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European Urology Today

EUT Congress News

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26th Annual Congress of the European Association of Urology

Saturday, 19 March 2011

Vienna, 18-22 March 2011

Young doctors are urology’s bedrock, say awardees Modern training for young urologists remain a priority By Loek Keizer and Joel Vega Young urologists and their training still remain a top priority and challenge for urology, according to the recipients of major awards from the EAU who expressed their hopes for the continued growth and development of urology during the opening ceremony of the 26th Annual EAU Congress held in Vienna, Austria. “Modern urological training is still a continuing challenge for us. We should give it the priority since young urologists are the future of our specialty,” said Prof. Alain Le Duc who was awarded the Frans Debruyne Lifetime Achievement Awards, an honour named after one of the EAU’s pioneering founders. “I am humbled, as there are many, many people out there perhaps even more deserving of this honour,” said Prof. Urs Studer of the University of Bern, Switzerland who was conferred the EAU Willy Gregoir award, granted to Europe’s most innovative and pioneering urologists. “Urologic oncology still needs a leap ahead. There is great emphasis on surgery, but in cases like metastatic cancer, refining surgery will not be enough. We need to support developments in other approaches, added Studer

The award recognises Studer’s achievements in bladder cancer. EAU Sec. General Per-Anders Abrahamsson remarked: “We recognise Prof. Struder’s efforts who is a real pioneer in his own field.” The ceremony opened with the music of Austrian’s most famous musician and composer Wolfgang Amadeus Mozart, child prodigy, with Congress President Prof. Michael Marberger welcoming all participants. Nearly 13,000 are participating or registered for the annual event. Abrahamsson meanwhile thanked the host country and mentioned the joint SIU-EAU-AUA urology-related charity project in Sub-Saharan Africa. Dr. Steven Joniau (Belgium) won the Crystal Matula award for his achievements in uro-oncology, whilst Prof. Christian Chaussy (Germany) was awarded with the first EAU Innovators in Urology Award. Joniau said getting the Crystal Matula was a complete surprise but conceded that he expects such a recognition to open opportunities to mid-career urologists like him. “The Matula certainly is an encouragement to know you’re on the right track,” Joniau added.

BCa biomarkers still limited ICUD-EAU BCa meeting yields useful insights By Joel Vega Despite the increasing number of studies in recent years on cancer biomarkers, the use of biomarkers as a diagnostic tool in bladder cancer (BCa) remains of limited use, according to a sub-panel working with the International Consultation on Urological Diseases (ICUD)-EAU International Consultation on Bladder Cancer. “Currently no prognostic marker is ready for integration into clinical decision-making… Bladder cancer develops along multiple molecular pathways- multiple molecular markers to capture biological potential of tumour,” said Dr. Shahrokh Shariat (New York, USA), a member of one of the panels created under the ICUD-EAU consultation on BCa. Led by Prof. Mark Soloway, the ICUD-EAU consultation on BCA involved 100 experts in urology, urologic pathology, medical and radiation oncology in 10 committees. In yesterday’s session the experts presented their recommendations on various aspects of BCa covering diagnosis, pathology, biomarkers, low-grade BCa, muscle-invasive BCa medical, urinary diversion and metastatic disease amongst others. Shariat said molecular medicine holds the promise that clinical outcomes will be improved by directing therapy tumour mechanisms and targets, as he added that the advent of high-throughput technologies is allowing comprehensive identification of molecular targets and markers “Despite numerous publications, the utility of markers in clinical decision-making remains limited,” Shariat reiterate as he noted that the first trials on a marker-guided follow-up in BCa patients are underway. He said that several screening studies could demonstrate the feasibility of molecular markers in certain settings. “Probably no single essay Saturday 19 March 2011

Dr. Morgan Rouprêt received the Hans Marberger Award 2011 for publishing one of the best articles on endoscopy during the last year. The young, Paris-based doctor earlier received citations from the EAU for submitting the best abstracts in previous congresses. Also commended and granted EAU Honorary Memberships were Ziya Kirkali (USA), Yan-Qun Na (China), P.F. Schellhammer (USA), Hans Goran Tiselius, (Sweden), Peter Whelan (UK) and Humberto Villavicencio (Spain).

Prof. Christian Chaussy (left) receives the first EAU Innovators in Urology Award from EAU Secretary General Per-Anders Abrahamsson

Urology Beyond Europe Participants observe minute of silence for victims The full-day, two-track Urology Beyond Europe joint sessions opened yesterday the 26th Annual EAU Congress, with participants from 10 international and regional associations tackling a wide range of current hot topics in urology. During the joint EAU meeting with Indonesia, participants observed a minute of silence for calamity victims.

“Many of our colleagues were severely affected by this and some have to cancel their flights. But with collective effort and determination we will pull through this very difficult time,” said Prof. Shin Egawa, co-chair of the EAU-JUA joint session with Prof. Manfred Wirth. For his part, Wirth commended the Japanese delegation for joining the congress despite the travel obstacles as he expressed his concern for the lingering threat to public health and safety arising from the nuclear plant accident.

“For the disaster victims in both the New Zealand and Japan earthquake, we invite everyone here to observe a minute of silence,” said Prof. Rainy Umbas, chairman of the Indonesian Urological Association. He The Pan-African Urological Association, which is participating for the first time in the EAU congress, and Prof. Vicenzo Mirone co-chaired the session underlined the dire need of more urologists in the which focused on uro-andrology. region, and highlighted the importance for strong ties At the Japanese urological Association (JUA), some with both regional and international associations such as the EAU. lecturers and participants were affected by the calamity due to travel difficulties and power outages in the northeast Japan, a region badly hit by the March 11 earthquake and tsunami that killed thousands. (Full Details on Page 2) The ICUD-EAU Consultation on Bladder Cancer

will be sufficient because of the molecular heterogeneity of bladder cancer,” explained Shariat. An ideal tumour marker, according to Shariat, has the potential to replace, delay or complement cystoscopy and/or cystoscopy. He listed some of the characteristics of these ideal markers as non-invasive, rapid, cost-effective and easy to perform and interpret and with high sensitivity and specificity, amongst others.

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Regarding the possible reasons why an efficient biomarker for BCa remains elusive, Shariat said that biomarker assays are not standardized and that most biomarker findings are not reproducible. “Biomarkers that appear biomedically and statiscally significant at one centre turned out to be not significant in other centres,” Shariat said. Soloway expressed thanks to the members of the ICUD-EAU panels and said that the recommendations offered useful insights to the diagnosis and treatment of BCa. The ICUD-EAU consultation during the congress will have another meeting on Monday during Sub-plenary Session 8, from 11-12.00 at Hall B.

Visit booth Y26 for more information.

Deliver sustainable patency. © COOK 2011

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Highlights of the Urology Beyond Europe sessions

Japan urologists remain hopeful

Joint meetings examine current urology issues

Teamwork against calamity

By Loek Keizer

By Joel Vega

Current urological issues and the EAU’s international ties were examined yesterday during the joint sessions with 10 urological associations. The Urology Beyond Europe sessions tackled the various developments in urological diseases, their diagnosis and treatment from the perspective of the EAU’s partners. Below are some of the selected highlights:

European Urology Today Editor-in-Chief Prof. M. Wirth, Dresden (DE) Section Editors Dr. A. Cestari, Milan (IT) Mr. Ph. Cornford, Liverpool (GB) Prof. O. Hakenberg, Rostock (DE) Prof. P. Meria, Paris (FR) Prof. Dr. med. J. Rassweiler, Heilbronn (DE) PD Dr. med. O. Reich, Munich (DE) Dr. Th. Roumeguère, Brussels (BE) Dr. M.S. Silay, Istanbul (TR) Mr. D. Summerton, Leicester (GB) Special Guest Editor Prof. F. Montorsi, Milan (IT) Advisory Board Prof. C. Abbou, Paris (FR) Prof. P. Abrams, Bristol (GB) Prof. W. Artibani, Verona (IT) Prof. T. Bjerklund-Johansen, Porsgrunn (NO) Prof. T. Esen, Istanbul (TR) Prof. F. Hamdy, Oxford (GB) Prof. D. Jacqmin, Strasbourg (FR) Prof. H. Madersbacher, Innsbruck (AT) Prof. M. Marberger, Vienna (AT) Prof. L. Martínez-Piñeiro, Madrid (ES) Prof. V. Mirone, Naples (IT) Prof. F. Montorsi, Milan (IT) Prof. P.F.A. Mulders, Nijmegen (NL) Prof. J.M. Nijman, Groningen (NL) Mr. K.F. Parsons, Liverpool (GB) Prof. H. Van Poppel, Leuven (BE) Dr. H. Van Der Poel, Amsterdam (NL) Prof. J. Rassweiler, Heilbronn (DE) Prof. I. Romics, Budapest (HU) Prof. J. De la Rosette, Amsterdam (NL) Prof. J. Schalken, Nijmegen (NL) Prof. C. Schulman, Brussels (BE) Dr. D. Schultheiss, Gießen (DE) Prof. I. Sinescu, Bucharest (RO) Prof. C. Stief, Munich (DE) Prof. A. Tubaro, Rome (IT) Founding Editor Prof. F. Debruyne, Nijmegen (NL)

Discussion Prof. Li-Ping Xie (Beijing), who replaced Prof. Ying-Hao Sun as co-chair, explained the emphasis on PCa in the morning’s session: “Until recently, PCa was a rare occurrence in China, but that has now increased dramatically. European urologists have much more experience in this field. Through sessions such as these, we hope to learn from them, avoid potential mistakes, and therefore develop our own treatment much faster.”

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The session was co-chaired by Profs. Peter Alken (Germany) and Lauri Managadze (Georgia). Managadze: “This session is an attempt of the EAU to get involved more actively in this Euro-Asian region. Georgian urology might have been involved with the EAU since the 1990s, but many countries in the region still need to experience the exchange of knowledge with the EAU for themselves.”

Alken explained that the CCA group intended to promote its Continuous Surgical Education (CSE) programme: This programme will be set up in Georgia, and from there hopefully reach urologists farther east. It should encourage Western-European Prof. Didier Jacqmin, Xie’s co-chair commented on the urologists to visit and participate for periods of cooperation between CUA and the EAU: “Our several weeks. partnership is very intensive, with a lot of common programmes like the Chinese Urology Education Arab panel discussion Programme. This year, two sessions are taking place The well-attended joint session of the Arab Association of Urology featured a panel discussion on small renal tumours. Prof. Raja Khauli moderated the lively discussion, and commented on a case he himself experienced, regarding a renal mass discovered in a 27 year-old woman.

Profs. Didier Jacqmin (left) and Li-Ping Xie following the joint CUA-EAU session

By Evgenia Starkova Prof. Michael Marberger, congress president and member the EAU Board and Ekkehard Büchler, representing Europa Uomo, discussed the role of urologists and national urological societies in the developing efficient patient-oriented information channels.

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“Prostate cancer patients do not have a lot of information sources to rely on,” said Büchler, himself

Ekkehard Büchler (left) and Prof. Michael Marberger

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Caucasus and Central Asia The afternoon sessions tackled a very broad range of topics with the Caucasus and Central Asia Session underscoring the role of regional strategies as opposed to a national approach.

In the discussion, Dr. Alexander Mottrie reiterated the expanding role and use of robotics in partial nephrectomy, although the other panelists expressed caution as they favoured more conservative techniques on the relatively young patient. Some even questioned the “maturity” of robotic surgery for cases like these.

Dr. Osamu Nishizawa

“We are concerned, of course, of the current state that northeastern Japan is in. As of now there is uncertainty and people are preparing themselves. Some of my colleagues cannot join this congress because of power outages and obstacles in travelling,” said Dr. Osamu Nishizawa of Nagano, who moderated a discussion on voiding dysfunctions in the joint Japanese Urological Association (JUA)-EAU session. Nagano said that his countrymen are counting on collective efforts and cooperation from within and outside Japan for the heavily-battered nation to pull through one of the world’s worst environmental calamities in decades. More than 12,000 people were killed and many more are missing following the earthquake and tsunami that hit Fukushima, one of the most affected northeastern cities.

“Power outages have crippled transport systems. Also there is a lack of suturing materials in hospitals....” During the Japanese Urological Association’s joint session with the EAU, three scheduled lecturers from northeastern Japan cancelled their participation due to travel difficulties such as the derailment of the train system and closed airports in the region. “What is still happening is that power outages have crippled transport systems. Also there is a lack of suturing materials in hospitals since the factories are located in the affected areas,” said Nagano. He added that people are also worried and would rather stay with their families in the affected region. “In this time we need this teamwork and we saw that cooperation here during the joint session,” said Nagano as he commended session co-chairman Shin Egawa for efficiently replacing the absent presenters. Prof. Manfred Wirth also commended the JUA organizers and said that of utmost concern is public safety and the return to normalcy in affected areas.

Patient information still insufficient, says cancer survivor

EUT Editorial Office PO Box 30016 6803 AA Arnhem The Netherlands T +31 (0)26 389 0680 F +31 (0)26 389 0674 EUT@uroweb.org

No part of European Urology Today (EUT) may be reproduced without written permission from the Communication Office of the European Association of Urology (EAU). The comments of the reviewers are their own and not necessarily endorsed by the EAU or the Editorial Board. The EAU does not accept liability for the consequences of inaccurate statements or data. Despite of utmost care the EAU and their Communication Office cannot accept responsibility for errors or omissions.

Despite potential downsides, such as the need for periodic revision, mechanical failure and the possibility of long-term physical complications, Liao reiterated that AUS remains the “gold standard” for the treatment of PPI.

Iranian urology The EAU - Iranian Urological Association Joint Session also discussed issues on PCa, although a sub-session on reconstructive surgery examined common clinical problems regarding the female urethra. Co-chaired by Profs. Seyed Jalil Hosseini (Tehran) and Bob Djavan (New York), Djavan noted the close ties between the two associations: “The Iranian Urological Association is very active in its cooperation with European centres,” to which Hosseini commented by stressing the importance of the close links with the EAU.

Japanese urologists attending this year’s congress expressed hope that the environmental disaster and nuclear accident in their country will be eventually resolved, even as they conveyed their concern over the lingering threat on public health and safety.

Europa Uomo tackles doctor-patient ties

Editorial Team L. Keizer, Arnhem (NL) E. Starkova, Arnhem (NL) J. Vega, Arnhem (NL)

Disclaimer

Prostate cancer The joint Session with the Chinese Urological Association (CUA) focused on prostate cancer with Prof. Li-Min Liao focusing on the “Management of incontinence after radical prostatectomy.” He presented videos that demonstrated the placement and use of an artificial urinary sphincter (AUS).

in Beijing and in Nanjing during the CUA meeting, featuring many European speakers. The collaboration has been strong for several years, and is a great success.”

a cancer survivor. “Awareness, however, is vital for those diagnosed with prostate cancer – it helps to make informed treatment decisions and deal with both physical and psychological consequences.” “Information helps the patients live,” he added. “Live with this disease and fight against this disease.” Europa Uomo - the European Prostate Cancer Coalition - is the European advocacy movement for the fight against prostate cancer, which works to increase awareness on prostate cancer in Europe. Marberger and Büchler stressed the importance of cooperation between urologists, patients and patient organisations - such as Europa Uomo indicating that well-informed patients become partners in treatment. On the other hand, it is important that men with prostate cancer, who have access to a wide range of information sources today, can rely on their doctors to receive accurate, detailed and clear answers to their questions.

“It is vitally important that the established cooperation between the EAU and patient organisations continues to develop into a dynamic, consistent and reliable network,” said Büchler. “We can then use it as a platform for leading a dialogue, for creating, disseminating information and for empowering both urologists and people with urological conditions to be pro-active in this field.” “Urology has changed tremendously in the last decade, and now the question is not “how we treat”, but “if and when we treat” – and we are moving towards highly individualised and complex treatment,” said Marberger. “This affects the decision process significantly, and communication plays the key role.” In line with this discussion, Europa Uomo is organising a joint symposium for patients during the congress on Tuesday, 22 March at 13.00-17.00. Some of the world’s leading experts will be participating in the event – Profs. P-A. Abrahamsson, G. Kramer, F. Schröder and others. Among the topics to be discussed during the symposium are quality of life for the ageing man, PCa prevention, curative therapy, medical therapy and prostate cancer screening. Saturday 19 March 2011


Challenges and prospects in urology Vienna’s legacy in the medical world Prof. Manfred Wirth Editor-in-Chief European UrologyToday Dresden (DE) Manfred.Wirth@ uniklinikumdresden. de This year’s congress in Vienna marks the third time that the EAU has organised its annual meeting in this city, and the significance is not lost to many of us since Vienna has played a key role in medical developments whose impact or influence has gone beyond European borders. Vienna’s role in medicine is clearly highlighted in an informative article contributed by the EAU History Office, and for the next three days you will be

receiving three printed editions of the EUT Congress News with contributions that are among the many enlightening reports we are publishing in the next two days. As expected by congress participants and EUT readers, the newsletter editions will highlight and report on the main congress events and activities. Contributors to this newsletter come from various fields and sub-specialties and their reports are as varied, with comprehensive updates from the European School of Urology, the European Board of Urology, the EAU’s Section Offices to guest lecturers who are participating in the annual congress for the first time. The key points of selected lectures or a preview of meetings are also reported here by the lecturers or organisers themselves. Readers will therefore have an overview that will help many of you choose which sessions are the most interesting or can fit in your congress planning.

From the Section Office meetings that will open today, the plenary and sub/plenary sessions to the Late Breaking News segment in the last session on Tuesday, the newsletter editions will present the relevant updates or highlight those meetings and discussions which show or reflect the many challenges we face in urology and the attendant prospects that have been identified.

Congress highlights . . . . . . . . . . . . . . . . . . . . 1 Congress news. . . . . . . . . . . . . . . . . . . . . . 2/3 ICUD-EAU bladder cancer consultation. . . . . . 4

And as part of our communication activities, and to support information dissemination particularly to those who are unable to attend this congress, our official congress website at www.eauvienna2011.org will also circulate the latest news and highlights of the congress. Webcasts will also be broadcasted or posted in the EAU´s websites, featuring selected state of the art lectures or plenary sessions and providing a direct link to audience.

Male fertility, OAB, Guidelines Office . . . . . . . 6 BoNT/A for Painful Bladder Syndrome . . . . . . 7 First Prize Winners, Best Abstracts. . . . . . . . . 8 The Living Witness Programme. . . . . . . . . . . 10 EAU expands international links. . . . . . . . . . . 11

Welcome to Vienna and we hope that you will have a productive and memorable congress weekend!

