European Urology Today - Vol. 27 No.5 - October/December 2015

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European Urology Today Official newsletter of the European Association of Urology


Vol. 27 No.5 - October/December 2015

All About Munich

The EUREP Experience

7th EMUC: Challenges and prospects

Check out the preview of next year’s Munich Congress

13th EUREP delivers the goods, residents say

Onco-urology in Europe posts steady gains


Dr. Domenico Veneziano


EBU-EAU Host Centre Certification Reliable partnership needed for efficient certification process The European Board of Urology (EBU) and the European Association of Urology (EAU) have developed a new type of certification specifically for training centres hosting European Urology Scholarship Programmes (EUSP) with the aim to streamline the certification process and become more responsive to new developments in continuing medical education.

young European urologists by exchanging clinical, surgical and laboratory knowledge among young urologists from different European nations, which therefore requires knowing with “certified” clarity where they are going and, based upon this knowledge, how to plan their visit or actual research. Q: How would you describe the collaboration between the EBU and the EUSP in the area of certification?

The EUSP anchors its goals on the belief that knowledge shared is knowledge multiplied, and that a sharing of expertise benefits not only a community but also enlarges the vision and influence of urology.

Mirone: The collaboration which has come about until now consists of an organisational effort necessary to choose the criteria for the certification. After a number of meetings and many hours of work, today we have been able, in less than a year, to launch an efficient application system to receive certification. Collaboration should continue to anticipate and manage all the eventual criticisms that will arise only at the moment when the certification process is implemented.

In this article EBU Chairman Prof. Dr. Stefan Müller and EUSP chairman Prof. Vincenzo Mirone spoke on the challenges and prospects faced by specialised training centres and how the certification and training programmes of both organisations can support the training and educational ambitions of urologists. Below is the edited transcript of the Q&A:

The EUSP scholarship programme includes:

Q: What has motivated the EBU to develop this new certification programme? Müller: The EBU aims to set standard requirements for optimal urological training and is assessing and certifying the quality of training institutions in Europe for many years. Our idea was to set up a certification programme for such host centres without being influenced by personal relations in order to provide more transparency and information about the structure and workload of these host centres. Having already established Internet-based evaluation criteria for sub-specialty centres, the EBU proposed this idea to the EAU and within our joint committee (EU-ACME) we agreed to use a very simplified version of our system to create a new Internet-based certification programme for these host centres. The European School of Urology (ESU) led by Chairman Dr. Joan Palou is doing excellent work to deliver education and to stimulate urologists at any stage of their urological career and keep up with new scientific and surgical techniques. For many years the European Urological Scholarship Programme (EUSP) believes that “knowledge shared is knowledge multiplied.” There are listed well-known departments and urologists who know each other very well and who have friends who know other friends very well, but little objective information is given about actual surgical procedures in a field or teaching facilities, housing and scientific support to those who are applying in these host centres. Q: Prof. Mirone, what do you consider are the main benefits of the EBU-EAU host centre certification? Mirone: To provide certification and international recognition to a European centre which will guarantee high standards of quality and quantity in areas of excellence (examples are andrology, IPB, stones, uro-oncology, etc.). This work will improve the hospital and academic environments. In Europe there are centres that work to high qualitative and quantitative standards. However, in some cases these are less “famous” than those centres which, for various reasons, become more well-known. Q: What is new in this type of certification? What has changed? Are there new criteria included?

Müller: To qualify as a certified EBU-EAU host centre, several criteria and requirements need to be fulfilled and will be made public through the internet. As a general requirement, an EBU-EAU certified host centre has to practise a multidisciplinary approach to the treatment of one of the listed urological fields: Andrology, BPH, Cancer (renal, penile, prostate, testicular, urothelial), Female urology and incontinence, Neurourology, etc.

many courses given by EAU which would be even more valuable when objectively certified by a neutral body. With this in mind, I think the EAU and EBU can form a strong force together to promote quality in urological teaching and education.

Among others, the centre has to work in line with the EAU Guidelines and show an adequate number of cases to maintain a high level of results and provide a comprehensive and practical training in the given specialty. All these requirements including surgical numbers will be listed in the internet so that any applicant can compare and choose which of the centres he wants to go to.

Mirone: To identify a centre is never a simple procedure because one must evaluate all of the variables and, above all, diverse viewpoints must be considered. One must consider the human and logistical resources of the centre itself or those who refer to the centre to receive treatment and, last but not least, the ambitions of those who wish to visit the centre for a short duration.

Müller: Quality in medicine is becoming a very big issue even on the political stage. The EAU provides excellent expertise in training and education for European urologists but quality assurance and certification needs to be done by a different body. The EBU as a section office of the European Union of Medical Specialists (UEMS) can ensure an unbiased high-quality assessment of all EAU and other European urology-related training activities, because the EBU works as an entirely independent regulatory organisation. Looking at these differences there is no doubt that EAU and EBU somehow need each other and if it is only for the sake of “who checks the checker.” In recent years, it is my personal impression that both institutions made a lot of progress in moving towards each other, combining forces on one hand, and at the same time gradually working out their differences. Quality should be objectively measured, evaluated and made transparent by somebody who is not actively involved in teaching and training. There are

October/December 2015

• Clinical Visit: Mentorship from leading experts in the field. EUSP Clinical Visit offers the opportunity for young urologists to sharpen their skills in a foreign European country for a period of six weeks to three months; and

Q: For the EUSP, what are the challenges, if any, when identifying centres for certification and in attracting urology fellows and scholars?

The application process to become such a host centre This last point is most important to the EUSP since its is done online and EU-ACME committee members role is precisely that of promoting the growth of also perform an online evaluation. The title “EBU-EAU certified host centre” is granted for a period of five EBU Certified Centres years, provided the core staff is not replaced. The applicant receives a certificate of accreditation issued by the EBU. The centres’ details are listed on the EBU and EAU websites. The evaluation process will be finished within four weeks from application. Q: Are there any areas in the EAU-EBU collaboration which do you think should be improved, modified or re-examined?

• Clinical/Lab Scholarship: Promotes excellent basic research work, EUSP Scholarship offers a year-long programme in a leading European research institution with the option for a one year extension;

• Short Visit: To support young urologists, the EUSP provides the Short Visit (SV) for the chosen candidates to experience first-rate urological care, for a period of two or three weeks in a centre of excellence in a foreign European country. This visit can only be done in preparation of a one-year scholarship or a one-year clinical fellowship. For more information visit or

EBU Online In-Service Assessment Thursday 3 & Friday 4 March 2016 Registration now available at


Register now for the early bird fee Deadline: 15 January 2016 European Urology Today


5th International Course and Workshop Sharing minimally invasive surgery expertise on advanced urological laparoscopy Dr. Bogdan Petrut Oncological Institute 'Prof. Dr. I. Chiricuta' Dept. of Urology Cluj-Napoca (RO)

petrutbogo@ Co-author: Dr. Dragos Feflea, Oncological Institute Cluj-Napoca, Dept. of Urology, Cluj-Napoca (RO) Figure 5: Souvenir group photo: 2015

For the fifth consecutive year eager novice laparoscopists from Romania, Turkey, Moldavia and Bulgaria met at the International Course and Workshop on Advanced Urological Laparoscopy held in Cluj-Napoca in conjunction with the 33rd International Turkurolap course.

Comprehensive training The workshop was held at the Center for Experimental Medicine at the University of Medicine and Pharmacy in Cluj-Napoca, which is equipped with eight fully equipped operating tables for laparoscopic surgery in animal models and five Twenty-eight trainees from Romania, Bulgaria, dry-lab training boxes. An experienced and Moldavia and Turkey attended the ESUT course competent team of veterinary anaesthesiologists chaired by Assistant Prof. Bogdan Petrut, which from the University of Agricultural Sciences and included dry lab and training on animal models Veterinary Medicine of Cluj-Napoca provided (pigs). Renowned European urologists also participated in the course and among them were Prof. assistance during the hands-on training sessions. The workshop consisted of three stations, and Evangelos Liatsikos (Patras University, Greece) and lectures, dry-lab training and laparoscopic Prof. Yasar Özgök, chairman of the Urology procedures performed on pigs were offered to the Department of the Military Medical Academy (GATA) trainees. The lectures covered major urologic in Ankara, Turkey. laparoscopic surgeries and ethical information The live surgery event included five minimally invasive regarding the training on live animal models. surgical interventions which were transmitted live in 3D to the auditorium: single-port radical nephrectomy and mini-lap pyeloplasty performed by Prof. Liatsikos, a laparoscopic retroperitoneal radical nephrectomy performed by Prof. Ozgok, a laparoscopic extraperitoneal radical prostatectomy and a laparoscopic partial nephrectomy performed by Prof. Petrut. The surgeons also gave insights on techniques and tips and tricks during and after each live demonstration.

European Urology Today

Figure 3: Wet lab: each pair of trainees benefit from a dedicated trainer

Editor-in-Chief Prof. M. Wirth, Dresden (DE) Section Editors Prof. T.E. Bjerklund Johansen, Oslo (NO) Mr. Ph. Cornford, Liverpool (GB) Prof. O. Hakenberg, Rostock (DE) Prof. P. Meria, Paris (FR) Dr. G. Ploussard, Toulouse (FR) Prof. J. Rassweiler, Heilbronn (DE) Prof. O. Reich, Munich (DE) Dr. F. Sanguedolce, London (GB) Dr. S. Sarikaya, Ankara (TR) Special Guest Editor Mr. J. Catto, Sheffield (GB) Founding Editor Prof. F. Debruyne, Nijmegen (NL) Editorial Team L. Keizer, Arnhem (NL) H. Lurvink, Arnhem (NL) J. Vega, Arnhem (NL) EUT Editorial Office PO Box 30016 6803 AA Arnhem The Netherlands T +31 (0)26 389 0680 F +31 (0)26 389 0674

The dry-lab training was designed to develop the participants’ skills in laparoscopy, including depth

perception, bimanual dexterity, and general confidence and efficiency. The exercises were also used as preparation for the E-BLUS examination which was held at the end of the course. The hands-on laparoscopic training session aimed to simulate real-life conditions for the trainees, providing them with the opportunity to apply the knowledge and skills acquired during the lecture and dry lab sessions. For the wet lab session, every two participants were paired with a mentor, a surgeon with experience in minimally invasive techniques, to guide them through every step of the procedure. The training mentors focused on providing individual guidance for every trainee in an informal and relaxed manner. Boosting laparoscopic training Aside from developing the practical skills required by laparoscopic surgery, the course aimed to provide the participants with an environment where they could build ties with fellow trainees and the mentors, thus creating a community of laparoscopic surgeons that would offer support for novice laparoscopists back home. To further support this training, we have established the “Club of Laparoscopy, Endoscopy and Robotics in Urology,” inviting every participant to be a member and provide them a networking platform for communication, sharing contacts, holding meetings and collaborating on research projects for members. To further boost knowledge sharing, we aim to do our best to organise the next course in the fall of 2016. We hope to welcome new trainees in 2016!

Figure 1: Opening ceremony at the Aula Magna at the University of Medicine from Cluj Napoca, Romania

Since laparoscopy truly relies on team work the participants were encouraged to invite their scrub nurses to enable them to create a stable and functional laparoscopic operating team back at their hospitals. The nurses had their own separate section which included lectures and hands-on training. The course offered the participants a chance to learn the basic principles of laparoscopy from highly experienced nurses – Mrs. Birgitta Keil, Mrs. Hilal Tüzer, Mrs. Laura Abrudan and Mrs. Ramona Hadnagy who shared their expertise and knowledge. The lectures covered the general principles of laparoscopic surgery and laparoscopic instruments and instrumentation, while the hands-on training offered insights on working in a real-life laparoscopic surgery setting.

Figure 4: Opening of the live surgery session. From left: Prof. Anca Bojan - medical manager of the Oncology Institute Cluj that hosted the live surgery session, Prof. Yassar Ozgok, Prof Evangelos Liatsikos - ESUT chairman elect, Assoc. Prof. Bogdan Petrut - University of Medicine Cluj, Romania

Figure 6: Scrub nurse session 2015

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Disclaimer 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.

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October/December 2015

Impact of prostate cancer on Europe Key opinion leaders meet in the European Parliament on 16 September As part of this year’s European Prostate Cancer Awareness Day (EPAD) on 16 September 2015, key policy makers, scientific experts on European urological associations and representatives of patient groups gathered at the European Parliament in Brussels to discuss the impact of prostate cancer on Europe. With over 417,000 men annually diagnosed with prostate cancer and 92,000 deaths attributed to the disease, the need to keep prostate cancer in the agenda of decision-makers in the region is crucial to improve healthcare and empower patients. Together with MEP Mr. Philippe De Backer and the European prostate cancer coalition Europa Uomo, the European Association of Urology (EAU) organised the event to raise awareness, understanding and knowledge in managing prostate diseases with prostate cancer topping the agenda. Although prostate cancer patients can benefit from effective treatment in the early stages of the disease, thanks to advances in medicine and improved screening, the disease greatly impacts on the quality of life (QoL) of many prostate cancer patients. Two issues dominated the lectures and presentations by experts, patients and politicians- the lack of communication regarding QoL issues and the necessity for PSA screening.

these personal matters than they worry about treatment outcomes. Moreover, men are more reluctant to consult their physician about chronic health issues, which justifies the need for a better European awareness campaign. By creating awareness and educating patients and their families regarding the social consequences of prostate cancer, what is generally seen as a ‘’taboo” topic will be demystified. Effective communication is essential in the early detection of the disease. “Men should check their body better. At the European level we should inform men about the early signs and risks similar to what has been done in breast cancer initiatives. This will lead to a lower mortality rate, better healthcare services and outcomes with less expenditure,” was the general opinion. The role of active surveillance was also highlighted. There was a common observation that PSA testing is disorganised within the EU and that primary care

have a bigger role in screening for prostate cancer. A prediction tool, which analyses other factors besides PSA, is expected to reduce the potential harms in screening tests. There was also agreement among doctors and patients that the European Commission can play a role in standardising guidelines and regulations for a more integrated management of prostate cancer. The optimal use of data should also be tackled at a European level. By comparing different outcomes healthcare professionals can properly validate different test results and can improve their treatment strategies, including a more individualised approach. Another benefit of data sharing is building trust with patients. By making results available and more accessible patients will gain better insights regarding the management of their disease. The participants noted that well-informed patients would lead to better results, lower costs and improved care.

EBU-EAU Host Centre Certification. . . . . . . . . 1 5th International Course and Workshop. . . . . 2 Impact of prostate cancer on Europe . . . . . . . 3 Urology Week 2015 hosted across Europe. . . . 3 Radical treatment of prostate cancer . . . . . . . 6

“Collaboration among patients, politicians and academia at the European level is crucial to increase the life expectancy of men,” said Philippe De Backer. The EAU will continue to link up with all stakeholders involved in prostate awareness programmes and will take the lead to achieve better treatment and quality of life for prostate cancer patients in Europe.

A recent study showed that prostate cancer patients find it difficult to talk about pain, incontinence and sexual dysfunction. In fact they worry more about

Urology Week 2015 hosted across Europe Activities range from EU meeting, press campaigns to patient counselling

Clinical challenge. . . . . . . . . . . . . . . . . . . . . . 7 Ten Questions: Kemal Sarica. . . . . . . . . . . . . . 8 International relations section: Van Poppel honoured with Francisco Diaz Medal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 RSU Congress in St. Petersburg. . . . . . . . . . . . 9 China, EAU to expand collaborative meetings. 9 ESUT: Advances in laparoscopy for urological indications - Part 2. . . . . . . . . . . . 10 Updates from the Guidelines Office. . . . . . . . 11 EAU Guidelines embraces Social Media . . . . . 11 Key articles from international medical journals. . . . . . . . . . . . . . . . . . . . 12-15 Book reviews. . . . . . . . . . . . . . . . . . . . . . . . 17

Diverse activities marked this year’s Urology Week ranging from the political, institutional to the personal as hospitals, clinics, urological associations and patient groups conducted information campaigns, dialogues with patients and press briefings that focused on prostate cancer and other urological diseases.

“We are encouraged by and thankful for the enthusiastic involvement in the wide range of activities led by doctors, nurses and patient organisations to raise awareness on urological conditions. Through lectures, press interviews and other information campaigns, participants of Urology Week have promoted wider public awareness with regards the treatment of urological conditions,” said EAU Secretary General Prof. Chris Chapple. From 14-20 September, several health institutions across Europe marked Urology Week with countries such as Belgium, Poland, France and Spain hosting dialogues with patients, press interviews and educational activities. Germany, Hungary, Italy,

Switzerland, Ukraine, Estonia and the Netherlands held free consults, demonstration of robotic surgery, press conferences and exclusive radio/TV interviews to promote understanding of health issues such as prostate, kidney and bladder cancers. On September 16, the European Association of Urology, in partnership with the patient organisation Europa Uomo and MEP Mr. Philippe De Backer, held the European Prostate Cancer Awareness Day (EPAD) at the EU headquarters in Brussel. They discussed current challenges in treating prostate diseases, particularly prostate cancer, and examined how various sectors can integrate long-term strategies with regards the delivery of optimal healthcare. “Prostate diseases are a significant health problem in our ageing society and we must find new costefficient treatments, better care and quality of life for all citizens,” said De Backer. Chapple highlighted the challenge in dealing with Europe’s highly diverse healthcare systems. “As a European Association we encounter the differences in national legislation on healthcare issues on a daily basis. With demographic ageing and the shift towards chronic conditions we must explore ways of collaborating at EU level to provide equality of optimal individualised treatment,” noted Chapple.

In social media such as Twitter and Facebook, the EAU has also initiated the Urology Week campaign to disseminate information and reach a wider public. More than 300 people tweeted at least 1,300 messages about or related to Urology Week. Within the week, the Twitter posts accounted for a total of nearly 1,3 million impressions or views.

#UrologyWeek in numbers

With the success of both the traditional and social media promotions, Chapple underscored the role of urologists and other health professionals in bridging the information gap between the public and healthcare specialists. “We are looking forward to the participation of healthcare professionals in hosting and sharing events related to urology. In future Urology Week events we hope to again actively engage the media and continue this vital dialogue with the public,” he said.

ESU section: EUREP15: Hands-on training: Improving skills . . . . . . . . . . . . . . . . . . . . . . 18 The EUREP experience. . . . . . . . . . . . . . . . . 18 Not just education but an association. . . . . . 19 An excellent training for young urologists . . 19 5th ESU Course in Moldova. . . . . . . . . . . . . . 20 ESU Course in Tashkent. . . . . . . . . . . . . . . . . 20 Who's Who in the Board of the ESU . . . . . . . 21 A successful first E-BLUS exam in Poland. . . 22 YUO section: The role of residents in the era of minimally invasive surgery. . . . . . . . . . . . . . 23 Uro Emergency Smartphone APP. . . . . . . . . 23 Clinical laparoscopic fellowship. . . . . . . . . . 23 ESRU looks into new projects and activities. 24 Founding the Swiss Residents Society . . . . . 24 Tweeting the #EUREP15 meeting . . . . . . . . . 24 Global shortage of BCG. . . . . . . . . . . . . . . . 25 Young Academic Urologist: Assessing gains and prospects. . . . . . . . . . . 25 EBU section: EBU Certified Residency Training Programmes in Urology. . . . . . . . . . . . . . . . 26 EBU recertifies St. Gallen Hospital’s Urology Department. . . . . . . . . . . . . . . . . . . 27 Hamburg hosts 67th German Urology Congress. . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 CEM15: Gains and diversity in Central European urology. . . . . . . . . . . . . . . . . . . . . 28 11th SEEM: The best of the EAU comes to Antalya. . . . . . . . . . . . . . . . . . . . . . . . . . . 29 7th EMUC: Challenges and prospects in onco-urology. . . . . . . . . . . . . . . . . . . . . . 30 ESO Interdisciplinary Conference on Prostate Cancer. . . . . . . . . . . . . . . . . . . . . . . 31 4th ESUI Meeting in Barcelona. . . . . . . . . . . 32 EULIS15 tackles challenges and prospects in stone disease. . . . . . . . . . . . . . 34 ERUS15: A focus on education in robotic surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 World Congress on Urological Research examines recent gains . . . . . . . . . . . . . . . . . 36 Telling the story of Urology through instruments . . . . . . . . . . . . . . . . . . . . . . . . . 37 Minimally Invasive Percutaneous (MIP) Stone Workshop. . . . . . . . . . . . . . . . . . . . . . 38 EAUN section: EAUN at SIU Conference. . . . . . . . . . . . . . . . 39 EAUN participates in Dubai conference. . . . . 40

Lots of selfies were shared on Twitter

October/December 2015

European Urology Today


EAU16 aims to trigger new ideas, examine prospects Scientific Programme: A “breeding ground” for medical innovations Now on its 31st year, the Annual EAU Congress is not only a platform to examine current urological practice and cast a critical eye on clinical issues but is also a meeting place which aims to inspire urological professionals to test new ground and explore alternatives in treating urological diseases. “The Annual EAU Congress is always an exciting meeting. It is unique in urology since it covers the full range of urological diseases and treatments. It has grown to be a very international meeting with participants from all over the world,” said Prof. Thomas Knoll (DE), consultant of the Scientific Congress Office (SCO) and vice-chairman of the EAU Section on Urolithiasis (EULIS). “This exchange alone is stimulating and gives ideas for the work at home and for new scientific projects.” This year the Congress is not only addressing controversial issues in treatment strategies but also looks into emerging prospects that could contribute to breakthroughs in clinical practice. Since medical research relies on evidence and data interpretation, the challenge for urologists and researchers is how to link-up and efficiently collaborate with other medical investigators- a need which, according to Knoll, the congress organisers have prioritised. Prof. Thomas Knoll (DE)

“We are creating a very interactive and controversial programme that covers virtually all fields in urology. The mix of state-of-the-art lectures with Point-Counterpoint discussions (on actual cases) is exciting,” he said. The main Scientific Programme which kicks off on Saturday (March 12) opens with a session on the role of Guidelines and their limits. Prostate cancer anchors the main programme on Day 2 with lectures and debates on topics such as pre-biopsy MRI and timing of post-operative radiotherapy. Monday’s agenda includes ageing and the lower urinary tract. “The goal is to provide more insights into medical and surgical treatments in the elderly, both males and females. We will have case discussions on how to manage anti-coagulation in surgical intervention,” said Knoll. Aside from the emphasis on major urological diseases, there are “focus lectures” on testosterone therapy, sexual dysfunction in the elderly couple and on non-urothelial bladder cancer, to name a few. “We will include case discussions on all main topics each day. Of course there will be the Late Breaking News session,” he added. And as in previous congresses, the plenary sessions will be complemented by Urology beyond Europe sessions, 19 Thematic Sessions, the meetings of the EAU Section Offices, courses from the European School of Urology and abstract presentations. Regarding urgent issues in uro-oncology, a key feature in the annual congress, Knoll said uro-oncologic specialists will have a wide range of topics to actively engage on. “We will discuss upcoming and interesting new concepts for diagnosis, both molecular/genetic and imaging. New treatment modalities for patients with progressive disease will be another major part of the programme,” he said. Asked to comment on how the SCO tackles the complex preparations, Knoll said: “Creating the

scientific programme is a real challenge. The members of the Scientific Office have to do a tremendous job by planning all the sessions and trying to include interesting, controversial and important topics. It’s my first year in the SCO and I am really impressed – not surprised – by the professionalism in our meetings and the communication among the members.” Although the Annual Congress is basically organised for urologists and related medical disciplines and professionals, Knoll noted the Annual Congress reflects the strength of urology as a specialty. “Urology is THE specialty of now and tomorrow! The most common diseases are urological: prostate cancer, bladder cancer, urinary stones, lower urinary tract symptoms, incontinence, erectile dysfunction, urinary tract infections, etc. People often associate urology as a medical specialty that deals only with old men,

incontinence and the prostate. But urology includes various areas from children, females to younger men and from conservative to surgical treatment. Our meeting is now one of the largest in the world which only shows the wide reach of urology. We have to convey that to the general public,” he said. Finally, Knoll drew attention to the importance of feedback from congress participants. “We review all feedbacks from congress participants and try to improve the meeting from year to year by giving serious attention to comments. We have had an amazing number of tweets on Twitter in Madrid and with much interesting feedback. All lectures are rated by the SCO and the moderators are asked to recommend talented speakers. We are convinced that such measures will help bring the meeting to a higher level,” according to Knoll.

Join the conversation We had nearly 8,000 tweets on #EAU15 last year.

