical demonstration visits. Surgical videos are a major “force multiplier” for learning technique,” discusses Dr. Richard A. Santucci, MD, FACS, Specialist-in-Chief of Urology at the Detroit Medical Center in Detroit, Michigan. “We have used this technique to enhance these visits to Nigeria, Mozambique and Rwanda.”

Innovative Learning Technologies Simulation has been used in health care around the world since antiquity and is enriching the world of e-learning. The first medical simulators were simple models of human patients. These representations in clay and stone were used to demonstrate clinical features of disease states and their effects on humans.

However, today’s technology has provided many advances into the world of simulation, offering innovative educational tools for the medical community. For instance, in Germany, the Inmedea simulator is used by fourth-year medical students.

It was developed as a Web-based interactive e-learning management system built around a virtual hospital that includes a department of urology and several other virtual departments.

The simulator creates virtual patients, and students play the role of the urologist. An assessment of the e-learning experience by these students revealed their preference for a combination of simulation and conventional instruction, or “blended learning” over conventional teaching alone.

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Another popular method of e-learning has developed in the form of online journal clubs, such as the AUA’s Evidence-Based Journal Club (EBJC) and the online presence of BJU International (BJUI), formally known as The British Journal of Urology. Both are platforms for sharing clinical urologic information and educating urologists, and are utilized all over the world. BJUI publishes clinical articles, reviews, comments and educational articles related to urology promoting awareness of new advances and supporting best practice. EBJC is free for AUA members, residents and medical students. Now in its fifth season, the program was developed for practicing urologists and residents-in-training to enhance their critical appraisal skills. The program strives to provide urologists with the highest standards in clinical research and educational information.

“Virtual education has the potential to fill in educational gaps and provide teaching and training material to urologists worldwide,” says Dr. Tanguay. “It can provide any urologist with access to knowledge at anytime and anywhere in the world — including in developing countries where the need for such a system is very important.”

From international education programs to simulation, it is evident the urologic community is rapidly expanding to embrace advances in technology — in turn, innovating methodologies of training, learning and practice in the world of urology. ●

Timothy D. Averch, MD, is Professor of Urology and Director of Endourology at the University of Pittsburgh Medical Center.

He is also Chair of the AUA International Academy Content Committee.

AUA’s Annual Meeting: A Global Forum Advancing Urology Around the World

By Lori Agbonkhese

Over 40 International Presidents and Representatives celebrated an evening of friendship and collaboration in San Diego at the 2013 Presidents Reception.

Close to 17,000 urologic professionals came together from around the globe to attend the American Urological Association’s (AUA) 2013 Annual Meeting in San Diego, California. With over 120 countries represented, the AUA’s Annual Meeting is truly the largest global forum for urologic professionals.

Although planning for the AUA Annual Meeting begins years in advance, the AUA is constantly developing new ways and ideas to ensure all of our attendees have an exceptional experience.

With more than half (55% in 2013) of all attendees coming from outside the United States, the AUA provides a wide array of services and accommodations to suit the various needs of international attendees. Whether it is providing assistance to attendees in obtaining visas to come to the United States or an area to relax during a long day of scientific sessions, the AUA strives to provide a forum for attendees to connect with their colleagues from around the world and discuss the latest advances and treatments in urologic health.

Some of the ways in which the AUA assists international attendees include:

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International programming. Experts from around the world present the latest science in a variety of educational formats throughout the entire meeting.

A comprehensive scientific program is created that includes 15 educational tracks and more than 2,000 abstracts in all fields of urology. Hands-on Courses and Skills Enhancement areas, Live Surgeries, Moderated Poster Sessions, and an extensive Science and Technology Hall provide a vast array of learning opportunities. Complementing AUA’s programming are international and subspecialty society meetings. In 2013, 17 international societies held educational sessions that were open to all registered attendees. In addition, more than 20 leadership meetings with international societies were held to build friendships and expand opportunities for collaboration.

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Creating a home base. The AUA launched its International Center in San Diego, which served as a central hub for international attendees to connect, relax and recharge throughout the course of the meeting. The Center featured an area where attendees could “Make Your Mark” by placing a sticker on a world map representing their countries,

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Plenary Session at AUA2013 San Diego.

and spotlighted AUA’s collaborations and educational programs around the world. This popular area also featured a wall of clocks representing time zones from several of the countries represented at the meeting, as well as a photo area. An afternoon reception sponsored by Janssen allowed attendees to network over great food and drink while discovering the International Center, the online International Academy and the Giving Back website.

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Beyond English – AUA language services.

Translational equipment and services are utilized during AUA Annual Meetings. Spanish- and Portuguesespeaking representatives are available in the Registration and Member Central areas to assist the large number of attendees from these regions. AUA’s plenary sessions and several IC/PG courses are also simultaneously translated and/or presented in Spanish. Simultaneous translation is available for the AUA/CAU Spanish Urology Program and the Portuguese Urology Program, as well. In addition, translated educational sessions are made available via webcast after the meeting so attendees can catch up on sessions they may have missed.

Attendees from the Dominican Republic “Make Their Mark” at the AUA International Center.

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Access to international cuisine. Cities hosting the meeting offer attendees a wide variety of cuisine from across the globe. Attendees can be adventurous and try something new, or take comfort in familiar flavors – often just a few steps away from their hotels and the convention center.

Urologic health is an issue that transcends geographic borders.

The AUA is committed to enhancing urologic education and patient care around the world through the collaboration and exchange of knowledge and resources. The AUA is honored to provide a global forum that promotes the interchange of urological skills, expertise and knowledge, which is critical to the continued success of urology in the world community.

To plan your trip to AUA’s 2014 Annual Meeting, please visit www.AUA2014.org. ●

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Bringing the destination to attendees. To ease the challenges associated with international travel, the AUA created an online International Attendee Guide that provides critical information to assist attendees with planning their trip to the United States. The Guide includes information and resources about visa applications, obtaining letters of invitation and how to acclimate to the United States.

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Destination selection. The AUA holds its Annual Meeting in locations that provide attendees with access to major international airports offering hundreds of flights outside of the United States on a daily basis. Many of these daily flights are non-stop from Canada, Europe, Asia and South America. A wide variety of hotel accommodations and complimentary shuttle services between official AUA hotels and the convention center are also provided.

save the date www.AUA2014.org

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AUA International Academy Your virtual classroom and global resource for urologic education.

Developed by urologic experts from around the world, the Academy taps into AUA’s global network of members and provides an on-line resource for lifelong learning for medical professionals practicing in the field of urology. As a central point of education, the Academy connects the world of urology by fostering and promoting the interchange of urological skills, expertise, and knowledge which is critical to the continued success of urology in the world community.

Visit www.AUAnet.org/Academy for more information.

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a sincere

Thank You

to our international president’s circle patrons

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