Calcium phosphate and renal stones . . . . . . . 11 Live surgeries at ESUT Meeting. . . . . . . . . . . 12 ESIU tackles key prostate cancer issues. . . . . 14

EAU Guidelines Office Training Session

Vision Award from ESUI. . . . . . . . . . . . . . . . 15 Winners list, Best Publications and Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

A practical approach to evidence-based medicine By Evgenia Starkova Evidence-based medicine and the challenges of putting together the EAU Guidelines were discussed yesterday during a three-hour training session aimed at members of the EAU Guidelines committees as well as urologists interested in writing systematic scientific reviews. The interactive format of the session enabled the participants to discuss the scope of clinical guidelines, the search for relevant data and the means to assess the quality of evidence.

“The objectives were well-met – we wanted to give a broad overview of the process – from developing a question to producing a recommendation,” said Prof. Steve Canfield (Houston, US), who gave three presentations at the session. “We had great questions from the participants and the feedback was fantastic.” Many of the challenges regarding the trends and challenges in today’s evidence-based approach to medicine have also been discussed. “The main challenge today is the amount of information we have to consider in order to gather and synthesise the evidence – the process is very resource-intensive,” commented Prof. James N’Dow (Aberdeen, UK), EAU

1st Joint ESFFU-ESGURS Meeting . . . . . . . . . 17 Prospects in kidney transplantation . . . . . . . 18

Guidelines Board Member.

ESU course: metastatic PCa. . . . . . . . . . . . . . 19

The contents of the training session was broken down into several sections which covered the development and use of care pathways, formulating the clinical questions, searching the literature, rating the evidence, and finally, formulating a recommendation.

ESOU tackles PCa issues in joint meeting. . . 19 Stem cell tissue engineering. . . . . . . . . . . . . 21 EULIS lecture: stone disease. . . . . . . . . . . . . 23

“I was excited to see full house attendance and active participation,” said Prof. Jacque Irani (Poitiers, France), EAU Guidelines Board Member and Vice-Chairmen, “This indicates that urologists are coming to realise that there is a need for such expertise in today’s medical research.”

What’s up in Vienna. . . . . . . . . . . . . . . . . . . 24 EBU: curriculum for urological training . . . . 25 Best Abstract, runner-up winners. . . . . . . . . 26

Souvenir photos: Opening Ceremony URODYNAMICS

P E LV I C F LO O R D I AG N O S T I C S

Ask us what’s NEW Dr. Morgan Roupret receives the Hans Marberger Award

Prof. Urs Studer (left) receives the Willy Gregoir Award from Prof. Per-Anders Abrahamsson

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Dr. Steven Joniau (left) won the Crystal Matula award with Per-Anders Abrahamsson (middle) and a representative from sponsor LABORIE

Prof. Michael Marberger

* we are dying to tell you • EAU booth Y33

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Prof. Alain Le Duc (left) won the Frans Debruyne Lifetime Achievement Award with Per-Anders Abrahamsson looking on

Saturday 19 March 2011

A Viennese opening to the ceremony: the child prodigy Mozart

www.LABORIE.com EUT Congress News

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ICUD-EAU International Consultation on Bladder Cancer 2011 Joint consultation tackles prospects and challenges in BC Prof. Mark S. Soloway Professor and Chairman Emeritus Department of Urology Miller School of Medicine University of Miami Florida (USA) The decision making for the patient with a newly diagnosed or recurrent bladder tumour requires a great deal of judgment. Like many tumours, bladder cancer (BC) is not one entity. There is a vast spectrum of histologic types, each of which can be further defined by its grade and stage. Tumours are either unifocal or may occur in multiple areas of the bladder. They may be papillary or flat. Carcinoma in situ may be associated. These and many other factors will play a part in the decision on treatment. Then there is the technical aspects of treatment – beginning with the initial endoscopic resection (urologist), correct diagnosis (pathologist), and treatment plan (urologist, medical oncologist, radiation oncologist depending on the above variables). The heterogeneity of BC is best illustrated by the great difference between the low grade Ta tumor which is the most common type and will rarely ever impact the patient’s life and the muscle invasive BC which can be lethal. A delay in treatment can be catastrophic. Obviously there are tumours which are in-between these extremes, and their management requires the most judgment as we as physicians walk the tightrope between undertreatment and its consequences (progression and metastasis) and overtreatment (treatment related morbidity and potential death). In my opinion these decisions are among the most challenging in all of urologic oncology. Over 100 experts in urology, urologic pathology, medical and radiation oncology in 10 committees have been working for six months to outline a set of recommendations based on the literature and, where available, prospective randomised trials to guide us as we serve our patients with BC. Recommendations The culmination of their work was presented yesterday in an all-day symposium, with the audience discussing the recommendations in an open forum. On Monday, March 21, there will be a 60-minute summary of the recommendations from each committee. Here are some of the recommendations that were presented. Over 30 urologic pathologists emphasised the critical nature of providing an accurate diagnosis. In most cases this is straightforward but there are a number of ingredients involved in “getting it right.” These were illustrated by the chair of this committee, Mohammed Amin. There are many subtypes of bladder cancer, and in certain instances (e.g. micropapillary, nested variant, small cell, adenocarcinoma subtypes), the treatment will be different from a urothelial (transitional cell) carcinoma. Amin illustrated each of these variants in addition to outlining the critical elements of a proper pathology report that each clinician should expect after resection of a bladder tumor. This report is the foundation for the treatment plan. Drs. Kamat and Hegarty discussed the recommendations regarding the diagnostic work-up expected of a clinician in dealing with someone with bladder cancer beginning with hematuria and proceeding to the endoscopy and proper tumour resection. There have been some improvements in the methodology of diagnosing and identifying bladder tumours via the endoscope, e.g. blue light fluorescent endoscopy and narrow band imaging. Are they now sufficiently useful to be a part of routine endoscopy/tumour resection when a patient has a bladder tumour? What is the role of urine-based markers including cytology? What is the role of imaging in the diagnosis and staging of BC? These and many more areas will be discussed in this committee report. 4

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Drs Karakiewicz and Shariat discussed the role of both urine-based and tissue markers as they relate to BC. There are many candidate urine based markers that are approved by regulatory bodies for the detection and monitoring of BC. How do they compare with urinary cytology and in which circumstances, if any, should they be used? Can they be used for an early detection program in an effort to diagnose BC at an early stage? PSA for BC In other words do we have a “PSA for BC”? This committee examined the question if we can use any tissue-based molecular marker to determine the prognosis or response to treatment for an individual tumor. We know that such molecular phenotypes are being used in breast cancer, for example, to help individualise therapy. Drs. Konety and Oosterlinck co-chaired the committee on low grade Ta BC. They emphasised the very low risk such patients have to ever develop a life-threatening BC. Their presentation dealt with the balance between minimising treatment (tumour resections, imaging, even endoscopy) and monitoring for the relatively uncommon event of progression. The recommendation for a single instillation of intravesical chemotherapy after tumour resection is an attempt to minimise the chance of a new or recurrent tumour, yet avoiding multiple instillations or the instillation of BCG for the low-risk subset. This group stressed the avoidance of regular imaging of the upper tract unless there is a reason to suspect an upper tract tumour (positive cytology without a bladder tumour, flank pain, etc.) because this is a very rare occurrence and there are cost and safety concerns with repetitive imaging with radiation. They also discussed the role of surveillance only in some patients with small low grade Ta tumors to delay or obviate the cost and morbidity of repeated tumour resections. The committee charged with discussing high-grade (HG) Ta and T1 BC was co-chaired by Drs. Witjes and Burger. They focused on the critical nature of performing a complete endoscopic resection. We know that in approximately 30% of TUR BTs all tumours have not been resected! Muscle invasive BC Before initiating a treatment plan for the patient with a high grade T1 (?Ta) the urologist must consider returning the patient to the operating theater and performing another TUR to ensure there is no remaining tumour. Only then can the clinician be certain of the grade and stage of the tumour. The team reviewed the important use of BCG intravesical therapy for these tumours and, equally importantly, delineate when it is necessary to abandon a bladder preserving strategy and recommend bladder removal. We have become increasingly aware that urologists are often too late in making this recommendation. A delay can risk lives! In some circumstances when a patient recurs, or has a persistent HG tumour despite an adequate resection followed by BCG, a second course of BCG or an alternative intravesical agent can be used. Dr. Stenzl delivered some of the recommendations from the committee charged with assessing the literature concerning muscle invasive BC. There are three parts to this discussion, including a presentation by David Quinn on the role of chemotherapy. First, there is the data regarding this major operative intervention. How to safely perform it, what are acceptable morbidity and mortality figures, and possibly who should be performing these procedures. The second aspect presented was the role of bladder preservation using chemotherapy and external beam radiation with careful endoscopic monitoring and prompt intervention in case of failure. The third part of the committee report summarised the data on perioperative systemic chemotherapy with the hope of improving the survival of this often lethal cancer. Urinary diversion is an important aspect of the bladder removal procedure. For the patient it is critical as it contributes to the morbidity and recovery from this operation and he/she must contend with the type of diversion they elect. Neobladder Dr. Hautmann presented the recommendations of his group and emphasised the rationale for electing one

A cutaway illustration of endoscopic resection

diversion versus another. He stressed that a key component is the expertise of the surgeon, be it an orthotopic neobladder, ileal conduit, or cutaneous continent diversion. In 2011, approximately 40% of men/women will choose a neobladder when performed in leading centers who specialise in cystectomy. Drs. Palou and Wood discussed the important area of urothelial cancer in the prostatic urethra, looking at questions such as: when should the urologist biopsy/ resect the prostatic urethra (PU) to determine whether a urothelial cancer is present in the urothelium, ducts, or the stroma? Should this be performed before deciding on a neobladder? What is the treatment for CIS (carcinoma in situ) of the PU? For TCC in the stroma of the prostate? Cora Sternberg provided the data on what is to be expected from systemic chemotherapy for the patients

with metastatic BC. She emphasised the role of cisplatin combination chemotherapy (either with gemcitabine or as part of the 4 drug M – VAC regimen). What if the patient can not receive cisplatin because of reduced renal function? What is second line when they progress after first line therapy? The final committee discussed the treatments for the 10% of BCs which are not urothelial/transitional cell. These consist of squamous cell, small cell, or adenocarcinoma. Total cystectomy alone is the primary treatment for many of these tumours. However the patient with small cell carcinoma requires initial treatment with chemotherapy. Monday, 21 March 2011 11.00 - 12.00: Sub-plenary session 8: ICUD/EAU International Consultation on bladder cancer

http://cem.uroweb.org

EAU 11th Central European Meeting (CEM) 28-29 October 2011, Timisoara, Romania EAU meetings and courses are accredited by the EBU in compliance with the UEMS/EACCME regulations

Call for Abstracts deadline 1 July 2011 European Association of Urology

Saturday 19 March 2011


OFFICIAL SATELLITE SYMPOSIUM TO BE HELD DURING THE 26TH ANNUAL EAU CONGRESS

Denosumab – targeting RANK Ligand for practice changing results across the prostate cancer continuum 17.45–19.15, Saturday 19 March 2011 Hall F2, Austria Center Vienna, Vienna, Austria

Interactive session

Programme Meeting chair: Kurt Miller (Germany) Bone loss and fractures in patients on ADT – managing the silent risk Juan Morote (Spain) Bone protection in men with advanced prostate cancer – challenging the standard of care Karim Fizazi (France) Extending bone metastases-free survival in men with prostate cancer – future prospects Bertrand Tombal (Belgium) Refreshments will be provided prior to the symposium

Denosumab (120 mg Q4W) is not approved for use in patients with advanced cancer to delay SREs. Denosumab is investigational in that setting. © 2010 Amgen Inc. All rights reserved. DMO-IHQ-AMG-196-2010.

Saturday 19 March 2011

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Varicocele in infertile men Using (sub)inguinal microsurgery to improve male fertility Dr. G. Dohle Department of Urology Erasmus MC Rotterdam (NL)

Varicocele is a physical abnormality present in 10-15% of the adult male population. It is more common in men of infertile marriages, affecting 25-30% of those with abnormal semen analysis. The exact relationship between reduced male fertility and varicocele is unknown, but analysis of the WHO data clearly indicates that varicocele is related to semen abnormalities, decreased testicular volume and a decline in Leydig cell function (WHO, 1992). The role of varicocele repair in improving male infertility has not yet been shown in a large randomised controlled trial (RCT). In fact, most of the published RCTs on varicocele treatment for male infertility show no benefit in terms of higher pregnancy rates in the treated couples (Evers et.al., 2009). Although sperm improvement is usually observed after varicocele repair (Agarwal et.al., 2007) it seems difficult to show that treatment also improves fertility outcome. The reason for this remains unclear, but several factors may be responsible for the absence of a clear difference between treated couples and controls: • It may be true that varicocele is not effective in improving the fertility status of a couple. This, however seems in contrast to the improvement of semen quality and a decrease in DNAfragmentation of spermatozoa as observed after surgical varicocele repair (Agarwal et.al., 2007, Smit et.al., 2010).

• The size of the varicocele may be important: in 3 small RCTs, treatment of subclinical varicoceles appeared as good as no treatment (Grasso et.al., 2000, Unal et.al., 2001, Yamamoto et.al., 1996). Treatment of subclinical varicocele cannot be recommended.

“If we compare the figures of spontaneous pregnancies to the numbers of spontaneous pregnancies in couples with unexplained infertility, it may be concluded that varicocele negatively influences natural conception rate.” • Pre-operative sperm quality seems to be an important factor for the outcome of varicocele repair: two RCTs with mainly normospermic men and a varicocele showed no benefit in the number of pregnancies as compared to controls (Nilsson et.al., 1979., Breznik et.al.,1993). In fact, varicoceles are frequently observed in men with normal semen analysis and routine treatment of all varicoceles would be overtreatment, if the fertility status of the patient and his partner is not considered (Zargooshi et.al., 2007). Also, in men with non-obstructive azoospermia and severe oligozoospermia the benefit of an operation in terms of spontaneous pregnancies appeared very limited and assisted reproduction is still needed (Schlegel et.al.,2004, Ishikawa et.al., 2008). • A female factor may be present also: in many infertile couples female factors, such as ovulatory disorders, coincide with the presence of the varicocele and successful correction of these factors could also account for the increase in spontaneous pregnancies, both in the couples treated for varicocele as in the control group (Baker et.al.,1985, Nieschlag et.al.,1998).

Treatment

Recurrence Rates

Complications

Antegrade Sclerotherapy

9%

Epididymitis - Testicular atrophy - Flank erytema

Retrograde Embolisation 10-15%

Trombophlebitis – Bleeding/heamatoma – Vene perforation Dislocation of the coil – Contrast allergy

Retroperitoneal Operation

13-30%

Hydrocele – Testicular atrophy – Haematoma

Laparoscopy

7-15%

Intestinal damage – Peritonitis – Pulmonary embolism

(Sub)Inguinal microsurgery

1-4%

Testicular atrophy – Hydrocele – Scrotal heamatoma

Table 1: Recurrence and complication rates of different treatment methods for variocele • The duration of the infertility may play an important role: in couples with unexplained infertility, the chance of spontaneous pregnancy after one year of infertility is as high as 49% for the next year and still an annual 20% in couples with two years of infertility (Te Velde et.al., 2000). Only after 3 years the pregnancy rates drops to 14%. This seems different for couples with a varicocele: Baker et.al. showed that in a group of 651 untreated men with a clinical varicocele spontaneous pregnancy was 30% in the second year of infertility and 15% in the third year (Baker et.al., 1985).

However, in case of a female age > 35 years treatment can start already after 1 year of infertility. Treatment Several treatment options are available for varicocele repair: Table 1 summarises the results of different procedures.

(Sub)inguinal “artery- and lymphatic-sparing” microsurgical varicocelectomy is a procedure with a low recurrence rate and minimal risk for postoperative complications and hydrocele formation. The most common complications after varicocelectomy are If we compare the figures of spontaneous pregnancies hydrocele formation, testicular artery injury and varicocele persistence or recurrence. Employing to the numbers of spontaneous pregnancies in microsurgical techniques, with inguinal or couples with unexplained infertility, it may be subinguinal operations, and exposure of the external concluded that varicocele negatively influences spermatic and scrotal veins can reduce the incidence natural conception rate. Abnormal semen analysis of these complications. Microsurgical reconstruction also seems relevant for the chance of natural of varicocele can be a very rewarding procedure for conception: in a group of untreated oligozoospermic both the infertile couple and the physician. Practical men from infertile couples, the cumulative live birth teaching courses are very helpful and a learning curve rate after 36 months of observation was 32% compared to 60% in couples with unexplained should be taken into account. Urologists with an infertility and normal sperm counts (Snick et.al., 1997). interest in male infertility should be encouraged to learn microsurgery as a part of their surgical training. This indicates that both the duration of infertility and the results of semen analysis need to be considered Sunday, 20 March 2011 before varicocele repair is performed for the 11.20 - 11.40: Sub-plenary Session 1 Modern treatment of male infertility. In general, any treatment management of genital problems of infertile couples should not start before 2 years of State-of-the-art lecture: Modern management of unprotected regular intercourse, unless there are a varicocele in an infertile man abnormalities found that exclude natural conception, such as azoospermia and bilateral tubal obstruction.

The overactive bladder

The EAU Guidelines Office

New insights, new strategies

A grateful, fond farewell to two board members

Prof. Martin Michel Dept of Pharmacology & Pharmacotherapy Academisch Medisch Centrum Amsterdam (NL)

For a long time, it had been assumed that the pathophysiology of overactive bladder was mainly driven by an enhanced activity of the parasympathetic nerves releasing more acetylcholine and/or an increased sensitivity of muscarinic receptors on detrusor smooth muscle cells. Neither hypothesis has been supported by data.

“Urothelial mediator release plays a more plausible role in storage symptoms, as parasympathetic nerve activity is largely limited to the voiding phase” In contrast, more recent concepts of bladder overactivity involve mediator release by the urothelium, altered activity of afferent nerves and intrinsic alterations of the detrusor. However, most of the experimental data relate to detrusor overactivity and/or non-voiding bladder contractions rather than the sensation of urgency, the hallmark of bladder overactivity, and the relationship between the two is not fully clear. Urothelium The urothelium produces and releases several mediators including acetylcholine, ATP, nitric oxide and nerve growth factor. This release itself is 6

EUT Congress News

regulated by a range of receptor systems and, in contrast to release from parasympathetic nerves, also occurs during the storage phase of the micturition cycle. Therefore, urothelial mediator release plays a more plausible role in storage symptoms, as parasympathetic nerve activity is largely limited to the voiding phase. Urothelium-derived mediators may affect the urothelium itself in autocrine loops but also afferent nerves and smooth muscle cells. Released nerve growth factor may be a biomarker of bladder overactivity. The bladder mucosa may also contain pace-maker cells which modulate smooth muscle cell function. While all of these components are likely to contribute to bladder overactivity, it remains to be studied in most cases whether they exhibit greater functionality in bladder overactivity. Scope for improved treatment In analogy to the pathophysiological concepts of bladder overactivity, it had long been assumed that drugs for the treatment of the condition mainly act on smooth muscle contractility.