Join EAU16! Read what your colleagues share about EAU16 on Twitter! #EAU16! congressesUrology and courses are accredited by the EBU in compliance with the UEMS/EACCME regulations 4 EAUEuropean Today

October/December 2015

Record high in abstract submissions for Munich

Important Dates

Prostate diseases, kidney cancer are most studied topics A record high of 4,414 abstracts were submitted for the 31st Annual EAU Congress in Munich next year with prostate cancer, functional urology (Lower Urinary Tract Symptoms), benign prostatic hyperplasia (BPH), and the surgical treatment of kidney tumours attracting the biggest number of submissions. Compared to last year’s 3,975 submitted poster abstracts in Madrid, this year exceeded the 4,000 mark with submissions coming from 79 countries from around the world, and as far Venezuela, Vietnam, Tajikistan, Hong Kong, Colombia and Argentina, among many others. Including the video submissions, the total submissions reached 4,414 submitted abstract (4,272 in Madrid).

treatment (surgery, radiotherapy and brachytherapy) posting the most number of submissions at 270, followed by 198 studies on functional LUTS (treatment and neuro-urology), 173 abstracts for the diagnosis and treatment of BPH, and 165 abstracts examining the surgical treatment (nephron-sparing) of renal tumours. Studies on new technologies and techniques and the management of advanced urothelial tumours recorded 138 and 135 submitted abstracts, respectively.

Similar to trends seen in previous congress years, the biggest number of submissions came from Italy (471), Germany (401), Japan (367), the United Kingdom (360) and South Korea (353). Spain, France and the United States also recorded high contributions. As seen in previous congress years, The video submissions also exceeded last year’s record mainland Europe, Asia, North America and the Middle East are among the most active regions. with 336 video submitted compared to 297 videos in 2014. The more than 250 reviewers are tasked to examine around 53 topics covering the whole range of Video submissions came mostly from Italy (79), Spain (62), India (20), France (19) and China (18). urology, with many topics focused on prostate cancer Ten video sessions will be held during the congress treatments, bladder and kidney cancers. with more than 75 videos selected for viewing. And as in previous years, the reviewers will screen the In terms of topic coverage, this year is not so submitted abstracts to select around 1,000 different from last year with prostate cancer

Congress dates

abstracts for presentation in Munich in 90 abstract sessions scheduled from the second to the fourth congress day, 12 to 14 March 2016.

11-15 March 2016 Exhibition dates

The highest number of abstracts submitted (1,012) were on prostate cancer, with around 13 sub-topics examined in studies, ranging from basic research (cell biology and biomarkers), screening and diagnosis (imaging, PSA and biopsies) and treatment (surgical, systemic and radiotherapy), to name a few. Urothelial tumour topics such as basic research, staging, disease management attracted 535 abstracts, while treatments of renal tumours (surgical and systemic) were examined in 402 studies.

12-14 March 2016 Early fee registration deadline 15 January 2016 Late fee registration deadline 9 February 2016

All accepted and presented abstracts are eligible for the prizes granted to the best abstracts in various categories such as oncology, non-oncology, abstracts (by residents) and for the three best video abstracts. Accepted abstracts will also be accessible on-line for EAU members one month before the congress and at later date to the general public.

Check out the programme overview at

line 15 January 2016

Register now for the early fee: dead

Tips on how to optimise your Scientific Programme coverage • Prepare for the congress in advance by looking carefully at the programme • Attend the highlight session early in the morning to have an overview of the best scientific data that will be presented

Munich: Village of a million people Monks, Olympics and beer fests To Germans, Munich is “Millionendorf,” or a “village of a million people” a monicker that perhaps Munich has earned with its casual, informal air and warm hospitality despite its modern achievements and cosmopolitan core. Germany’s third largest city, after Berlin and Hamburg, Munich’s 1.5 million population enjoys a thriving economy, largely driven by information technology, biotechnology, and publishing sectors. As one of Germany’s financial centres, the city is the headquarters to some of the world’s iconic brands and manufacturers such as Siemens AG (electronics), BMW (car), MAN AG (truck manufacturer, engineering), Linde (gases), Allianz (insurance), Munich Re (re-insurance), Rohde & Schwarz (electronics) and Swiss Life AG.

• Stay until Tuesday and attend the souvenir session with all highlights of the EAU16 congress • Download the EAU16 Congress App on your smartphone or tablet and build your own personal agenda or meeting planner • Use social media such as Twitter to monitor topics that are generating extra interest. Morning sessions usually have intense discussions and debates that can prompt insights and fresh ideas

October/December 2015

Green Munich The city’s name is derived from the Old-Middle High German term Munichen, meaning “by the monks,” a reference to the Benedictine monks who ran a monastery at a place that was later to become the Old Town of Munich. The monks are also depicted on the city’s coat of arms. But although Catholicism has waned from mainstream Bavarian culture, the imposing Frauenkirche remains the most famous

building in the city centre, and the main square Marienplatz is named after the Mariensäule, a Marian column located on the square’s central point. Munich’s industrial progress does not hinder the city from being “green” as before with its numerous leafy parks. The popular Englischer Garten is close to the city centre and covers a 3.7 km2 area (larger than New York’s Central Park), one of the world’s largest urban public parks. Other green spaces are the modern Olympiapark, Westpark, and the parks of the Nymphenburg and Schleissheim palaces. The city’s oldest park is the Hofgarten which dates back to the 16th century, and best known for the largest beer-garden in town is the former royal Hirschgarten, founded in 1780. Oktoberfest One famous albeit cliched tag identified with Munich is the Oktoberfest, a folk festival which attracts for two weeks an estimated six million people to numerous beer tents scattered across the city. Oktoberfest actually takes place in September but ends in the first Sunday of October. Beer culture is strong in Bavaria and in Munich the Hofbräuhaus am Platzl is probably the most famous beer hall worldwide. Starkbier is the strongest Munich beer, containing 6% to 9% alcohol. Dark amber in color with a heavy malty taste, Starkbier is available and popular during the Lenten Starkbierzeit (strong beer season), which begins on or before St. Joseph’s Day on 19 March.

“Elite University” by a selection committee composed of academics and members of the Ministries of Education and Research. Max Planck Society, an independent German non-profit research organisation, has its administrative headquarters in Munich. Deutsches Museum (German Museum), located on an island in the River Isar, is the largest and one of the world’s oldest science museums.

Eclectic charm Whether it is the city’s eclectic mix of historic buildings and modern architecture, the easygoing Munich in medicine nature of its residents, the efficient machinery of Munich is a magnet for science and research with a industry or the nostalgia found in grand palaces long list of Nobel Prize laureates from Wilhelm and gardens, Munich inevitably leaves a distinct Conrad Röntgen in 1901 to Theodor Hänsch in 2005. impression to the visitor. No wonder even the The Ludwig Maximilian University and the German non-residents are drawn back to the city, Technische Universität München were two of the first re-visiting to experience that peculiar charm that three German universities to be awarded the title its distinctively Münchner. European Urology Today


Radical treatment of prostate cancer How does a radical PCa therapy affect the bladder function? Mr. Reinhold Zimmermann SALK Universitätklinikum/Paracelsus Medizinische Privatuniversität (PMU) Salzburg (AT) r.zimmermann@

Mr. Nikesh Thiruchelvam Addenbrooke's Hospital Dept. of Urology Cambridge (UK) nikesh. thiruchelvam@

Prof. Dr. Karl-Dietrich Sievert SALK Universitätklinikum/Paracelsus Medizinische Privatuniversität (PMU) Salzburg (AT)

these were symptomatic. Some of the pre-existing DO patients can have symptom relief; others developed a de novo DO, in up to 25% three months after a robotic RPE. Solely DO-related incontinence was seen in 2% to 35%; most cases with incontinence were stress UI, independent from the type of surgery. These findings underline that DO is rarely the dominant reason for UI after RPE, but UD is essential to clearly differentiate among the various causes. Nevertheless, DO after RPE is obviously more persistent, unlike the mostly transient DO following TURP, with a considerable clinical and therapeutic impact. Pre-existing LUTS As DO after RPE is identified as an important clinical scenario after RPE, it is unclear to what extent pre-existing LUTS interferes with the post-operative situation. Many studies rely on questionnaires rather than UD to identify AOB symptoms and DO. This is a less proper evaluation as the discrimination between storage and voiding symptoms is less adequate by questionnaires. However, it turned out that the pre-operative symptom scores do significantly correlate with the post-operative situation. As a dominant finding LUTS or DO improved after RPE even in a long-term follow-up, based on IPSS, AUA-SS scores, in up to 50% of the cases. Obviously, patients with questionnaire-verified pre-existing LUTS do benefit from a RPE, regardless of the surgical approach. Considering the postoperative anatomical and functional situations, many factors could contribute to The success of prostate cancer (PCa) treatment is the DO, as partial decentralisation of the bladder assessed in terms of oncological results, continence during mobilisation, somatic nerve impairment, and potency. Besides oncological outcome, there is an specifically of the pudendal nerve, as well as increasing focus on the functional results of the post-operative decentralisation of the bladder, various therapies. Both radical surgery and inflammation and infection and a geometric bladder radiotherapy do interfere with bladder functionality in disorder based on compromised neuroplasticity. different ways and can lead to the patient suffering overactive bladder (OAB), urinary frequency, urgency Radical Radiotherapy (RRTx) and incontinence. Although being considered a targeted procedure, RRTx as external beam radiotherapy (EBR) or brachytherapy Stress urinary incontinence (SUI), post-radical (BTx) is still linked to irritative symptoms of pelvic prostatectomy, is a different entity and has been organs, such as urinary symptoms, proctitis, erectile extensively described in terms of prevalence (but less dysfunction and penile alterations, caused by local so in terms of pathophysiology). Post-treatment, OAB radiation toxicity. OAB may be due to bladder outflow shows its own prevalence and pathophysiology. Thus, obstruction (bladder neck stenosis, urethral stricture treatment options must be defined accordingly. OAB disease), bladder stones or mucosal inflammation. results from detrusor overactivity (DO) and is There is no straightforward clinical correlation well-known to have a significant long-term negative between RTx dosage and symptoms like incontinence impact on quality of life. The prevalence of OAB in and voiding disorders. The vascular supply and males > 60 years is 19% for urgency, 11% for innervation of the bladder neck might be frequency and 2.5% for urge incontinence. compromised, either leading to an irreversible alteration with subsequent clinical impact. DO can be observed during urodynamics (UD) and is defined by involuntary detrusor contractions during "...detrusor overactivity is rarely the filling phase of the test. Pre-existing lower urinary tract symptoms (LUTS) can influence the PCa therapy the dominant reason for urinary outcome. On the one hand, the symptoms can be incontinence after RPE, but reduced in patients who undergo radical surgery, radiotherapy, or hormonal therapy compared with urodynamics is essential to clearly those who undergo non-operative surveillance. On the differentiate among the various other hand, LUTS may be exacerbated or occur de novo as a result of prostate cancer treatment, causes." regardless of the treatment method. Little data is available on the context of PCa and OAB. This review1) should elucidate urodynamic evidence regarding prevalence of OAB after surgery or radiotherapy, the relationship between pre- and post-treatment of LUTS, the factors predictive of achieving continence, including surgical technique, and options for the management of LUTS.

Brachytherapy Brachytherapy seems to deteriorate OAB significantly compared to RPE even in the long-term. Initially, OAB rates quadrupled after BTx and remained at a three times higher level after three years, whereas OAB can decrease down to pre-operative rates after 12 months following RPE. OAB was even more severe after BTx.

UD after Radical Prostatectomy (RPE) Amongst patients with UI, eight to 24 months after RPE, approximately 60% will develop DO as seen on UD. In another study, DO was described in about 27%, with 46% of the patients being continent. Detrusor underactivity was also found by the same authors in 41% with 48% of patients having to undergo abdominal straining to support voiding.

Up to 79% of the patients had OAB symptoms and 85% exhibited DO which was again a two-fold increase compared to an unselected patient population. 17% of patients after brachytherapy had a Grade 2 or higher genitourinary toxicity with symptoms, persisting even after 10 years.

In general, elevated OAB scores after RTx return to baseline levels by 12 to 18 months and the time to After a laparoscopic RPE, detrusor underactivity was at normalisation was longer for storage than for voiding 9% and DO in 33%. Another group reported DO alone symptoms. Nevertheless, long-term UI or LUTS are in only 4% but 39% of post-operative patients had a rare after brachytherapy. As transitional urinary combination of bladder and sphincter dysfunction. retention is common after BTx, BOO rates requiring surgical intervention are between 2% and 8.3%. Pre-existing DO in UD has been seen in 26% to 61% of patients post-surgery but only a very small number of External beam radiotherapy Various parameters can be influenced by EBRT like UD, bladder compliance/instability and BOO. Generally, EAU Section of Female and Functional Urology (ESFFU) bowel symptoms dominate but there is also a marked 6

European Urology Today

toxicity in urinary symptoms due to ERBT. For instance, OAB symptoms significantly increased temporarily during RTx. Both UI and irritation/obstruction returned to baseline after one year and improved even further on the long run. On the other hand, in up to nine years follow-up, the rates of nocturia and daytime frequency had a higher prevalence after radiation compared with control. Prevalence for UU/UUI was also significantly higher in all radiation groups. Management of LUTS As in usual urological practice, alpha-blockers are most commonly used for urinary symptoms after RPE. Storage symptoms respond well and also IPSS after RTx as well as BTx. The prophylactic use of α-blockers could significantly reduce the urinary morbidity with a particular beneficial effect on IPSS but no improvement of retention rates or the need for interventions. Trospium chloride improved urinary irritation following BTx for 80% even with a late therapy onset. Interestingly, the use of phosphodiesterase inhibitor substances after RPE improved continence rates may be due to an improved perfusion rate in the entire pelvic floor. Antimuscarinic drugs have not yet been specifically investigated after PCa treatment but, as they are widely used in daily practice, there is no reason to exclude them. The further therapy cascade in case of oral drug failure includes procedures such as Botulinum toxin A and sacral neuromodulation, although these treatments have not been well evaluated in patients following radical treatment of prostate cancer. Future treatment options could be the same as for “ordinary” symptoms with new drugs like mirabegron or even options in the field of regenerative medicine and stem cells for urethra, urinary sphincter and even the bladder. Individual assessment Each case of UI following PCa therapy has to be considered individually with the specific aspect of the

pre-operative situation. All reviewed studies outline a wide range of severity of OAB/DO, depending on the kind of PCa therapy. Proper evaluation is needed and urodynamic investigation has a significant role for the assessment, in particular for the long-term disorders. OAB symptoms after PCa can be difficult to treat. Surgical treatment for PCa seems, in general, superior than radiation in terms of mortality and metastatic disease. Due to the difficult treatment of postoperative OAB and the significant impact on quality of life it is mandatory to evaluate the patients even before PCa therapy, to follow them up thoroughly and to counsel them adequately to align their expectations with possible treatment outcomes with regards cancer as well as lower urinary tract functionality. Reference 1. A review of detrusor overactivity and the overactive bladder after radical prostate cancer treatment. Thiruchelvam N, Cruz F, Kirby M, Tubaro A, Chapple C, Sievert KD. BJU Int 2015 Feb 13. doi: 10.1111/bju.13078.

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October/December 2015

Clinical challenge Prof. Oliver Hakenberg Section editor Rostock (DE)


The Clinical challenge section presents interesting or difficult clinical problems which in a subsequent issue of EUT will be discussed by experts from different European countries as to how they would manage the problem. Readers are encouraged to provide interesting and challenging cases for discussion at

Case study No. 44 This 41 year-old man presented with a large tumour of the right kidney, the CT scan is shown in figure 1 a/b. The diagnosis had been made due to fatigue and weight loss of 10 kg. Radical nephrectomy with adrenalectomy and lymphadenectomy was performed. A large renal vein tumour thrombus was found extending just into the vena cava and infiltration of the liver, requiring local excision and resection of liver parenchyma; the postoperative course was uneventful. The histology reported a poorly differentiated clear cell renal carcinoma with Fig. 1a/b: Abdominal CT scan a sarcomatoid appearance in parts of the tumour, before radical nephrectomy an adrenal metastasis and infiltration of the liver. Surgical margins were negative, resulting in the pathology classification of pT4 pN0 (0/5) V1 R0 pM1.

One year later the patient presents with a new lesion on follow-up CT which is situated behind the liver and close to the vena cava on the right side (fig.2a/b). The patient is completely asymptomatic. Discussion points: 1. What is the likely diagnosis? 2. Should other investigations be done? 3. What treatment options are there and what is recommended?

Fig. 2a/b: Abdominal CT scan one year after radical nephrectomy

Case provided by Oliver Hakenberg, Department of Urology, Rostock University Hospital, Germany. Readers are encouraged to provide interesting and challenging cases for discussion.

Case study No. 45 A 15-year-old boy was referred with a four-day history of a painless growing mass in the right testis. There was no previous history of trauma, infection or lower urinary tract symptoms. However, the boy had been previously diagnosed with congenital adrenal hyperplasia due to early puberty at age 9 and intermittent episodes of paralysis. Physical examination showed a normal left epididymis and testis while the right testis was found to contain a small palpable mass. Serum levels of alpha-fetoprotein, beta-hCG and LDH were within normal limits. Ultrasound showed a hypoechoic 4 x 3 cm mass in the right testicle. Radical orchiectomy was performed. Histology confirmed a 4-cm yellow tumour without invasion of the tunica albuginea or rete testis and negative surgical margins. The tissue was positive for vimentin, negative for PLAP and with weak expression of CK and KI 67. These findings strongly suggested the diagnosis of a Leydig cell tumour. A CT scan of the abdomen and chest showed a 3 x 4 cm left adrenal mass, with presumable compression of the left renal vein and infiltration of the upper left renal pole. No paraortic or paracaval lymph node enlargements were seen. Adrenal function tests were normal.

Open surgery for recurrence Comments by Tomas Hanus Prague (CZ)

2. Should other investigations be done? I would suggest a bone scan as well as a CAT scan of the head and lungs to find or exclude metastatic disease.

1. What is the likely diagnosis? The most likely diagnosis simply seems to be local recurrence of the renal cell carcinoma.

3. What treatment options are there and what is recommended? If on these examinations, no metastases can be detected, I suggest open surgery for removal of the

tumour recurrence. However, if multiple metastases are found, systemic medical treatment is indicated and removal of the recurrence is not warranted. In case of serious doubt about this lesion, one could consider percutaneous CT-guided biopsy of the lesion, if feasible. Fig. 1: Yellowish intratesticular tumour

Surgical treatment only if no other metastases are present Comments by Nina Wagener and Maurice Stephan Michel Mannheim (DE) 1. What is the likely diagnosis? A locoregional recurrence in the right renal fossa or a lymph node metastasis of the renal cell carcinoma are the most likely diagnoses. 2. Should other investigations be done? In case of a local recurrence or metastatic disease of renal cell carcinoma, staging examinations including a CT scan of the chest should be done.

Since most brain and bone metastases are symptomatic at diagnosis, brain CT or MRI are not recommended in this patient. Bone scan may only be used in the presence of specific laboratory findings as an elevated alkaline phosphatase or calcium. A biopsy of the lesion could provide information about histology (i.e. renal cell carcinoma with clear cell and/ or sarcomatoid features or other cancer origin). 3. What treatment options are there and what is recommended? If the staging examinations are without evidence of metastatic disease or – in case of metastatic disease - a complete metastectomy seems feasible, a resection of the locoregional recurrence and possibly metastatic sites should be discussed with the patient,

especially if he has a good performance status. Generally, with a surgical approach which results in R0 resection a benefit in terms of overall survival, cancer-specific-survival and delay of systemic therapy can be achieved. Alternatively, systemic therapy with tyrosine kinase inhibitors or mTOR inhibitors is a treatment option. Since oncological outcome after resection of locally recurrent renal cell carcinoma is worse in presence of sarcomatoid histological features, a biopsy of the lesion could be used for selection of surgery or systemic therapy in this patient and – if systemic therapy is chosen- to guide what sequence of targeted agents is used.

Fig. 2: Left adrenal mass on CT scan

Discussion points: 1. What diagnosis is likely? 2. What should be done? 3. What management is advisable? Case provided by Dr. Mohamad Yasin Lutfi, MD, MS, University Hospital Hama, Syria.

Case Study No. 44 continued This patient underwent open surgery for exploration and resection of a suspected local recurrence of renal cell carcinoma. Not surprisingly, surgery was difficult and the tumour had to be removed in several pieces, which also required further resection of liver parenchyma. The vena cava appeared macroscopically thickened but not infiltrated. The postoperative course was initially uneventful but on Day 10 the patient became febrile. A repeat CT scan showed an intrahepatic abscess and also an intracaval thrombus (fig.1). Again surgery was done, draining the abscess and resecting the lateral vena cava, removing the thrombus and performing a patch replacement of the lateral part of the vena cava. Postoperative

October/December 2015

recovery was uncomplicated and swift. Histopathology of the first surgery had confirmed renal cell cancer which due to fragmentation could not be assessed for surgical margins. The specimen from the second surgery showed infiltration of the caval wall with tumour and viable renal cell carcinoma within the intracaval thrombus.

Fig. 1

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• What do you think is the biggest challenge in stone management? Technology is developing and there are huge advances which means new systems. The younger generation of doctors have to know the role of technology and its impact on our specialty and evolution of minimally invasive techniques. Experience is the single most inevitable factor for success in the minimal invasive management of stones. • If you were not a urologist, what would you be? I would have been a teacher. I like teaching and sharing the experience that I gained so far. The new generation can benefit from the shared experience of experts. In my position now I have residents and it’s good to be guiding young minds. • What is your most important piece of advice for doctors just starting out today? They should be dedicated, enthusiastic and ready to take the initiative. Competition is so high and knowledge is expanding rapidly. They should read, be dedicated to their work and be responsive to their patients by spending enough time on their cases. • What is the most rewarding aspect of being a doctor? To make a big difference in other people’s lives. Doctors are in a position of privilege since they can have an enormous impact on the lives of patients, physically as well as psychologically. By providing adequate health care we influence their hopes and future. • What is your advice to other physicians on how to avoid burnout? We should take care that we don’t push ourselves too much. Success does not come instantly. Patience and dedication to one’s work is paramount. • If you could change something in the healthcare system, what would it be? It would be a change that would lead to better health care for everyone and make basic healthcare available and more accessible. Right now there are people who get the best while many others are deprived of very basic services. We must have a balanced system where everyone gets equal access to healthcare. • What’s the last wonderful book you have read? I read “Latife” and it’s about the marriage of Ataturk, founder of modern Turkey. The book recounts the efforts of both Ataturk and his wife Latife to improve women rights and the involvement of women in daily work-life by giving them the necessary social status during the 1920s. • What’s the last thing that surprised you? A year ago my older daugther came to me and my wife and she told us, “I want to get married.” I was shocked because she’s still 23 and young but I said, “It’s your decision.” The main thing is love itself. • What’s your favourite hour in a day and why? It is between 6:30 and 7:30 in the morning when the day is just beginning and it’s calm and quiet. • What do you most often wish you could say to patients, but didn’t? I always want to be honest with my patients. Today’s healthcare system is under enormous financial pressures and this has changed the way patients look at medical professionals and doctors. I would like to have assured my patients that doctors are not only on their side but are also fighting the same issues like everyone else.

TEN QUESTIONS Interview and Photograpy by Joel Vega

Kemal Sarica

Age: 52 Specialty: Urology City: Istanbul Current Post: Chairman, EAU Section of Urolithiasis (EULIS), Professor of Urology and Chair, Dr. Lutfi Kirdar Training and Research Hospital

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October/December 2015

Van Poppel honoured with Francisco Diaz Medal Spanish urology cites Van Poppel’s dedication to international urology Prof. Hein Van Poppel, EAU Adjunct Secretary General for Education, won the Francisco Díaz Medal, the highest honour given by the Asociación Española de Urología (AEU), for his lifetime dedication and consistent contributions to international urology.

In a press statement, the AEU said the award recognises the singular and lifetime achievement of leading and pioneering urologists who have significantly contributed to urological advances in academic and clinical research, education and healthcare.

An honour jointly granted by the AEU and the Fundació Puigvert since 1972, the award commemorates the achievements of Spanish physician Francisco Díaz (1527-1590), considered in Spain as the ‘Father of Urology’ and the lead author of the first urological treatise published in medical history.

During the awarding ceremonies, Van Poppel

EAU International Relations Office

expressed his gratitude to his mentors and colleagues who have supported him through the years and mentioned the dynamic role that Spanish urology played in the region. He was selected by panels from the AEU and the Fundació Puigvert which cited his significant achievements in the last two decades in boosting European urology through education and research. The honour is given every three years. Previous and recent awardees from the EAU were Claude Schulman (BE), Urs Studer (Bern, CH ), Frans Debruyne (Nijmegen, NL) en Richard E. Hautmann (Ulm, DE).

RSU Congress in St. Petersburg EAU, RSU to strengthen collaborative activities Prof. Igor Korneyev Chair Membership Office St. Petersburg (RU)

iakorneyev@ St. Petersburg, Russia’s second biggest city and “cultural capital” hosted from September 18 to 20 the 15th Annual Russian Society of Urology (RSU) Congress in collaboration with the EAU. The three-day event attracted a record number of 1,720 Russian and foreign participants. RSU Chairman Prof. U.G. Alyaev and EAU Secretary General Prof. Chris Chapple opened the congress, and highlighted the importance of the national meeting in developing the long-term cooperation between the two organisations. The collaboration started years ago with the involvement of Russian opinion leaders in the scientific and educational activities organised by the EAU Section Offices and the European School of Urology (ESU), as well as the individual initiatives of EAU faculty members who participated in the national and regional meetings organised by RSU. EAU International Relations Office

“The scientific programme of the 15th Congress is remarkable as it has been prepared in collaboration with the European Association of Urology, making it a significant event. Over the years many Russian urologists have been actively involved in the EAU’s committees and sections and with the European School of Urology. Understanding the need for mutual exchange of experience and educational resources has led to this meeting,” said Dr. Y. Alyaev, who led the organising committee The EAU team was headed by no less than Prof. Chapple with Professors Manfred Wirth, Hein Van Poppel, Walter Artibani, Frans Debruyne, Arnulf Stenzl, Bob Djavan and Wolfgang Weidner. Also joining as faculty members and lecturers were Professors Maurizio Brausi, Joan Palou, Olivier Traxer, Wolfgang Aulitzky, Luis Martinez-Pineiro, Alberto Briganti, Marcus Drake, Dmitry Pushkar, Marco Scoffone, Jeroen Van Moorselaar and Dr. Henk Van Der Poel. The faculty joined the 33 plenary, thematic and moderated poster sessions. The EAU speakers highlighted contradictions in current urological practice and prompted enthusiastic pointcounterpoint discussions even beyond the lecture halls. “This joint activity is part of the EAU’s goals to intensify its links and collaboration with other countries and international associations. We are delighted to be part of the RSU’s efforts to further boost urology in Russia,” said Chapple as he

underscored the importance of mutual cooperation between the two associations. Alyaev said the RSU is looking at best practices from other regions such as Western Europe and learn from joint activities in scientific research and continuing medical EAU Membership Coordinator Jessica Bijlsma-Hatzmann with three Russian delegates at the education. “We are working on key issues to EAU membership booth improve the postgraduate training programme for urologists. The RSU participates in European and infertility and locally advanced prostate cancer. international clinical and research projects. One Reports, presented by academic urologists, have example of cooperation was the joint translation work shown the need for academic and practical support and adaption of the EAU Guidelines within a Russian for the younger generation of urologists. context,” according to Alyaev. At the congress venue, EAU membership coordinator The RSU is one of the largest professional medical Jessica Bijlsma-Hatzmann, with the help of Russian organisations in Russia with over 5,000 Russian urology residents, set up the EAU information booth urologists. In recent years, many individual Russian for active and junior EAU members and also for new urologists have been active in EAU activities, and applicants. Alyaev noted that this has prompted the RSU to harness the talents of Russian experts and benefit Alyaev said the RSU is grateful for the EAU’s active from their expertise. support and thanked the RSU’s partners for a successful congress. At the closing ceremony, the RSU In one of the sessions Professors Jeroen Van announced the next congress which will be held in Moorselaar and Wolfgang Aulitzky gave detailed September 2016. RSU looks forward to welcome the overviews of new developments in treating male EAU in Russia next year.

China, EAU to expand collaborative meetings Abrahamsson, N’Dow receive honorary awards The Chinese Urology Association (CUA) intends to further expand their participation in the Annual EAU Congress and hopes the closer ties between the CUA and the European Association of Urology (EAU) will lead to a more dynamic exchange of professional skills and knowledge exchange among its members.

CUA cited N’Dow’s work and involvement in CUA’s educational activities. The UAA, on the other hand, highlighted Abrahamsson’s valuable contributions to the development of urology and his contributions to international urology by linking up various urological groups.

“We are very keen to collaborate with the EAU during its annual congress. This can be achieved through more educational exchanges and with a bigger number of congress participants,” said CUA during a joint executive meeting with the EAU held in Shanghai in September.

During the Shanghai meeting, CUA executive members Professors Yinghao Sun, Jian Huang and Li-Ping Xie met with EAU Secretary General Chris Chapple to discuss the aims of both the CUA and the EAU on how to further boost their ties in the coming years.

The joint meeting coincided with the 13th Urological Association of Asia (UAA) Congress & 22nd CUA Annual Meeting in Shanghai from September 3 to 6. Under the auspices of CUA, the Chinese European Urology Education Programme (CEUEP) also welcomed young urologists across China for the annual education and training event patterned after the EAU’s European Urology Residents Education Programme (EUREP). Meanwhile, EAU Guidelines Chairman James N’Dow received an honorary membership award from CUA, while former EAU Secretary General Per-Anders Abrahamsson was granted honorary membership by the UAA. EAU International Relations Office

October/December 2015

Profs. Chapple and Sun acknowledged the strong collaboration between the associations, which has

seen remarkable growth in the last 10 years. They also reaffirmed their aims to intensify collaborative projects such as in training, education and scientific exchanges. Currently, the EAU and CUA have collaborated in various educational activities including training workshops, educational courses and participation in scientific meetings. Chapple said the EAU will continue its support to the CUA through its active participation in the association’s project and by sending visiting lecturers and scholars to China. Other collaborative activities would be in Guidelines training, scientific publications and expanded links with young urologists from Europe and China. “We affirm the warm and cordial relations we have with CUA and we look forward to strengthening these ties in the future through projects in education, science and collaborative meetings,” added Chapple. Mentorship in CEUEP The CEUEP which was held on August 29 and 30 preceded the CUA meeting. Professors Abrahamsson, Chapple and Bertrand Malavaud chaired three sessions during the CEUEP event where they gave update lectures in prostate and bladder

cancers and benign prostatic obstruction (BPO), respectively. Abrahamsson discussed the optimal way to evaluate a patient with elevated PSA (e.g. biopsies, imaging, counselling), while Profs. Y. Zhang and Y. Niu tackled issues such as individualised treatment for prostate cancer and treatment strategies for recurrent disease. Chapple took up the conservative, medical and surgical treatment of BPO and examined both the pitfalls and benefits of each treatment. The Chinese faculty composed of Profs. Y. Shao and K. Xu looked into new treatments in BPO including medical and minimal invasive treatments and the challenges in diagnosing the disease. Malavaud gave a comprehensive presentation on the management of non-muscle invasive bladder cancer (NMIBC), including diagnostic and operative endoscopy, issues in risk stratification and bladder instillation techniques. His counterparts Profs. G. Zhu and S. Du focused on surgical and non-surgical management such as radical cystectomy and diversion, neoadjuvant chemotherapy, and managing metastatic disease. Chapple noted the EAU’s commitment to support the CEUEP educational goals and with his colleagues from CUA re-affirmed both organisations’ strategy to strengthen their partnership through scientific and scholarship exchanges. European Urology Today


Advances in laparoscopy for urological indications - Part 2 Armamentarium By Prof. Jens Rassweiler

robot-assisted surgery, there might be a need to improve haemostatic devices. Recently, particularly for Co-Authors: Dogu Teber, Medical School of Medicine, laparoscopic ablative surgery, new advanced sealing University of Heidelberg, Ali Serdar Gözen, SLK devices enabling easy and quick haemostasis and Kliniken Heilbronn (DE), Jan-Thorsten Klein, University cutting of tissue have been introduced by different of Ulm (DE) manufacturers such as (i) ultrasound shears, (ii) radiofrequency-based systems, and (iii) electroIn a series of articles, we summarize emerging thermical bipolar vessel systems (Table 1).14 technology and also speculate on the future of laparoscopy in urology. Basically, this concerns Ultrasonic devices (ie Harmonic Ace) combine both development in (i) video-endoscopy, (ii) endoscopic sealing and cutting steps into a single process, thus armamentarium, (iii) surgical platforms, single-port increasing dissection speed. However, ultrasonic surgery (iv), and (v) robot-assisted surgery. devices may create temperatures of up to 200°C. This can potentially put adjacent tissue at risk to lateral Advances in armamentarium damage.14 1. Improvement of trocar technology Considering over two million laparoscopic and Advanced bipolar devices (Ligasure, Bicision, and retroperitoneoscopic cases performed in the United EnSeal) provide active feedback control of the applied States, the basic common requirement and first step energy output14. Consequently, production of heat in remains access to peritoneal or retro/extraperitoneal tissue can be kept below 100°C. However, these cavity by C02-insufflation, which may rarely lead to devices do not allow simultaneously division of the even fatal complications.2,3 A multicentric prospective tissue thus requiring a cutting blade, which may study from 72 hospitals revealed overall incidence of increase operating times. Enseal (Ethicon, USA) offers intestinal injuries and major complications as 5.7 per articulation of the tip. 1,000 procedures. 70% of these were related to Thunderbeat (Olympus, Japan) integrates ultrasonically primary port entry. Overall incidence of laparoscopic generated frictional heat and advanced bipolar energy entry injuries was 3.3 per 1,000 including 29 cases of gastrointestinal damage (1.3 per 1,000) and 27 in a single instrument. It delivers the energies interchangeably, thus allowing surgeon to abdominal vessel injuries (1.05 per 1,000).4,5 simultaneously seal and cut vessels up to a diameter of Basic principles of trocar systems have been 7 mm providing minimal thermal spread. The design of developed at the end of the last century, including jaws enables precise, controlled dissection as well as reusable metal trocars, shielded trocars, radially combination of continuous bipolar energy with expanding trocars, and optical trocars.5 Regarding the grasping capability. A randomized study revealed shape of trocars, disposable shielded “safety” trocars shorter OR-time (85 vs. 115 min) for laparoscopic radical were introduced in the early 1980s followed by hysterectomy compared to standard electrosurgery.15 radially expanding trocars in the 1990s. Looking at principle design, all these abdominal wall access The Altrus Thermal Tissue Fusion system (ConMed, systems consist of the obturator part (trocar itself) Centennial, USA) uses electricity to create heat that in facilitating the insertion and the outer cannula or turn achieves the desired tissue effect. In contrast with “port,” which remains in place to allow passage of true electrosurgical instruments, the Altrus system instruments and insufflation.3 uses direct current to heat the jaws of the instrument and then passively transfer that heat to the tissue. No A comprehensive evaluation of different obturators like electricity enters the patient through the device. The single-blade cutting, blunt-radial dilating, plastic system monitors the temperature at the jaws and blade, triangle blade cutting, hybrid dilating then cuts also through tissue.16 demonstrated an advantage towards radial dilating and hybrid systems in terms of tissue defect and Classical monopolar and bipolar technology is safe insertion force.5 Furthermore, radially dilating trocars and efficient as proven by various comparative caused significantly less post-operative pain, shorter studies.15,16 However, in some situations (i.e. malignant wound scars, less wound induration and better patient perinephric fat, control of smaller vessels), such satisfaction.6.7 Accordingly, a recent meta-analysis devices may speed up dissection and help surgeons to documented a lower trocar-associated morbidity for better identify the respective surgical planes. Some blunt versus bladed trocars (3% vs 10%).8 devices have been modified also for use with robot-assisted surgery including monopolar and With increasing experience, laparoscopy was also bipolar cautery instruments (electrical energy), offered to patients who underwent previous abdominal Harmonic™ ACE (mechanical energy), and PK™ surgery eventually requiring an open HassonDissecting Forceps (advanced bipolar).17 Advanced technique, respectively, insertion systems under visual sealing and dissection devices increase procedural control (optical trocars). Endoscopic threaded imaging costs compared to monopolar or bipolar technology. ports (EndoTIP (Karl Storz, Germany), Endopath Optiview optical trocar (Ethicon Endo-Surgery, United 3. Mechanical suturing devices States) and Visiport (Covedien, Unites States) represent Endoscopic freehand suturing represents one of the alternatives to classical trocar insertion as the surgeon most difficult and sometimes time-consuming parts of has visual control during access.9,10 Visiport uses a any laparoscopic reconstructive procedure.18 This was a firing blade under visual control, whereas Endopathreason for success of the robot. One may improve XCEL Optiview provides a bladeless optical tip to suturing technique by following rules according to the eliminate blind entry. Reusable EndoTIP-trocars use a geometry of laparoscopic suturing and knotting.19 rotating screw-like mechanism.10 Nevertheless, the following technologies to alleviate laparoscopic suturing can be distinguished: (i) Changes in trocar design were not only driven by endoscopic staplers, (ii) endoscopic suturing devices, safety requirements but also by expanding surgical and (iii) an endoscopic sewing machine. techniques and indications claiming to improve surgical quality. A new valve-less trocar principle 3.1 Endoscopic staplers (AirSealTM; SurgiQuest, USA) was used for laparoscopic Endoscopic staplers were primarily used for safe renal surgery and it works with the creation and ligation and division of larger vessels (i.e. renal vein); maintenance of a gas pressure barrier in the proximal however, with introduction of more complex trocar end, enabling a significantly more stable procedures like radical cystectomy and urinary pneumoperitoneum/-extraperitoneum than standard diversion, endoscopic staplers have been used for port systems.11 This might offer advantages especially bowel anastomosis.20 The main development of in extra- and retroperitoneal approaches where staplers consisted of the ability to deflect the tip of pressure loss episodes could lead to a complete instrument. Staplers can also be used for the control collapse of surgical situs.12 Use of a valve-less trocar of the pedicles during radical cystectomy.20 significantly reduced CO2-consumption as well as CO2-elimination and absorption during transperitoneal Interestingly, linear staplers play an important role for laparoscopy when compared with standard trocars.11 robotic radical cystectomy with intracorporeal creation of a neobladder.21 A recent study compared stapled However, in a prospective comparison to standard trocars, the system failed to demonstrate an influence intestinal versus hand-sutured anastomosis in an on overall surgical time and blood loss.13 animal model of peritonitis: anastomosis by stapler proved to be safer and more effective than that by 2. Devices for haemostasis (advanced sealing devices) hand suturing, since it requires less operating time Whereas, most instruments for dissection and cutting and creates stronger anastomoses in the early of tissue have been well developed and may not need postoperative period.22 further improvement, including basic instruments for Staplers have no clinical relevance for creation of a neo-bladder due to stone formation around titanium Expert views clips and risk of stricture formation at urethral 10

European Urology Today

anastomosis23 Staplers with absorbable clips are not yet available. General surgeons predominantly use circular staplers when performing laparoscopic sigmoid resection or esophagojejunostomy.24 In urology, they do not yet play any role.

Ti-Knot alleviates extracorporeal knotting: The end of the sutures are snared and fed through a titanium cylinder at the end of the device. While holding the sutures under proper tension, the instrument is 3.2 Endoscopic mechanical suturing devices advanced to the closure site and fired. This crimps the EndoStitch (Covedien, Unites States), specifically for titanium knot onto the suture. COR-KNOT, a further laparoscopy designed mechanical suturing device, was development of Ti-Knot micro-transducer technology, initially frequently used during laparoscopic was tested in a porcine model of mitral annuloplasty procedures, such as laparoscopic radical ring resulting in sutures stronger, more consistent, prostatectomy or pyeloplasty.25,26 Recently, a motorized and faster than with manually tied knots.31,32 However, device based on the same principle (Autostitch) has as a foreign body to fix the knot may restrict its use for been presented and compared to EndoStitch: There urological procedures. was no significant difference between the two systems with respect to stitching accuracy. However, Nevertheless, we may definitively learn from new the suturing time was significantly shorter with suturing devices such as Overstitch (ApolloAutostitch. Weight and size of Autostitch was criticized Endosurgery, United States) especially developed for as well as its cable. However, comfortable handhold, gastrointestinal endoscopy (Fig. 1b).33 automatic needle change, and ergonomic manipulation were rated positively.27 The recently Endo360° (EndoEvolution, United States) has been available flexible version of the device (SILSTM-Stitch) already used clinically and mainly for bariatric may enhance application of this suturing technique.28 laparoscopic surgery.34 The automated suturing device The principle of EndoStitch / SILSTM Stitch represents a with a flexible tip is reusable using a standard curved straight needle which can be manipulated from one needle in contrast to all other mechanical suturing branch of the device to the other. The suture material devices (Fig. 1c). is attached to the middle of the needle (Fig. 1a). Freehand laparoscopic suturing has become much Suture Assistant (Ethicon, USA) was also tested in vitro easier using barbed sutures (V-lock, Clip-lock, Quill) showing no distinct advantages compared to as well as using clips (Lapra-Ty; Hem-o-lock) instead EndoStitch.26 It represents a 5 mm instrument of knotting.35-38 However, these suture materials can designed to place a pre-tied knot quickly after using be also effectively use in combination with either the device or a needle driver to place a single mechanical suturing devices.38 suture. Continuous suture cannot be performed with this device. 4.3.3 Endoscopic sewing machine The University of Aachen in collaboration with Karl The Suture lock (Anpa-Medical United States) has been Storz has designed the endoscopic sewing machine recently compared versus different laparoscopic EndoSew, which should be helpful for long continuous techniques (intracorporeal, extracorporeal, Clipbowel suture (i.e. creating a laparoscopic neoassisted) revealing the greatest tensile strength. The bladder).39 The concept has been tested successfully time to secure a knot using the ANPA device was also during extracorporeal construction of an ileal conduit significantly quicker than tying a standard surgeon's in 10 patients. However, in four patients additional knot.29 In 2015, the patent expired without seeing the freehand stitches were necessary.40 We found it in an device on the market. experimental laparoscopic setting, very difficult to use: mainly because transportation of the sutured Further tested suture devices include Sew-Right and tissue has to be performed manually step-by-step Ti-Knot (LSI Solutions, Unites States): when tried with (Fig. 1d). medical students, both devices were easy to learn and use for laparoscopic suturing and tying with minimal The full article including reference list is available instruction.30 Sew-Right uses two built-in needles to from the EUT Editorial Office. Send your request place a simple suture through the tissue. However, to, indicating the title and with tenacious tissue, if the needle deviates or does authorship as follows: “Advances in laparoscopy for not fully penetrate tissue, it may not engage the urological indications – Part 2” by Prof. Rassweiler, suture at the distal jaw. Oct./Dec. issue 2015. Table 1: Comparison of advanced sealing devices

Table 1: Comparison of advanced sealing devices Technology

Working mechanism




Vibration of the two jaws create heat to cut through tissue and coagulation (depending on frequency)

Combination of both mechanims in one instrument (Harmonic Ace) Integrated in Da Vinci (Harmonic Ace)

Ultrasonic devices crate heat up to 200° C and may put adjacent organs to risk of damage (even if 10 seconds after activation)


Feedback control of applied bipolar energy between jaws allowing temperature < 100°C Additional cutting blade

Articulation of tip (Enseal) Combination with utrasound technology (Thunderbeat) Integrated in Da Vinci (PK-Dissection forceps)

Jaws of the device can be used for blunt dissection

Electronic heat (Thermal tissue fusion)

Electricity used to heat up jaws for cutting

No electricity enters body

Possible risk of heat injury





Fig. 1: Mechanical suturing devices a) Endo-Stitch (Covedien, Boulder, USA) straight needle, which can be manipulated from one jaw to the other. The suture material is attached to the middle of the needle. Use during vesico-urethral anastomosis. b) Overstitch (Apollo Endosurgery, Austin, United States) developed for NOTES using a spring-loaded curved needle with suture attached proximal to the needle-tip. c) Endo360° (EndoEvolution, Raynham, United States), automated suturing device with a flexible tip being reusable for standard curved needle (Schematic drawing of tip and endoscopic view). d) EndoSew (Karl Storz, Tuttlingen, Germany) endoscopic sewing machine introduced via a 15 mm port.

October/December 2015

Updates from the Guidelines Office Autumn Panel Meetings Autumn was a busy time for Guideline Panel meetings with the Panels finalising their text for the 2016 version in time for the October deadline. The main focus of the Panels in preparing the 2016 Guidelines was on: • incorporating the findings of systematic reviews • ensuring all Guidelines are based on evidence based literature searches and • standardising the phrasing of recommendations.

Photo 1: Chronic Pelvic Pain Panel Meeting in London

The Guidelines Office is also delighted to announce the formation of a new working group to address the EAU Guidelines on Renal Transplantation (RT). The panel, chaired by Dr. Alberto Breda, met for the first time in August this year to discuss the processes involved in updating the previous RT guidelines (Photo 3). All panel members agreed that the current text offers an excellent starting point, but some sections require updating and expansion to cover new developments in renal transplantation. The panel also attended a one and a half day training workshop in October which included presentations on guidelines development methods, as well as dedicated time for panel research questions. Guided by the workshop faculty, detailed PICOs (Population, Intervention, Comparison, Outcome) were developed with the panel as a whole to set up systematic reviews. The panel is acutely aware of the importance of EAU RT guidelines to European urologists and as such, the panel is eager for the updated guidelines to assist European urologists in their clinical practice. Collaboration with, and involvement of other specialty groups working in the RT field is currently being explored. Additionally, the RT Panel is keen to incorporate patient perspectives in their updated document.

A snap shot of panels who met over the autumn months include the the Chronic Pelvic Pain Panel in London (Photo 1), Urological Infections Panel in Budapest (Photo 2), Non-Muscle-Invasive Bladder Cancer Panel in Prague, the Male Infertility Panel in Vienna and the Urological Trauma Panel in Amsterdam. The Guidelines Office is sad to say goodbye to Mr. Duncan Summerton, who has been an exceptional chairman for the Urological Trauma Panel for the past six years. However, we are delighted to announce that Dr. Noam Kitrey will replace Mr. Summerton and we have no doubt that the Urological Trauma Panel will continue to maintain the same level of excellence under Dr. Kitrey’s guidance. Guidelines Office

Photo 2: Urological Infections Panel meeting in Budapest

Presentations were given by Mr. Des Watson, expert in medico-legal aspects of clinical practice guidelines, and by Prof. Maria Ribal, Chair of the New Media Group, on the success of the EAU GO new media activities on Facebook and Twitter (See Article). Other issues addressed were the challenges related to capturing patient perspectives in guideline production and the on-going EAU Photo 3: Renal Transplantation Panel meeting Associates’ programme. In addition, Prof. Alberto Briganti, the Chairman of Prof. Jacques Irani the new Guidelines Impact Assessment group The Guidelines Office Board is sad to announce that (IMAGINE) reported the group’s plans to measure Prof. Jacques Irani, the Vice-Chairman of the Board for impact of the EAU guidelines on clinical practice, a 7 years and a member for 10 years has stepped down. challenging but fundamental project for the GO Office. We would like to thank him for his unwavering commitment and hard work for the GO Board during Above all, the meeting provided an opportunity for his tenure and wish him well for the future. the Panel Chairs to ask questions of the Board and (see Photo 4) discuss plans for the future development of the guidelines. The Guidelines Board and Panel Chairs Chairmen Meeting will meet again in May 2016 in Dresden, Germany. The Guidelines Panel Chairmen met with the Guidelines Office Board last October in Prague. This highly productive meeting, chaired by Guidelines Office Chairman Prof. James N’Dow discussed updating guidelines production methodology, including the rephrasing of the guidelines recommendations which will be introduced in the Photo 4: Prof. Jacques Irani, Vice-Chairman of the Guideline Board, is leaving 2016 edition.

EAU Guidelines embraces Social Media Remarkable first-year SoMe results for EAU Guidelines To enhance the dissemination of the EAU Guidelines, a new social media workgroup within the dedicated Guidelines Office Dissemination sub-committee was created in October last year with the added goal to prompt discussion and trigger feedback from guidelines users. Social media (SoMe) tools like Facebook and Twitter are the perfect vehicles to inform urologists regarding treatment recommendations in urology in a simple and effective manner. Furthermore, by employing these new media channels the engagement among urologists and the Guidelines Office can be stimulated, and the ‘by word of mouth’ advertisement usually leads to an efficient promotion. Over the last year we have seen an enormous increase of healthcare communication in social media. Platforms like Symplur provide persuasive

The Numbers

2,816,735 3,067 2,000 603 5


New followers


Avg Tweets/Participant

Fig. 1: Statistics

Guidelines Office

October/December 2015


recommendations for Health care professionals regarding treatment and lifestyle tips for patients. For Facebook, several panels shared their pictures of team meetings while working on the next year’s guidelines. In our first year, the social media achievements of EAU Guidelines have already been rewarded with the Innovation Award given by BJU International. This is a great boost to continue our activities in social media.

With these remarkable results the Dissemination Committee, led by Prof. Maria Ribal and with social media experts such as Dr. Stacy Loeb, Prof. Morgan Roupret, Dr. Inge Van Oort and Jarka Bloemberg of the communication team at the EAU Central Office, is enthusiastic to further develop this project and take the dissemination of EAU Guidelines to the next level. Follow us on Facebook EAUpage or on Twitter or via #eauguidelines.