Mr. Keith F. Parsons Chairman EAU Guidelines Office The Royal Liverpool Hospital Dept. of Urology Liverpool (UK)

We are also most fortunate to have as speaker the editor-in-chief of the Journal of the American Medical Association (JAMA), Prof. Catherine DeAngelis (Chicago, USA). She is a very gifted, authoritative and engaging speaker who will discuss “Conflict of interest, guidelines After having served on the board of the EAU Guidelines and industry involvement.” The subplenary session will Office for over eight years, two of our dedicated board be concluded by a brief overview of the findings of the new Upper Urinary Tract Tumours guidelines document members will step down in Vienna: Prof. Dionisios Mitropoulos (Athens, GR) and Prof. Hans Peter Schmid by Dr. Morgan Rouprêt (Paris, FR). (St. Gallen, CH). The Guidelines Office Board would like to thank them for the expertise and guidance that they We will certainly provide a very entertaining and informative session on Sunday, so I hope you will be brought to our board, and for their ongoing able to attend! commitment to the EAU Guidelines cause. Publications The Guidelines Office traditionally presents a number of publications at the EAU Annual meetings. All members of the association can pick up their large print copy at the EAU booth (Hall Z, Booth #50).

Meanwhile, it has become clear that urothelium and afferent nerves may also contribute to the therapeutic effects of muscarinic receptor antagonists and some novel classes of overactive bladder drugs such as β3-adrenoceptor agonists. In this regard, urothelium, afferent nerves and smooth muscle cells are not mutually exclusive as therapeutic targets, but their relative roles remain to be determined. Therefore, it is hoped that this new evidence not only improves our understanding of the overactive bladder but will also lead to improved therapeutic strategies. Saturday, 19 March 2011 8.30 - 8.45: Plenary Session 1, The overactive bladder: New insights State-of-the-art lecture: Bladder control

Presentations The topic of his presentation will be “Complications of Urological Procedures.” Since complications reporting in the literature will only gain more significance in the years to come, this project may well evolve into more than just an ad-hoc activity.

Prof. D. Mitropoulos

Prof. H-P. Schmid

Both Dionisios and Hans-Peter are also involved in guidelines activities in a different capacity: Hans-Peter Schmid has been a long standing member of our prostate cancer guidelines panel and Dionisios Mitropoulos is currently completing a very ambitious project. As chairman of an ad hoc guidelines panel he will present their preliminary findings here in Vienna in a subplenary session scheduled on Sunday, 20 March.

The pocket guidelines (including a CD-ROM containing the full text documents) can be collected at the exhibition area, Olympus booth (Hall Z, booth #32). We are aware that all of these guidelines documents are produced by our expert colleagues, who freely make their time and expertise available to us. We are most grateful for their contributions and ongoing enthusiasm, also recognising that the support from all of you - association members and guidelines users - is driving this project forward. So thank you all very much indeed! Sunday, 20 March 2011 11.00 - 12.00: Sub-plenary session 5: EAU Guidelines Office presentations

Saturday 19 March 2011


Using Botulinum Toxin Type A More research needed for treating painful bladder syndrome The analgesic effect presumably results from a decreased neuropeptide release at peripheral nerves, and glutamate substance P, ATP and calcitonin gene-related peptides from the central endings of bladder sensory nerves. In the first case, neurogenic inflammation is prevented, and in the second, nociceptive transmission becomes inhibited at the spinal cord.

Prof. Antonella Giannantoni Dept. of Urology Perugia (IT)

The International Continence Society defined the term ‘‘painful bladder syndrome’’ (PBS) as ‘‘the complaint of suprapubic pain related to bladder filling, accompanied by other symptoms such as increased daytime and nighttime frequency, in the absence of proven urinary infection or other obvious pathology’’. Approaches to treatment and management vary widely, and different types of behavioral, dietary, interventional, pharmacologic and surgical therapies have been used. This diversity reflects the complexity of the condition in terms of etiology and pathogenesis, and the lack of clear diagnostic criteria for the disease.

To date, the few studies with BoNT/A in patients with PBS/IC have globally reported satisfactory results. In a multicenter case series, 13 patients with refractory interstitial cystitis were treated with intravesical Botox or Dysport.1

“As the use of BoNTs in lower urinary tract dysfunction and pelvicfloor disorders is rapidly evolving, it will be possible very soon to better establish the efficacy of single and repeat injections, the duration of effect, the short- and longterm safety and timing for repeat injection…”

Botulinum toxin type A (BoNT/A) is currently used to treat focal muscle overactivity and spasticity as well as autonomic disorders. In the last few years, BoNT/A has also been used to treat a number of pain Overall, 69% of patients reported subjective conditions. improvement lasting a mean of 3.72 months. In a preliminary experience, we observed that Pain diseases alleviated by BoNT/A encompass two intravesically injected BoNT/A significantly increased main categories: one including those related to maximum cystometric capacity and decreased painful muscle hyperactivity, including dystonia, spasticity, bladder symptoms in 12 of 14 patients at the myofascial pain, chronic pelvic pain and tension type three-month follow-up.2 headache, and another that includes those possibly related to neurovascular disorders, including In a subsequent study, we evaluated the one-year migraine headache. Pain related to spinal cord efficacy and tolerability of the neurotoxin intravesically pathology has also been treated with BoNT/A. injected in patients with refractory PBS and we confirmed BoNT/A was effective for the short-term The exact mechanism of the analgesic effect of management of the condition, although pain recurred BoNT/A into the bladder is still poorly understood. in 73% of the patients at 5 mo.3

In the study of Kuo et al, BoNT/A injection was combined with hydrodistention, and 55% of the PBS patients still reported improvement at 12 mo.4 In that study however, the long-lasting effect of BoNT/A could be attributed to hydrodistention. When investigating the impact of intravesically injected BoNT/A upon bladder pain and symptoms of anxiety and depression, and Quality of Life (QoL), we observed a significant amelioration of bladder pain, psychological functioning and well being of these patients at 3 mo followup.5 More recently, Pinto et al. evaluated the effects of trigonal injection of BoNT/A in patients with PBS, and found that more than half the patients reported symptoms improvement during at least the first 9 mo of treatment.6 No complications have been observed and repeat injections remained effective for a long time. Overall, the low number of patients included in these studies and the lack of placebo-controlled trials represent a limitation for a definitive conclusion in this matter. As the use of BoNTs in lower urinary tract dysfunction and pelvic-floor disorders is rapidly evolving, it will be possible very soon to better establish the efficacy of single and repeat injections, the duration of effect, the short- and long-term safety and timing for repeat injection also for patients with PBS. For other pathologic conditions (eg. idiopathic and neurogenic detrusor overactivity), further collaborative and larger placebo-controlled and comparative trials are needed to establish these issues more firmly. References 1. Smith CP, Radziszewski P, Borkowski A, Somogyi GT, Boone TB and Chancellor MB: Botulinum toxin A has antinociceptive effects in treating interstitial cystitis. Urology 2004; 64: 871-75.

2. Giannantoni A, Costantini E, Di Stasi SM, Tascini MC, Bini V and Porena M: Botulinum A toxin intravesical injections in the treatment of painful bladder syndrome: a pilot study. Eur Urol 2006; 49: 704-709. 3. Giannantoni A, Porena M, Costantini E, Zucchi A, Mearini L, Mearini E. Botulinum A toxin intravesical injection in patients with painful bladder syndrome: 1-year followup. J Urol. 2008; 179:1031-4. 4. Kuo HC, Chancellor MB. Comparison of intravesical botulinum toxin type A injections plus hydrodistension with hydrodistension alone for the treatment of refractory interstitial cystitis/painful bladder syndrome. BJU Int 2009;1:1–5. 5. Giannantoni A, Cagini R, Del Zingaro M, Proietti S, Quartesan R, Porena M, Piselli M. Botulinum a toxin intravesical injections for painful bladder syndrome: impact upon pain, psychological functioning and quality of life. Curr Drug Deliv. 2010 Dec 1;7:442-6. 6. Pinto R, Lopes T, Frias B, Silva A, Silva JA, Silva CM, Cruz C, Cruz F, Dinis P. Trigonal injection of botulinum toxin A in patients with refractory bladder pain syndrome/ interstitial cystitis. Eur Urol. 2010;58:360-5.

Sunday, 20 March 2011 11.45-12.00: Sub-plenary Session 3, Hot topics in painful bladder syndrome State-of-the-art lecture: Botulinum toxin

Dendreon Is Proud to Support the 26th Annual European Association of Urology Congress Please visit us at Booth Z23 Come talk with us and find out more about Dendreon, active cellular immunotherapy, and how we share your commitment to fighting prostate cancer.

©2011 Dendreon Corporation. All rights reserved. January 2011. Dendreon and the Dendreon logo are registered trademarks of Dendreon Corporation.

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Saturday 19 March 2011

www.dendreon.com

2/3/11 11:12 AM

EUT Congress News

7


Best abstract, first prize winners Innovative studies in prostate cancer stem cells, female OAB top abstracts submissions Editorial Note: We are re-printing on this page the two abstracts submitted to this year’s congress that won the first prize in Oncology and Non-Oncology categories. A French-Swiss group of researchers won the first prize for Best Abstract in Oncology with their work on prostate cancer stem cells, whilst a Portuguese group bagged the first prize for Best Abstract in Non-Oncology for their findings in female Overactive Bladder Syndrome. Below are the original, unedited abstracts without additional editorial commentary: Abstract Nr: 838 Title: Testing and prognostic implications of prostate cancer stem cells in bone marrow Topic: 7.1 Prostate cancer: Basic research Author list: Ricci, E.1, Bourrelie, E.1, Martin, X.1, Dumontet, C.2, Clezardin, P.3, Thalmann, G.N.4, Colombel, M.1 1 Hôpital Edouard Herriot, Service Urologie, Lyon, France, 2Hôpital Edouard Herriot, Service Hematologie, Lyon, France, 3INSERM, U664, Lyon, France, 4Berne University, Dept. of Urology, Berne, Switzerland

Introduction & Objectives Previous work have showed that the percentage of cells positive for markers of stem cells: integrin alpha 2, alpha 6 and c-Met was correlated with bone metastatic progression. Our objective was to analysis these markers in the hematopoietic bone marrow of patients treated for prostate carcinoma. Material & Methods In this prospective study, bone marrow aspiration from control (healthy donors) and a cohort of patients treated for prostate cancer were processed for analysis and quantification of CD45-/ alpha 2+/ alpha 6+/ c-met + cells using Flow Cytometry Patients were stratified according

8

EUT Congress News

Abstract Nr: 883 Title: Urinary levels of Brain Derived Neurotrophic Factor (BDNF) in women with overactive bladder (OAB) syndrome correlate with the severity of symptoms Topic: 12.1 Female urology: Basic research

Basal stem (above) and luminal cells (below)

See Page 26 for other prize-winning abstracts

to stage and biological status: Group 1: clinically localized (T1-T2), group 2: biochemical progression after primary tumor treatment ; Group 3: metastatic androgen-sensitive, group 4: hormone refractory prostate cancer Results Dilutions of BO2 and PCA3 cells into the bone marrow of healthy donors were used to calibrate the test. Threshold of detection was 0.001%. In total, 12 controls and 120 informed consent patients (30 pts per group) were included. Results showed that the percentage of cells was significantly associated with prognosis. Percentage of c-met, alpha 2 and alpha 6 positive cells were particularly high in hormone refractory prostate cancer patients, In addition, the percentage of c-met+/ alpha 2+ or c-met+/ alpha6+ was significantly higher among patients who had bone metastasis during follow up. Conclusions The percentage of c-met+/alpha 2+/alpha 6+ cells in the bone marrow of prostate cancer patients significantly correlates with prognosis. These results bring new evidence that the release of cells with a “stem cells like “ phenotype from the primary tumor is an early event of metastatic progression in prostate cancer.

Author list: Antunes-Lopes, T.1, Pinto, R.1, CarvalhoBarros, S.2, Diniz, P.1, Martins-Silva, C.1, Duarte-Cruz, C.2, Cruz, F.1 Hospital de São João and University of Porto, Urology and IBMC, Institute of Biology, Molecular and Cellular, Porto, Portugal, 2Faculty of Medicine, University of Porto, Institute of Histology and Embryology and IBMC – Instituto De Biologia E Molecular E Cellular, Porto, Portugal

1

Introduction & Objectives Nerve Growth Factor (NGF) may constitute a useful biomarker of OAB syndrome. Less is known about the role of BDNF, another ubiquitous neurotrophin, in lower urinary tract (LUT) function, both in normal and pathological conditions. However, BDNF was recently found in high concentrations in the urine of patients with bladder pain syndrome. In this study, we investigated urinary levels of BDNF in OAB patients and correlated them with the severity of symptoms. Additionally, we described urinary BDNF in a population of healthy volunteers to investigate physiological pattern of secretion and gender differences. Material & Methods Urine samples from 40 healthy volunteers (20 men and 20 women) were collected in the morning, afternoon and evening. The procedure was repeated 3 months later. Samples were adequately stored until further processing. Seventeen naive OAB female patients were enrolled in this study from the out-patient clinic consultation. Urine was also collected at baseline and 3 months. Urine samples were processed for ELISA analysis of urinary BDNF. The urine BDNF content was normalized against

creatinine (Cr) concentration (BDNF/Cr ratio – pg/ mg). For each OAB patient the severity of symptoms was accessed using Indevus Urgency Severity Scale (IUSS), at the time of urine collection, and correlated with the respective BDNF/Cr ratio. Results In healthy volunteers, urinary BDNF levels were constantly very low, despite the time of urine collection (morning, afternoon and night). Moreover, no significant differences were found between male and female volunteers. In contrast, BDNF/Cr ratio was significantly higher in OAB patients compared to healthy female volunteers (morning urine sample) at baseline (980.3 ± 1774.8 vs 110.4 ± 159.5, p<0.01) and 3 months (399.5 ± 487.9 vs 131.1 ± 289.0, p<0.01). At baseline, there is a trend for patients with IUSS score of 4 (OAB wet) to have higher levels of urinary BDNF than those with 3 or less (1795.2 ± 2874 vs 535.8 ± 541). From baseline to 3 months evaluation, after non-pharmacological interventions, there was a decrease in urinary BDNF (980.3 ± 1774.8 vs 399.5 ± 487.9), accompanied by a reduction in IUSS score (3.29 ± 0.59 vs 3.18 ± 0.39) A significant correlation between BDNF/Cr ratio and IUSS score variations was found (r = 0.684, p<0.01). Conclusions To our knowledge, this is the first comprehensive study of urinary BDNF in healthy volunteers. In this group BDNF/Cr ratios were systematically low, irrespective of gender or time of urine sampling. In contrast, in OAB patients, urinary BDNF was very high and correlated with the severity of symptoms. The striking differences observed between OAB patients and controls clearly point that urinary BDNF may serve as a potential biomarker of OAB syndrome. This study was funded by INComb FP7 HEALTH project no 223234.

Saturday 19 March 2011


Experience LIVE and 3D HD da Vinci Surgery ®

Lounge 4, Level 01 & Intuitive Booth Z18, Level OE

Sunday 12:30 – 14:00

3D HD da Vinci Prostatectomy Presented by Prof. Richard Gaston and by Prof. Francesco Montorsi

Sunday 10:30 – 12:00

“Live” Surgery da Vinci Prostatec-

tomy performed by Prof. Jens Rassweiler moderated by Prof. Peter Wiklund

Sunday 15:00 – 17:00

“Live” Surgery da Vinci Partial

Nephrectomy performed by Dr. Christophe Vaessen moderated by Prof. Stephane Droupy

Test Drive the da Vinci Si System with Dual Console and Skills Simulator ®

Intuitive Booth Z18, Level OE

Saturday 19 March 2011

Schedule subject to change. While clinical studies support the use of the da Vinci Surgical System as an effective tool for minimally invasive surgery, individual results may vary. Before performing any clinical procedure utilizing the System, physicians are responsible for receiving sufficient training and proctoring to ensure that they have the requisite training, skill, and experience necessary to protect the health and safety of the patient. For technical information, including full cautions and warnings on using the da Vinci System, please refer to the System User Manual. Read all instructions carefully. Failure to properly follow instructions, notes, cautions, warnings, and danger messages associated with this equipment may lead to serious injury or complications for the patient. © 2011 Intuitive Surgical. All rights reserved. Intuitive, Intuitive Surgical, da Vinci, da Vinci S HD, da Vinci Si, InSite, TilePro and EndoWrist are trademarks or registered trademarks of Intuitive Surgical. All other product names are trademarks or registered trademarks of their respective holders. PN 874784 Rev A 1/11

EUT Congress News

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The Living Witness Programme Encouraging urologists to record history for posterity Mr. Dominic Hodgson University College London (UK)

Mr. Peter Thompson King’s College Hospital London (UK)

We are aware that the 1960s and 70s were decades that saw great development and innovation in our discipline and that many of the pioneers from that time are elderly. Similarly, we feel there is a limited opportunity to record their recollections of that period, for the education and enjoyment of urologists both today and in the future. To this end we set out to interview urologists in the UK who were highly influential in shaping modern practice. This article outlines our experience. We would very much encourage others to carry out similar projects and give a guide as to how this might be achieved. Oral history Oral history, of course, is the oldest form of passing on human recollections, but became less influential with the development of written language and the invention of the printing press. In the latter half of the 20th century, however, there was a new enthusiasm for oral history, and particularly the importance of recording individual recollections in relationship to local history was recognised. In the UK, the Oral History Society (OHS) (www.ohs.org.uk) was established in 1973 to encourage and educate those interested in making such recordings. Similarly the International Oral History Society (IOHS) was founded in 1996 (www.iohanet.org). In the UK, the OHS runs a day-long introductory course for interested parties. This covers preparation for interviewing, advice on recording equipment and transcription, and, essentially, guidance on consent. We attended this. Participants also included postgraduate students, university researchers, and amateur historians.