Fig. 2: Meeting of the Working Group Social Media of the Guidelines Office

proof that healthcare promotion via social media is here to stay. After the first year of being active on Twitter, we can only conclude that the EAU Guidelines’ first-year presence in social media is a big success. From its official start in January 2015 the hashtag #eauguidelines achieved the following results: • Over 3,000 tweets including #eauguidelines have been disseminated; • Over 600 people distributed a tweet with #eauguidelines; • The average tweets per participant are 5; • This all resulted in nearly three million impressions or ‘eyeballs’; and • The number of followers of the EAU Twitter account @uroweb increased from 5,000 to 7,000. Real team effort is behind this impressive achievement. These statistics couldn’t be realised without the input of members of the Guidelines Panels themselves. Each panel has provided the social media workgroup with 10 tweets, containing

European Urological Scholarship Programme (EUSP) Do not forget to submit your online applications for Short Visit, Clinical Visit, Clinical and Lab Scholarship, and Visiting Professor Programme, before the next deadline of 1 January 2016! For more information and application, please contact the EUSP Office – or check our website

European Urology Today


Key articles from international medical journals Prof. Truls Erik Bjerklund Johansen Section editor Oslo (NO)

Antimicrobial prophylaxis protocol using rectal swab cultures for transrectal prostate biopsy

The aim of the present study was to evaluate the benefit of an antimicrobial prophylaxis protocol using rectal swab cultures in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy in a Veterans Affairs population.

Predictive factors of harboring fluoroquinolone-resistant and extended-spectrum β-lactamase-producing rectal flora in Hong Kong Chinese men undergoing TRUS-guided prostate biopsy The aim of this project was to study the prevalence of fluoroquinolone-resistant (FQ-resistant) and extended-spectrum β-lactamase-producing (ESBL-producing) bacteria in the rectums of patients undergoing transrectal ultrasound-guided prostate biopsy (TRUS-Bx), to identify predictive factors for such carriage and to correlate the findings with the microbiology of those who developed post-biopsy infection (PBI). A total of 371 men undergoing TRUS-Bx were prospectively enrolled from August 2011 to March 2012. Rectal swab was obtained before antimicrobial prophylaxis on the day of biopsy and cultured in selective media for resistant bacteria. Standard FQ prophylaxis was used without guidance from rectal swab results. Univariate and multivariate analyses were performed to identify predictive factors of either FQ-resistant or ESBL-producing bacteria carriage. The authors found that: • A total of 199 of 371 patients (53.6%) carried antimicrobial-resistant rectal flora, with 150 (40.4%) and 152 (41.0%) patients having FQresistant and ESBL-producing bacteria, respectively; and • Diabetes mellitus (odds ratio, 2.075; p = .028) and the use of antimicrobials within the prior five years (odds ratio, 1.550; p = .047) were independent predictors of rectal carriage of such flora.

…a high prevalence of FQ-resistant and ESBL-producing rectal flora in Chinese men undergoing TRUS-Bx was found. Diabetes mellitus and prior antimicrobial use within five years were significant predictors for resistant bacterial carriage PBI occurred in nine patients, of which seven harbored pre-biopsy antimicrobial-resistant bacteria, which completely matched the microbiological data collected during the patients' PBI episodes. It is concluded that a high prevalence of FQresistant and ESBL-producing rectal flora in Chinese men undergoing TRUS-Bx was found. Diabetes mellitus and prior antimicrobial use within five years were significant predictors for resistant bacterial carriage. Despite the high-resistant bacteria prevalence, PBI rate remained low. A targeted approach of antimicrobial prophylaxis using pre-biopsy culture swab in areas with high prevalence of resistant bacteria should be further investigated.

Source: Prevalence and predictive factors of harboring fluoroquinolone-resistant and extended-spectrum β-lactamase-producing rectal flora in Hong Kong Chinese men undergoing transrectal ultrasound-guided prostate biopsy. Tsu JH, Ma WK, Chan WK, Lam BH, To KC, To WK, Ng TK, Liu PL, Cheung FK, Yiu MK. Urology 2015 Jan;85(1):15-21. doi: 10.1016/j. urology.2014.07.078. Epub 2014 Nov 8.

Key articles


Between June 1, 2013, and June 1, 2014, authors implemented an antimicrobial prophylaxis protocol using rectal swab cultures on selective media containing ciprofloxacin for all men scheduled for TRUS-guided prostate biopsy. Data from 2,759 patients from January 1, 2006 to May 31, 2013, before protocol implementation served as historical controls. Patients with fluoroquinolone (FQ)-susceptible organisms received FQ monotherapy, while those with FQ-resistant organisms received targeted prophylaxis. The objective was to compare the rate of infectious complications 30 days after prostate biopsy before and after implementation of the antimicrobial protocol. One hundred and sixty-seven patients received rectal swab cultures according to the protocol. Seventeen (14 %) patients had FQ-resistant positive cultures.

…an antimicrobial prophylaxis protocol using rectal culture swabs is a viable option for prevention of TRUS-guided prostate biopsy infectious complications

A total of 151 females which included 70 diabetic (Group A) and 81 non-diabetic (Group B) females were studied. The most common symptom was fever in both groups. UTI was classified as per the EAU grades of UTI. In group A, the number of patients having severity grade from 1 to 6 were 47, 9, 4, 2, 4, and 4 respectively. The most common clinical presentation in both the groups was cystitis followed by pyelonephritis and urosepsis. In group B, the number of patients having severity grade from 1 to 6 were 66, 4, 5, 5, 0 and 1, respectively. Most common organism was E-coli, which was susceptible to most of the antibiotics. The authors concluded that: UTI in diabetic and non-diabetic female patients have different patterns. Uncontrolled diabetes was more commonly associated with severe UTI like pyelonephritis and emphysematous pyelonephritis.

UTI in diabetic and non-diabetic female patients have different patterns. Uncontrolled diabetes was more commonly associated with severe UTI like pyelonephritis and emphysematous pyelonephritis E. coli was most common isolate in either group, followed by Klebsiella and Pseudomonas. Candida was isolated only from the diabetic population. Therefore, the most common type of UTI as per the EAU classification in both diabetic and non-diabetic female was CY-1R: E. coli(a): 'simple cystitis but recurrent with susceptibility to standard antibiotics', in our study.

Patients with positive FQ-resistant culture results were more likely to have had a history of previous prostate biopsy and a positive urine culture in the last 12 months (p = 0.032, p = 0.018, respectively).

Source: Comparison of Clinical Presentation and Risk Factors in Diabetic and Non-Diabetic Females with Urinary Tract Infection Assessed as Per the European Association of Urology Classification. Garg V, Bose A, Jindal J, Goyal A.

The average annual infectious complication rate within 30 days of biopsy was reduced from 2.8 to 0.6 % before and after implementation of our antimicrobial prophylaxis protocol using rectal swab cultures, although this difference was not statistically significant (p = 0.13).

J Clin Diagn Res. 2015 Jun;9(6):PC12-4. doi: 10.7860/ JCDR/2015/14177.6029. Epub 2015 Jun 1.

Authors concluded that an antimicrobial prophylaxis protocol using rectal culture swabs is a viable option for prevention of TRUS-guided prostate biopsy infectious complications. After implementation of an antimicrobial prophylaxis protocol, authors observed a non-significant decrease in the rate of post-biopsy infectious complications when compared to historical controls.

Source: An antimicrobial prophylaxis protocol using rectal swab cultures for transrectal prostate biopsy. Summers SJ, Patel DP, Hamilton BD, Presson AP, Fisher MA, Lowrance WT, Southwick AW.

New treatment options in renal cancer Despite the increasing incidence of incidentally detected renal cell carcinoma, approximately 30% of patients present with metastatic disease worldwide. A number of targeted therapies have been approved for the treatment of advanced or metastatic renal cell carcinoma. These agents include vascular endothelial growth factor (VEGF) pathway inhibitors, which are the standard first-line treatment, and mammalian target of rapamycin (mTOR) inhibitors such as Everolimus that is recommended after treatment with sorafenib or sunitinib has failed.

Nivolumab is a programmed death 1 (PD-1) immune checkpoint inhibitor antibody that selectively blocks the interaction between PD-1, which is expressed on activated T cells, and PD-1 ligand 1 (PD-L1) and 2 (PD-L2), which are expressed on immune cells and Risk factors in diabetic and tumor cells. Interaction between PD-1 and PD-L1 or non-diabetic females with UTI PD-L2 normally results in inhibition of the cellular immune response. Previous studies have shown that Diabetes has been known to cause severe complicated PD-L1 expression is associated with a poor prognosis urinary tract infection (UTI) as a result of its various in renal-cell carcinoma, presumably because of its changes in the genitourinary system. This study of UTI immunosuppressive function. It has been postulated in diabetic females was undertaken to learn the that PD-L1 expression would be associated with pattern of infections, their causative organisms and improved overall survival in response to nivolumab therapy, because disruption of PD-1–PD-L1 signaling severity, with particular reference to European Association of Urology (EUA) guidelines for UTI 2015. mediated by nivolumab leads to restored antitumor immunity. This study reports results from a phase 3 This is a prospective single-centre study done over a study comparing nivolumab with everolimus in the period of one year at Dayanand Medical College and treatment of patients with previously treated advanced Hospital on a total of 151 diabetic (Group A) and renal cell carcinoma. non-diabetic (Group B) female patients with diagnosis of UTI. A thorough history of the patients was taken Patients with advanced clear-cell renal-cell carcinoma which included looking for the anatomical level of for which they had received previous treatment with infections, host risk factors; extra-urogenital risk one or two regimens of antiangiogenic therapy and factors and nephropathy disease were assessed. now had evidence of disease progression were randomly assigned (in a 1:1 ratio) to receive 3 mg of All patients were adequately investigated. The UTI nivolumab per kilogram of body weight intravenously was classified according to the EAU classification for every two weeks or a 10-mg everolimus tablet orally UTI (severity grading and ORENUC-phenotyping), and once daily. Patients were stratified on the basis of an effort was made to find out the most frequent MSKCC prognostic groups and the number of previous phenotype in this study group. antiangiogenic therapy regimens. Patients with a World J Urol. 2015 May 3. [Epub ahead of print]

Dr. Guillaume Ploussard Section editor Toulouse (FR)

g.ploussard@ Karnofsky performance score of less than 70 or those previously exposed to mTOR inhibitors were excluded. The primary end point was overall survival. The secondary end points included the objective response rate, progression-free survival, and the incidence of adverse events. From October 2012 through March 2014 821 patients were randomised of which 803 were treated – 406 in the nivolumab group and 397 in the everolimus group. The median overall survival was 25.0 months (95% CI, 21.8 to not estimable) with nivolumab and 19.6 months (95% CI, 17.6 to 23.1) with everolimus. Death occurred in 183 (45%) of the patients assigned to receive nivolumab and in 215 (52%) assigned to receive everolimus. The hazard ratio for death was 0.73 (98.5% CI, 0.57 to 0.93; p = 0.002), which met the pre-specified criterion for superiority (p ≤ 0.0148). The overall survival benefit was observed across all pre-specified subgroups.

Median overall survival was 5.4 months longer with nivolumab than everolimus. Grade 3 or 4 toxicity was less commonly seen and treatment discontinuation was less likely with nivolumab The objective response rate was greater with nivolumab than with everolimus (25% vs. 5%; odds ratio, 5.98 [95% CI, 3.68 to 9.72]; p < 0.001). The median progression-free survival was 4.6 months (95% CI, 3.7 to 5.4) with nivolumab and 4.4 months (95% CI, 3.7 to 5.5) with everolimus (hazard ratio, 0.88; 95% CI, 0.75 to 1.03; p = 0.11). Treatmentrelated adverse events leading to discontinuation occurred in 31 of 406 patients (8%) treated with nivolumab and in 52 of the 397 patients (13%) treated with everolimus. Grade 3 or 4 treatment-related adverse events occurred in 19% of the patients receiving nivolumab and in 37% of the patients receiving everolimus; the most common event with nivolumab was fatigue (in 2% of the patients), and the most common event with everolimus was anemia (in 8%). Median overall survival was 5.4 months longer with nivolumab than everolimus. Grade 3 or 4 toxicity was less commonly seen and treatment discontinuation was less likely with nivolumab. As a consequence the Independent Data Monitoring Committee stopped the study early. This is a major step forward in the development of immuno-oncology.

Source: Nivolumab versus Everolimus in advanced renal-cell carcinoma. Motzer RJ, Escudier B, McDermott DF, George S, Hammers HJ, Srinivas S, Tykodi SS, Sosman JA, Procopio G, Plimack ER, Castellano D, Choueiri TK, Gurney H, Donskov F, Bono P, Wagstaff J, Gauler TC, Ueda T, Tomita Y, Schutz FA, Kollmannsberger C, Larkin J, Ravaud A, Simon JS, Xu L-A, Waxman IM, Sharma P, for the CheckMate 025 Investigators. NEJM (2015)

Using CTC to predict disease status in prostate cancer It is recognised that men with prostate cancer who develop visceral metastases have significantly more aggressive disease. In typical practice, patients are monitored by serum PSA concentrations without frequent radiographic assessment. However, it is recognised that serum PSA changes do not detect certain disease alterations such as the emergence of non-PSA-producing neuroendocrine PC (NEPC) or small cell PC. Additional highly sensitive, minimally


European Urology Today

October/December 2015

Acute renal dysfunction in brain-dead donors still leads to good outcomes after kidney transplant

Dr. Francesco Sanguedolce Section editor London (UK)

This study clearly shows that prolonged anastomosis It remains a difficult question whether or not to accept time is not only detrimental for early renal allograft a kidney for transplantation from a brain-dead donor outcome but also for longer-term allograft function (DBD) who has some degree of acute renal failure and histology. (acute kidney injury or AKI).

fsangue@ invasive, serially obtainable means of monitoring disease status are still needed, especially for those patients with castrate resistant prostate cancer. Circulating tumour cells (CTCs) have been suggested as a contemporary prognostic and predictive biomarker for prostate cancer. However they have not allowed the detection of changes in clinical behavior such as the detection of emerging or occult visceral spread. This group hypothesised that variations in the CTC morphology and nuclear size could be used to detect such changes.

CTC biology is an area of rapid development and an automated process, which reliably identifies patients with poor prognosis, might allow us to tailor the use of novel treatments for the high-risk group A total of 148 blood samples were obtained from an existing biobank. Specimens from 57 patients with prostate cancer across the spectrum of metastatic states: no metastasis, non-visceral metastasis, and visceral metastasis, as judged by contemporaneous imaging, were included. CTCs were captured and enumerated on NanoVelcro Chips (CytoLumina, Los Angeles, Calif). This emerging isolation system uses a combination of a microfluidic chaotic mixer and a nanostructured capture substrate. By incorporating higher-resolution fluorescence microscopy into the system, they were able to observe cellular features of the captured CTCs and perform pathologic review for cellular morphology and nuclear size. The distribution of nuclear size was analysed using a Gaussian mixture model. Correlations were made between CTC sub- populations and metastatic status. The data pool was generated by performing 148 enumeration studies that provided a total of 304 CTCs for analysing the nuclear size distribution. When examining the total CTC count, there was a statistically significant difference between metastatic and nonmetastatic disease (0.94 ± 1.91 vs 2.42 ± 3.60 cells per mL of blood; p < 0.002). Statistical modeling revealed three distinct subpopulations: large nuclear CTCs (>14.99 μm) , small nuclear CTCs (8.54-14.99 μm), and very small nuclear CTCs (vsnCTCs) (< 8.54 μm). Small nuclear CTCs and vsnCTC identified those patients with metastatic disease (See Table). However, vsnCTC counts alone were found to be elevated in patients with visceral metastases when compared with those without (0.36 ± 0.69 vs 1.95 ± 3.77 cells/mL blood; p < 0.001). Serial enumeration studies suggested the emergence of vsnCTCs occurred before the detection of visceral metastases. Relationship between CTC nuclear size and metastatic status Large Nuclear CTCs Non-metastatic

Small nuclear CTCs





Nonvisceral mets 22%



Visceral Mets




CTC biology is an area of rapid development and an automated process, which reliably identifies patients with poor prognosis, might allow us to tailor the use of novel treatments for the high-risk group. Larger scale prospective trials need to be conducted to confirm these initial findings

Source: Subclassification of prostate cancer circulating tumor cells by nuclear size reveals very small circulating tumor cells in patients with visceral metastases. Chen J-F, Ho H, Litchterman J, Lu Y-T, Zhang Y, Garcia MA, Chen S-F, Liang A-J, Hodara E, Zhau HE, Hou S, Ahmed RS, Luthringer DJ, Huang J, Li K-C, Chung LWK, Ke Z, Tseng H-R, Posadas EM. Cancer 2015; 121: 3240-51.

Key articles

October/December 2015

blindly reviewed. Prolonged anastomosis time independently increased the risk of interstitial fibrosis and tubular atrophy on these protocol-specified biopsies post-transplant (p < 0.001, generalized linear models).

This controversial question was looked at in this retrospective matched cohort study with 33 renal transplant patients who received a renal allograft from a DBD with AKI. Sixty-five kidney transplants without donor AKI transplanted directly before and after the index transplantation served as controls.

Source: The Effect of Anastomosis Time on Outcome in Recipients of Kidneys Donated After Brain Death: A Cohort Study. Heylen L, Naesens M, Jochmans, Monbaliu D, Lerut E, Claes K, Heye S, Verhamme P, Coosemans W, Bammens B, Evenepoel P, Meijers B, Kuypers D, Sprangers B, Pirenne J.

Am J Transplant. 15(11):2900-7, 2015. doi: 10.1111/ ajt.13397. All AKI donors were classified according to RIFLE criteria: 9.1 % risk, 54.6 % injury, and 36.4 % failure. Mean serum creatinine was 2.41 ± 0.88 mg/dL at procurement and 1.06 ± 0.32 mg/dL on admission. AKI Influence of extraction time in donors had lower 24-h urine production (3.22 ± 1.95 organ procurement for vs. 4.59 ± 2.53 L, p = 0.009) and received more frequently noradrenaline (93.9 vs. 72.3 %, p = 0.02) outcomes of renal transplants and/or adrenaline (15.2 vs. 1.5 %, p = 0.02).

…kidneys from AKI donors can be transplanted with good intermediate prognosis and should not be discarded Recipient and transplant characteristics were similar except a more favorable HLA match in control patients (p = 0.01). Hemodialysis after transplantation was more frequently used in AKI recipients (14/33 [42.4 %] vs. 18/65 [27.7 %], p = 0.17). While significant elevations in serum creatinine were noted in these patients until 10 days after transplantation, this difference lost statistical significance by Day 14. One-year graft survival was very similar when comparing the groups (93.6 % [95 % CI 76.8-98.4 %] vs. 90.3 % [95 % CI 79.6-95.5 %], log rank p = 0.58). The authors concluded that kidneys from AKI donors can be transplanted with good intermediate prognosis and should not be discarded. This important result should be considered by all faced with such decisive questions.

Source: Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case-control study. Benck U, Schnuelle P, Krüger B, Nowak K, Riester T, Mundt H, Lutz N, Jung M, Birck R, Krämer BK, Schmitt WH. Int Urol Nephrol. 2015 Oct. [Epub ahead of print]

Measuring the effect of anastomosis time in renal transplant It is well understood that warm ischemia time affects outcome after renal transplantation. However, the database for this notion is not very good. Whether warm ischemia during the time to complete the vascular anastomoses really determines renal allograft function has not been investigated systematically. The authors of this study investigated the effect of anastomosis time on allograft outcome in 669 first, single-kidney transplantations from brain-dead donors. The results were conclusive. Anastomosis time independently increased the risk of delayed graft function (odds ratio per minute [OR] 1.05, 95% confidence interval [CI] 1.02-1.07, p < 0.001) and independently impaired allograft function after transplantation (p = 0.009, mixed-models repeatedmeasures analysis).

…prolonged anastomosis time is not only detrimental for early renal allograft outcome but also for longer-term allograft function and histology In a subgroup of transplant recipients, protocolspecified biopsies at three months (n = 186), one year (n = 189), and two years (n = 153) were done and

Cold ischemia time (from flush to out-of-ice) and warm ischemia time (from out-of-ice to reperfusion) are known to impact delayed graft function (DGF) rates and long-term allograft survival following deceased donor kidney transplantation. This group proposes an additional ischemia time – called extraction time - beginning with aortic cross-clamping with perfusion/cooling of the kidneys and ending with removal of the kidneys and placement on ice on the back table. During this time the kidneys re-warm, suffering an additional ischemic insult, which may impair transplant function. The authors measured the extraction times of 576 kidneys recovered and transplanted locally between January 2006 and December 2008, then linked these data to the Scientific Registry of Transplant Recipients (SRTR) for outcome data.

…extraction time is a novel and important factor to consider when evaluating a deceased donor kidney offer Extraction times ranged from 14 to 123 min, with a mean of 44.7 min. In SRTR-adjusted analyses, longer extraction time and DGF were statistically associated (odds ratio [OR] = 1.19 per 5 min beyond 60 min, 95% confidence interval [CI] 1.02-1.39, p = 0.03). Up to 60 min of extraction time, DGF incidence was 27.8%; by 120 min it doubled to nearly 60%.

Mr. Philip Cornford Section editor Liverpool (GB)

philip.cornford@ In the present article, intraoperative nerve conduction studies of the pudendal nerve and of the NVB were performed in 17 men undergoing robot-assisted radical prostatectomy. Conduction was obtained using St Mark’s pudendal electrode and ProPep Nerve Monitoring System designed for neuromonitoring during robot-assisted surgical procedures. Two nerve conduction studies were performed during each operation, first prior prostate removal, and then after prostate excision. Sphincter innervation was defined by an appropriate rhabdosphincter EMG signal with visual contraction. The electrode monitoring the rhabdosphincter was inserted via a suprapubic introducer under direct vision.

…these preliminary findings supported the presence of intrapelvic somatic nerves traveling through the NVB in a small proportion of cases Overall, among the initial 17 cases, only seven cases in the final analysis were included due to unsatisfactory initial quality control or inadequate results. The stimulation of NVB led to an evoked compound motor action potential in two cases (29%). In one case, only an apical stimulation of the NVB elicited a rhabdosphincter contraction whereas stimulation of the whole NVB was positive in the other case. This study has several limitations including a small number of cases and a large number of exclusion cases. Indeed, in most cases, no satisfactory pudendal control was obtained. In addition, rhabdosphincter evoked compound motor action potential in response to NVB stimulation was seen only in cases after prostate removal. That’s why no definitive conclusion can be drawn. However, these preliminary findings supported the presence of intrapelvic somatic nerves traveling through the NVB in a small proportion of cases. For these patients, preservation of NVB could improve post-operative urinary continence and justify intra- or extrafascial techniques, regardless of the erectile dysfunction status, provided that oncologic control and margin status are not affected. Further studies are warranted to confirm these initial results.

Although not statistically significant (OR = 1.19, 95% CI 0.96-1.49, p = 0.11), primary non-function rate also rose dramatically to nearly 20% by 120 min extraction time.

Source: Stimulation of the neurovascular bundle results in rhabdosphincter contraction in a proportion of men undergoing radical prostatectomy. Reeves F, Everaerts W, Murphy DC et al.

The authors concluded that extraction time is a novel and important factor to consider when evaluating a deceased donor kidney offer. It also impacts on strategizing personnel for kidney recovery.

Urology 2015 doi: 10.1016/j.urology.2015.09.016

Source: Extraction Time of Kidneys From Deceased Donors and Impact on Outcomes. Osband AJ, James NT, Segev DL. Am J Transplant. 2015. doi: 10.1111/ajt.13457. [Epub ahead of print]

Neurovascular bundles and rhabdosphincter contraction: importance of nerve-sparing techniques in early urinary recovery after radical prostatectomy Clinical studies have suggested that preservation of neurovascular bundles (NVB) during radical prostatectomy could improve post-surgery continence and shorten the time-to-continence recovery. The hypothesis was that some intrapelvic somatic nerves are traveling in the bundle to the rhabdosphincter. Nevertheless, no dedicated in vivo study has explored the impact of NVB conduction on rhabdosphincter contraction.

Continuous mid-term improvement of functional outcomes after radical prostatectomy Physicians usually tell patients that recovery in urinary and erectile function may be achieved during the 12 or 24 first months after the surgery. Beyond this delay, few improvements are awaited. However, few studies have investigated very long-term functional outcomes. The aim of the present study was to determine the long-term probability of achieving urinary continence and erectile recovery in men who reported functional dysfunction 12 months after the surgery. A singlecentre retrospective analysis in 3,187 patients undergoing a radical prostatectomy between 2007 and 2013 was done. Erectile and urinary function was assessed by the IIEF-6 scale and the Prostate Quality Life Survey scale. Patients receiving hormone therapy were excluded and patients were censored at the date of biochemical recurrence (risk of salvage treatment by hormone therapy or radiotherapy). Overall, 26% and 52% of patients did not recover urinary and erectile function at 12 months, respectively.


European Urology Today


Prof. Oliver Hakenberg Section Editor Rostock (DE)

Oliver.Hakenberg@ These patients were included into statistical analysis. For patients with persistent incontinence, 30%, 49%, and 59% recovered urinary function at 24, 36, and 48 months, respectively. Median time to continence in that cohort was 38 months. For 12-month impotent patients, the probabilities of recovering erectile function at 24, 36, and 48 months were 22%, 32%, and 40%, respectively. Interestingly, no changes in Kaplan-Meier estimates were reported after censoring patients who underwent artificial sphincter/sling insertion (n=29) or penile prosthesis insertion (n=17). The two main factors predictive for long-term recovery were age and the 12-month functional score. Men with high functional scores at 12 months are more likely to improve. Unfortunately, the impact of erectogenic agents or physiotherapy on the long-term erectile and urinary function recovery has not been assessed. Results of this study may help patient monitoring within the survivorship program. Even if the majority of men undergoing radical prostatectomy will expect urinary or erectile recovery during the first 12 months following surgery, a not negligible proportion of persistently impotent or incontinent patients will experience erectile and/or urinary recovery after a longer follow-up.

Source: Unexpected long-term improvements in urinary and erectile function in a large cohort of men with self-reported outcomes following radical prostatectomy. Lee JK, Assel M, Thong AE et al. Eur Urol 2015;68:899-905

Image-guided, roboticallyassisted waterjet ablation of the prostate This first-in-man study was designed to demonstrate the safety and feasibility of Aquablation. This is a novel minimally invasive water ablation therapy combining image guidance and robotics (AquaBeam®) for the targeted and heat-free removal of prostatic tissue in men suffering from lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). A prospective, non-randomized, single-center trial in men between the ages of 50 - 80 years of age with moderate-to-severe LUTS was conducted. Under real-time image-based ultrasonic guidance, AquaBeam technology enables surgical planning and mapping, and leads to a controlled heat-free resection of the prostate using a high-velocity saline stream. Patients were evaluated at one, three, and six months.

These preliminary results from this initial study demonstrate Aquablation of the prostate is technically feasible with a safety profile comparable to other BPH technologies Fifteen patients were treated with Aquablation under general anaesthesia. The mean age was 73 years (range of 59 to 86 years) and a mean prostate size of 54 ml (range of 27 to 85 ml). A significant median lobe was present in six of the 15 subjects. The mean International Prostate Symptom Score (IPSS) was 23 and peak urinary flow rate (Qmax) was 8.4 ml/s at baseline. The mean procedural time was 48 minutes with a mean Aquablation treatment time of eight minutes. All procedures were technically successful with no serious or unexpected adverse events. All but one patient had removal of catheter on Day 1, and the majority of patients were discharged on the first postoperative day.

first procedure. The mean IPSS score statistically improved from 23.1 at baseline to 8.6 at six months (p << 0.0001) and the Qmax increased from 8.6 ml/sec at baseline to 18.6 ml/sec at the six-month follow-up (p < 0.001). At six months, mean Pdet@Qmax decreased to 45 cmH20 from 66 cmH20 at baseline (p < 0.05), and mean prostate size was reduced to 36 ml, a 31% reduction in size when compared to baseline (p < 0.001). There were no cases of urinary incontinence or erectile dysfunction reported. These preliminary results from this initial study demonstrate Aquablation of the prostate is technically feasible with a safety profile comparable to other BPH technologies. The combination of surgical mapping by the operating surgeon and the high-velocity saline provides a promising technique delivering a conformal, quantifiable, and standardized heat-free ablation of the prostate.

Source: Aquablation - Image Guided Robotically-Assisted Waterjet Ablation of the Prostate: Initial Clinical Experience. Gilling P, Reuther R, Kahokehr A, Fraundorfer M. BJU Int. 2015 Oct 19. doi: 10.1111/bju.13358.

Hypovitaminosis D linked to LUTS and BPH in type 2 diabetes patients Lower urinary tract symptoms (LUTS) may develop more commonly in men with type 2 diabetes mellitus (T2DM). LUTS are often associated with benign prostate hyperplasia (BPH), in general population. An association between LUTS and hypovitaminosis D, and between hypovitaminosis D and type 2 diabetes (T2DM), has also been suggested. The investigators aimed to evaluate possible relationships between hypovitaminosis D, LUTS, and BPH in T2DM men. In this prospective observational study, 67 T2DM males (57.9 ± 9.28 years) underwent medical history collection, International Prostate Symptom Score (IPSS) questionnaire, that allows the identification and grading of LUTS, physical examination, biochemical/hormonal blood tests (fasting plasma glucose, glycated haemoglobin, total cholesterol, high-density lipoprotein cholesterol, triglycerides, creatinine, LH, total testosterone, estradiol (E2 ), 25-OH-vitamin D, PTH, calcium, phosphate, and PSA) and ultrasound transrectal prostate examination.

…the authors demonstrated an association between 25-OH-vitamin D deficiency, LUTS, and BPH in T2DM men Subdividing patients into three groups, on the base of 25-OH-vitamin D concentration (sufficiency ≥ 50; insufficiency > 25 < 50; and deficiency ≤ 25 nm), a significant progressive increase of prostate volume (p = 0.037), IPSS score (p = 0.019), diastolic blood pressure (p = 0.018), and a significant decrease in HDL cholesterol (p = 0.038) were observed. 25-OH-Vitamin D levels were inversely correlated with both IPSS (R = -0.333; p = 0.006) and prostate volume (R = -0.311; p = 0.011). At multivariate analysis, hypovitaminosis D remained an independent predictor of both IPSS and prostate volume. In conclusion, the authors demonstrated an association between 25-OH-vitamin D deficiency, LUTS, and BPH in T2DM men.

Source: Hypovitaminosis D is associated with lower urinary tract symptoms and benign prostate hyperplasia in type 2 diabetes. Caretta N, Vigili de Kreutzenberg S, Valente U, Guarneri G, Pizzol D, Ferlin A, Avogaro A, Foresta C. Andrology. 2015 Sep 4. doi: 10.1111/andr.12092

Metabolic syndrome amongst men with and without clinical BPH

The aim of this study was to compare the prevalence No patient required a blood transfusion, and postof the metabolic syndrome and the components of operative sodium changes were negligible. No serious the metabolic syndrome in men aged 50 years and 30-day adverse events occurred. One patient underwent older with and without clinical benign prostate a second Aquablation treatment within 90 days of the hyperplasia (BPH). Key articles


This was a cross-sectional study using the UK Clinical Practice Research Database (CPRD). Men were selected from the UK CPRD that were ≥ 50 years of age and still registered as of 31 December 2011. Cohort 1 included men with clinical BPH, and cohort 2 men without clinical BPH that were matched 1:1 to those in cohort 1 by general practice, year of birth and prior years of available history (1 to < 2 years, 2 to < 3 years, 3 to < 4 years, ≥ 4 years of prior history). The prevalence of the metabolic syndrome and its components (for men alive and still registered in CRPD as of 31 December 2011) was calculated using all available prior history (lifetime prevalence) and prior medical history from 2010 and 2011 (current prevalence). Crude odds ratios and 95% confidence intervals (CI) for the occurrence of the metabolic syndrome and the occurrence of the components of the metabolic syndrome were calculated by comparing men with and without BPH.

The presence of clinical BPH was associated with a 37% increased odds of having the metabolic syndrome (for both lifetime prevalence and current prevalence) compared with matched controls without clinical BPH A total of 26.5% of men with clinical BPH had metabolic syndrome compared with 20.9% of matched controls without clinical BPH (absolute difference 5.6%; p < 0.001); men with clinical BPH were therefore significantly more likely to have metabolic syndrome than matched controls without clinical BPH. Significantly greater proportions of men with clinical BPH also had each component of the metabolic syndrome compared with matched controls without clinical BPH. The presence of clinical BPH was associated with a 37% increased odds of having the metabolic syndrome (for both lifetime prevalence and current prevalence) compared with matched controls without clinical BPH. The authors concluded there is a significant crosssectional association between clinical BPH and the metabolic syndrome in the UK primary care population.

Source: The prevalence of metabolic syndrome and its components amongst men with and without clinical benign prostatic hyperplasia: a large, cross-sectional, UK epidemiological study. DiBello JR, Ioannou C, Rees J, Challacombe B, Maskell J, Choudhury N, Kastner C, Kirby M.

Prof. Oliver Reich Section editor Munich (DE)

oliver.reich@ were in follow-up. Adherence rate was only 51.1%; however, patients presumably undertaking the medications had lower chances with respect to the non-adherent patients in terms of attendance to the ED, to the frequency of hospitalization and need of surgical manipulation (9.26% vs 12.93%; 4.51% vs 7.20%; 19.78% vs 23.70, respectively. p < 0.001).

…practitioners should be encouraged to prescribe relevant medications more extensively and counsel more properly this group of patients on the benefits of the longterm medical treatments The same results were confirmed at the logistic regression analysis where non-adherent patients had an Odds Ratio 1.37 to attend the ED, 1.69 OR to be hospitalised and 1.29 OR to undergo a surgical treatment. Even though there are significant potential biases that may limit the results of the study, outcomes should support even more AUA and EAU Guidelines recommendation for stone former patients at high risk of recurrence to receive preventive pharmacological treatment; similarly, practitioners should be encouraged to prescribe relevant medications more extensively and counsel more properly this group of patients on the benefits of the long-term medical treatments to prevent significant and painful clinical events.

Source: Medication Non-Adherence and the Effectiveness of Preventive Pharmacological Therapy for Kidney Stones. Dauw CA, Yi Y, Bierlein MJ, Yan P, Alruwaily AF, Ghani KR, Wolf JS Jr, Hollenbeck BK, Hollingsworth JM. Urol. 2015 Oct 17. pii: S0022-5347(15)05022-3. doi: 10.1016/j.juro.2015.10.082. [Epub ahead of print]

Partial nephrectomy: laparoscopic or robotic?

BJU Int. 2015 Sep 22. doi: 10.1111/bju.13334.

Preventive medical treatment for renal stone: myth or reality? A group of researchers of the University of Michigan have recently investigated the rate of adherence to the preventive pharmacological therapy and its potential consequences on patients affected by renal stones. They reviewed the large amount of data available from the Truven Health Analytics MarketScan, a multinational company focused in capturing healthcare information like tracking of hospitalization, drug prescription, attendance to the Emergency Department (or Accident and Emergency), etc. It is well known that adherence to long-term treatments in general tends to diminish with time; moreover, adherence to pharmacological therapy for the prevention of renal stones may be more affected by factors dependent to the practitioners, like scepticism on the treatments or (presumed) lack of clear guidelines for indications. The authors analysed data from 8,890 patients with renal stones who were given preventive medical treatments which included Thiazide diuretic, Potassium Citrate and Allopurinol. Most of them (83.6%) were prescribed one drug only with Thiazide being the most popular (56.3%).

As per the EAU Guidelines on Renal Cell Cancer (RCC), partial nephrectomy (PN) is the gold standard for cT1a renal masses and should also be preferred for cT1b RCC, when feasible. There is no recommendation with respect to the approach –open, laparoscopic or robotic- when choice depends on the surgeons’ expertise and skills. In recent years, some papers have investigated differences between robotic assisted (RAPN) versus laparoscopic (LPN) partial nephrectomy, in terms of surgical, oncologic and functional outcomes. More recently, a multi-centric study has been conducted to investigate the effect of intra- and post-operative outcomes on the long-term renal function, by comparing a group of patients undergoing a RAPN with another group treated by LPN. There was a significant difference in the number of procedures performed with the two techniques across the five centres involved, as RAPN accounted for 78.6% of the 1,032 patients who underwent a PN. They selected 390 out of these cases, in order to perform a 1:1 match-paired analysis. Since the study was retrospective, in order to reduce the effect of selection bias, the selection of the cases was performed with a propensity score matching, i.e., selecting cases with similar characteristics adjusted for age, sex, body mass index, pre-operative eGFR, and tumour size.

Regardless of this selection process, patients in the RAPN group had a significant higher proportion of Adherence was estimated by using the Proportion of hilar and endophytic lesions. Most remarkable intraDays Covered (PDC) method, calculated as the number and peri-operative findings included a significant of days covered by the prescription vetted at the shorter warm ischaemia time (WIT) and operative pharmacies and divided by the total days the patients time for RAPN group (34.47 min vs 23.82 mins; 210


European Urology Today

October/December 2015

mins vs 135 mins, respectively. p < 0.001), and a lower estimated blood loss and transfusion rate (300 mls vs 200 mls; 28% vs 8%, respectively. p < 0.001). However, there was no difference in terms of positive surgical margins rate (2% vs 3%) and peri-operative change of eGFR (11.45 vs 12.3). Renal function trends in follow-up were similar in both groups: after an initial drop, eGFR tended to improve after nine and 12 months in the RAPN and LPN groups, respectively. At five-year follow-up, eGFR was 95.2% and 92.6% of the pre-operative values, respectively; authors reported a significant difference in the degree of the renal function recovery, even though this did not translate to different rates of new onset of stage ≥3 of chronic kidney disease (CKD); by performing a multivariate analysis, significant independent factors predicting a new onset of CKD were pre-operative eGFR and hypertension. The authors commented on the results by highlighting the tendency of treating more complex renal tumour with a RAPN without affecting the surgical, oncologic and functional outcomes, the latter actually resulting more favourably with this approach. On the other hand, the authors were unable to classify the tumour characteristics as by nephrometric scores (PADUA/RENAL) and to adjust the groups samples for this covariate; more importantly, they also included all the early cases treated through the two approaches, which may have negatively affected more the LPN group’s outcome because of the longer learning curve that this technique implies.

…it is confirmed that RAPN may provide a shorter WIT thanks to the higher degree of dexterity provided by the robotic arms in performing the renoraphy Interestingly, the authors observed that WIT in patients treated after the recruitment period has been declining in both RAPN and LPN approaches, but of course they were unable to provide more precise figures: this may confirm that the inclusion of early patients in the study could have affected some outcomes. Finally, no information were reported regarding the expertise of the surgeons who actually performed the procedures as this is another considerable factor, which may have a greater impact than the centre-volume. Overall, it is confirmed that RAPN may provide a shorter WIT thanks to the higher degree of dexterity provided by the robotic arms in performing the renoraphy. It is also possible that robotic surgeons may feel more confident in conducting a PN on patients with more complex renal tumours, even though it is likely that the most significant factor is the level of expertise and skills of a surgeon with respect to the preferred technique.

iatrogenic injuries caused by malfunctioning of the da Vinci system and (more frequently) by the inadequate training of the surgeons. In both sides of the Atlantic, European and American scientific societies are developing sophisticated curriculum for the surgeons to be certified as proficient for RAS. The EAU European Robotic Urology Section (ERUS) has recently developed a curriculum for the training of the Robotic Assisted Radical Prostatectomy1, where a significant part of the process includes simulation training with dry and wet laboratories and VR.

Overall, even though there is a need for more robust data in literature to support the use of VR simulators, the current evidence show the utility of VR as one of the key curricular parts needed in the training process for RAS A systematic review has been also undertaken to evaluate the quality and level of evidence on the efficacy of VR for the training in RAS. The authors identified 36 studies: 26 cohort studies, two case series and eight Randomised Controlled Trials. Interestingly, urology was the prevalent specialty where the participants were recruited from. Simulators identified in the studies were the Surgical Education Platform (SEP), the Robotic Surgical System (RoSS), the da Vinci-trainer (dVT), the da Vinci Skills Simulator (dVSS) and the Robotix Mentor.

Unfortunately, methods differed in most of studies so authors could not perform pulled analysis; moreover, the small number of participants and lack of metrics to distinguish between levels of proficiency limited the level of evidence of the outcomes reported. Only one trial compared a VR trained group to a control group of surgeons performing robotic hysterectomies on real patients: by using the GOALS (Global Operative Assessment of Laparoscopic Skills) score, the experimental group outperformed the control group in most of the domains scores. In urology, Robotix Mentor, dV-Trainer and RoSS offer VR modules for radical prostatectomy and partial nephrectomy by providing satisfactory realism and good stratification of competency.

World J Urol. 2015 Oct;33(10):1579-84. doi: 10.1007/ s00345-015-1488-5.

More interestingly, the authors found an article analysing cost-effectiveness where it was shown that training on VR simulators would have spared exposure to 73 real patients: the relevant cost of the procedures needed to equal the hours spent on the simulator corresponded to at least five times the price of the training device (600.000$ vs 125.000$). However, the lack of robust evidence proving a linear correspondence of the time spent on a simulator to that on a real procedure may limit this finding.

Since the introduction of highly sophisticated technologies in surgery, there has been the need to develop appropriate and standardised training processes for surgeons to become proficient, safely and quickly. As a result we are contributing to a significant departure from the old fashion way to train surgeons - which involved mostly the trainees in “watching and stealing” the art of the masters- to a more modern and complex approach which involves, equally and more dynamically, the trainers and trainees. Technology also plays a dominant role: virtual reality (VR) has been adopted from aviation and several software have been created for trainees to assist their learning curves in endoscopic and laparoscopic surgery. The latest frontier with regards the training in robotic surgery is the increasing number of roboticassisted surgeries (RAS), which have also been accompanied by an increased number of lawsuits for

October/December 2015

Targeted treatment in prostate cancer moves a step closer Prostate Cancer is a heterogeneous disease with a suggestion this increases as tumours evolve to evade new treatments. In metastatic, castration-resistant prostate cancer (mCRPC) this includes genomic aberrations that interfere with DNA repair. Some of these aberrations have been associated with sensitivity to platinum and poly(adenosine diphosphate [ADP]–ribose) polymerase (PARP) inhibitors, suggesting that treatment with a PARP inhibitor may exploit a synthetic lethal interaction. PARP is involved in multiple aspects of DNA repair, and the PARP inhibitor olaparib has recently been approved for treating ovarian cancers with BRCA1/2 mutations. This study hypothesized that olaparib would have antitumor activity in sporadic cases of metastatic, castration-resistant prostate cancer with DNA-repair defects.

…molecular stratification might be possible to predict high response rates in prostate cancer

Eligible patients had histologically confirmed mCRPC with progression after one or two regimens of chemotherapy (based upon PCWG2) a performance score of 0-2, adequate organ and 5 or more circulating tumour cells (CTCs) per 7.5 ml of blood. The authors assessed several parameters such as the Men were treated with olaparib 400 mg b.d. until the realism of the VR simulators (face validity), usefulness occurrence of radiologic progression, unacceptable of simulator as training tools (content validity), ability side effects, withdrawal of consent or death. Patients of simulators to differentiate performance and novices underwent tumour-biopsy of the metastasis prior to with respect to a given task (construct validity), treatment to allow whole-exome sequencing and agreement of tests scores between different transcriptome studies and germline sequencing was simulators (concurrent validity), ability to predict performed on DNA from saliva samples. The primary performance after the training (predictive validity), end point was response rate defined as a response capability to differentiate ability levels within a group according to RECIST, a 50% reduction in PSA or a of individuals with similar experience (discriminant validity) and ability to transfer skills to the real operations.

Source: Perioperative and long-term renal functional outcomes of robotic versus laparoscopic partial nephrectomy: a multicenter matched-pair comparison. Kim JH, Park YH, Kim YJ, Kang SH, Byun SS, Kwak C, Hong SH.

Training in robotics: Is virtual reality the way?

Eur Urol. 2015 Sep 30. pii: S0302-2838(15)00929-X. doi: 10.1016/j.eururo.2015.09.021. [Epub ahead of print]

Overall, even though there is a need for more robust data in literature to support the use of VR simulators, the current evidence show the utility of VR as one of the key curricular parts needed in the training process for RAS.

Sources: 1) Pilot Validation Study of the European Association of Urology Robotic Training Curriculum. Volpe A, Ahmed K, Dasgupta P, Ficarra V, Novara G, van der Poel H, Mottrie A. Eur Urol. 2015 Aug;68(2):292-9. doi: 10.1016/j. eururo.2014.10.025. Epub 2014 Oct 31.

2) A Systematic Review of Virtual Reality Simulators for Robot-assisted Surgery. Moglia A, Ferrari V, Morelli L, Ferrari M, Mosca F, Cuschieri A.

conversion in the CTC count with a confirmatory assessment at least 4 weeks later. Between July 2012 and September 2014 50 patients were enrolled but 1 man was lost to follow-up after 1 week and couldn’t be evaluated for response. Median overall survival was 10.1 months. 16 of the 49 evaluable patients had a response and in this group the median duration of treatment was 40 weeks. Next-generation sequencing identified homozygous deletions, deleterious mutations, or both in DNA-repair genes (including BRCA1/2, ATM, Fanconi’s anemia genes, and CHEK2) in 16 of 49 patients who could be evaluated (33%). Of these 16 patients, 14 (88%) had a response to olaparib, including all 7 patients with BRCA2 loss (4 with biallelic somatic loss, and 3 with germline mutations) and 4 of 5 with ATM aberrations. The most common Grade 3 or 4 drug-related events were primary anaemia (20%), fatigue (12%), leukopenia (6%) thrombocytopenia (4%) and neutropenia (4%). Over all 13 men required a reduction of dose to 300 mg bd. And just 3 patients discontinued because of adverse events. This study suggests that molecular stratification might be possible to predict high response rates in prostate cancer. It will also drive the acquisition of fresh tumour-biopsy samples as a way of explaining drug action. It might also have identified RARP inhibition as a new therapeutic pathway for mCRPC.

DNA-Repair Defects and Olaparib in Metastatic Prostate Cancer. Mateo J, Carreira S, Sandhu S, Miranda S, Mossop H, Perez-Lopez R, Nava Rodrigues D, Robinson D, Omlin A, Tunariu N, Boysen G, Porta N, Flohr P, Gillman A, Figueiredo I, Paulding C, Seed G, Jain S, Ralph C, Protheroe A, Hussain S, Jones R, Elliott T, McGovern U, Bianchini D, Goodall J, Zafeiriou Z, Williamson CT, Ferraldeschi R, Riisnaes R, Ebbs B, Fowler G, Roda D, Yuan W, Wu Y-M, Cao X, Brough R, Pemberton H, A’Hern R, Swain A, Kunju LP, Eeles R, Attard G, Lord CJ, Ashworth A, Rubin MA, Knudsen KE, Feng FY, Chinnaiyan AM, Hall E, de Bono JS. NEJM 2015; 373:1697-1708.

- Astellas

European Foundation Award 2016 The Société Internationale d’Urologie and the Astellas European Foundation (AEF) are pleased to sponsor a $20,000 USD award granted to a scientist of notable professional and ethical standing. In preparation for the 36th SIU Congress, to be held October 20-23, 2016 in Buenos Aires, Argentina, the SIU and the AEF solicit nominations for this prestigious award. Nominations should include a detailed curriculum vitae and a letter with a full explanation of the candidate’s merit, and must be submitted to the Awards Committee, SIU-Astellas European Foundation Award 2016 c/o SIU Central Office at the coordinates below no later than March 1, 2016. The Awards Committee, appointed by the SIU’s Board of Directors, will review all applications and announce the SIU-Astellas European Foundation Award 2016 laureate at the 2016 SIU Congress in Buenos Aires. Previous laureates were Dr. Donald S. Coffey (1994), Dr. Nils Kock (1997), Dr. Emil Tanagho (2000), Dr. Alvaro Morales (2002), Dr. Michael Marberger (2004), Dr. Frans Debruyne (2006), Dr. Andrew Novick (2007), Dr. Peter Alken (2009), Dr. Fritz Schröder (2011), Dr. Peter Scardino (2012), Dr. Ralph Clayman (2013), Dr. Urs Studer (2014), and Dr. Arthur Smith (2015).

Research Fellowship The California Urology Foundation, in association with the Société Internationale d’Urologie, announces the availability of a Research Fellowship for a fully- trained Urologist from Africa to do research for one year in a medical laboratory of the University of California in San Francisco (UCSF). This award is intended to prepare the candidate for an academic career in his or her home country; a firm commitment to return will be a material consideration in the evaluation of candidates. This fellowship carries a stipend of $50,000 USD, of which $14,000 is used to cover medical insurance and administrative fees. Applications for this fellowship will be evaluated by a joint SIU/UCSF Committee and should include a proposed area of study, a detailed CV, and a minimum of 2 letters of professional references. An application missing any of the items listed above will be considered incomplete. The deadline for the January-December 2017 Fellowship will be February 29, 2016. Application forms are available on the SIU website under Scholarships and Training Fellowships. Applications can be submitted by mail, fax or e-mail to UCSF-SIU Research Fellowship c/o SIU Central Office at the coordinates below.

SIU Central OffICe 1155 Robert-Bourassa Blvd., Suite 1012, Montreal, Quebec, Canada H3B 3A7 Telephone: +1 514 875 5665 Fax: +1 514 875 0205

European Urology Today


ESUT16 Abstract submission now open!