Preparation: We did not find it difficult to draw up an initial shortlist of four whom we considered were the key urologists to interview. They were written to, or approached through mutual acquaintances, and were all very keen to participate. Because of their illustrious careers, there is plenty of published material written either by them or about them. Contemporaries or ex-trainees of the individuals were approached for biographical information, and a set of questions that would provide the framework for the interview was drawn up. One of the most rewarding aspects of the process was how often the four surgeons mentioned each other, which would go on to inform subsequent interviews. Equipment The OHS course recommended digital recorders costing upwards of £300 (€350). We borrowed a digital recorder that was probably inferior to this, but bought a high quality microphone, and have been happy with the quality of the sound. The interviews were also recorded on two analogue (tape) machines and on a smart phone. Environment All interviews were held in the participants’ houses. Consent The interviewees were asked to read through and sign a copyright and consent form. This had been adapted from one given at the time of the OHS course. 10

EUT Congress News

The interviews The questions roughly followed a chronological exploration of the surgeon’s career. All four were very expansive and, in the main, they were allowed to continue uninterrupted, with interjections being made for clarification. We ensured, though, that all the questions had been answered. We also gave the subjects the opportunity at the end of the interviews to expand on anything that they wished to, and discuss areas that hadn’t been covered in our questions. One of the participants was uncomfortable with something that he had said about a colleague John Blandy and asked for the quote to be removed from the recording which we subsequently did. Professor John Blandy Our first interview took place in September 2009 with Professor John Blandy. He is perhaps most renowned for his teaching and training, and his textbooks are still very relevant today. A very interesting and hugely relevant theme of the interview was the introduction of new techniques and technology to urology. Professor Blandy was aware of the considerable mortality associated with open retro-pubic prostatectomy, but also faced great resistance from senior colleagues for his attempts to introduce TURP. John Wickham We met with Professor Wickham in March 2010. He worked at St Bartholomew’s and the Institute of Urology at the Middlesex Hospital in London. He is seen by many as a godfather of robotics in urology following his (not unsuccessful) attempts to build an autonomous TURP machine. Our conversation, not unlike with Professor Blandy, covered the resistance to change in surgical practice.

“We feel that these interviews are very precious- a single chance to record something truly unique.” Sir David Innes Williams Sir David is the oldest of the four at 90. All of the remaining interviewers had been taught by him and talked of him as a great surgeon and inspiration. Sir David has great interest in history himself, and had very interesting opinions on the effect of the Second World War on medicine. He said he felt guilty being at medical school when his friends were fighting overseas. He also remarked that many surgical specialties, such as orthopaedics, neurosurgery and plastic surgery had gained greatly from the war, but that the same wasn’t true for urology. Professor Richard Turner-Warwick We were kindly invited by Professor Turner-Warwick to stay with him and his charming wife in rural Devon where the interview was conducted in June 2010. He talked of the freedom that he had to innovate. This was at a time when he could design and make a surgical instrument in his work-shed and take it to work the following day and ask his operating theatre nurse to sterilise it before using in vivo. He explained how innovation in medicine is very largely due to collaboration, not only between doctors, but also allied health professionals and industry. Transcription Transcribing a two-hour interview is a very laborious task. We commissioned a trained audio secretary who performed this in a fraction of the time that it would take us, but the manuscript still had to be carefully edited as many of the names and medical terms are unfamiliar to non-urologists. Storage Currently, the digital material is stored on two computers, computer discs and on an e-mail account. We very much hope that the recordings can be made accessible to all. It will probably be necessary to edit them considerably for a wider readership. Editing software is commercially available, although this process is time-consuming. It may also be possible to store the recordings at places such as the Wellcome Institute in London (a medical history charity) or the British Library. Publication The editor of the British Journal of Medical and Surgical Urology (BJMSU) has kindly agreed to publish profiles of the four urologists based on the interviews. The future The royal colleges of Surgeons of Edinburgh and London are aware of this project and are keen that

John Wickham

other specialties carry out similar work. We would like to film future interviews, and, perhaps standardise the length and format of edited videos. These could be made available for viewing via the BAUS or EAU websites.

Practical advice for interviewers: Preparation We think it is important the subjects understand the purpose of the proposed interview so they can gather their thoughts in advance. All of our subjects had collected memorabilia to show us at the time of the recordings, ranging from old photographs to programmes from past conferences, which often provided a focal point for discussions. Similarly gaining information on their career and achievements in advance allows the interview to be highly focused. On one of our interviews we were accompanied by an ex-trainee of the subject who provided unique knowledge which again permitted very pertinent questioning. Equipment We feel that these interviews are very precious- a single chance to record something truly unique. It would be a terrible shame if the experience was wasted because of technical failure. Buying a good quality digital recorder is essential, as well as having spare batteries. We would strongly recommend using more than one recorder, even if it is a humble Dictaphone. Environment The subject needs to feel comfortable, and there should be a minimum of background noise which could spoil the recording. The microphone should be placed as near as possible to the subject without being obtrusive. Consent It is important that your subject trusts you so that they will open up. Similarly they need to be aware of what your recording may be used for and an essential aspect of this is having them read and sign a copyright assignment and consent form. Given the nature of these interviews, it is entirely reasonable that the subjects should have a final say on the content of publications or audio files.

Sir David Innes Williams

Richard Turner-Warwick

The interview It is important to be realistic about what can be covered in the allotted time. It might be appropriate to schedule more than one meeting. Allow the subjects to talk freely but make sure all the relevant areas are covered. At the end ask whether there are any important areas that you may not have covered in your questions. It is also very useful to “leave your tape running” in the moments after (and possibly before) the formal interview as this is when many candid and important remarks will be made. Information regarding consent is available on the OHS and IOHS websites. Transcription It is essential to be aware of what is involved in transcribing- a two-hour interview can take 10 or more hours of transcription.

“It is important that your subject trusts you so that they will open up.” Publication Publishing the interviews in their entirety would probably make for an uninspiring read. A degree of editing is therefore essential. It might be a profiletype article which allows you to add biographical information and perhaps quotes from other sources or even contemporaries. Archiving The material should be of interest not only to today’s urologists but also to future generations. Imagine how fascinating it would be to listen to recordings of urologists from the turn of the last century! It may be that national urological organisations can provide facilities for archiving. Alternatively, University History departments (particularly those with an interest in the History of Medicine) may be able to help. The History Office of the EAU would like edited interviews to be available on the EAU website. Historical knowledge We feel that this source of material is important in furthering our knowledge of the evolution of our specialty and that we have demonstrated that it is feasible to capture these memories. We would encourage the urology community at large to perform similar ventures in a timely manner.

The EAU History Office Activities in Vienna Prof. Dirk Schultheiss Chairman, EAU History Office Department of Urology Gießen (DE) Email: dirk. schultheiss@ urologie-giessen.de Dominic Hodgson and Peter Thompson from the UK have set an impressive starting point for this vivid technique to preserve history. Oral interviews with significant time witnesses are planned to enlarge the activities of the EAU History Office in the future. The 25th Anniversary EAU Congress in Barcelona in 2010 also presented video interviews with urologists sharing their memories from 25 EAU congresses. These interviews had been made

public through the EAU web system before the congress, and were on display next to the “EAU History Wall” in Barcelona, commemorating 25 EAU Congresses. A part of this display will be shown again at the 26th Annual EAU Congress in Vienna. To this end we will also try to arrange a course at the Vienna congress run by tutors from the Oral History Society in London. To those who are interested in taking on such projects kindly contact the chairman or the members of the EAU History Office. The full version of Hodgson and Thompson’s article, including detailed reports of the interviews with the four prominent British urologists, appears in De Historia Urologiae Europaeae Vol. 18. This publication is free for all EAU members and will be distributed at the EAU Square. Be sure to also visit the historical exhibition for more insight into the history of urology in Vienna.

Saturday 19 March 2011


EAU expands overseas ties Recent focus on mutually beneficial activities the second joint course was held in Manila, Philippines which also coincided with the 52nd annual meeting of the Philippine Urological Association.

These initiatives are only among the first educational activities that the EAU has encouraged, a trend that reflects not only the growing partnerships amongst medical groups outside Europe but also the need to Didier.Jacqmin@ share best practices. On the other hand, the “reverse” chru-strasbourg.fr is also happening with the EAU annually expanding its Urology Beyond Europe Day during its annual congress. The meeting is one of the most wellIn the last few decades it has become apparent that attended sessions in the annual congress, serving as globalisation has become a byword not only in the an ideal platform to examine common challenges in financial world, but also in other areas of our lives. In clinical practice, and providing European urologists a medicine, professional groups in Western countries more in-depth view of the obstacles and opportunities faced by their colleagues in other have increasingly expanded their reach, and today our partners come from as far as the Middle East, regions. Asia and the Americas, reflecting the reality that medical advances and issues often transcend artificial These collaborations are not only being nurtured but borders. are also gaining momentum. For instance, under the EAU-CUA (Chinese Urological Association) a new For the last six years, the EAU has created strong links initiative will soon be launched: the EAU-CUA with some of these countries, nurturing collaborative Exchange Programme. A similar programme has been ongoing between the EAU and the American efforts by sending its expert speakers to EAUorganised courses in many national or regional Urological Association (AUA) for several years now. In meetings. The European School of Urology (ESU) is in Vienna, for the first time, three promising young Chinese urologists will attend the 26th Annual EAU the frontline of the EAU’s educational activities, and one of the most remarkable examples of the ESU’s Congress, after which they will visit four expert collaborative initiatives is its participation in the China centres in Europe to meet, discuss and form ties with Urology Educational Programme (CUEP). In CUEP, a their European colleagues, an essential step to mixed faculty composed of speakers from the host establish future collaborations and professional country and Europe has been involved in the exchanges. In 2012 their European counterparts will visit renowned urology centres in China as part of the programme for the past three years. exchange programme. Another initiative which begun in December 2009 was the first joint course between the Asian School of Without a doubt, the EAU has increasingly played a Urology (ASU) and the ESU, with the first course frontline role in the progress and development of organised in Bali, Indonesia. Held in conjunction with urology, not only within its traditional borders but the 32nd Annual Scientific Meeting of the Indonesian also, and equally important, in other regions where it can engage in mutually productive endeavours. In this Urological Association, the meeting elicited enthusiastic response from both the course respect, there is no other real option but for us to actively forge on to meet our goals. participants and faculty. In December 2 and 3, 2010,

GHENT LIVE SURGERY DAYS www.ghentlivesurgery.com

Prof. Didier Jacqmin Chairman EAU International Relations Office Strasbourg (FR)

2011, APRIL 10 - 12 URETHRAL STRICTURE REPAIR Live surgery from 3 different expert centers: Arezzo, Ghent and London Live transmission and audiovisual assistance by Mediaventures

FACULTY Andrich D, London, UK Barbagli G, Arezzo, Italy Hoebeke P, Ghent, Belgium Lumen N, Ghent, Belgium Martinez-Pineiro L, Madrid, Spain Mundy A, London, UK Oosterlinck W, Ghent, Belgium Van Laecke E, Ghent, Belgium REGISTRATION Early registration until the 10th of March, 2011. www.ghentlivesurgery.com

ORGANISATION Prof. Dr. Willem Oosterlinck and Dr. Nicolaas Lumen Ghent University Hospital De Pintelaan 185 9000 Gent, Belgium CONTACT US The congress organisation can be reached (secretary Mrs. Ilse Maes) by email: poli.urologie@uzgent.be by telephone: +32 - 9 - 332 22 79 by fax: +32 - 9 - 332 38 89

Calcium phosphate and renal stones Randall’s Plaque: the role of CaP in the formation of CaOx stones Prof. Hans-Göran Tiselius Dept. of Urology Stockholm (SE)

Although the majority of calcium renal stones has calcium oxalate (CaOx) as the dominating constituent, the formation of these stones is incompletely understood. Despite an enormously increased knowledge of CaOx crystallisation in human urine, urine-like solutions and animal experiments, the mechanism of CaOx stone initiation has remained unexplained to a large extent. There are, however, some recent observations that provide valuable clues to a better understanding of the initial steps in CaOx stone formation. In this regard it is important to note that calcium phosphate (CaP) is also a common constituent in more than 60% of all calcium stones, albeit usually in very small amounts. Pure CaP stones on the other hand are encountered only occasionally. The common occurrence of CaP crystal material in urine is of note, and the possible role of this crystal type has been repeatedly emphasised during the past decades, but without being seriously considered as etiologically important. Revival – after almost 75 years – of the role of Randall’s plaques (subepithelial papillary accumulations of apatite) is an interesting and promising explanation of early steps in CaOx stone formation1. Thus, it has been observed from clinical and morphological observations that denuded Randall’s plaques constitute a base for CaOx precipitation and Saturday 19 March 2011

subsequent CaOx stone formation. The conclusion thereby was that the initiation of CaOx stone formation is an overgrowth with CaOx. From the knowledge of urine composition at various levels of the nephron it seems likely that the first crystallisation product in urine is CaP formed in the loop of Henle or possibly in the distal part of the distal tubules2. The major determinant of the high ion-activity product of CaP (APCaP) is a high pH that is present at those nephron levels. The formation of subepithelial calcifications can be explained by internalisation of CaP, dissolution and re-precipitation in the basement membrane, simple translocation of intratubular CaP to the interstial tissue or a primary precipitation of CaP in the interstitial tissue where APCaP also is high1. That CaP is formed in the tubular system has been demonstrated in several SEM-studies and although some of these crystal masses can be eliminated by crystal cell interaction, CaP might also be transported down the nephron in an intratubular route. During the latter process, CaP might grow and aggregate to crystal masses of various sizes, some of which are easily eliminated from the tubules and excreted whereas others grow sufficiently large to be retained. The latter crystal aggregates can be trapped at the end of the collecting duct. A sufficiently high APCaOx (ion-activity product of CaOx) for heterogenous CaOx precipitation is present only in distal collecting duct urine and caliceal urine2. The early precipitation of CaP now provides two possible promoting surfaces for CaOx crystal formation: the subepithelial apatite mass (Randall’s Plaque) and the apatite mass trapped at the end of the collecting duct. The next important determinant of the CaOx crystallisation process seems to be pH3. Experimental studies have shown that when the urine pH is low (less than 5.7-5.8) the CaP crystal phase will dissolve. This might lead to very high concentrations of calcium in the macromolecular environment. In situations

Figure 1

when CaP dissolution coincides with peaks of APCaOx, References 1. Coe FL, Evan AP, Worcester EM, Lingeman JE. Three nucleation of CaOx might occur. The rich supply of pathways for human kidney stone formation. Urol Res. inhibitors in urine will certainly counteract CaOx 2010; 38:147-60. crystal growth on CaP, but by focal accumulation of 2. Luptác I., Bek-Jensen H., Fornander AM, Höjgaard I, calcium very high concentrations can be established. Nilsson MA & Tiselius HG Crystallization of calcium The ensuing levels of APCaOx might accordingly be sufficiently high for CaOx nucleation. oxalate and calcium phosphate at supersaturation levels It has been shown that self-aggregation of TammHorsfall protein that occurs at a low pH and with low levels of citrate play an important role for the necessary aggregation of CaOx crystals. The subsequent development of a CaOx stone involves growth and aggregation first of the attached crystal mass and later of a free stone. A schematic overview of the various possible steps in CaOx-stone formation is shown in Figure 1.

corresponding to those in different parts of the nephron. Scanning Microscopy 1994; 8 : 47-62. 3. Tiselius HG, Lindbäck B, Fornander AM, Nilsson MA. Studies on the role of calcium phosphate in the process of calcium oxalate crystal formation. Urol Res. 2009 37:181-92.

Saturday, 19 March 2011 10.20 - 12.00: Meeting of the EAU Section of eUrolithiasis (eULIS), Urolithiasis – what’s up doc? eULIS honorary lecture: Studies on the role of calcium phosphate in the process of calcium oxalate crystal formation

EUT Congress News

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Live surgeries focus on emerging technologies Meeting of the EAU Section of Uro-Technology (ESUT) Prof. Jens Rassweiler Dept. of Urology SLK-Kliniken Heilbronn Heilbronn (DE)

To fulfil its goals of offering a dynamic and interactive learning session, the EAU Section of Uro-Technology (ESUT) will be transmitting live broadcasts of surgeries from the Allgemeinen Krankenhaus Vienna, University of Vienna (AT) and SLK Kliniken Heilbronn (DE) Following a more than ten-year tradition of livesurgery sessions, the ESUT presents an ambitious programme that focuses on novel techniques in percutaneous, endourological, laparoscopic, and

robotic-assisted procedures. This year, with “From Lab to OR – are we ready?”, we combine the demonstration of experimental and clinical cases. Like last year, we want to challenge new technological improvements of TRUS-guided biopsies (C-TRUS, Elastography) by the results demonstrated by the pathologist. Therefore, these cases were pre-recorded on Friday, 18 March 2011 to allow sufficient time for histopathological diagnosis. This session is conducted in collaboration with the EAU Section of imaging in Urology (ESIU). Novel techniques for ablation of benign and malignant tissue will include high-intensity focused ultrasound (HIFU) for LESS-assisted renal focal therapy, laser-mediated vascular therapy (Tookad Soluble) for focal therapy of the prostate, laser enucleation (Thulium) and vaporisation (Green-light) for benign prostatic hyperplasia, as well as bipolar vaporisation using different devices. In the laparoscopic and robot-assisted cases, we will compare new access techniques (LESS versus SMART/ Mini-LAP versus NOTES) as well as new instruments and devices improving the ergonomics of laparoscopy. This will include the CAMeleon, a camera system that can vary the angle from 0°-70°, a motorised 6-DOF-instrument (Kymerax) for endoscopic suturing, and an ergonomic chair with arm-rests (ETHOS) enabling the surgeon to sit over the head of the patient during pelvic laparoscopic surgery (see above, right).

Finally, the latest digital developments for flexible endoscopy of the upper urinary tract for diagnosis and treatment of tumours and calculi are demonstrated. This will also include the demonstration of photodynamic diagnosis as well as narrow-band imaging. This session is conducted in collaboration with the EAU-session of urolithiasis (EULIS). The ESUT faculty consists of internationally renowned experts serving as surgeons and moderators. The different surgical procedures will be transmitted from two sites (Vienna and Heilbronn) in high-definition quality. A split-screen will allow the delegates to follow the procedures. Traditionally, the format of ESUT-Live Surgery will allow all delegates to directly communicate with the surgeons to ask questions and to discuss every aspect of the procedure.

Coordinators in Vienna: C. Klingler, Vienna (AT) G. Janetschek, Salzburg (AT) Coordinators Heilbronn: R. Muschter, Rothenburg (DE) M. Schulze, Heilbronn (DE) Coordinator Auditorium: T. Frede, Müllheim (DE) Saturday, 19 March 2011 10.15 - 17.30: Meeting of the EAU Section of Uro-Technology (ESUT) Technical innovations in endourology, laparoscopy and robotics Supported by unrestricted educational grants from Advanced Medical Diagnostics, Fokus Surgery, Fresenius Kabi, GE Healthcare, Hitachi Medical Systems, Intuitive Surgical, Karl Storz GMBH & Co.KG, Olympus, Starmedtec, Steba Biotec and Terumo.

http://esuberlin.uroweb.org

4th ESU Masterclass on Female and functional reconstructive urology 11-13 November 2011, Berlin, Germany EAU meetings and courses are accredited by the EBU in compliance with the UEMS/EACCME regulations

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EUT Congress News

Saturday 19 March 2011


Watch for progression in mHRPC.