5th Meeting of the EAU Section of UroTechnology (ESUT)


8-10 July 2016, Athens, Greece Highlights of the scientific programme The ESUT meeting aims to introduce and provide updates of the most recent technological advances to European urologists and the impact of these developments on our everyday clinical practice. The scientific programme will also provide a comprehensive description and live demonstrations of urological procedures using modern instrumentations, with expert panels critically evaluating the benefits and limits of emerging technologies. Moreover, the plenary discussions will focus on all available treatment options for the same disease, with treatment strategies directly compared to enable participants to draw conclusions and gain new insights regarding the superiority or drawbacks of these technologies. Our Scientific Programme organisers are exerting all efforts to come up with a memorable meeting with the support of our partners and affiliates. The ESUT has always been a family for all endourologists and all these years we are fortunate to have the collaboration of many experts and specialists.

The meeting will also mark another significant transition - the departure as current chairman of Prof. Jens Rassweiler who is nearing the end of his successful term, and we hope the ESUT members will be present to wish him further success. So mark the date, tighten the bonds in our family as we continue to boost our scientific activities and social exchanges. We look forward to see you in Athens in July 2016!

Prof. E. Liatsikos Chairman ESUT meeting, Chairman-Elect ESUT Board

Prof. J. Rassweiler Co-Chairman ESUT meeting, Chairman ESUT Board

More information about the scientific programme at


Daily practice versus randomised clinical trials PDD-assisted TURB appears to be associated with improved 3-year recurrence-free survival Recently published real-world data (RWD) studies confirm previous trial results in daily clinical use and demonstrate that HAL-guided blue-light cystoscopy is an effective tool for improving NMIBC detection and management. Non-muscle-invasive bladder cancer (NMIBC) is characterised by a high risk of recurrence after transurethral resection of an initial tumour; the 1-year recurrence rate is 15 to 61%, and the 5-year recurrence rate is 31 to 78%1. In particular, early recurrence after transurethral resection of the bladder tumour (TURB) is most probably associated with missed lesions or inadequate resection at the time of initial TURB2. Photodynamic diagnosis (PDD)-assisted TURB has been shown to reduce the risk of early recurrence compared with white-light TURB in several randomised controlled trials (RCTs)3. RCTs are indispensable to prove the effect of a new therapy. However, its significance also needs to persist in clinical routine practice. Concerns relate to performance in different clinical settings and in unselected patient populations. These trials do not necessarily translate into real-life experience in a non-experimental setting4. Improved 3-year recurrence-free survival Mariappan et al. published exciting data from a real-life experience, demonstrating that the RFS (recurrence-free survival) is significantly better with PDD-TURB when compared to good-quality white-light (GQ-WL) TURB5. In a prospective controlled trial a total of 808 bladder cancer patients were assessed. Recurrence was defined as a biopsy-proven tumour. The overall recurrence rates at first follow-up cystoscopy (RRFFC) for GQ-WL-TURB and GQ-PDD-TURB were 30.9% and 13.6%, respectively (odds ratio = 2.9; 95% CI = 1.6–5.0; P< .001), with statistically significant lower recurrence rates in low- and intermediate-risk NMIBC after GQ-PDD-TURB (Figure). 16

European Urology Today

with PDD-assisted TURB. It was shown that hexaminolevulinate (HAL)-guided cystoscopy identified a vital number of additional CIS lesions (+25%, p < 0.0001). Additionally, in 10.0% of patients with NMIBC, ≥1 positive lesions were detected with PDD only and 2.2% of NMIBC patients would have been missed with white-light cystoscopy. These results are in line with previously conducted randomised clinical trials Facilitated detection of additional CIS lesions demonstrating that HAL-guided cystoscopy significantly At this year’s DGU (German Society of Urology) congress improves the detection of bladder cancer and provides a diagnostic benefit to patients with suspected NMIBC in Hamburg, Professor Maximilian Burger presented the results of a prospective non-interventional study in daily clinical practice. (OPTIC III), investigating optimised photodynamic diagnosis for TURB7. 403 patients with suspected “Even outside of well-controlled non-muscle-invasive bladder cancer, undergoing TURB in daily clinical practice, were included by 30 German settings of prospective controlled sites to assess additional detection of bladder cancer At this year’s Annual Scientific Meeting of the British Association of Urological Surgeons (BAUS) the group presented a 3-year ‘snapshot’ of the assessed cohort: The actual recurrence was 48.8% following GQ-WLTURB and 42.2% following PDD-TURB (p = 0.01)6. These data represent the potential benefits of photodynamic diagnosis in a real-life setting.

Figure: The overall recurrence rate at first follow-up cystoscopy was 30.9% (48 of 155) for GQ-WL-TURB and 13.6% (26 of 191) for GQ-PDD-TURB (adapted from Mariappan et al., 2015)

trials, PDD shows advantage in detecting CIS and thus can be held valuable in the management of high-risk NMIBC patients and especially in selecting patients for early cystectomy, which we indicate increasingly.” Professor Maximilian Burger Professor and Chairman, Dept. of Urology, Caritas St. Josef Medical Centre, University of Regensburg

PDD and chemoprophylaxis reduces recurrence Another study, published in the Scandinavian Journal of Urology earlier this year, concludes that fluorescence cystoscopy with PDD combined with immediate post-TURB chemoprophylaxis effectively reduced the recurrence risk and the number of follow-up TURB procedures under clinical routine conditions8. In total, 190 consecutive patients were enrolled over a 2-year period and followed as the intervention group; 216

patients treated over a 2-year period before introduction served as controls. The intervention group showed a 41% reduction in the risk of recurrence (hazard ratio 0.59, 95% confidence interval 0.45–0.78), and median recurrence-free survival was extended from 13.6 months to 36.8 months. A saving of roughly every third TURB was demonstrated during follow-up. Lykke et al. were able to confirm that patients with primary and recurrent disease, as well as those with low-risk tumours benefit from the treatment. The authors concluded that the procedure was costeffective, with savings realised through the reduced number of TURB procedures. Several new studies demonstrate that photodynamic diagnosis-assisted cystoscopy used in daily practice enhances the diagnostic accuracy of standard cystoscopy, permitting an improvement in patient prognosis and a reduction of the disease burden for patients and the health care system. References 1. Van der Heijden et al., 2009 Eur Urol Suppl (8):556-62. 2. Babjuk M et al., European Association of Urology. Guidelines on NMIBC (TaT1 and CIS). 2015. 3. Hermann et al., BJU Int. 2011 Oct; 108(8 Pt 2):E297-303. 4. Sanson-Fisher et al., Am J Prev Med. 2007 Aug; 33(2):155-61. 5. Mariappan et al., Urology. 2015 Aug; 86(2):327-31. 6. Gallagher et al., Real-life experience: Recurrence-free survival at 3 years is significantly better with Hexvix® PDD-TURBT when compared with Good Quality White Light TURBT (GQ-WL-TURBT) in new non-muscle-invasive bladder cancer (NMIBC) – a prospective controlled study (Paper 9, BAUS 2015) 7. Burger et al., Optimized photodynamic diagnosis for Transurethral Resection of the Bladder (TURB) in clinical practice – Results of the Non-Interventional Study (NIS) OPTIC III (V 38.8, DGU 2015). 8. Lykke et al., Scand J Urol. 2015 Jun; 49(3):230-6.

October/December 2015

Book reviews Prof. Paul Meria Section Editor Paris (FR)

Pages : 257 Illustrations : 10, 141 in colour Website :

Preventing Hospital Infections paul.meria@

Minimally Invasive Urology

The number of healthcare-associated infections has dramatically increased during the last 20 years and represents a public health problem. Nowadays the prevention of such infections requires a strong commitment of healthcare professionals to put in place and practise various preventive methods since most infections are really preventable.

Urology became undoubtedly a minimally invasive specialty since most of the procedures are currently performed by the means of endoscopy, laparoscopy or robotics while open procedures have declined. Notable developments have changed our practice with the help of new miniaturised devices and robots. Editors Best and Nakada, with the help of 40 experts as contributors, have assembled in a comprehensive review all aspects of minimally invasive urology. Eleven chapters were dedicated to laparoscopy and robot-assisted procedures in urology. The initial access to the peritoneal cavity, a critical step in such procedures, was exhaustively described. The authors focused on the prevention of various complications such as bowel or vascular injuries. A short chapter detailed the general aspects of extirpative surgery before addressing the current aspects of laparoscopic and robot-assisted reconstructive procedures of the upper urinary tract. Minimally invasive adrenalectomy was considered in a special chapter describing the peculiar aspects of laparoscopic and robot-assisted procedures with focus on related complications and their management and prevention. Robot-assisted radical prostatectomy was addressed exhaustively, with a step by step description of the procedure. Various tips and tricks were described such as clinical results and outcome. Robot-assisted radical cystectomy was also considered and a special paragraph was dedicated to cost analysis. Two chapters addressed kidney procedures, focusing on robot-assisted pyeloplasty and partial nephrectomy. Laparoscopic and robotic single site operations were also described in dedicated chapters addressing the available devices and various procedures currently performed. Various endoscopic procedures for upper urinary tract stones and strictures were described in the succeeding chapters, including ureteroscopy and PCNL.

This textbook is the first to be dedicated to the prevention of hospital infections. Editors Sanjay Saint, Sarah L. Krein and Robert W. Stock wrote this outstanding textbook intended for all practitioners regardless of their specialty. They considered three frequently used indwelling devices to illustrate their comments and remarks: respirators, central venous catheters and bladder catheters. The authors focused on catheter-associated urinary tract infection (CAUTI), the most relevant problem for urologists, considering preventive actions as a part of a larger goal.

Authors ISBN e-Book Publisher Publication Edition Binding Price Pages Illustrations Website

Authors ISBN E-book Publisher Publication Edition Binding Price

: S.L. Best, S.Y. Nakada : 978-1-4939-1316-9 : available : Springer New York : 2015 : 1st : Hardcover : €148.39

Book reviews

October/December 2015

General aspects were considered in the introductory chapters, including experimental and clinical trials, genetic aspect of tumours and various problems such as emergencies, haematuria, diet, anaesthesia, and general principles in laparoscopy, robotics, chemotherapy and radiation therapy. Palliative care was also addressed.

: S. Saint, S.L. Krein, R.W. Stock : 978-0-19-939883-6 : available : Oxford University Press USA : Nov. 2014 : 1st : Paperback : €41.99 : 176 : tables, graphs, flow charts :

changes in the management of congenital urogenital conditions, including malformations. Nevertheless, many patients are afflicted with problems beyond infancy and childhood and require long-lasting management involving paediatric urologists and, sometimes, adult urologists.

The succeeding chapters dealt with different genitourinary cancers. Eight chapters were dedicated to all aspects of kidney cancer, including clinical and pathological features, medical and surgical treatments. An overview of testicular cancer took into account all aspects of diagnosis and treatment, focusing on chemotherapy. Prostate, bladder and upper urinary tract cancers, either localised or metastatic, were addressed through a series of chapters, with updates on recent advances in diagnosis and management of such tumours. Minimally invasive therapies were also described and the authors focused on distinctive aspects. The recent symposium dedicated to “Innovative Strategies in Paediatric Urology” was the basis of this Some chapters dealt with unusual cancers such as textbook edited by Mario Lima and Gianantonio those involving the penis, urethra, adrenal glands, Manzoni. More than 50 contributors, from Italy, France and urachus. The authors also addressed the and other countries took part and provided the reader aspects related to non-urological cancers affecting with a state-of-the-art textbook on paediatric urology. the urinary tract. The general aspects were addressed in the first part All practitioners, whatever their specialty, will find of the book, focusing on prenatal diagnosis, antenatal comprehensive theoretical and practical information and perinatal management of urological in this well-prepared and illustrated textbook. malformations, imaging, anaesthesia, endoscopy, laparoscopy and robotics. The succeeding part was Editors : V.H. Nargund, D. Raghavan, dedicated to the upper urinary tract and the kidney. H.M. Sandler The authors focused on uretero-pelvic junction ISBN : 978-0-85729-481-4 obstruction, whose management has dramatically Publisher : Springer changed. They addressed new strategies in diagnosis e-Book : available and surgical treatment, including minimally invasive Publication : 2015 techniques such as one-trocar pyeloplasty. Edition : 2nd Binding : Paperback Lower urinary tract problems were exhaustively Price : €201.39 described including bladder conditions such as reflux, Pages : 907 exstrophy, neurogenic bladder, incontinence, urethral Illustrations : 65 illus., 71 in colour diseases and various other conditions. The authors Website : addressed clinical problems, current controversies and unanswered questions. Two important parts were dedicated to genitalia and urogenital tumours. The authors focused on hypospadias and cryptorchidism and addressed an exhaustive review about adrenal, renal and genital tumours. The last part dealt with various conditions related to nephrology and urology with focus on renal failure, transplantation, infection and urolithiasis.

They addressed the current cost of CAUTI and suggested recommendations for prevention. The type of interventions was detailed in the succeeding chapters and they provide the reader with the “urinary catheter reminder.” They addressed various barriers and “realistic solutions” and demonstrated the role of a collaborative approach.

The special problem of C difficile was addressed in a dedicated chapter since the use of broad spectrum antibiotics is responsible for an increasing number of C difficile enterocolitis. Protective measures were detailed and a specific check-list was established for The endoscopic management of BPH focused on bipolar C difficile prevention. TURP, photoselective vaporization and enucleation. The last chapter addressed various aspects of financial The concluding chapter of the textbook considers the implications of minimally invasive urology. future of infection prevention. A CAUTI prevention guide was established for patients. We recommend this textbook to all urologists aiming to acquire best practices in the prevention of hospital infections.

This textbook provides the reader with a broad-based survey on minimally invasive techniques and represents a valuable purchase. The illustrations are numerous and of quality. We hope some videos will be included for the next edition.

been addressed such as urology, oncology, radiation therapy, radiology, palliative and supportive care.

Numerous illustrations are included in this comprehensive textbook intended for paediatricians and paediatric urologists. Nevertheless, urologists treating grown-up patients or young adults will also find relevant updates in this textbook.

Pediatric Urology Paediatric urology is a subspeciality to both urology and paediatric surgery which is currently scientifically managed in Europe by the European Society for Paediatric Urology. Recent advances in neonatology, antenatal diagnosis, imaging, minimally invasive surgery and genetics have contributed to dramatic

Editors ISBN Publisher e-Book Publication Edition Binding Price Pages Illustrations Website

: M. Lima, G. Manzoni : 978-88-470-5692-3 : Springer : available : 2015 : 1st : Hardcover : 158.99 euro : 402 : 53, 132 in colour :

Go forward with Flexor®.

Urological Oncology Although urologists have a central role in the treatment of urogenital cancers, a multidisciplinary approach is required. Today, patients are aware of the available treatments and the physicians, whether they are urologists or oncologists, must consider patient’s opinion in the decision-making process. Consequently, an exhaustive knowledge of various treatments is quite useful for all practitioners involved in the management of urogenital cancers. The second edition of this comprehensive textbook provides the reader with a noteworthy survey dedicated to all aspects of urological oncology. Editors V.H. Nargund, D. Raghavan, and H.M. Sandler have assembled a team of 80 international contributors to provide updates to the first edition. Various areas have

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European Urology Today


EUREP15 13th European Urology Residents Education Programme 4-9 September 2015, Prague, Czech Republic

Hands-on training: Improving skills ESU’s flagship practical course gets ready for 10th Anniversary Dr. Domenico Veneziano Dept. of Urology and Kidney transplant Ospedali Riuniti Reggio Calabria (IT)

approach, with just two trainees per tutor for almost 90 minutes of training. I had the chance to return to Prague as a laparoscopic tutor and Ben selected me as the new coordinator for the hands-on training. It was a great honour, but with a difficult goal to achieve: bringing the course to a higher level.


The hands-on training programme offered during EUREP 2014 looked already perfect. To further improve it, we had to work hard in close collaboration with the tutors’ group, the technical sponsor Olympus, ESU chairman Dr. Juan Palou and the ESU office who gave me excellent support.

Since 2006, the hands-on training (HOT) has become a key part of the EUREP’s core programme. With 22 tutors involved, 24 training stations, and over 600 total slots for training and exam sessions, the 2015 edition reached an unmatched offer in terms of numbers and quality. During the last eight years under the coordination of Dr. Ben Van Cleynenbreugel, the training sessions changed radically, starting from few laparoscopic stations and growing until the introduction of the E-BLUS exam sessions in 2011. When I took part in EUREP as a resident in 2010, I was enthusiastic about the programme’s practical

We collected a huge amount of data last year to set a starting point for our work. The ESU office received 183 evaluation questionnaires from the trainees, who were asked to rate different aspects of the course. To know more about the teaching method used by every single tutor, we decided to record one complete training session from each video tower, for a total of 32 hours of videos. After a complete review of the videos, we wrote a teaching guide in collaboration with the ESU training research group, which contained a standardised

EUREP15 tutor group (from left): S.Barmoshe (BE),S. Haensel (NL), L.Villa (FR), O.Rodrigues Faba (ES), J.Beatty (GB), C.Wagner (DE), H.Langenhuijsen (NL), D.Veneziano (IT), A.Skolarikos (GR), G.Pini (IT), B.Somani (GB), V.Eret (CZ), A.Gozen (DE), MKlitsch (AT), G.Hellawell (GB), A.Ploumidis (GR), S.Vesely (CZ), S.Biyani (GB), J.M.Gaya (ES), R.Sanchez Salas (FR), M. Arnolds (NL) and M. Schmidt (CZ, not in the picture)

teaching method to be followed by all laparoscopy tutors during the sessions starting with this year’s edition. The “basic laparoscopic-skills teaching guide” aims not only to raise the quality of teaching inside EUREP, but also to export the same standards to other countries, making EUREP HOT a true test-bench for novel training modalities. Personalised training To allow a more personalised training approach and higher interaction with the experts, hands-on training sessions were modified to last 45 minutes with a one-tutor-per-one-resident rate. The intermediate training step for laparoscopy has been another critical novelty introduced this year. Two 3D-stations, guided by Dr. Rafael Sanchez Salas and Dr. Andreas Skolarikos, were provided with synthetic pyeloplasty

EUREP15 hands-on training room

and Major Vessel Injury synthetic models and were dedicated to those who already achieved the E-BLUS or an equivalent exam in the past. This experimental curriculum could become the second part of a modular curriculum of three steps (basic, intermediate, advanced). Even ambient lights were different from before, lowered down with a blue accent to recall the “appeal” of a real OR. As options, TUR and URS training were also delivered, as in the last two years. Despite all the novelties introduced, the course ran smoothly and we had the chance to collect even more data than before, with the goal of improving what was already perfect. Indeed, right after the last edition, we are already working to make the 10th Anniversary EUREP HOT course the best ever.

The EUREP experience Nepalese resident gives high points to EUREP experience Dr. Kiran Jang Kunwar Urology resident Tongji Medical College of Huazhong University Dept. of Urology Wuhan (CN) kjk_kunwar@

getting admission to EUREP may be tough since there are fewer slots and which means that EU-ACME score and one’s CV become more crucial. Merit-based selection in an open category has made EUREP more inclusive, admitting residents from outside Europe. When I received news of my selection it made me feel like walking in the clouds since I really worked hard to get EUREP admission. The dedicated expert lectures which trigger lively discussions are the major highlights of this educational programme, and the lectures cover almost all of urology. The six-day intensive course on evidence- based modern urology, along with the interaction with experts in clinical case management, shows the quality of EUREP’s curriculum.

I am from Nepal which is far less known to the developed world especially when you have the likes of China and India as your neighbours. Many of my fellow European residents can’t even pinpoint where Nepal lies in the world map. I consider being selected as a EUREP participant in the non-EU category as an With insights from the faculty members and their tips on the practical applications of guidelines, the achievement and it is with pride that I represent my comprehensive updates and current best practices, country. certainly make EUREP a unique opportunity. The The European School of Urology (ESU) has made this Hands-on-Training was another highlight, and I residency programme as one of the best education appreciated the individual mentorship given throughout the laparoscopy course. programmes for residents. For non-EU candidates


European Urology Today

In the social programme, the barbecue and karaoke evening was something special and will be remembered by many of the participants. The UK group led by Professors M. Drake and J. Khastgir invited us (residents from India, Australia, South Africa) to join their residents and we had a memorable evening. Interestingly, last year’s participants picked an alternate name for EUREP: “PERUE” or the acronym for “Powerful Experience of Rapid Urological Education.” Our thanks to the EAU and the ESU for the two decades of EUREP which is now considered as one of the best urology residency programmes in the world. This quality programme can only be possible by the efforts of dedicated ESU professors. We are indeed grateful to all faculty members for the wonderful six days of intensive teaching and to the team of Prof. Joan Palou and Jacqui McGrath for their hard work and dedication. Being part of EUREP 2015 has been very productive and will definitely boost my knowledge in urology.

October/December 2015

EUREP: Not just education but an association Unique training programme known for its quality curriculum Dr. Raman Tanwar Final Year Resident in Urology PGIMER and Dr. RML Hospital New Delhi (IN)

EUREP is one of those unique training programmes where you have access to the study materials well in advance and the goals and objectives are clearly laid out. And there is more to EUREP than meets the eye. The efficient communication between participants and organisers ensures everything is prepared and taken care of on time.

My journey to EUREP began a week earlier with my clinical visit to the medical university of Vienna where I observed the European approach to urology. I met faculty who were trained at EUREP or had been part Every urology resident today recognises EUREP as the of the programme and everyone assured me of a great opportunity that lay ahead. I arrived at Prague world's best urology residents training programme late evening and the course was to start the next day which attracts some of the brightest young minds. and yet the EUREP team worked relentlessly to It is fortunate that residents from India also get a register delegates and provide learning materials. chance to be a part of this event through the joint Everything was well laid out and easy to understand. collaboration of the Urological Society of India and the European Association of Urology. The lectures started on time not just on the first day but throughout the course. The professionalism and Selection for Indian residents is by taking an exam dedication towards teaching was evident by religious and an interview conducted by our national attendance of all teachers and tutors. Likewise in society. Being admitted is certainly inspiring since reciprocation the student chairs were full every time EUREP is a programme known for its quality curriculum. The excitement starts building up from and getting late meant that you'll end up sitting on the last bench. It is unbelievably difficult to cover the the very first mail by the EUREP office and one can entire urology in a matter of days but EUREP is one of see just by the invitation that everything is going the finest examples of how this can be done. It will be to be great and well organised. Even though unrealistic to expect all the details and concepts to be EUREP comes with a reputation, the belief is discussed, but the curriculum is designed to cover the reconfirmed with the attention to every detail with basics in entirety and one manages to identify ones regards to skills-building, academic interest, stay problem areas and doubts with ease. and travel. dr.ramantanwar@

EUREP is a refresher course in urology that focusses on concepts that you can't live without as a urologist. More than that it gives a unique opportunity to interact with renowned experts and clear concepts and get some unique opportunities. While it tries to establish a platform and bring everyone on the same starting level the course also feeds the doubts and fears of the ignited minds. The lectures are well prepared with regards to content and so well-rehearsed that it seems like a play is being presented before you. Following case discussions reemphasise the practical points and ensure that important messages have been delivered to everyone sitting in the room. However what you learn during EUREP is not just within these halls but also outside them. You learn from discussions with the teachers and more importantly the new friends that you make. I think it is the most useful opportunity to learn. Talking about unique facets available at different centres widens the horizons and provides food for thought. EUREP is the ground for lifelong friendships and collaborations and now that it is over, these associations are the ones that will remind me of

the course for a lifetime. EUREP is a unique course that one gets to attend only once during residency and later maybe as a faculty but I hope to hear about more twitter interactions or maybe an app to connect with the speakers to clear more doubts and stay in touch with academic updates in EUREP 2016. I also wish that all delegates can spend some time in the dry lab and eventually get some hands on wet lab training as well with some of the finest tutors. Attending EUREP is a once in a lifetime experience for everyone who gets to be a part of it and I am thankful to the European Association of Urology and the Urological Society of India to have given this chance to me.

EUREP 2015: An excellent training for young urologists Comprehensive programme is marked by informal, friendly atmosphere Dr. Michal Smolski Christie Hospital Foundation NHS Trust Manchester (UK)

michasmolski@ I am on the urology residency in the North West of England. Trainees in the UK are encouraged to apply for the EUREP course as it has a reputation of being an excellent resource for residents preparing for urology exit exams. To secure a place on the course one should apply literally as soon as application for the programme opens. Since acceptance is not guaranteed one can increase the chances by securing EAU membership which you need before the registration deadline. It is also worth getting some CME credits by completing European Urology on-line reading and associated MCQs. Priority is given to final-year trainees and those with a good command of English as the course is run in English (apart from karaoke night).