Despite a survival benefit with first-line chemotherapy, disease progression

is inevitable. The signs of progressionâ&#x20AC;&#x201D;rising PSA levels, new lesions, and painâ&#x20AC;&#x201D; can be discouraging. However, at long last, healthcare providers and their patients have something to look forward to.

Significant change is on the horizon... Visit Booth #85 to find out more. mHRPC=hormone-refractory metastatic prostate cancer.

COM.CAB.11.01.03 Saturday 19 March 2011

1/2011 EUT Congress News

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ESIU Meeting: key issues in prostate cancer Increasing importance of infectious complications in prostate biopsies Prof. Truls E. Bjerklund Johansen Arhus University Hospital Aarhus (DK)

tebj@ki.au.dk

Urologists from all parts of the world keep asking the EAU Section of Infections in Urology (ESIU) about preventive measures against infective complications after prostate biopsies. Usually they have seen patients with serious complications, where the culture tests show that the pathogen is resistant to the antibiotic given for prophylaxis. Urologists have started to ask what the best route is for taking prostate biopsies, transperineal or transrectal, and if prostate biopsies may be replaced by imaging. In the very end we have to consider if the side effects of biopsies outweigh the benefits of prostate cancer treatment. All these issues will be addressed in the upcoming ESIU section session on Saturday, 19 March 2011. The session consists of three parts and each part will be chaired by leading urologists and international opinion leaders: Rob Pickard (UK), Peter Tenke (HU), Anup Patel (UK) and Vladimir Mouraviev (US). Risk factors The stage will be set by case presentations addressing patient assessment before biopsy, administration of antibiotics and follow-up after biopsies. Studies from Sweden have shown that biopsies may be done with very low complication rates if basic recommendations in patient work-up are adhered to and the right antibiotics are used1. Prof. Bjørn Wullt (Lund, SE) will share his views on the most important patient-related risk factors for infective complications. Surgical field contamination The risk of infection related to the surgical field needs to be assessed before every surgical procedure. This risk is described in contamination categories. Originally the classification system was developed to assess war injuries in the World War II. However, since then huge databases have been built and nowadays the risk of infection following any surgical procedure may be estimated by means of certain criteria. Recently, the ESIU updated these criteria for modern urological surgery, including prostate biopsies2. The urologist should be aware that in certain situations prostate biopsies are taken in an infected field where the risk of infective complications without prophylaxis is as high as 40%3. Prof. Magnus (Grabe, SE) who is head of the ESIU guidelines panel will explain the meaning of contamination categories and what to tell patients about the risk of infective complications. Prevalence of complications The only way to learn what the causative pathogens

are is to keep a record. ESIU has been doing that for eight consecutive years and has amassed important information about prevalence and causative pathogens in hospital-acquired urinary tract infections on a global scale through the GPIU (Global Prevalence study on Infections in Urology). The overall risk of infection is about 11%, but the risk of urosepsis increases, which is a cause for concern4,5. E coli is still the most important bug, but it is getting more and more dangerous. Today, omni-resistant bacteria have become a threat also in urology. Prof. Mete Cek (Edirne, TU) will give an update on the prevalence, pathogens and antibiotics used in urology departments. The results of the prostate biopsy side study in the GPIU-2010 will be of particular interest. Prophylactic regimens The key issue is which antibiotics to administer before prostate biopsies. However, this is not as simple as it might initially seem. The antibiotic must be able to penetrate the tissue, and it must be administered at the right time point to reach the right concentrations in tissue and blood when biopsies are taken. Furthermore, the antibiotic should also not cause collateral damage and harm the surrounding area. It is evident that recommendations cannot be the same in all parts of the world, and not even the same all the time in a given institution. Patients who are frequently coming back for a repeat biopsy and intestinal bacteria may have developed resistance to the drug that was prescribed on the first occasion. Each urology department should therefore have an armamentarium of several antibiotic regimens. Prof. Florian M. Wagenlehner (Giessen, DE) will guide us through the pharmacology of antibiotic prophylaxis which every urologist needs to know3. Transrectal route, transperineal route or not at all? In transrectal biopsies, the biopsy needle passes through the rectal wall which is never sterile. The fact that we use the same needle for all 10 or 12 biopsies means that after the first biopsy, the needle is no longer sterile. These are good arguments for avoiding the transrectal approach, and to find another route. Transperineal biopsies have a lower contamination category and obvious advantages in terms of getting more representative biopsies from the anterior part of the prostate. However, the procedure is more invasive and usually requires general or spinal anaesthesia. Furthermore, the prostate is movable and the needles do not always go where we want them to, so the procedure requires special training. Prof. Damian Greene (Sunderland, UK) will present UK data on complication rates and diagnostic yield as compared to transrectal biopsies6. Imaging and the need for biopsies A set of ten biopsies in an average-sized prostate removes only about 1% of prostate tissue for histological examination. A prostate tumour may have odd shapes and even be multifocal. Thus, the chance of detecting a small cancer with 10 needle biopsies is quite low. Different techniques have been developed to improve diagnosis, such as elastography and MRI. The concept of focal treatment of prostate cancer introduces a new perspective in patient evaluation. If only one lobe is to be treated we need to rule out the presence of a tumour on the presumed healthy side.

Fig. 1: Prostate biopsy by transrectal route. Courtesy of dr. Knud V. Pedersen, Lindkøping, SE

To meet this need, saturation and even mapping biopsies have been done in numbers up to 100 specimens.7 Our dream is therefore to replace prostate biopsies with imaging, in order to eliminate infective complications and improve diagnosis. Prof. Arnauld Villers, (Lille, FR) will tell us how close we are to realising this dream. Side effects of biopsies The aim of prostate biopsies is more than diagnosing prostate cancer. Urologists want to improve survival and quality of life for patients. In doing so, we must always be guided by the famous words of Hippocrates, primum non nocere, first of all do not harm the patient. Most urologists ask themselves if the results of treatment justify our diagnostic efforts. Do side effects of biopsies and lymph node staging outweigh the benefits of radical treatment? For example, through screening a man at the age of 60

may reduce his risk of dying from prostate cancer within the next 10 years from 4/1000 to 3/10008. But if two out of 100 patients undergoing prostate biopsies get urosepsis, the life-years account may be negative even before we consider complications of radical treatment4,5. Prof. Michael Borre (Aarhus, DK) will guide us through this delicate and important evaluation. Literature References can be obtained from the author upon request. Saturday, 19 March 2011 10.15 - 14.00: Meeting of the EAU Section of Infections in Urology (ESIU) Prostate biopsies and the increasing importance of infectious complications

Fig. 2: Transrectal biopsy specimens. Courtesy of dr. Knud V. Pedersen, Lindkøping, SE

Do you listen to your patients? Visit the Europa Uomo Booth

Hall D – D7 and meet the representatives of your national patient groups. Europa Uomo – The European Coalition against Prostate Cancer www.europa-uomo.org Fig. 3: Set-up for prostate biopsy by transperineal route. Courtesy of prof. Damian Greene, Sunderland UK

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EUT Congress News

Saturday 19 March 2011


Take a Viennese whirl

ESUI confers first Vision Award

EAU Evening: from Grand Ball, jazz to tavern music A boost for innovative research in urological imaging a lively party and modern dance. The EAU has invited “Lou,” a band known for their party repertoire- from jazzy lounge music to popular dancing hits.

Asso. Prof. Jochen Walz Chairman EAU Section of Urological Imaging (ESUI) Institut PaoliCalmettes Marseille (FR)

At the Swiss Wing (where the castle’s oldest areas are located), the Knight’s Hall (Rittersaal) will be transformed to a Viennese tavern, catering to guests who enjoy the musical traditions of the saloon. “Trio Wien” will perform, showing their mastery of the old-school “Heurigen-Musik,” and bringing guests to a cheerful mood. Vienna exudes a melancholy beauty, and winter is the time when the city’s park and palaces look magical in a light dusting of snow. For the EAU Evening, the specially prepared programme attempts to capture the Vienna of opera balls, coffee house music, modern jazz to Austrian folk. As the former capital of the Holy Roman, Austrian and Austro-Hungarian Empires for 700 years, Vienna has the Schönbrunn, Belvedere and Hofburg, palaces which are amongst the most magnificent in the world. Hofburg Palace is the backdrop venue for the EAU Evening. It serves as the official residence of the Austrian president and was the Habsburgs’ principal winter residence, as the Schönbrunn Palace was their preferred summer residence. In 1958, part of the Hofburg was opened to the public as a centre for congresses and events, laying the groundwork for conference tourism in Vienna. At the 1,000m2 Festsaal (Festival Hall), with its impressive ceiling paintings by Alois Hans Schramm, the EAU Evening will open to the music by Mozart and Strauss, performed by the Wiener ResidenzOrchester. Dancers of the Vienna State Opera will add a touch of sparkle, and the ball will then unfold in traditional fashion with the ball-master inviting everyone to dance with the customary “Alles Walzer.” Meanwhile, at the Zeremoniensaal (Ceremonial Hall), where Napoleon asked for the hand of Marie Louise, the daughter of Emperor Franz II/I, and where the exclusive Ball at the Court was held, the mood shifts to

EAU Evening guests will also be treated to Austrian culinary specialities, accompanied by the famous Austrian wine. From exquisite buffet arrangements, to hearty traditional tavern menu, guests will find not only a glimpse but also a taste of authentic Vienna.

Monday, 21 March 2011 19.30 - 00.00: Hofburg Vienna, Heldenplatz 1 Black Tie Optional Gentlemen: Black Tie -If you prefer to dress less formally, a dark suit will be sufficient. Ladies: Evening attire - Ball gown or a cocktail dress You can buy your EAU Evening ticket at the EAU evening desk in the registration area. Congress delegates: € 71,- (excluding 20% VAT) Exhibitors and non-delegates: € 132,- (excluding 20% VAT) Accompanying persons: ticket included in the registration fee

urological imaging done by urologists strengthens its role and provides the advantage of being close to urological clinical practice. The ESUI Vision Award was created to reinforce and to support this goal.

In addition, this year’s ESUI section meeting addresses imaging of the kidney and the pelvis. Several speakers will provide state-of-the-art lectures During the meeting of the EAU Section of Urological Imaging (ESUI), the first Vision Award will be given to on kidney imaging including ultrasound, CT-scan and MRI. A guest lecture given by Jaime Landman from the author of the most innovative urological imaging study published during the last year. Sponsored by an the Imaging Guided Therapy Working Group (IGTWG) is covering the role of imaging in the treatment of unrestricted grant of €1500 from Hitachi Medical small renal masses. The emerging topic of focal Systems Europe, the award aims to encourage novel therapy of small renal masses will be further research in urological imaging. addressed in an overview presentation on the role of kidney biopsy and the role of imaging during the The award will be formally announced today, 19 follow up phase after focal therapy. March at 13:30 in Hall F1. The aim of the ESUI Vision Award, which will be given for the first time, is to Also to be featured in the meeting is a panel encourage urologists and investigators to devote discussion that will examine the limits of imaging in research and resources to innovative imaging in urology. It is the policy of the ESUI to strongly support daily practice, and the possible clinical problems. Several case studies will be presented and solutions and encourage all imaging and imaging-based activities done by urologists. It is obvious that imaging will be discussed to avoid potential complications or consequences. The second part of the session will has, in recent years, gained an increasing role in the provide a timely overview regarding pelvic imaging. diagnosis and treatment of urological pathologies. The focus will be on imaging before and after pelvic surgery, and will include radical prostatectomy, Moreover, it is very likely that this trend will become urinary incontinence and urethral strictures. Finally, even more pronounced in the future. Current the session will highlight and summarise the most developments and technologies, especially imagingrecent findings in urological imaging of the prostate, guided therapy such as focal therapy, often involve other specialities and pose the risk for urology to lose urinary tract, lymph nodes and outer genital organs. its primary role in the management of urological Saturday, 19 March 2011 patients. The ESUI is convinced that urologists should 10.00-14.00: Meeting of the EAU Section of remain the primary actors in diagnosis and treatment Urological Imaging (ESUI) in the urological field. How does imaging help in the treatment of renal and pelvic pathologies? This also includes the use of new imaging tools and imaging-based treatment technologies. Research in

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Visit us at the EAU 2011, Booth No. Z22 EUT Congress News

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2011 Awards for Best Publications and Abstracts Innovative, insightful studies impress jurors We congratulate the winners of the best publications which appeared in European Urology in 2010 and the best abstracts submitted to this congress. Below is the list of winners, their prizewinning publications and studies.

Prize for the Best Scientific Paper published on Clinical Research in European Urology by a young urologist (max. 35 years) in 2010 Complications in 2200 Consecutive Laparoscopic Radical Prostatectomies: Standardised Evaluation and Analysis of Learning Curves M. Hruza, H.O. Weiß, P. Giovannalberto, Prize for the Best Paper published on Fundamental S.A.S. Goezen, M. Schulze, D. Teber, J. Rassweiler Research in the Urological Literature in 2010 SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany Inhibition of the cation channel TRPV4 improves bladder European Urology, Volume 58, Issue 5, November 2010, function in mice and rats with cyclophosphamidePages 733-741 induced cystitis W. Everaerts, Leuven, Belgium, Katholieke Universiteit The European Urology Platinum Award Leuven In recognition of your dedication, collaboration and continued support to The Platinum Journal Prize for the Best Paper published on Clinical G. Dalbagni, New York, United States of America, Research in the Urological Literature in 2010 M.J. Robol, Rotterdam, The Netherlands Olfactory Detection of Prostate Cancer by Dogs Sniffing Urine: A Step Forward in Early Diagnosis First Prize for the Best Abstract (Non-Oncology) J-N. Cornu, Paris, France, Hôpital Tenon, Departement Abstract 883 (AM11-1060) of Urology Urinary levels of Brain Derived Neurotrophic Factor (BDNF) in women with overactive bladder (OAB) Prize for the Best Scientific Paper published in syndrome correlate with the severity of symptoms European Urology in 2010 T. Antunes-Lopes1, R. Pinto1, S. Carvalho-Barros2, P. Diniz1, C. Martins-Silva1, C. Duarte-Cruz2, F. Cruz1 Positive Surgical Margin Appears to Have Negligible 1 Hospital de São João and University of Porto, Urology Impact on Survival of Renal Cell Carcinomas Treated by and IBMC, Institute of Biology, Molecular and Cellular, Nephron-Sparing Surgery K. Bensalah, A.J. Pantuck, N. Rioux-Leclercq, R. Thuret, Porto, Portugal, 2Faculty of Medicine, University of F. Montorsi, P.I. Karakiewicz, N. Mottet, L. Zini, Porto, Institute of Histology and Embryology and R. Bertini, L. Salomon, A. Villers, M. Soulie, L. Bellec, IBMC, Institute of Biology, Molecular and Celular, P. Rischmann, A. De La Taille, R. Avakian, M. Crepel, Porto, Portugal J-M. Ferriere, J-C. Bernhard, T. Dujardin, et al. Rennes University Hospital, Rennes, France Second Prize for the Best Abstract (Non-Oncology) European Urology, Volume 57, Issue 3, March 2010, Abstract 689 (AM11-2826) Pages 466-473 Does varicocele repair improve male infertility? An evidence-based perspective from a randomized controlled trial Prize for the Best Scientific Paper published on Fundamental Research in European Urology by a T.A. Abdel-Meguid, A.G. Al-Sayyad, A.M.S. Tayib, young urologist (max. 35 years) in 2010 H.M.A. Farsi Stem Cell Characteristics in Prostate Cancer Cell Lines King Abdulaziz University Medical City, Dept. of M.J. Pfeiffer, J.A. Schalken Urology, Jeddah, Saudi Arabia UMC St. Radboud, Nijmegen, The Netherlands European Urology, Volume 57, Issue 2, February 2010, Third Prize for the Best Abstract (Non-Oncology) Pages 246-255 Abstract 479 (AM11-1247)

Local estrogen enhances the innate immune defences of vaginal epithelium by increasing secretion of betadefensin-2 antimicrobial peptide A.S.M. Ali1, T. Stanly2, M. Lanz2, C.L. Townes2, J. Hall2, R.S. Pickard1 1 Newcastle University, Institute of Cellular Medicine, Newcastle upon Tyne, United Kingdom, 2Newcastle University, Institute of Cell and Molecular Biosciences, Newcastle upon Tyne, United Kingdom First Prize for the Best Abstract (Oncology) Abstract 838 (AM11-4073) Testing and prognostic implications of prostate cancer stem cells in bone marrow E. Ricci1, E. Bourrelie1, X. Martin1, C. Dumontet2, P. Clezardin3, G. Thalmann4, M. Colombel1 1 Hôpital Edouard Herriot, Dept. of Urology, Lyon, France, 2Hôpital Edouard Herriot, Dept. of Hematology, Lyon, France, 3INSERM, U664, Lyon, France, 4Berne University, Urology, Berne, Switzerland Second Prize for the Best Abstract (Oncology) Abstract 435 (AM11-3439) A prospective randomised trial of Hexylaminolevulinate (Hexvix) assisted transurethral resection (TURBT) plus single shot intravesical mitomycin (MMC) versus conventional white light TURBT plus single shot MMC in newly presenting bladder cancer T.S. O’Brien1, K. Chatterton1, E.R. Ray1, D. Wilby1, A. Chandra2, F. Dickinson1, M.S. Khan1, K. Thomas1 1 Guys Hospital, Dept. of Urology, London, United Kingdom, 2Guys Hospital, Dept. of Pathology, London, United Kingdom

Third Prize for the Best Abstract (Oncology) Abstract 833 (AM11-0559) Statins reduce the androgen sensitivity and cell proliferation by decreasing the androgen receptor protein in prostate cancer cells A. Yokomizo, M. Shiota, E. Kashiwagi, K. Kuroiwa, K. Tatsugami, J. Inokuchi, A. Takeuchi, S. Naito Kyushu University Graduate School of Medical Sciences, Dept. of Urology, Fukuoka, Japan MISA Award for the Best Abstract published on Minimally Invasive Surgery Abstract Nr: 229 (AM11-0407) Comparison between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the treatment of single pelvic renal stones between 2 and 4 cm G. Giusti1, G. Bonvissuto1, G.S. Zandegiacomo1, G. Taverna1, O. Maugeri1, A. Benetti1, R. Peschechera1, V. Guarella1, P.G. Graziotti2 1 Institute Clinic Humanitas, IRCCS, Stone Center at Dept. of Urology, Milan, Italy, 2Institute Clinic Humanitas, IRCCS, Dept. of Urology, Milan, Italy

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Survey on sexual health and overall wellness The importance of sexual satisfaction and erection hardness for a positive overall outlook on life The Sexual Health and Overall Wellness (SHOW) survey carried out in 9 countries (Central and Eastern Europe, Israel and Turkey) was commissioned to quantify sexual satisfaction whilst gaining an insight into the sexual health and aspirations of men and women in this region. The SHOW survey revealed that while sex is considered one of the main life priorities, 58% of men and 64% of women across the countries are not very/completely satisfied with their sex lives (figure 1). The findings also suggest that sexual satisfaction is linked not only to better sex but also to a better outlook on life overall. The Sexual Health and Overall Wellness (SHOW) survey included interviews with 3,780 sexually active participants: 1,893 men and 1,887 women in Czech Republic, Hungary, Israel, Poland, Romania, Russia, Slovakia, Turkey and Ukraine. An online self-administered method was used in Czech Republic, Hungary, Poland, Romania, Russia, Slovakia and Ukraine. A pen-and-paper based method was used in Turkey. In Israel the survey was either online or pen-and-paper based. The survey was conducted from June to August 2010. The name of the sponsor of the study was not disclosed in any of the survey materials. Satisfaction with sex is strongly associated with a positive overall outlook on life The results oft he SHOW survey indicate that sex ranks as one of the main life priorities for both men and women. 67% of men and 55% of women consider sex ‘absolutely essential’ or ‘very important’, yet satisfaction with sex can be described as only moderate in the surveyed region: less than half of the respondents are completely or very satisfied with their sex lives. Among both men and women, greater levels of satisfaction with sex are strongly associated with greater levels of satisfaction with the most important aspects of life. Men and women who are 16

EUT Congress News

figure 1: Sex is very important to most men and women but less than half are very satisfied with sex

more satisfied with sex are significantly more likely to feel good about their lives and personal relationships, acknowledge that there is a balance in their lives and that they have opportunities to get what they want in life, and like to be around people. According to the findings of the SHOW survey, optimal erection hardness1 is strongly associated with greater satisfaction with all elements of sexual performance. Among both men and women, self-reported and partner-reported erection hardness are also closely associated with the frequency of sexual intercourse. Men who are EHS (Erection Hardness Score) Grade 4 (optimal erection hardness) and women who report their partners are EHS Grade 4 had sex on average 11.5 and 10.8 times in the past 4 weeks while men with EHS Grade 3 (sub-optimal erection hardness) and women whose partners are EHS Grade 3 report having

figure 2: Frequency of sexual intercourse in the past 4 weeks

had sex 8.5 and 7.0 times, respectively (figure 2). 40% of men find that less than optimal erection hardness can be seen as a medium or large problem and, not surprisingly, 87% of men and 77% of women are slightly to very highly interested in improving their sexual experience. Only three out of ten discussions about sexual health initiated by the doctor Though very few men in the region surveyed report speaking to their physician about erectile function, sexual health and medication (14%), seven out of ten who do report having initiated the discussion. In most of the cases, men tend to have these discussions with their general practitioner (33%) or urologist (32%). Men without erectile dysfunction (EHS Grade 4) are significantly more comfortable discussing these topics with their doctor (24% are very comfortable) as

compared to men who are EHS Grade 3 – only 12% are very comfortable to consult their physician concerning sexual health issues. The SHOW survey was preceded by two surveys on sexual health and satisfaction performed in 2006 and 2008: The Global Better Sex Survey (GBSS) with 12,563 participants and the Asian Pacific Sexual Health and Overall Wellness (AP SHOW) survey with 3,957 participating men and women. Both of these prior surveys also supported the finding that satisfaction with sex and erection hardness is associated with satisfaction with life overall. 1. Goldstein I et al. N Engl J Med. 1998;338:1397-404

Sponsor: Pfizer

Saturday 19 March 2011


Become an associate of the EAU Section of Female and Functional Urology! The EAU Section of Female and Functional Urology (ESFFU) aims to recruit highly motivated professionals who dedicate a significant part of their urological career to female and functional urology, a field of expertise that has recently been gaining renewed interest amongst young urologists. With the challenges and manifold developments in this field, one of the ESFFU’s goals is to organise a group of experts with thorough and highly specialised knowledge regarding the clinical practice of female and functional urology. Achieving this will help boost or further advanced the gains made in recent years. Moreover, the ESFFU believes that by strengthening the ranks of urologists specialised in this area, the issues they face today will be given more careful attention, enabling them to identify solutions that will improve treatment procedures. Equally important, the ESFFU recognises the central role played by specialists to rightly identify and address on a pan-European level what is lacking or should be developed in the current practice of female and functional urology. In this respect, the ESFFU has exerted efforts to represent urological specialists dealing with female and functional urology. With the urgent need to provide better healthcare, the ESFFU consider it crucial to have the active support of a group of associates that would ably assist the ESFFU Board achieve its long-term objectives.

The ESFFU associates have the following responsibilities: • Suggest or nominate candidates for ESFFU Board membership • Elect members of the ESFFU Board • Attend the ESFFU business meetings and collaborate in designing future activities • Help define new areas to be developed by the ESFFU Associates also have to meet the following qualifications: • They have to devote most of their working hours to female and/or functional urology; • They work in a teaching environment wherein the clinic they are working for is a recognised urological training centre; • They have authored or at least have-co-authored a peer-reviewed publication; • They are willing to accept responsibilities or perform tasks for the ESFFU whenever requested. Interested urologists and potential candidates can contact Astrid Venhorst of the Section Office of the EAU for further information at a.venhorst@uroweb. org. Candidates will receive a standard application form that needs to be properly filled out and returned. The ESFFU Board will select the successful candidates.

Ureteral access sheath When the working guidewire becomes the safety guidewire

NEW CONCEPT

Poster Session 20 Ureterorenoscopy 1 Saturday, 19 March 2011 from 16:00 to 17:30 Location: Hall E2 * this is my way

* this is my way

* this is my way

* this is my way

John Heesakkers Chairman EAU Section of Female and Functional Urology

Tübingen to host 1st Joint ESFFU-ESGURS meeting Functional urology and reconstructive surgery take centre stage in specialised joint meeting By Joel Vega For the first time the EAU Section of Female and Functional Urology (ESFFU) and the EAU Section of Genitourinary Reconstructive Surgeons (ESGURS) have collaborated to organise live simultaneous surgeries and practical demonstrations that aim to refine and master skills needed for the latest procedures in reconstructive surgery and functional urology. “We want to show how the newest surgical procedures are done. There are many new developments in functional urology and this requires that practitioners know how to master these procedures. We will discuss them in a technical way with the aim that participants learn how to execute these procedures themselves,” said Dr. John Heesakkers, ESFFU chairperson. To be held from October 6 to 8 this year at the University Hospital of Tübingen in Germany, the two-and-a-half day meeting will highlight surgical procedures in both reconstructive and functional urology, with topics ranging from urethral strictures, stress incontinence, male incontinence, OAB procedures, neobladders to troubleshooting issues, to name a few. “The collaboration with the ESGURS is important since we try to cover the whole spectrum of surgical procedures. The live surgeries will provide insights into how these procedures impact our daily practice and how we can best deal with the various technical and procedural challenges,” Heesakkers added. Together with co-chairmen Professors Dr. KarlDietrich Sievert and Serdar Deger, Heesakkers said the two groups have planned a programme that will include live simultaneous surgeries and cadaveranatomical demonstrations, workshops and state-of-the-art lectures. Around 25 to 30 major and minor procedures in reconstructive and functional urology will be demonstrated, with expert participants in the live surgeries actively interacting with the audience throughout the surgical sessions. Saturday 19 March 2011

Under the auspices and coordination of Dr. Sievert of the Urology Department in Tübingen, Heesakkers said the university hospital has one of the finest facilities suited for the live surgeries and cadaver-anatomy demonstrations. Not only is John Heesakkers the hospital and laboratory centre well-equipped, but the communication facilities allow simultaneous surgeries with direct transmission into a lecture hall.

Berlin, participants to the Tübingen meeting can also advance to observation fellowships or hands-on scholarship training in experts centres. “If there are participants who really want to go deeper into practise then they can apply for or register for training in specialised centres. This field of urology is rapidly evolving and we can see that there is not only heightened interest amongst young urologists but also

the need to back up or boost our skills in this specialised field,” according to Heesakkers. Organisers hope to attract around 250 participants to the meeting which marks one of the first of such joint or collaborative activities amongst the EAU section offices. Aside from providing specialised training, the event is also a platform for the section offices to recruit new members who can actively participate.

“For urological residents with interest in this field and even for junior practitioners the Tübingen meeting will be just the right occasion to refine and update their skills since the emphasis is on the practical know-how,” explained Heesakkers. Delivering optimal treatment Heesakkers noted that at the moment, technical developments have swept the field of functional urology with industry-driven devices and technologies that a gap exists between actual surgical know-how and how this growth can impact existing surgical treatment and medical therapies. “There is a need for us to examine these procedures, for them to be appreciated and learned, and we want to fill that gap in skills knowledge. We have to catch up with the developments that are going on in this field if we really want to deliver optimal treatment and care to our patients,” Heesakkers said. The Tübingen meeting is also the latest addition to the education and training activities launched or organised in collaboration with the EAU’s European School of Urology and the affiliated section offices who are specialised in reconstructive, functional and female urology. Complementing the annual masterclass on functional and female urology held in The laboratory of the Anatomy Institute at the University Hospital of Tübingen, Germany EUT Congress News

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Challenges and prospects in kidney transplantation From Ullmann’s first kidney transplantation in Vienna to xenotransplantation Dr. Markus Giessing Chairman of the ESTU Vice Director Department of Urology Heinrich Heine University Düsseldorf (DE) markus.giessing@med. uni-duesseldorf.de

Time is a healer? Not always, particularly for patients awaiting a renal transplantation. Unfortunately, a death on the waiting list is still a frequent event. Urologists must be made aware that they play a central role in performing a successful renal transplantation: as the transplanting surgeon, as part of a transplantation team or as a consultant of a transplantation centre.

on the topic of renal transplantation attracted a large number of professionals to the EAU Section of Transplantation Urology (ESTU) section meeting, we look forward to this year’s Vienna meeting. Besides a section meeting on “Renal Transplantation,” there will be a poster session and other interesting presentations. The ESTU meeting will also feature ‘a travel through time,’ looking at the first renal transplantation in Vienna to recent medical and surgical issues, and finally to the future of xenotransplantation. We are honoured with presentations from internationally renowned speakers. Challenges and prospects What has been learned at the beginning of the last century is one of the keys to success today. The chairman of the History Office of the EAU will take us back to the beginnings of renal transplantation more than a century ago: to the Vienna of the early 1900’s. The present – with KTX (kidney transplantation) having become a routine procedure- is marked by

“The ESTU meeting will also feature ‘a travel through time,’ looking at the first renal transplantation in Vienna to recent medical and surgical issues, and finally to the future of xenotransplantation.”

Finding new ways to increase the number of donors by expanding the donor pool is just one attempt to overcome organ shortage; prevention of graft failure yet another. Also, we will be dealing with malignancy in recipients, as they are getting older. Quality-of-life is an important issue for donor and recipient alike, and the different facets will be highlighted. Finally, the future of renal transplantation: to some of us the future has already started with even more minimal invasive techniques than pure laparoscopy. For the final part of this historic overview, we have invited a speaker who will present the most recent developments in xenotransplantation. With this comprehensive programme, we hope to provide the latest developments on medical and political issues in renal transplantation in Europe. With urologists playing a crucial role in successful renal transplantation, the ESTU invites professionals in this specialised field to join the section, poster, and other sessions here in Vienna. Whilst on the subject of time, in the near future- this year or in 2012- the ESTU board will organise an “EAU Masterclass in Renal Transplantation” – the details on the time and place will be announced shortly.

Urological expertise is of utmost importance, not only covering surgical issues but also in donor and recipient follow-up, solutions for post-operative complications, individually-tailored immunosuppressive strategies and in ethical as well as in quality-of-life issues. This knowledge is the basis for optimal patient treatment. After a very successful meeting in Barcelona in 2010, where the plenary, sub-plenary and poster sessions

one central issue: the lack of donor organs.

Saturday, 19 March 2011 10.15 - 14.00: Meeting of the EAU Section of Transplantation Urology (ESTU) Emerich Ullmann: pioneer of renal transplantation

Xenotransplantation: the future

Strengthening outcomes for patients receiving ADT* Prolia® – the first and only RANK Ligand inhibitor for the treatment of bone loss1

*ADT = androgen-deprivation therapy.

Reference: 1. Prolia® (denosumab), Summary of Product Characteristics, 2010. Prolia® (denosumab) Brief Prescribing Information

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Please refer to the SmPC (Summary of Product Characteristics) before prescribing Prolia®. Pharmaceutical Form: 1 ml solution for injection presented in pre-filled syringe containing 60 mg of denosumab. Contains sorbitol (E420). Indications: Treatment of osteoporosis in postmenopausal women at increased risk of fractures. Prolia® significantly reduces the risk of vertebral, non-vertebral and hip fractures. Treatment of bone loss associated with hormone ablation in men with prostate cancer at increased risk of fractures. Dosage and Administration: Single subcutaneous injection of Prolia® 60 mg is given once every 6 months. No dose adjustment for renal

impaired patients. Patients must be supplemented with calcium and vitamin D. Prolia® is not recommended in paediatric patients (age < 18). Contraindications: Hypocalcaemia. Hypersensitivity to the active substance or any of the excipients. Special warnings and precautions for use: Hypocalcaemia must be corrected by adequate intake of calcium and vitamin D before initiating therapy. Patients with severe renal impairment or receiving dialysis are at greater risk of hypocalcaemia. Clinical monitoring of calcium levels is recommended for patients predisposed to hypocalcaemia. Patients receiving Prolia® may develop skin infections (predominantly

© 2011 Amgen, Zug, Switzerland. All rights reserved.

DMO-IHQ-AMG-220-2011 01.2011

AMG05J11001_EAU_EUT_news_ad.indd 1

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cellulitis) leading to hospitalisation and should contact a healthcare professional immediately if they develop signs or symptoms of cellulitis. Osteonecrosis of the jaw (ONJ) has been reported with denosumab and with bisphosphonates. ONJ has been reported rarely with Prolia® 60 mg every 6 months. A dental examination should be considered prior to treatment with Prolia® in patients with concomitant risk factors (refer to SmPC). While on treatment, these patients should avoid invasive dental procedures if possible. Good oral hygiene practices should be maintained during treatment with Prolia®. The needle cover of the syringe contains dry natural rubber

(latex derivative), which may cause allergic reactions. Patients with rare hereditary problems of fructose intolerance should not use Prolia®. Interactions: No interaction studies have been performed. The potential for pharmacodynamic interactions with hormone replacement therapy (HRT) is considered to be low. Pregnancy and lactation: Prolia® is not recommended for use in pregnant women. A risk/benefit decision should be made in patients who are breast feeding. It is unknown whether Prolia® is excreted in human milk. No data are available on the effect of Prolia® on human fertility. Undesirable effects: Adverse reactions reported in placebo-

controlled clinical studies in women with postmenopausal osteoporosis and breast or prostate cancer patients receiving hormone ablation: Common (> 1/100, < 1/10) Urinary tract infection, Upper respiratory tract infection, Sciatica, Cataracts, Constipation, Rash, Pain in extremity; Uncommon (> 1/1,000, < 1/100) Diverticulitis, Cellulitis, Ear infection, Eczema; Very Rare (< 1/10,000) Hypocalcaemia. In the osteoporosis clinical program ONJ has been reported rarely with Prolia®. Please consult the SmPC for a full description of side effects. Pharmaceutical Precautions: Do not mix with other medicinal products. Store in a refrigerator (2°C–8°C). Do not freeze. Keep the pre-filled syringe in

the outer carton in order to protect from light. Do not shake excessively. Prolia® may be stored at room temperature (up to 25°C) for up to 30 days in the original container. Once removed from the refrigerator use within these 30 days. Marketing authorisation holder: Amgen Europe B.V., Minervum 7061, NL-4817 ZK Breda, The Netherlands. Further information is available from the SmPC. Date of PI preparation: May 2010. Adverse events should be reported. Legal Category: Medicinal product subject to medical prescription. Marketing authorisation number: EU/1/10/618/003.

21/01/2011 17:10

Saturday 19 March 2011


ESU Course: metastatic prostate cancer An interactive overview of the latest developments in androgen deprivation therapy Prof. Karl Pummer Medizinische Universität Graz Dept. of Urology Graz (AT)

Although the percentage of patients with metastatic prostate cancer at diagnosis has decreased over the past years, a significant proportion of patients undergoing local therapy will ultimately fail either biochemically, locally or distantly, thus becoming candidates for androgen deprivation therapy (ADT). Therefore, ADT is still an important issue for the management of patients with prostate cancer. During the ESU course on metastatic prostate cancer, Profs. Karl Pummer (Graz, AT) and Kurt Miller from (Berlin, DE), will hold a presentation on the current standard of care in both first and second line hormonal therapy, and give new insights into the management of castration-resistant and hormonerefractory prostate cancer which, after many years of stagnancy, has started to yield promising results. The presentations will include cases to be discussed with the audience to allow their active contribution. We would like to invite all participants to challenge the presenters with their questions and comments and be as interactive as possible. Hormonal therapy The era of hormonal therapy was ushered in by Charles Huggins in 1941, who established surgical castration as the treatment of choice for metastatic adenocarcinoma of the prostate. Ever since, androgen deprivation therapy (ADT) has been considered the most effective form of systemic therapy for men with metastatic prostate cancer, producing subjective and/

or objective responses in more than 80% of the patients. Hormonal therapy is based on the assumption that ADT will result in a reduced proliferative but enhanced apoptotic activity of prostatic tumour cells. However, although awarded with the Nobel prize for medicine, Huggins’s concept was only based on a very small number of patients, and it is no wonder that seven decades after its introduction a lot of controversy about the role of circulating androgens in prostate cancer still exists, particularly since prostate cancer seems to become more prevalent in those age groups where testosterone levels have already declined. In any case, there is no doubt that castrate levels of serum testosterone are required to achieve at least a transient therapeutic effect. In the last decades, surgical castration has been replaced by various forms of medical castration either with LHRH analogues or, more recently, with LHRH antagonists. But again, the evidence is poor that these kinds of treatment are equally effective since the few studies addressing this issue at all are substantially underpowered, even in combined analysis. In fact, the mere ability of these drugs to lower serum testosterone is the only surrogate for their therapeutic effectiveness. The interest in research on androgen deprivation therapy has increased in the last couple of years, and several interesting observations have been made. In this context, it has become evident that tissue levels of androgens are more important than serum levels. Whereas in previous years adrenal androgens have been blamed for comparably high androgen tissue levels following ADT (having been the rationale for combined androgen blockade for more than a decade), other mechanisms have been identified more recently. Responsiveness It has been shown, for example, that lower Gleason grade tumours have higher dihydrotestosterone (DHT)

tissue levels than high grade tumours. However, when ADT is applied, the decrease in tissue DHT is much less pronounced in high-grade compared to low-grade tumours. This could explain why highgrade tumours are less likely to respond to ADT and responses are usually of shorter duration. In addition, about 20 different genes have been found involved in androgen synthesis and metabolism. So far, some 127 single nucleotide polymorphisms (SNP) have been identified as leading to significant differences in hormone responsiveness. It turned out that the homozygote forms always do better than the heterozygotes with median times to progression ranging from 11 to 34 months, although both tumour characteristics and treatment are identical. Another important issue is the appropriate timing of ADT. Due to the introduction of PSA as a diagnostic tool in the late 1980s, the diagnosis of prostate cancer is made significantly earlier, thus leading to longer treatment periods than in previous years. Consequently, a variety of long-term side effects of androgen deprivation therapy have been recognised and need to be taken into account when counselling a patient. Progression Despite a high initial response rate in excess of 80%, castration-resistant progression will inevitably occur in most patients, many of whom will ultimately die from hormone-refractory disease. This is a difficult to treat condition, lacking an effective and generally accepted treatment regimen. In fact, hormonerefractory prostate cancer is the scourge of older men and it is expected to take the lives of an estimated 90,000 European males every year. For many years, chemotherapy has been considered the standard treatment for patients having failed first, second, and sometimes third line hormonal therapy, respectively. However, although some progress has been made, the average gain in survival is disappointingly low. Fortunately, the development of new and probably more potent but less toxic cytostatic agents continues.