Pleasant surprise On arrival I was pleasantly surprised that the venue was a four-star hotel in Prague - a city renowned for its heritage with a modern vibe. With its continental climate, Prague can get warm with daytime temperatures in September reaching around 15 to 25 degrees Celsius. Nights are colder and a jacket or a warm jumper is a must. Rain is not unusual. I have been lucky with good weather throughout the duration of the course. I arrived a day before EUREP started and the EAU reception desk was already open for registration where I received a warm welcome and all relevant instructions regarding the course. I was impressed. During the course, a small EAU administrative team was working tirelessly to ensure all 360 participants were well looked after.

What makes this course unique are the faculty and participants. The faculty are world renowned urologists in their sub-specialties. Participants are young aspiring urologists who hopefully soon will become urology specialists. The lectures were far from being dry didactic talks. Discussions were getting heated at times and even lecturers admitted to learn from the participants. The course covered most of the urology curriculum with the material divided into five themed modules. For the faculty to deliver that huge amount of information, lectures Selection results are available a few months before the course, leaving more than enough time to prepare were fast paced but with a sufficient balance of for the course. Successful applicants will receive presentations from previous years to help them prepare for the course. To those who are interested, hands-on training courses are available during EUREP. Having first-hand experience, I must praise both tutors and equipment for the high quality. I have to mention that the course is free. EAU, with the generous help of sponsors, cover the costs of more than 300 participants and faculty.

October/December 2015

The full faculty of the 15th edition of EUREP

didactics and interactivity. Course handouts allowed for additional notes and remarks and helped the participants to follow the presentations. Twitter Social media is becoming increasingly popular among junior and senior urologists. Twitter turned out to be very popular among the participants and faculty. During EUREP tweets were used to send important organisational information, succinct session summaries, key slides or even interesting videos. Twitter also provided a platform to allow easy communication with fellow participants. EUREP received the official hashtag #eurep2015 and 1598 Tweets were generated during the whole course. Many new people joined Twitter #conversion and on one of the last #eurep2015 snapshot photo tweets, we saw a course participant explaining to faculty members the nuances of Twitter.

Karaoke night EUREP is not only about urology but also about gaining new friends. Karaoke is the main social event during EUREP allowing participants to spend time together in an informal atmosphere. Prague is renowned for its beer and during karaoke night I had the opportunity to verify it. Apparently the karaoke contest had always been dominated by our Italian and Spanish colleagues. Indeed their spontaneous joyful performance was truly genuine! Overall, EUREP is a unique opportunity not only to acquire knowledge required for the exam but also a chance to meet fellow colleagues from all over the world, exchange opinions and enrich ourselves with new experiences. I am thankful to the EAU for the wonderful opportunity they provided to urology residents and to the faculty for their efforts to teach us in an informal atmosphere.

European Urology Today


5th ESU Course in Moldova

ESU Course in Tashkent

ESU faculty tours new urology facilities in Chisinau Uzbekistan sees high, enthusiastic attendance Prof. Vitalii Ghicavii Medical State University Dept. of Urology Chisinau (MD) The 6th National Congress of Urology, Dialysis and Renal Transplantation held in the Moldovan capital of Chisinau last 21 to 23 October also featured the 5th Course of the European School of Urology (ESU). The scientific event was organised by the Society of Urologists from the Republic of Moldova in cooperation with the European Association of Urology (EAU) and the ESU. The ESU courses were supported by Prof. Hendrik Van Poppel (BE), Ass. Prof. Andreas Skolarikos (GR), Dr. Tobias Klatte (AT) and Dr. Michael Straub (DE). Over 200 urologists from Moldova and 25 overseas guests attended the meeting, including renowned

scientists and specialists from Austria, Germany, Belgium, Greece, Israel, Romania, Ukraine and Russia. Various problems in contemporary urology, dialysis and renal transplantation were discussed during the forum. Problems related to reconstructive surgery in urology, endourological and laparoscopic treatment, the contemporary diagnosis and treatment of urolithiasis, diagnosis and treatment of kidney and prostate cancers, the modern treatment of urogenital infections and some aspects of paediatric urology were highlighted. The educational programme also included various topics, such as prevention, minimally invasive and endourological treatment of urolithiasis, the radical treatment of prostate and kidney tumours in accordance with the EAU Guidelines. During the discussions and analysis of the clinical cases, the urologists from Moldova and specialists from European urological clinics reported their experience in solving challenging cases and the treatment of patients with serious urological pathologies and associated diseases. At the end of the sessions, the guests, led by course chairman Prof. Hendrik Van Poppel, visited Moldova’s main medical facility, the Republican Clinical Hospital, where they toured the new surgical facilities, the hospital wards and the urology clinic. They also had a brief meeting with the urologists in the clinic who informed them of the clinic’s routine activities and working conditions.

Board, faculty and organisers of the Society of Urologists from the Republic of Moldova, (ESU) EAU and ESU at the 6th National Congress of Urology, Dialysis and Renal Transplantation in Chisinau

The continuing collaboration of the ESU with Moldova’s urological community has attracted the attention of the country’s medical community and has contributed to the progress achieved by specialised urological medical care in Moldova.

Teaching activities 2015/2016 European School of Urology November 26-28

8th ESU Masterclass on Female and functional reconstructive urology, in collaboration with the EAU Section of Female and Functional Urology (ESFFU), Berlin (DE)

December 2 15

ESU course on Endourology at the national congress of the Egyptian Association of Urology, Cairo (EG) ESU course on Prostate and bladder cancer at the national congress of the Georgian Association of Urology, Tbilisi (GE)

February 2016 2-5 13-16

Hands-on training course on Laparoscopy and Endourology, Caceres (ES) European Urology Forum 2015 – Challenge the experts, Davos (CH)

Dr. Bekhzod Ayubov Republican Specialized Center of Urology Tashkent (UZ)

fascinating architectural monuments, such as mausoleums, madrassahs, mosques, and city squares. At the 15th century Bibi-Khanum Mosque, for instance, the ESU faculty and organisers enjoyed their visits and took a lot of photographs.


This year our national congress saw the 5th edition of a European School of Urology (EAU) course. The lectures examined updates on lower urinary tract symptoms (LUTS) and the management of incontinence and vesico-vaginal fistulas. Although we expected around 200 participants, more than 260 urologists from all over Uzbekistan attended the meeting.

In Tashkent, last November 2, the Scientific Society of Urologists of Uzbekistan has organised its National Congress in collaboration with the European School of Urology (ESU). The continued and extended support by the ESU is very much appreciated by the Uzbekistan urologists.

Preceding the National Congress, on Saturday 31 October, a medical course lecture had been organised that attracted more than 100 students from the Tashkent Medical Academy. The medical course lectures included "Stone Treatment" given by Prof. Stefan De Wachter (BE), "Prostate and Acute Retention" by Emmanuel ChartierKastler (FR), and a lecture titled "The bladder: Medicine Local organisers and ESU Faculty with Ms. Claudia Van Ijzendoorn (EAU staff) must do better," by Marcus Drake (UK). The participants gave positive feedback and said the presentations were excellent and that they appreciated the enthusiastic discussions that followed each presentations and the chance to ask questions directly to the ESU faculty members. We believe these educational programmes are very beneficial to young medical students and doctors since they get updates on modern diagnosis and treatment. The social programmed featured a tour for the historical city of Samarkand which is renowned for its

The guest speakers discussed updates on diagnostic tools and treatment strategies, followed by an open forum. Local faculty members also presented several interesting cases which offered insights and lively debates. We are grateful to the EAU and the ESU board for this close collaboration, and our society is keen to maintain our partnership. On behalf of Tashkent Medical Academy, we convey our thanks to all professors for their active support and we hope for more active collaborative exchanges in the future.

ESU - Weill Cornell Masterclass in General urology 26 June-2 July 2016, Salzburg, Austria EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations

March 2016 11-15

ESU Courses, HOT, Innovation in Education at the time of the 31st Annual EAU Congress, Munich (DE)

May 2016 20-21 28

1st ESU-ESUT Masterclass on Operative management of Benign prostatic obstruction, Heilbronn (DE) ESU course on Urethral reconstruction and urogenital fistulae repair at the time of the EAU Baltic Meeting, Tallinn (EE)

June/July 2016 26-2

ESU – Weill Cornell Masterclass in General urology, Salzburg (AT)

September 2016 2-7 14-16 23

14th European Urology Residents Education Programme (EUREP), Prague (CZ) ESU-ERUS courses at the 14th Meeting of the EAU Robotic Urology Section (ERUS), Milan (IT) ESU course on General update on oncological urology at the time of the national congress of the Armenian Urological Society, Yerevan (AM)



European Urology Today

October/December 2015

Who's Who in the Board of the European School of Urology Henk Van Der Poel: Clear training goals have to be identified The European School of Urology (ESU) is running a series of interviews with its board members to shed insights of its board members on various issues such as the role of technology, future prospects in urology, training and education, among others. Below is a transcript of the Q&A with Dr. Van Der Poel:

on dexterity development. Novel training systems will help the trainee to overcome years of skills development in clinical practice, saving time and reducing patient morbidity. The EAU-ESU in collaboration with EAU Section Offices is essential to find the needs of training in all aspects of urology.

Question: Can you tell us a bit more about your background, specialty and experience?

Q: Technology versus evidence-based outcomes are recurring themes. What are your perspectives or views in this debate?

Van Der Poel: After training as urologist in Nijmegen (The Netherlands) and an oncology fellowship in Baltimore I started at the Netherlands Cancer Institute. The main focus is currently prostate cancer. As urologists we treat men with localised prostate cancer helping them to decide on the treatment options. Surgically my interest is robotic surgery for prostate, bladder, and renal cancer. Currently, we perform around 350 robotic procedures yearly, including 250 prostatectomies and 30 cystectomies. The scientific activity oriented at prostate cancer management of localised and metastatic diseases with topics as sentinel node, neoadjuvant treatment, and training in robotic surgery. Q: What is your role in the ESU board? Van Der Poel: Within the ESU I’m involved in hands-on training (HOT) courses for robotic and laparoscopic surgery, online learning activities, such as the Guidelines courses and theoretical courses for the HOT courses. Since I’m also part of the EAU Robotic Urology Section (ERUS) board I’m the liaison between the ERUS and the ESU. Q: What are your goals for the European School of Urology? Van Der Poel: Besides theoretical expertise development within the ESU, we hope to improve surgical expertise, in particular in minimal invasive

Dr. Henk Van Der Poel, ESU Board Member

surgery. The classical surgical training of “see-onedo-one-teach-one” is outdated. Simulation and virtual training systems are now available for dexterity development and assessment. We train novice as well as experienced surgeons through a rapid and safe training programme. This has resulted in a scientific approach to surgical training of simulator and modular training programmes. The success of these programmes is reflected by the fact that gynaecology and surgery are now copying our basic and fellowship training modules. At the heart of the training is the final video assessment by an expert that scores, anonymously, each segment of the procedure. And not only to score but also to reflect back to the trainee those elements of surgical skills that do require further improvement. Q: How do you see the future of education and urology? Van Der Poel: Education in urology will change in

several ways. E-learning options, which show promise for years, gradually enter the field of professional training. And not as stand-alone programmes but in combination with live and classroom training. The EAU-ESU has the educational material and a strong faculty of trainers that will help develop new ways to disseminate knowledge in Europe and beyond. E-learning web-based training will provide an instant option without the inconvenience of travelling and expensive accommodations. Besides knowledge, dexterity is one of the pillars of the urological profession. New virtual training systems are rapidly being developed. It is the EAU-ESU’s goal to help these systems find their way into clinical practice. Validation of training programmes will result in Europe-wide standards. Video assessment of surgical performance will have to be standardised and preferably correlated with patient outcome. Although learning curves in surgical performance have been extensively studied, there is little emphasis

Van Der Poel: To further the field of medicine clear goals have to be set. Reducing complications and patient morbidity of basically all urological treatments should be a prime subject of studies. To obtain transparency of outcome, better registries, preferably Europe-wide, are required to identify treatment options and techniques with least morbidity and maximal outcome. Registries will also allow us to identify those individuals and centres that perform exceptionally well and use their experience and knowledge to teach others. Furthermore, I would stress ESU to stay critical on their own achievements. What are trainees actually taking home after a course? How are the new skills changing daily practice? Only when we monitor the performance of trainees in the years after training will we learn how to adapt training to the specific needs. For dexterity training, we are currently building a registry of course participants including all their attendances and performances to record patient outcome in the interval after training. Early studies now evaluate the performance during courses, with patient outcome several years later. Only when we understand how training is shaping the urology profession will we be able to provide the training that is really practice-changing and leads to improvements.

European Urology Forum 2016 Challenge the experts

1st ESU-ESUT Masterclass on Operative management of Benign Prostatic Obstruction

13-16 February 2016, Davos, Switzerland

20-21 May 2016, Heilbronn, Germany EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations

EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations

Register Now! Check the programme online at

October/December 2015

European Urology Today


A successful first E-BLUS exam in Poland Polish trainees benefit from comprehensive laparoscopic training The School of Laparoscopy in Bydgoszcz provides a system-teaching programme for laparoscopy, which was developed and implemented 15 years ago by the Department of Laparoscopic Urology of the Jan Biziel University Hospital Bydgoszcz. The programme, offered since 2000, comprises theoretical and practical courses including surgical procedures on living animals, workshops with live transmission of laparoscopic surgeries and internships in laparoscopic centres.

Dr. Piotr Jarzemski Dept of Laparoscopic Urology Jan Biziel University Hospital Bydgoszcz (PL) Besides the E-BLUS exam, the laparoscopic course included the following modules: theoretical lectures, exercises on trainers and live transmission of laparoscopic surgeries. The 24 participants came from various academic and city hospitals in Poland. (See Photo 1) The classes were run by experienced laparoscopists from the Department of Laparoscopic Urology Jan Biziel University Hospital Bydgoszcz, led by Dr. Piotr Jarzemski, department head. The course received 17 CME –CPD points.

Dr. Roman Sosnowski European Medical Training Center Saint Luke Hospital Bydgoszcz (PL)


The first European training in basic laparoscopic urological skills (E-BLUS) exam in Poland took place from 13 to 14 April 2015 at the newly developed European Medical Training Center of the St. Luke's Hospital in Bydgoszcz. Dr. Ali Gozen from the Clinic of Urology of the University of Heilbronn Germany supervised the exam on behalf of the EAU. The exam was an integral part of the laparoscopic course at intermediate level for urologists and residents organised within the School of Laparoscopy in Bydgoszcz.

E-BLUS exam Introduction for the E-BLUS exam included lectures describing issues associated with acquisition of laparoscopic skills and laparoscopic training systems in Europe, presented by Dr. Ali Gözen. The training also included workshops on endoscopic surgery trainers (hands-on training). Dr. Gözen and other experienced laparoscopists provided comments, suggestions and tips. A total of 24 candidates took the E-BLUS exam and everyone performed the respective stages of the E-BLUS exam under supervision of the tutor. (Photo 2) At the end of each exam, the tutor provided comments and established the areas (of skills) which the trainee should improve. All documents related to the exam were sent to Ton Brouwers of the EAU - E–BLUS exam.

Live surgery The course also included live transmissions of laparoscopic procedures (four laparoscopic radical prostatectomies). The surgeries were preceded by a lecture by Dr. Piotr Jarzemski, describing the respective stages of radical prostatectomy, with special focus on elements which are considered difficult for beginners. Tips and tricks were also presented including problems and difficulties and the possible solutions or procedures. Advanced training The most difficult stage of laparoscopic radical prostatectomy is vesicourethral anastomosis. Since no model has been standardised so far, practising it is possible in a repeatable manner. During the course in Bydgoszcz, an endoscopic surgery trainer with animal model was presented for the first time. For this purpose an endoscopic surgery trainer was developed and made with exchangeable insert of own construction, imitating the anatomy of the human small pelvis together with elements for fixing the animal preparation (Photo 2). Every course participant had a chance to perform vesicourethral anastomosis on their own. Exercises on endoscopic surgery trainers were an excellent conclusion to the live surgeries. Mastering practical skills One of the most difficult elements is verifying the progress of the trainees in mastering practical skills. The E-BLUS exam seems to be an excellent tool that facilitates evaluation and qualifications of the participants for further training. Our observations have shown that many participants in the last course, and due to E-BLUS exam, critically graded their skills and were willing to intensify the

Dr. Piotr Jarzemski demonstrates a self-constructed animal model endoscopic surgery trainer imitating the anatomy of the human small pelvis, intended for learning vesicourethral anastomosis. Insert: Surgery trainer with preparation of a porcine urinary bladder

exercises on the endoscopic surgery trainers. Regarding other trainees, the positive exam results supported their decision to participate with increased self-confidence in advanced training. Motivation and self-confidence brought about by proper evaluation of practical skills are the keys to success in surgical training. For teachers, the exam also provides the opportunity to evaluate the efficacy of the system that we have developed. Developing and implementing the exam at the advanced level with use of animal models will be the next challenge in developing an integrated training system. Exam prepared in such a manner is an excellent match to our training system and complements the laparoscopic education programmes we have organised.

Comprehensive ESU programme in Munich From the newest updates in urology, practical insights, core theoretical knowledge to best practices, the course programme of the European School of Urology (ESU) at the 31st Annual EAU Congress in Munich next year will encompass the full breadth of urology, providing expert knowledge and in-depth views on major topics and procedures. The ESU aims to not only offer the insights of experienced mentors and faculty but also ensure participants will get, first-hand, the best practices that are vital in offering optimal care to patients. At least 16 areas in urology will be covered by around 50 courses ranging from Female Urology, Infections, Stones, Trauma, Male LUTS to, onco-urology to paediatric urology, among others. The courses will be offered from March 12 to 14 (Saturday to Monday). Complementing this structured programme, are the various hands-on training courses the ESU is known for, and which include five major fields such as Endoscopy (upper and lower), Laparoscopy, Robotic Procedures, Diagnostics and Follow-up and Functional Urology. To facilitate your participation, we encourage those who are interested to register in advance for the courses since a number of the courses and workshops are easily filled up. Below are the lists of courses and hands-on training available in Munich. Dr. Joan Palou Chair European School of Urology (ESU)


European Urology Today


ESU Courses Adrenals • Advanced course on upper tract laparoscopy (UPJ, adrenal and stones) • Adrenalectomy Andrology • Office management of male sexual dysfunction • The infertile couple - Urological aspects Female urology • Prolapse management and female pelvic floor problems • Advanced vaginal reconstruction Infections • Dealing with the challenge of infection in urology Kidney transplantation • Renal transplantation: Technical aspects, diagnosis and management of early and late urological complications Male LUTS • Management of BPO: From medical to surgical treatment • Post-surgical urinary incontinence in males Neurogenic and non-neurogenic voiding dysfunction • Chronic pelvic pain in men and women • General neuro-urology • Lower urinary tract dysfunction and urodynamics • Video Urodynamics Paediatric urology • Paediatric urology for the adult urologist: A practical update Penis/testis • Testicular cancer • Penile diseases

Prostate cancer • Robot-assisted laparoscopic prostatectomy • Retropubic radical prostatectomy – Tips, tricks and pitfalls • Focal treatment in prostate cancer • Surgery or radiotherapy for localised and locally advanced prostate cancer • Prostate cancer imaging: When and how to use it • Screening and active surveillance – where are we now • Prostate biopsy - tips and tricks • Metastatic prostate cancer Renal tumours • Robot renal surgery • Small renal masses: From concepts to tips and tricks in daily management • Advanced course on laparoscopic nephrectomy • Surgery for renal cancer beyond minimally invasive approaches: Opportunities and limits Stones • Percutaneous nephrolithotripsy (PCNL) • Update on stone disease • Flexible ureterorenoscopy and retrograde intrarenal surgery: Instrumentation, technique, tips and tricks, indications Trauma • Urinary tract and genital trauma Unclassified and miscellaneous topics • An introduction to social media: Why this is important for urologists • Evaluation of risk in comorbidity in uro oncology • How to proceed with an hematuria • How to write a manuscript and get it published in European Urology • Surgical anatomy • Ultrasound in urology • Laparoscopy for beginners • What's new in the guidelines • New technologies • Basic surgical and endo urological skills

• Practical aspects of cancer pathology for urologists. The 2016 WHO novelties Urethral strictures • Advanced course on urethral stricture surgery Urothelial tumours • Practical management of non-muscle invasive bladder • UTUC: Diagnosis and management • Laparoscopic and robot-assisted laparoscopic radical cystectomy • Management and outcome in invasive and locally advanced bladder cancer • Nerve-sparing cystectomy and orthotopic bladder substitution - Surgical tricks and management of complications

ESU Hands-on Training Courses Laparoscopy • E-BLUS • Suturing and knotting (Anastomosis or Pyeloplasty) Robot • Introduction to Robotic Surgery • Simulation training in Robotic Surgery Diagnostics and follow-up • Urodynamics • Fluorescence imaging • MRI Fusion biopsy Functional urology • Womans Health SUI • OnabotulinumtoxinA Administration for OAB Endoscopy • Lower • Upper

• • • • •

TUR (b/p) Enucleation techniques Greenlight vaporisation PCNL URS semirigid and flexible

October/December 2015

Young Urologists/Residents Corner The role of residents in the era of minimally invasive surgery A resident’s view of laparoscopic radical prostatectomy Dr. Moises Rodriguez Urology resident Vigo (ES)


Dr. Leonardo Tortolero Scientific Activities Manager of the Spanish Residents and Young Urologist Workgroup Vigo (ES) @DrTortolero Almost two decades ago, the first series of laparoscopic radical prostatectomy (LRP) was published by Schuessler in 1997 wherein he highlighted the technical difficulties in performing this procedure. From then until now the technique has improved and has become a routine procedure in many centres worldwide. Many urologists have overcome the steep learning curve and nowadays following the first generation of urologists who learned this complex technique, the second and third generations of urologists have started to perform this procedure. So is it possible that the residents in urology can perform LRP? Which

is the right way for a resident to successfully complete this challenge? We have to note that laparoscopy was probably the most important development in surgery during the 20th century, so the generation of young urologists should move forward with this technology. We may consider that it is entirely possible to perform LRP with the right training during the residency. However it is not an easy path. Residents should invest hours of hands-on-training to acquire the necessary skills in pelvic trainers and other types of simulators. It is also important to attend training courses in hospitals or perform courses in certified centres which use animal or cadaveric models.

"...the acquisition of laparoscopic skills... can significantly contribute to motivate young urologists..." A major drawback in this training programme is that some hospitals do not have access to training labs; this issue may be resolved using homemade models of laparoscopic trainers that can be made with inexpensive and easy-to-find materials at home. An example of this is the the “iTrainers” described by Ruparel et al in Urology in 2014. It has already been reported that LRP is a safe surgery for residents under close supervision and mentorship. In Spain, the La Paz University Hospital (Alonso S et al) has published in 2014 their training model for residents which requires participating at the beginning of the residence as an assistant during the surgery, followed by performing non “complex” parts of the surgery and, by the end of the residency, the urology trainee should be able to perform the entire

procedure under the supervision of a staff with laparoscopic experience. These are the steps followed in most of the hospitals in Spain to perform their training in this surgery: 1) training in pelvic trainers in hospital or models at home, 2) training in certified centres with animal models. In Spain we have the Minimally Invasive Surgery Center “Jesus Uson” in Cáceres. Dr. Laura Martinez (ES) wrote an article for this newsletter (March/May edition 2015) about this center’s participation as an LRP Performed by Staff Member and Urology trainee assistant surgeon in LRP and, finally, as principal practical skills are tested. ( surgeon in the last years of residency. This exam is a good initial step in laparoscopic training. You can participate in the E-BLUS exam during the However, the current status of participation or EUREP and the EAU Annual Congress. performance of residents in LRP in our country is unknown, and we hope to get and assess this data Moreover, it is important to note that the acquisition with the help of the survey of the current state of of laparoscopic skills and the opportunity to perform surgical training of residents in Spain performed by LRP and other laparoscopic procedures during the the Spanish Residents and Young Urologist period of residency training can significantly Workgroup (RAEU). contribute to motivate young urologists who are It is important to remember that the European interested in minimal invasive procedures and to join Association of Urology (EAU) provides E-BLUS basic fellowships in minimally invasive surgery and/or laparoscopy examination where theoretical and robotic surgery.

Uro Emergency Smartphone APP Clinical laparoscopic fellowship GeSRUs handy informative APP for uro emergencies A comprehensive learning experience in Krakow Dr. Hendrik Borgmann Chairman, GeSRU Chairman & Founder of Research network GeSRU Academics Frankfurt (DE)

The Jagiellonian University Urology Clinic is one of the best clinics and laparoscopic centres in Poland. The department chief, Prof. Piotr Chlosta is well experienced in all types of laparoscopic and open urological surgeries. During one of the EAU meetings I was invited by Prof. Chlosta to a fellowship in the clinic and I accepted without hesitation.

Dr. Klim Leonenko Riga East Clinical University Hospital Dept. of Urology Riga (LV)


From the first day, I was directly involved in urology department work by Prof. Chlosta and his team. The friendly atmosphere among the doctors and residents creates a great opportunity for professional learning and development.