Metastatic PCa

In addition, new forms of immunotherapy, as well as targeted therapy have emerged. Together with much better possibilities of innovative hormonal manipulations such as inhibitors of androgen synthesis, or with a new class of antiandrogens which show a higher binding affinity to the androgen receptor, inhibit the AR-complex translocation to the nuleus, and also prevent the complex from binding to the androgen responsive elements, respectively, these developments will give us a unique opportunity to substantially improve the treatment of our patients, and hopefully prolong their survival. Sunday, 20 March 2011 12.00 - 14.00: ESU Course 18: Metastatic prostate cancer

ESOU tackles PCa issues in joint meeting Re-visiting medical and surgical options in PCa therapy Dr. Alexander Govorov Department of Urology Moscow State Medical University Moscow (RU)

The meeting of the EAU Section of Oncological Urology (Chairman – Maurizio Brausi, Modena, Italy) will discuss issues relevant to the standard treatments and controversial aspects of oncological urology. An internationally renowned faculty as well as ESOU Board members will participate today in the meeting, to be held in collaboration with the EORTC-GU and the ESUR, which will feature state-of-the-art lectures and debates. S. Culine (Montpellier, France) will present some new data on the second-line hormonal treatment in metastatic prostate cancer patients. The response to second-line antiandrogens is typically of short duration, and none have shown sufficient activity in castration-resistant prostate cancer (CRPC). Last year the encouraging antitumour activity in patients with CRPC was recorded with MDV3100, which is an androgen receptor antagonist that blocks androgens from binding to the androgen receptor and prevents translocation of the receptor to the nucleus and recruitment of co-activators. In the other study, Sipuleucel-T, an autologous active cellular immunotherapy, has shown evidence of efficacy in reducing the risk of death among men with metastatic CRPC. Several clinical trials have demonstrated the safety and efficacy of abiraterone acetate - a small molecule that irreversibly inhibits CYP17 - in men with metastatic CRPC. Recently, a randomised phase 3 trial evaluating abiraterone Saturday 19 March 2011

acetate in docetaxel-refractory CRPC patients demonstrated a survival improvement over placebotreated patients (14.8 vs 10.9 months; HR 0.646; P < 0.0001). A similar trial in the pre-chemotherapy setting has completed accrual and is undergoing analysis. Multimodal approach A presentation from A. Heidenreich (Aachen, Germany) will open the debate on multimodality approach for high-risk locally advanced prostate cancer. In general, designation of high-risk prostate cancer implies the presence of disease that is likely to become progressive or lethal if not managed aggressively. The major issues surrounding the clinical management of high-risk prostate cancer revolve around the definition of high-risk disease as well as the benefits of multiple modality therapy. Over the years, numerous attempts have been made to develop risk assessment tools such as risk categories, scoring systems and nomograms, but a widely accepted definition is yet to be determined. Several multimodality therapeutic approaches were discussed, especially in combination with androgen ablation, to improve the outlook for men with high risk or locally advanced prostate cancer.

Maurizio Brausi

the issue of frozen section assessment of pelvic lymph nodes during radical prostatectomy (RP). The routine frozen section of pelvic lymph nodes is common but not uniformly used, and has been questioned by several studies. RP may be aborted if a nodal metastasis is found on frozen section, under the assumption that patients with metastatic cancer do not benefit from radical surgery. However this assumption has been challenged by studies showing long-term survival advantage in patients with Transvaginal NOTES-assisted metastatic disease who laparoscopic nephrectomy, Figure underwent RP and courtesy of Prof. A. Alcaraz androgen ablation compared with those who received androgen ablation alone. NOTES nephrectomy Finally, the role of single port / NOTES nephrectomy will be debated. Overall, minimally invasive scarless surgery is a challenging technique, which may improve quality of life and offers an advantage over conventional laparoscopy. LESS (laparoscopic single-site) and NOTES (natural orifices transluminal endoscopic surgery) are complementary techniques that should be included in this new concept.

retraction and limits the access for good haemostatic devices.

The NOTES approach avoids large skin incisions and thus reduces postoperative pain, prevents abdominal hernia development and improves cosmetic results with an earlier recovery of the patient. However, pure NOTES has the disadvantage that the employed instruments are flexible, which prevents proper

Saturday, 19 March 2011 10.15 - 14.10: Joint meeting of the EORTCGU Group in conjunction with the ESUR and the ESOU: Translational research and multidisciplinary approach to urological cancers

To overcome these limitations “hybrid-NOTES,” combining NOTES access and a minimum number of abdominal trocars possible, has been developed. The objective of this technique is to make surgical manoeuvres feasible and safe while maintaining the philosophy of NOTES surgery.

Bob Djavan

The importance of multimodality approach for urogynaecological cancers will be presented by Maurizio Brausi (Modena, Italy), while Bob Djavan (New York, US) will highlight several key messages on

EUT Congress News

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Wherever it is, weâ&#x20AC;&#x2122;ll catch it Kidney and ureteral stone retrieval.

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COM FOR E VISIT U MOR S E IN AT H ALL FO Z STAN D 38

Saturday 19 March 2011


The elusive urothelial stem cell Uniquely self-generating and long-lived cells show great promise Prof. Jennifer Southgate Dept. of Biology University of York York (UK)

As the epithelium that lines the ureters and bladder, urothelium is a remarkable tissue. Not only is it recognised as the tissue that forms the tightest barrier in the body, but it also has an exceptional regenerative ability, being regarded as one of the most rapidly repairing of all mammalian tissues.

Epithelial stem cells are generally considered as long-lived cells that divide relatively rarely by asymmetric division to both sustain the stem cell population and give rise to a differentiating population of cells of limited proliferation potential. In some epithelia, including cornea and prostate, the specific stem cell populations have been identified. Although some effort has been made to find a specific stem cell population in urothelium, the precise identification of this cell remains elusive so far and it is not currently possible to unequivocally identify or isolate a human urothelial stem cell.

differential attachment to extracellular matrix proteins, and examined for differences in proliferative capacity. This may separate cells according to position in the urothelium (e.g. basal versus superficial) rather than by more nebulous criteria and the question of whether in fact a specific stem cell population exists or whether all urothelial cells retain “stemness” has yet to be fully addressed.

Stem cell populations The assumption that progenitor cells reside within the urothelium means that strategies to isolate the entire urothelial cell population must by default contain all progenitor cells. Human urothelium may be separated cleanly from the basement membrane of surgical samples, and the sheets of cells further disaggregated into single cells.

Practical use Why should we be interested in isolating urothelial stem cells? These elusive cells may contain the basis for understanding diseases A fluorescence image of urothelial cells after differentiation in vitro such as cancer, or even chronic benign conditions, such as interstitial cystitis, where there may be an aberration of urothelial regeneration. Stem cells However, the use of autologous urothelial cells may may also have practical applications – for example in not be possible in patients with high-grade or tissue engineering. invasive urothelial carcinoma, or with benign bladder conditions associated with compromised urothelial proliferation potential.

Most epithelia, such as those of skin and gut, show a continuous turnover, as cells are continually lost from the differentiated cell compartment to be replaced by At this point the entire isolated population may be cells from the proliferative pool. By contrast, urothelial seeded into culture, or separated into subcells are long-lived and under normal conditions, populations based on specific characteristics, such as mitotically-quiescent. Unlike other epithelia, urothelium appears to have evolved to respond rapidly to tissue damage by enabling all cells, irrespective of position, to switch out of quiescence into a highly proliferative state. This presumably reflects the critical importance of maintaining an intact urinary barrier and makes it a most interesting tissue, not least from the point of view of understanding the mechanisms that regulate the switch from differentiated to proliferative/regenerative states. Self-regeneration A question that arises is the nature of the progenitor or stem cell population. As with other epithelia, urothelium is self-regenerating, meaning that the progenitor population resides within the urothelium itself, and is not recruited from elsewhere, such as the A growing colony of urothelial cells bone marrow.

“Urothelium appears to have evolved to respond rapidly to tissue damage by enabling all cells, irrespective of position, to switch out of quiescence into a highly proliferative state”

For a number of years we have been investigating the effects of combining in vitro-propagated autologous urothelium with a de-epithelialised segment of bowel in a so-called “composite cystoplasty.” We have demonstrated the ability to generate clinically-useful amounts of urothelial cells by in vitro propagation of normal human and porcine urothelium.

This raises the question as to whether we can identify alternative sources of stem cells to deliver autologous urothelium for transplantation. The introduction of specific stem cell-associated transcription factors into somatic cells to generate “induced pluripotent stem cells” (iPSC) appears to be the most promising route for generating patient-specific stem cells. However, although some of the critical factors required for urothelial differentiation have been identified, we are currently some way off being able to direct pluripotent stem cells into functional urothelium. Sunday, 20 March 2011, 11.00 - 12.00: Sub-plenary Session 2: Stem cells State-of-the-art lecture: Stem cell tissue engineering

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EUT Congress News

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TODAYâ&#x20AC;&#x2122;S EUROPEAN UROLOGY EVENTS MARCH 19TH SURGERY IN MOTION During this session, authors of the top rated contributions published in 2010 will discuss their most recent technical refinements with novel videos and supplementary long term data. Presenters: Robotic Assisted Partial Nephrectomy: Alex Mottrie (Belgium) Robotic Assisted Radical Prostatectomy: Henk van der Poel (The Netherlands) Robotic Assisted Radical Prostatectomy: Richard Gaston (France) Robotic Assisted Pyeloplasty: Giorgio Guazzoni (Italy) To be held in Lounge 6 from 10:30 to 12:00.

AWARD SESSIONS Come watch this yearâ&#x20AC;&#x2122;s Award winners presentation. Best Scientific Paper 2010 European Urology: Karim Bensalah Best Scientific Paper 2010 Fundamental Research: Minja J. Pfeiffer Best Scientific Paper 2010 Clinical Research: Marcel Hruza European Urology Platinum Award: Guido Dalbagni and Monique Robol To be held in Foyer F from 14:15 to 15:25. Residents Corner Award: Jean-Nicolas Cornu and Mario W. Kramer To be held in Hall F2 at 17:00.

europeanurology.com 22

EUT Congress News

Saturday 19 March 2011


Tiselius examines stone disease in honorary lecture EULIS honours distinguished Swedish expert Prof. Palle Osther Chairman EAU Section of Urolithiasis (EULIS)

All sessions showing the webcast symbol will be

published 187 original peer-reviewed papers, 114 book contributions and has given more than 240 oral presentations.

available online at www.eauvienna2011.org

Despite his busy medical career, Tiselius has supported and guided young researchers who eventually received their doctoral degrees. Aside from his academic work, Tiselius has been one of the main Prof. Hans-Göran Tiselius, considered one of the contributors to the EAU Guidelines on Urolithiasis. He world’s finest opinion leader in the field of urolithiasis, will present the honorary lecture during was the first to perform Extracorporeal Shock Wave Lithotripsy (ESWL) in Scandinavia, and is known to the EAU Section of Urolithiasis (EULIS) meeting have significantly contributed to developing and scheduled today. refining ESWL to a high level of excellence. His outstanding research and theories on crystallisation In his honorary EULIS lecture scheduled from 10:20 am, Prof. Tiselius will speak on “Studies on the role of processes in the renal nephron have bridged our understanding of the stone forming process from calcium phosphate in the process of calcium oxalate earlier data mainly based on research performed in crystallization and calcium oxalate stone formation.” whole urine, whilst his recent research also describes The lecture will highlight new pathophysiological aspects of stone disease, which will potentially guide stone disease more as a micro-environmental disorder. When he is not into “the stone business,’ doctors into new ways of treatment. Hans-Göran Tiselius is a skilful and respected artist, painting in oil his impressions of the magnificent Tiselius, who officially retired in 2009 from his Swedish natural landscapes. clinical work at the The EULIS meeting will also feature issues such as, Renal Stone Unit of “Treating troublesome ureteric stones: How to avoid Karolinska University problems,” with experts lectures, a debate and a Hospital, received his panel discussion on topics such as stenting, medical degree in 1972, laparoscopy and URS in the treatment of large ureteric completing his PhD stones. degree only two years later. His has dedicated Saturday, 19 March 2011 his professional life to Hans-Goran Tiselius 10.15 - 14.00: Meeting of the EAU Section of the study and treatment Urolithiasis (EULIS) of kidney stone disease Urolithiasis – what’s up doc? and is widely known to be at the forefront in both basic and clinical stone research. Tiselius has

137_09_GB_270_194_EAU11__ 25.01.2011 10:59 Seite 1

As the leading manufacturer in uretero-renoscopy, Richard Wolf has made a major breakthrough in the field of flexible uretero-renoscopes. With the first flexible dual-channel laser uretero-renoscope, an instrument has come onto the market that was developed specifically for laser lithotripsy. Up to now, laser lithotripsy with a flexible uretero-renoscope was an awkward and timeconsuming application, but this instrument simplifies handling and speeds up the intervention considerably. The main features of this new flexible uretero-renoscope are the two separate working or irrigation channels and a special laser shifter. One 3.3 Fr. working channel is intended for a 230 µm laser fibre that can be advanced with the aid of the fibre shifter to make contact with the stone. The second channel is also 3.3 Fr. and can be used for a stone basket or auxiliary instruments up to 3 Fr. allowing stone fragments to be retrieved immediately following laser lithotripsy. Apart from using both working channels for irrigation with auxiliary instruments inserted, the user can also take advantage of continuous irrigation and enjoy the benefits of an excellent, clear picture quality. The user can also make use of the full 270° deflection without any restrictions with both a 230 µm laser fibre and a 1.5 Fr. stone basket inserted. We are looking forward to your visit at our booth DX7 in the foyer between hall D and X.

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What to do around Vienna Suggested entertainment taking place during the EAU Congress After a long day exchanging urological developments and taking in the expansive Scientific programme, take a change of scenery and explore the vibrant city of Vienna. Vienna’s cultural history means it’s ideally suited for catching the odd performance, be it ballet, an opera or a concert. Naturally, many of the city’s delights can be enjoyed year-round. City tours involving history and architecture, and the city’s many museums and parks are all recommended events for those interested in this Central European capital. But here we point out some specific events of a more topical nature. In the weekend and the days surrounding the 26th Annual

EAU Congress, certain must-see performances, exhibits and events are taking place around Vienna. The baroque palace of the Lower Belvedere, for instance, plays host to a temporary exhibit of the works of Egon Schiele, one of Austria’s foremost expressionist artists of the early 20th century. At the Academy of Fine Arts, meanwhile, a collection of the works of Dutch painter Hieronymus Bosch is on show, a rare treat for the visiting art aficionado. Mozart The Mozarthaus is showcasing a special exhibit at the time of the Congress, titled “You will see how merry

we can be” – Mozart and women. It deals with the Austrian composer’s relationships with his wife and mistresses as preserved in their written correspondence of the time. Mozart’s music can also be heard around Vienna in the days of the Congress. His popular opera The Magic Flute will be performed at the Volksoper (People’s Opera) on Saturday the 19th. Additionally, his famous Requiem will be played on period instruments at the Karlskirche, also on Saturday evening. On Tuesday the 22nd, the Volksoper will host a ballet featuring Mozart’s and other composer’s works, Marie Antoinette. For those more inclined to modern composers, Arabella by Richard Strauss is on at the Vienna State Opera on Monday the 21st. Box office tickets are often made available on the day of the performance itself. Low-key Be sure to take the opportunity to enjoy some more low-key live music as well. Congress visitors interested in a lively night out are in for a treat at the city’s many clubs. Vienna’s burgeoning live music scene incorporates jazz, blues and contemporary alternative rock. The more intimate and spontaneous atmosphere should appeal to visitors looking to unwind after a long day at the busy Congress. Vienna is a perfect city to explore on foot: every street has its own story and plethora of architectural styles to admire, from the Habsburg Baroque to the dawn of the 20th century’s Jugendstil. On Saturday, a large flea

A casual stroll is rewarding in itself, considering the wealth of architecture on offer

market is happening at the famous Naschmarkt, a vast produce market popular for locals as well as tourists. This should appeal to those looking for some authentic souvenirs.

The (Lower) Belvedere www.belvedere.at/ The Academy of Fine Arts www.akbild.ac.at/ The Mozart House www.mozarthausvienna.at/ The People’s Opera www.volksoper.at/ The Vienna State Opera www.wiener-staatsoper.at/ …and check out www.wien.info/ for all your other touristic needs Egon Schiele, self-portrait (1912). Temporary exhibit at the Lower Belvedere

NEED SOME QUALITY TIME? We cordially invite you to attend the Platinum Hour drinks reception. Join us at the European Urology booth #D4 every day from 16:00 to 18:00 to toast the success of European Urology, “Your” Platinum Journal.

europeanurology.com

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EUT Congress News

Saturday 19 March 2011


European Urology Residency Curriculum by EBU Improving urologists’ training: a dimension of competence to core procedures Prof. Stefan Müller EBU Committee Chairman Bonn (DE)

The European Board of Urology’s (EBU) Accreditation Committee oversees the curriculum for urological training in Europe. In accordance with European legislation, it covers a minimum period of five years

of specialty training and it is designed to create ethical and professional competence. The training aims to create a broad base of theoretical knowledge in emergency and elective cases, build up experience and the practical skills necessary for a urologist to practice independently (Fig 1). The curriculum should serve as a guide and a template against which European training schemes can be compared. It follows a logical framework starting with the need for all trainees to understand the basis of disease, history taking, proper documentation, good communications, informed consent, and adequate time management. Most of these will be generic to any medical training, but the practical solutions are left to individual educators and institutions.

Learning is a lifelong process, and the likelihood that large areas of urological disease will be treated and managed without surgical intervention becomes more apparent each day. The EBU believes that the care of a patient with urological disease is best delivered by a trained urologist, who delivers system-specific therapy. As part of this process, the curriculum asks for regular assessment meetings to improve the personal interaction between trainees and their trainers. A web-based logbook of procedures performed each year, as well as an accurate record of the trainees’ attendance at congresses, workshops, and courses; together with a list of congress presentations and publications in journals will help to ensure that areas of urological practice are not taken over by other specialists who focus on drugs or techniques with no consideration for the patients’ total urological care. The ability to demonstrate awareness of change and how to implement that change is an integral part of training and of this curriculum. Trainees will know how well they are doing in relation to their own national colleagues as well as other residents across Europe. Moreover, trainers will have information about the extent of their training in comparison with other centres throughout Europe. In the past, many training schemes were based on specific numbers of procedures to be completed by the trainee but without an evaluation of his competence. The EBU, feeling that the accumulation of numbers in itself is not a good example of satisfactory training, has worked out a number of ‘core’ procedures. These have to be carried out competently to enable a urologist to practice independently and safely.

Figure 1: Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7.

There are 14 procedures in which, we believe, the trainees’ competence to perform is mandatory. All trainees should be able to present a satisfactory skills assessment record at the end of training. Even within this minimum skill set there are some procedures, in some countries, that are carried out by other

specialties, e.g. percutaneous nephrostomy by interventional radiologists. Nevertheless, we hope that this list will serve as guide or reference to trainers as to whether such a situation is satisfactory. The EAU has devoted immense efforts and resources to teaching and training through their congresses, workshops, and training courses over the last 20 years. The Fellow of the EBU (FEBU) of the future will have sat “in-service” tests of knowledge, will have passed practical assessments and shown competence in the core procedures. By passing the final written and oral examinations, they will demonstrate that urological care can be delivered safely and expertly by urologists who will be recognised as the specialists for managing all urological maladies.

European Board of Urology - Accreditation Committee Prof. Stefan Müller EBU Committee Chairman Bonn (DE)

Mr. Peter Whelan EBU Committee Expert Leeds (UK)

Dr. Artur A. Antoniewicz - Warsaw (PL) Dr. Margrethe Andersen - Odense (DK) Dr. Luis Campos Pinheiro - Lisbon (PT) Dr. Karl German - Birkirkara (MT) Prof. Alberto Matos Ferreira - Lisbon (PT) Prof. Rien Nijman - Groningen (NL) Dr. Ales Petrik - Ceske Budjovice (CZ)

http://historyandrology2011.uroweb.org

http://eulis.uroweb.org

5 th International Congress on the History of Urology in conjunction with the Andrology Update 2011

1st Meeting of the EAU Section of Urolithiasis (EULIS)

3-4 June 2011, Budapest, Hungary Organised by the European Association of Urology, European Section of Andrological Urology (ESAU) and the Semmelweis University Dept. of Urology, Budapest

7-10 September 2011 London, United Kingdom EAU meetings and courses are accredited by the EBU in compliance with the UEMS/EACCME regulations

European Association of Urology

Saturday 19 March 2011

European Association of Urology

EUT Congress News

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Part 2: runner-up winners for best abstracts UK, Japan and Saudi Arabia lead prize-winning studies Second Prize, Best Abstract (Oncology) Abstract Nr: 435 Title: A prospective randomised trial of Hexylaminolevulinate (Hexvix) assisted transurethral resection (TURBT) plus single shot intravesical mitomycin (MMC) versus conventional white light TURBT plus single shot MMC in newly presenting bladder cancer Topic: 8.3 Urothelial tumours: Management of superficial tumours

Editorial Note: We are re-printing on this page the four abstracts submitted to this year’s congress that won the second and third prizes in both Oncology and NonOncology categories. Researchers from the United Kingdom made a strong showing this year in both categories, whilst contributors from Japan and Saudi Arabia also topped the best abstract list.

Below are the original, unedited abstracts without additional editorial commentary: Second Prize, Best Abstract (Non-Oncology) Abstract Nr: 689, Title: Does varicocele repair improve male infertility? An evidence-based perspective from a randomized controlled trial Topic: 14 Infertility Author list: Abdel-Meguid, T.A., Al-Sayyad, A.G., Tayib, A.M.S., Farsi, H.M.A. King Abdulaziz University Medical City, Dept. of Urology, Jeddah, Saudi Arabia Introduction & Objectives Background: Randomised-controlled trials (RCTs) addressing varicocele treatment are scarce with conflicting outcomes. Objective: To determine whether varicocele treatment is superior or non-superior to notreatment in male infertility; through an evidencebased perspective. Material & Methods Design and Setting: A prospective, non-masked, parallel-group, RCT with 1:1 concealed computer generated random-allocation; conducted at authors’ institution between February 2006 and October 2009. Participants: Married men, 20-39 yr old, with infertility ≥ 1 yr, clinically palpable varicoceles, and impaired at least one semen parameter (sperm density < 20X106/ml, progressive motility < 50% or normal morphology < 30%) were eligible. Exclusions were men with subclinical or recurrent varicoceles, normal semen parameters, azoospermia, abnormal hormonal profile, additional causes of infertility, female partner infertility, female partner ≥ 35 yr old; or who refused randomization. Sample size analysis prior to study commencement suggested 68 participants per arm with statistical power of 80% and alpha level at 5%.

Abstract presentation during the 25th Annual Congress in Barcelona last year

Author list: O’Brien, T.S.1, Chatterton, K.1, Ray, E.R.1, Wilby, D.1, Chandra, A.2, Dickinson, F.1, Khan, M.S.1, Thomas, K.1

Intervention: participants were randomly allocated to observation (control arm; CA) or subinguinal microsurgical varicocelectomy (treatment arm; TA). Semen analyses were obtained at baseline (3-analyses); and at follow-up months 3, 6, 9 and 12. Mean of each sperm parameter at baseline and follow-ups were determined.

Guys Hospital, Dept. of Urology, London, United Kingdom, 2 Guys Hospital, Dept. of Pathology, London, United Kingdom

Measurements: Spontaneous pregnancy rate (primary outcome); changes from baseline of mean of semen parameters, and occurrence of adverse effects (AEs) (Secondary outcomes) during 12-months follow-up. P <0.05 was significant. Results Analysis included 145 participants (CA=72; TA=73) with mean ± SD age=29.3 ± 5.7 (CA), and 28.4 ± 5.7 (TA) (p=0.34). Baseline demographic, clinical and semen characteristics in both arms were comparable. Spontaneous pregnancy was achieved in 13.9% (CA) vs. 32.9% (TA), with odds ratio=3.04 (95% CI=1.33-6.95) and number needed to treat to benefit (NNT) =5.27 patients. In CA within-group analysis, none of semen parameters revealed significant changes from baseline: sperm density (p=0.77), progressive motility (p=0.88) and normal morphology (p=0.77). Conversely, in TA within-group analysis, mean of all semen parameters improved significantly in follow-up versus baseline (p <0.0001). In betweengroup analysis, all semen parameters improved significantly in TA vs. CA (p <0.0001). No AEs were reported. Conclusions Our RCT provided level-1b-evidence of superiority of varicocele repair over observation in infertile men with clinically palpable varicoceles and impaired semen quality; with increased odds of spontaneous pregnancy and improvements of semen characteristics within one year of follow-up.

1

Introduction & Objectives Photodynamic ‘blue-light’ cystoscopy is recognised to provide a more complete assessment of a bladder tumour than white-light cystoscopy. Whether this translates into lower recurrence rates following initial resection is unknown because previous studies often included patients with recurrent tumours; did not offer the control group best current treatment i.e. TURBT plus single shot intravesical chemotherapy; used surrogate end-points e.g. histology rather than recurrence; and in older trials used 5-aminolaevulinate as the photosensitiser. Material & Methods 249 patients enrolled at a single centre, between March 2005 and April 2010 into a randomised trial of Hexvix assisted blue-light (B/L) TURBT plus single shot intravesical MMC versus white-light (W/L) TURBT plus single shot MMC. All patients had suspected non-muscle invasive bladder cancer (NMIBC) based on appearance at flexible cystoscopy or imaging. Patients with a previous history of bladder cancer were excluded. 129 patients randomised to B/L and Third Prize, Best Abstract (Oncology) Abstract Nr: 833 Title: Statins reduce the androgen sensitivity and cell proliferation by decreasing the androgen receptor protein in prostate cancer cells Topic: 7.1 Prostate cancer: Basic research Author list: Yokomizo, A., Shiota, M., Kashiwagi, E., Kuroiwa, K., Tatsugami, K., Inokuchi, J., Takeuchi, A., Naito, S. Kyushu University Graduate School of Medical Sciences, Dept. of Urology, Fukuoka, Japan

Third Prize, Best Abstract (Non-Oncology) Abstract Nr: 479 Title: Local estrogen enhances the innate immune defences of vaginal epithelium by increasing secretion of beta-defensin-2 antimicrobial peptide Topic: 5 Infectious diseases Author list: Ali, A.S.M.1, Stanly, T.2, Lanz, M.2, Townes, C.L.2, Hall, J.2, Pickard, R.S.1 Newcastle University, Institute of Cellular Medicine, Newcastle upon Tyne, United Kingdom, 2 Newcastle University, Institute of Cell and Molecular Biosciences, Newcastle upon Tyne, United Kingdom 1

Introduction & Objectives Recurrent urinary tract infection (rUTI) is a troublesome consequence of post-menopausal vaginal atrophy. Infection typically begins with vaginal colonisation by uropathogenic Escherichia coli (UPEC) with subsequent urethral ascent and bladder infection. In healthy women, colonisation is prevented by a variety host innate immune mechanism including synthesis of cationic antimicrobial peptides (AMPs). Localised estrogen treatment reduces rUTI in post-menopausal women and interestingly also in pre-menopausal women. However, systemic adverse-effects and concerns regarding cancer risk have limited its usage. In addition oral and systemic administration of estrogen does not seem to confer the same benefits. Some AMPs are known to be responsive to increased levels of hormone. We investigated the hypothesis that estrogen reduces rUTI risk by increased vaginal AMP expression.

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EUT Congress News

Material & Methods The VK2-E6/E7 vaginal epithelial cell-line was used as an in vitro model to examine previously identified urogenital AMPs: beta-defensin-1, beta-defensin-2, human alpha-defensin-5 and cathelicidin. Cells were cultured in serum-free growth medium with or without physiological concentrations (4nM) of 17-beta-estradiol, and were challenged with either 105 CFU of NU14 E.coli (a UPEC strain) or bacterial components including 0.5-1μg/ml lipopolysaccharide (LPS) and 100ng/ml of flagellin for 48 hours.

Introduction & Objectives Statins (3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors) are cholesterol-lowering drugs that are widely used to prevent and treat atherosclerotic cardiovascular disease. Recent epidemiological studies suggest that statins reduce serum prostate-specific antigen (PSA) levels and decrease the risk of prostate cancer. In the present study, we determined the molecular mechanisms related to the regulation of PSA, androgen receptor (AR) and cell proliferation in prostate cancer cell lines by statins.

Results In the absence of estrogen, no response in AMP mRNA expression or peptide synthesis was detected in response to challenge by bacteria, LPS or flagellin. Of the AMPs analysed, only betadefensin-2 was significantly up-regulated in cells grown in estrogen. This response associated with LPS treatment resulted in significant rises in both mRNA, measured by qRT-PCR (n=6, p<0.05), and peptide levels, measured by ELISA (n=3, p<0.05) at 48-hours. Beta-defensin-2 expression demonstrated a dose related response to estrogen.

Material & Methods Western blotting, quantitative real-time polymerase chain reaction, cytotoxicity analysis and a cell proliferation assay were used to resolve the regulatory role of statins (mevastatin and simvastatin) in three prostate cancer cell lines, RWPE-1, 22Rv1 and LNCaP. Castration-resistant derivatives of LNCaP cells (CxR), hydrogen peroxideresistant LNCaP cells (HPR50) and 22Rv1-AR-GFP cells that were derived from 22Rv1 cells and stably expressed AR- Green Fluorescent Protein (GFP), were also used in this study.

Conclusions These data suggest that up-regulation of betadefensin-2 AMP secretion by vaginal epithelium functions as a mechanism by which local estrogen enhances immunity against rUTI. An improved understanding of this mechanism may facilitate the design of novel local agents that can enhance the endogenous antimicrobial response without the concomitant hormonally-related adverse-effects of estrogen.

Results Western blotting revealed that both mevastatin and simvastatin down-regulated AR and PSA protein in a time and dose dependent manner in LNCaP, 22Rv1 and CxR cells. However, these statins did not down-regulate AR mRNA expression, while they decreased PSA mRNA. This finding indicated that AR expression was not transcriptionally regulated by mevastatin and

120 to W/L. 183 (73%) patients were male; mean age 68 (range 29-95); 201 (80%) presented with macroscopic haematuria. Primary endpoints: tumour recurrence within 3/12 and at 12/12 post initial TURBT (Pearson chi square). Results In 207/249 (83%) histology revealed cancer, and in 184/207 (89%) the diagnosis was NMIBC (B/L 99: W/L 85). Final TNM classification was low grade/ G1pTa =98 (B/L 50: W/L 48) ; high grade/G3pTa = 28 (B/L 13:W/L 15); high grade/G3pT1=57 (B/L 35:W/L 22). Primary CIS was seen in one patient and secondary CIS in 37 (B/L 25:W/L 12). 128/184 (70%) patients received single dose MMC (B/L 62:W/L 66). MMC was not administered to 56 (30%) patients due to concerns about the safety of intravesical MMC after a deep resection. 8/184 (4%) (B/L 5:W/L 3) patients did not undergo a cystoscopy within 3/12 (3 died, 2 refused, 2 lost, 1 discharged). There was no statistically significant difference in recurrence between the 2 arms at 3 or 12 months. 3/12 recurrence: 17/94 (18%) B/L vs. 14/82 (17%) W/L (p=0.86). By November 2010, of those 145 patients (B/L 77:W/L 68) recurrence free at 3/12, 10 patients (4 B/L:6 W/L) were still awaiting their 12/12 cystoscopy, and a further 8 patients had been lost to follow up (B/L 7: W/L 1) (5 died, 1 refused, 2 lost). Recurrence at 12/12 was seen in 10/66 B/L (15%) vs. 12/61 (20%) W/L (p=0.50). No adverse reactions attributable to Hexvix were seen. Conclusions Although photodynamic diagnosis offers a more accurate diagnostic assessment of a bladder tumour, in this trial we have not shown that this reduces recurrence. Novel treatment strategies need to be developed to be used in combination with improved diagnostic tools, such as photodynamic diagnosis, if recurrence rates are to be reduced in NMIBC.

simvastatin. The protease inhibitor MG132 inhibited the down-regulation of AR protein which suggested that statins decreased AR protein levels by increasing AR proteolysis. And the application of cycloheximide, a translational inhibitor, did not affect the down regulation of AR in the presence or absence of dihydrotestosterone (DHT), indicating that statins did not regulate AR expression at the translational level. Furthermore, exogenously introduced expression vector AR-GFP was also down-regulated by mevastatin, which again supports the data that statins down-regulated AR by proteolysis. Finally, statins reduced cell proliferation in AR positive cells (LNCaP and 22Rv1) but not in AR negative cells (RWPE-1 cells), suggesting that statins regulate cell proliferation via AR expression. In addition, cell proliferation assay at various concentrations of DHT showed that statins decreased androgen sensitivity in LNCaP cells. Conclusions Statins decreased AR protein by proteolysis but not mRNA transcription. The drop in AR levels resulted in a reduction in androgen sensitivity and a decrease in cell proliferation in AR positive prostate cancer cells. This observation could be a one of the molecular mechanisms that statins prevent prostate cancer.

Audience at the abstract session during the 2010 congress in Barcelona

Saturday 19 March 2011


Announcement

EAU-RF Basic Research Grant

The EAU Research Foundation’s (EAU-RF) announces the official call for applications to the first EAU-RF Basic Research Grant to a young urologist who will focus in the next two to three years on basic research work in urological oncology. In a milestone development of the EAU-RF’s efforts to advance urological research training a unique collaboration between the EAU-RF and Amgen has resulted in a fellowship position been created, supported by Amgen, at the Bone Oncology Group, Nuffield Department of Surgical Sciences at Botnar Institute, University of Oxford (UK). The appointment to this position will be administered by the EAU-RF Basic Research Committee. The Bone Oncology Group, Nuffield Department of Surgical Sciences at Botnar Institute, University of Oxford (UK), headed by Prof. Freddie C. Hamdy, has a proven track record in achieving significant outcomes and offers the project the “Role of microRNA in the development of bone metastasis.” The successful candidate will join the distinguished research team in Oxford starting this year.

Call for applications for the first Basic Research Grant

“We consider this research grant a breakthrough development particularly with regards to Basic Research since this kind of work embodies the EAURF’s mission and objectives. We can only bring the state of urological research to the next level if we actively support crucial work being done in basic science,” says EAU-RF Chairman Prof. Peter Mulders.

8th men’s health world congress 4th european men’s health conference

Conditions for application • Young urologist • In last-year residency • Recommendation letter • Motivation letter • Detailed CV • Applications in English Deadline for application 1 April 2011 How to apply Potential candidates, who are in their last-year residency, are required to submit a recommendation letter, a motivation letter and their detailed CVs to the EAU-RF at the following address: EAU Research Foundation European Association of Urology, PO Box 30016, 6803 AA Arnhem, The Netherlands Fax: + 31 (0)26 389 06 74 The EAU-RF will also welcome interested applicants at their booth Z50 at the forthcoming 26th Annual EAU Congress in Vienna, Austria from 18 to 22 March 2011. The EAU-RF Basic Research Grant is supported by an unrestricted educational grant from AMGEN

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MEN AND AGEING: A LIFE-LONG PROCESS! IMPROVING HEALTH BY ENSURING INTERDISCIPLINARY CARE 2 – 5 October 2011, Vienna / Austria ’S HEALT EN 2001

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SUPPORTED BY AN UNRESTRICTED GRANT FROM

SUNDAY 20 th MARCH 2011 - 17.30-19.00 • HALL E1 - YELLOW LEVEL

ON BEHALF OF OUR DISTINGUISHED FACULTY, WE ARE PLEASED TO INVITE YOU TO THE FERRING-SPONSORED SYMPOSIUM:

U/070 /03/11

Chairman: Mr John Anderson Moderator: Professor Laurence Klotz 17.30 17.35

Professor Laurence Klotz

17.35 17.55

Professor Jelle Barentsz

17.55 18.15

Mr John Anderson

18.15 18.35

Professor Laurence Klotz

18.35 18.55

Professor Thomas Keane

18.55 19.00

Mr John Anderson

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