Dr. Johannes Salem Vice Chairman, GeSRU Chairman & Founder of Research network GeSRU Academics Dortmund (DE) johannes.salem@ The German Society of Residents in Urology (GeSRU) has developed a smartphone application (APP) for urological emergencies: Uro Emergency is the first-in-field APP that helps urology residents, emergency physicians and urologists to find valuable disease information quickly – just one touch away with the mobile smartphone. After turning on the APP, users can choose either English or German language setting. The Home screen shows eight frequent and important urological emergencies: Acute Scrotum, Anuria, Haematuria, Urinary Retention, Renal Colic, Paraphimosis, Priapism and Urosepsis. A quick navigation menu is available for direct access to the desired information (Figure 1). Each chapter starts with a definition of the disease or the leading symptom. The next sub-chapter lists all relevant questions to ask when taking the medical history. The following sub-chapters cover physical examination and diagnostics. The chapter on therapy explains established therapeutic options for each emergency. Pictures illustrate key findings and the October/December 2015

Figure 1: Navigation menu for quick access to relevant disease information

literature sub-chapter supports the information for each urologic emergency. Uro Emergency is now available for iOS and Android. Just search for “Uro Emergency” in the AppStore or in Google PlayStore and download the APP for free. The APP was developed by urology residents Hendrik Borgmann, Johannes Salem, Maximilian Brandt, Kai Probst, and Eva Steiner and urology professor and chairman, Axel Merseburger. Uro Emergency is the third APP developed by GeSRU. In April 2014 the DocsLog-Urology APP was launched which serves as documentation platform for procedures performed during residency training. In May 2014 the Gross Hematuria APP was developed by a working group from the GeSRU Mentoring programme. Using this APP, urologists can quantify gross haematuria by real-time comparison of haematuria to a quantification scale using the built-in smartphone camera. The GeSRU believes physician participation in APP development increases the quality of mobile health information. We encourage urology residents and board urologists to contribute to the development of urology APPs and we share our still developing expertise with all interested European urologists.

During morning meetings every uncommon or difficult surgery case was discussed in detail and the discussions looked into how to choose the best treatment strategies, which were later implemented in the clinic. My laparoscopic education started with hands-on training on a simulation box where different laparoscopic tips and tricks were shown, after which I was closely involved in surgical work. My tutors Dr. Dudek and Dr. Gronostaj explained in detail topics such as patient position, trocar placement and operation technique. All this theoretical knowledge provided an informative orientation that helps me understand and absorb the various surgical procedures and techniques.

Prof. Piotr Chlosta and Dr. Gronostaj during surgery

Work processes and the overall atmosphere in the department motivated me to improve my skills and at the end of my fellowship I gained confidence in laparoscopic surgeries.

"...I learned new theoretical and practical skills which will definitely serve me well in my own clinic..."

The Department of Urology of Jagiellonian University

The Jagiellonian University Urology Clinic enables and trains doctors to use the best approaches and the latest technology for urology pathology treatment, with an emphasis on an individual case approach. The fellowship was a great experience and I learned new theoretical and practical skills which will definitely serve me well in my own clinic. European Urology Today


Young Urologists/Residents Corner ESRU looks into new projects and activities Prague hosts ESRU Board Meeting Dr. Selcuk Sarikaya Chairman-Elect of ESRU Kecioren Research and Training Hospital Dept of Urology Ankara (TR) drselcuksarikaya@ The ESRU Board meeting held in Prague last September during the EUREP provided a wonderful chance for the board members to plan events and activities and exchange ideas on various topics. There were new board members who attended the meeting for the first time and they were very enthusiastic about the ESRU activities and being

involved in current projects. We look forward in the coming months to working actively with them.

Luis Vasquez as EBU delegate presented the latest issues and the ongoing collaboration with the EBU. He did an excellent job to improve the collaboration with both EBU and the EAU.

The meeting’s main agenda included the programme for the Residents Day during the Annual EAU Congress in Munich. We exchanged new ideas to present a very exciting programme for residents. There were also reports by the chairman, the chairman-elect’s role as editor for this newsletter, internal coordinator and the European Board of Urology (EBU) delegates. Chairman Dr. Giulio Patruno gave an informative introduction regarding the ESRU and its main goals.

The meeting’s social event was the barbeque party, a well-known activity carried over from the EUREP and which enabled the board members to reconnect with old friends and meet new ones from various countries. Certainly, the ESRU hopes to grow in various platforms and the ESRU executive committee members are working hard to achieve this goal. The ESRU Board in Prague for the meeting of September

The author and chairman-elect Dr. Selcuk Sarikaya discussed the Residents’ Corner page in this newsletter and plans for upcoming issues, while the internal coordinator gave an interesting talk about the latest database, social media events and statistics. In recent months the ESRU has developed a stronger presence in social media with the wonderful work being done by Dr. Juan Gomez Rivas.

The ESRU has become an official part of the EAU Young Urologists Office and together we are stronger. There are ESRU pages in different social media We are organising new events and one of them is the platforms and the number of followers has grown. ESRU Session during the SEEM 2015 congress in The ESRU is actively employing social media to inform Antalya. The ESRU hopes to see everyone’s its members and acknowledges the important role of involvement in our activities. And in next year’s EAU new media in reaching residents since many of them Congress, we promise a very interesting Residents are using social media in their daily activities. Dr. Juan Day. Join us in Munich, Germany!

Founding the Swiss Residents Society Achieving team spirit, communication and solidarity Dr. Sergej Staubli Dept. of Urology Cantonal Hospital St Gallen St. Gallen (CH)

Dr. Marco Randazzo Dept. of Urology University Hospital Zürich Zurich (CH)



Why should a country have an organised resident society? And if so, what are the goals to fulfil? In December 2014 we have founded the society of Swiss Residents in Urology ( to build a national network. Switzerland might be a small country but it has four languages (German, French, Italian and Romansh) which hamper the exchange of knowledge among residents. In fact, residents from the French part of Switzerland such as Geneva or Lausanne usually do not have direct contact with those of the German-speaking cities such as Zürich, Basel, Berne and St. Gallen. Thus, it was one of our aims to overcome these “linguistic barriers” and build up a resident’s society to improve Swiss team

spirit in urology. In our opinion, residents must actively participate in discussing the main political and medical issues in their country and not only because they will be the future generation in urology (an important fact that residents need to be aware of). Currently, Switzerland has an increasing number of urology residents which is around102. Since Swiss residents need to have at least one year in General Surgery to become urology residents, the median age of our residents is slightly above 30 years. Most of us have a bit more than two years left to complete urological education. This means Switzerland will soon have a new wave of boardcertified urologists.

Our society started by inviting residents from various parts of Switzerland. To this end, all urological departments were contacted because we needed motivated residents to participate in SRU. After a couple of meetings, our first step was to evaluate goals for the first year and we prioritised education and networking. And to achieve networking through residents, we created a webpage ( where we can disseminate information. SRU and the Swiss Urology Society The full support of the Swiss Urology Association (“Swiss Urology”) has provided us a good background for future activities. Creating the national resident’s society within the national association is a clear advantage since we can learn from the obstacles they have faced and dealt with. Moreover, being recognised as part of the national urology association allows an open and active debate that includes various viewpoints from consultants, young urologists and residents (Figure).

We strongly encourage countries that still haven’t created their own national residents society to consider the benefits and take the first steps. ESRU members can certainly provide support by sharing lessons from their own experience.

The Swiss Urology Association has also given us a time slot for a plenary session during their national annual congress. This year, we have presented our new association and invited young urologists to become a member.

Residents need to know their priorities and build up political awareness. Switzerland has done so and is linked up to the European Society for Residents in Urology (ERSU). We look forward to a fruitful teamwork in Europe!

Relationship between the Swiss Residents in Urology (SRU) and the main Swiss Urology Association (SGU)

Tweeting the #EUREP15 meeting Remarkable response and feedback through SoMe Angelika Cebulla German NCO in ESRU Mannheim (DE)

Dr. Hendrik Borgmann Chairman and Founder of Research Network GeSRU Academics Frankfurt (DE)


borgmann.hendrik@ Figure 1: #EUREP15 Participants (A), Tweet Activity (B) and Geolocation of Tweets (C)

The use of Social Media (SoMe) is expanding in the medical field and urologists are increasingly using Twitter as a communication tool. Nowadays, urology conferences and meetings have their own hashtags and Twitter feeds with hashtags are used to group related tweets together in one place, providing an easy way to follow the conference. This year the European Urology Residents Education Programme (EUREP) took place from 4 to 9 September in Prague, and used the hashtag #EUREP15. We used the Twitter Analysis Tools provided by Symplur, TweetArchivist and Twitonomy to analyse activity, participants and content of the Twitter discussion on #EUREP15. There was a huge 24

European Urology Today

contribution from 151 participants to the Twitter discussion on #EUREP15 (Fig. 1A). These participants contributed 1,651 tweets and generated 1,345,090 Impressions – which are tremendous numbers (Fig. 1B)! The main language of the Twitter discussion was English and the most common accompanying hashtags – besides #EUREP15 – were #Cancer, #Urology, #hcms, #module1, #eauguidelines and #ILookLikeAUrologist. The Top Ten by Mentions consisted of EAU Twitter handles, EUREP Faculty and residents urology residents from Australia, Germany and the UK: ESU EAU (@UrowebESU), EAU (@Uroweb),

Morgan Roupret (@MRoupret), Markus Drake (@markusdrakeurol), ESRU (@ESRUrology), Amanda Chung (@AmandaSJChung), GeSRU (@GeSRU_de), Johannes Salem (@JohannesSalem), Hendrik Borgmann (@HendrikBorgmann) and Fardod O’Kelly (@FardodOKelly). The Top Ten by Tweets were ESU EAU (@UrowebESU), ESRU (@ESRUrology), Markus Drake (@markusdrakeurol), Residentes AEU (@ResidentesAEU), EAU (@Uroweb), Juan Gómez Rivas (@JGomezRivas), Morgan Roupret (@MRoupret), Angelika Cebulla (@AngelikaCebulla), Michal Smolski (@michasmolski) and

Amanda Chung (@AmandaSJChung). The #EUREP15 Twitter feed was a total success and has spread across the globe on all continents (Fig. 1C). Exchange of information on Twitter enriched the meeting experience of #EUREP15 participants on professional and personal levels. It was amazing to be part of this experience, and we look forward to #EUREP16 and an even more vibrant Twitter exchange! More #EUREP15 - SoMe Highlights can be found via the EAU account on Storify: Uroweb/eurep15 October/December 2015

Young Urologists/Residents Corner Global shortage of BCG Treating bladder cancer: Onco-urology training for residents and young urologists Dr. Moises Rodriguez Socarrás Urology resident Vigo (ES)


Dr. Juan Gómez Rivas Chairman of the Spanish Residents Workgroup ESRU Internal Coordinator La Paz University Hospital Madrid (ES)

Bladder cancer (BCa) represents a constant challenge in the research and clinical practice of urologists, and residents and young urologists should acquire the knowledge for diagnosing and treating this malignancy. Bladder cancer is considered the fifth most common malignancy in Europe with 151,000 new cases per year; more than 70% of patients are diagnosed with non-muscle invasive bladder cancer (NMIBC). Some of them are high-risk patients and adjuvant treatment

with chemotherapy or immunotherapy with Bacille Calmette Guerin (BCG) would be part of the recommendations.

quality TURB, since this is the first and most important of the treatments for NMIBC. Residents are trained to perform TURB with the best technique. It is recommended that two urologists should perform the TURB with the supervision of the most experienced urologist at least in the most complex procedures.

BCG instillations have been the standard of care of patients with high-risk NMIBC for at least 25 years. There are at least eight strains of BCG with similar biological activity; however BCG Connaught and Tice BCG strains are most widely used in Europe and North 2. 2nd TURB: in high-risk patients or in those where America. there is no muscle layer in the first intervention. In 2012, the production of BCG Connaught was interrupted by FDA regulations in the manufacturing plants of the world's largest producer. Apparently by the end of 2015, production and normal distribution is expected to recover; however there is still no date for the normal distribution to hospitals. Situation in Spain Since the start of the shortage, the Spanish Agency for Medicines and Health Products (AEMPS) has intervened and issued official communications with recommendations. Although the situation proved to be difficult, Spain started to import and use other strains such as the Tokyo, Indian and Russian strains which have similar biological activity as shown in some studies. The Spanish Association of Urology (AEU), as expected, has issued recommendations which can be accessed at their official website, How recommendations may help us? 1. Quality of TURB: In the present circumstances it is very important to perform an extreme high-

3. Immediate postoperative instillation with MMC: should be always done if there is no contraindication.

"Spain started to import and use other strains such as the Tokyo,..." New Technologies Nowadays, and more than ever, it is important to use all the available tools we have, and we should be at the vanguard regarding the use of new technologies that allow us to be a step ahead in the fight against bladder cancer. The use of cystoscope TURB with narrowband images, SPIES system, Hexvix© (5-ALA) and other tools are actions that can improve the quality of TURB and may lead to reducing the number of relapses and hospitalisations. Below are some of these technologies: • Chemohyperthermia: Combination of heat and intravesical chemotherapy increases the tissue penetration with an increased cytotoxic effect. • EMDA (Electromotive drug administration): As

demonstrated by J.L. Vasquez and Cols, EMDA is a system that uses an electric field to enhance tissue penetration and cytotoxic effects of chemotherapeutic agents such as Mytomicin. These data suggest that EMDA may become an alternative treatment for patients with high-risk NMIBC. Implications for young urologists The regular supply of Connaught and Tice strains is expected by the end of 2015, but until the normal distribution is reached we should be capable by using new technologies such as those mentioned earlier. It is necessary to reaffirm the importance of TURB quality, second TURB and the role of early cystectomy; each of these techniques has a big impact on the prognosis of patients. It is more important than ever that residents and young urologists accept the challenge of surgical training in TURB. In our hands lies the ability to obtain surgical excellence which can be achieved with rigorous training. It is important to encourage the development of training courses in TURB, HOT (Hands-on-Training) programmes, training simulators and courses which aim to achieve a refined surgical technique. Treating bladder cancer usually begins with the best surgical intervention possible. Also of crucial importance is the role of oncology learning as conveyed in an article in this newsletter (June 2015 edition) by Babjuk, Van Moorselaar and Palou. Residents must possess all possible oncological urology knowledge, and not only in surgical skills but also in the diagnosis, therapeutic options and follow-up strategies.

Young Academic Urologist: Assessing gains and prospects Tremendous team effort for YAU’s early years Dr. Francesco Sanguedolce Consultant Urological Surgeon King's College Hospital London (GB) fsangue@

The 4th Autumn Meeting of the Young Academic Urologists (YAUM) took place in Barcelona on November 15 as one of the satellite meetings held with the 7th European Multidisciplinary Meeting on Urological Cancers (EMUC). Some of the YAU members attended the EMUC meeting as speakers, enjoying the unique opportunity to join world-renowned experts from various specialties who are involved in the diagnostic and therapeutic management of urological cancers. The first YAUM activity was the welcome dinner (perhaps in support of the view that bright ideas may come in a friendly and relaxed atmosphere). The next morning was sunny and warm and yet 60 YAU members gathered in a room at the Palau de Congressos de Catalunya for the YAUM general assembly. The meeting assessed the first four years of the group. YAU was created in the autumn of 2011 as first envisioned by Professors C. Chapple, W.

Mansson and F. Montorsi, with the goal to boost excellence in research by gathering top young thinkers in urology across Europe. Prof. Montorsi attended the whole general assembly and prompted a stimulating discussion regarding the achievements (and deficiencies) which I presented in my role as the outgoing chairman of YAU. We also have Dr. M. Sedelaar, Chairman of the Young Urologist Office – with which YAU is affiliated, as guest. After an initial period of internal reorganisation, YAU has gradually gained a distinct role within the EAU network by becoming a key partner in some key initiatives: the Patient Information Project (led by Dr T. Bach) is probably among the most relevant ones. Brochures published by the information project were translated in several languages and downloaded worldwide. YAU members have contributed their expertise to this project. In 2013 the Guidelines Office has asked the YAU to revise the full text of the Guidelines and check the consistency of recommendations across the different Guidelines. Since 2014, a collaboration of the YAU Working Groups was promoted with the matched EAU Sections. This integration is gradually being implemented to maximise resources in research and prevent overlap of projects. But the most remarkable achievement has been the quantity and quality of projects already published or ongoing, and made possible through the influential network created from scratch by the hardworking YAU members. As a consequence, more YAU members have become opinion leaders in their own subspecialty. For instance, many YAU members have been invited to write editorials for European Urology, while others serve as key reviewers. The YAU platform is also developing itself as more than a scientific network by sharing common interests –or passions. YAU is also a community of friends whose talents and ambitions are enhanced by mutual cooperation. YAU is certainly not a closed club but it has its exclusivity which makes admission to YAU more competitive.

October/December 2015

integration process with the relevant EAU bodies, and these are the main challenges for new YAU Chairman Dr. S. Silay (Turkey) who was deservedly elected at the end of the general assembly. Congratulations Selcuk! The YAUM assembly also included the brainstorming meeting of the Working Groups whose members showed enthusiasm regarding new projects, both short and long-term. My years as YAU Chairman have been one of my most challenging and intense experiences and our success was made possible with the support of a wonderful team. My thanks to friends Drs./Profs. S. BrookmanMay, N. Buffi, J.N. Cornu, C. De Nunzio, G. Giannarini, S. Silay, N. Suardi, P. Verze and E. Xylinas. We shared difficult challenges and they are among the finest colleagues I have ever met.

Dr. Michiel Sedelaar speaking at the 4th YAUM Meeting

However, there is still a long way to go for YAU to realise its full potential and to complete the

We could not have delivered anything without the tremendous support of the EAU Executive Committee and the EAU Board. The YAU members are all aware of the relevant resources that have been made available for us to fully deliver and we believe that we can only do better. And special thanks to Angela Terberg of the EAU Office for her tireless support.

Win a free registration to Munich in 2016! EU-ACME members, join the MCQ quiz published in European Urology For details, visit: European Urology Today


EBU Certified Residency Training Programmes in Urology Institute Austria Medical University of Graz Krankenhaus Hietzing Landeskrankenhaus Leoben University Hospital Salzburg SMZ Ost - Donauspital Vienna SMZ Süd - Kaiser-Franz-Josef-Spital Vienna Krankenhaus der Barmhezigen Brüder Vienna Medical University of Vienna, Comprehensive Cancer Center Landeskrankenhaus Wiener Neustadt Belgium Ghent University Hospital University Hospitals Leuven Croatia University Hospital “Sestre milosrdnice” Zagreb Czech Republic Charles University Hospital Plzen Charles University Hospital Motol General University Hospital and Charles University 1st Faculty of Medicine Prague Estonia North Estonian Medical Centre Tallinn Tallinn Childrens Hospital Affiliated with North Estonian Medical Centre Tallinn Finland Oulu University Hospital

Programme Director

Prof. Dr. K. Pummer Prof. Dr. H. Pflüger Prof. Dr. T. Colombo Prof. Dr. G. Janetschek Dr. M. Rauchenwald Prof. Dr. S. Madersbacher Dr. P. Schramek Prof. Dr. S.F. Shariat Prof. Dr. J. Hofbauer

Prof. Dr. P. Hoebeke Prof. H. Van Poppel

Prof.Dr. D. Trnski


Graz Hietzing Leoben Salzburg Vienna Vienna Vienna Vienna Wiener Neustadt

Ghent Leuven


Assoc. Prof. M. Hora Prof. M. Babjuk

Plzen Prague

Prof. T. Hanuš


Dr. L. Kukk


Dr. L. Kukk


Dr. P. Hellström


Germany Universitätsklinikum der RWTH Aachen Prof. Dr. A. Heidenreich Aachen Klinik für Urologie und Kinderurologie Klinikum Bamberg Dr. K. Weingärtner Bamberg University of Bonn Prof. Dr. S.C. Müller Bonn Klinikum Braunschweig Prof. P. Hammerer Braunschweig University Hospital Carl Gustav Carus, TU Dresden Prof. M. Wirth Dresden Urologische Klinik der Universität Düsseldorf Prof. Dr. P. Albers Düsseldorf Universitätsklinikum Essen Prof. H. Rübben Essen Ev.-Luth. Diakonissenanstalt zu Flensburg Prof. Dr. T. Loch Flensburg University Hospital Frankfurt Prof. A. Haferkamp Frankfurt Klinikum Garmisch-Partenkirchen Prof. Dr. H. Leyh Garmisch Partenkirchen Justus Liebig-University Giessen Prof. W. Weidner Giessen St. Antonius-Hospital Gronau GmbH Dr. J. H. Witt Gronau Universitätsklinikum Halle (Saale) Prof. P. Fornara Halle (Saale) Asklepios Klinik Barmbek Hamburg Prof. Dr. A. Gross Hamburg Heidelberg University Hospital Prof. Dr. M. Hohenfellner Heidelberg SLK Kliniken Heilbronn Prof. Dr. J. Rassweiler Heilbronn Urologische Klinik und Poliklinik des Universitätsklinikums Jena Prof. Dr. M.-O. Grimm Jena Klinikum Kassel GmbH Prof. Dr. B.G. Volkmer Kassel Universitätsklinikum Schleswig-Holstein, Campus Kiel Prof. K.P. Jünemann Kiel Klinik für Urologie, Klinikum Ludwigsburg Dr. Med. A. Jurczok Ludwigsburg Urologische Klinik, Klinikum der Stadt Ludwigshafen gGmbH Prof. Dr. M. Müller Ludwigshafen Klinik für Urologie, Universitätsmedizin Mannheim Prof. Dr. M.S. Michel Mannheim Technische Universität München Klinikum rechts der Isar Prof. Dr. J.E. Gschwend Munich University of Regensburg - Caritas St. Josef Medical Centre Prof. Dr. W.F. Wieland Regensburg Julius-Maximilians University Medical Center Würzburg Prof. Dr. H. Riedmiller Würzburg


Programme Director


Greece Sismanoglio Hospital Athens University of Crete, Medical School

Prof. C. Deliveliotis Ass. Prof. C. Mamoulakis

Athens Heraklion Crete

Hungary Semmelweis University Budapest

Prof. P. Nyirády


Italy General Hospital of Bolzano

Prof. Dr. A. Pycha


Malta Mater Dei Hospital

Dr. K. German


Prof. Dr. T. De Reijke Prof. Dr. E. Meuleman

Amsterdam Amsterdam

Prof. Dr. E. Meuleman


Prof. Dr. E. Meuleman


Dr. A. Andersen


Dr. A. Andersen


Poland Holy Cross Cancer Centre Kielce University Hospital in Kraków European Health Centre Otwock Pomeranian Medical University Szczecin Specjalistyczny Szpital Miejski im. M. Kopernika Torun Interdisciplinary Hospital Miedzylesie Warsaw Medical University of Warsaw

Prof. P. L. Chłosta Prof. P. L. Chłosta Prof. A. Borówka Prof. A. Sikorski Prof. T. Drewa Dr. A. Antoniewicz Prof. P. Radziszewski

Kielce Kraków Otwock Szczecin Torun Warsaw Warsaw

Portugal Coimbra University Hospital

Prof. A. Mota


Spain Hospital Clínic de Barcelona Vall D'Hebron University Hospital Barcelona Hospital del Mar (Parc de Salut Mar) Barcelona Fundació Puigvert Barcelona Hospital Universitario la Paz in Madrid Cliníca Universidad de Navarra in Pamplona

Dr. A. Alcaraz Dr. J. Planas Morin Dr. A. Francés Prof. H. Villavicencio Mavrich Dr. F.R. De Bethencourt Codes Prof. J.I. Pascual Piédrola

Barcelona Barcelona Barcelona Barcelona Madrid Pamplona

Sweden Urologiska kliniken Universitetssjukhuset Örebro

Dr. O. Andrén


Switzerland University of Bern Kantonsspital St. Gallen Kantonsspital Winterthur University Hospital Zürich

Prof. Dr. G.N. Thalmann Prof. Dr. H.-P. Schmid Prof. Dr. H. John Prof. T. Sulser

Berne St. Gallen Winterthur Zürich

Turkey Ankara University Medical Faculty Hacettepe University, School of Medicine Ankara Uludag University in Bursa Istanbul University Faculty of Medicine

Prof. M.Y. Bedük Prof. H. Özen Dr. Y. Kordan Prof. Dr. N. Aras

Ankara Ankara Bursa Istanbul

The Netherlands Academisch Medisch Centrum Amsterdam VU University Medical Centre Amsterdam St. Lucas Andreas Ziekenhuis - Amsterdam Affiliated with VU University Medical Centre Amsterdam Onze Lieve Vrouwe Gasthuis - Amsterdam Affiliated with VU University Medical Centre Amsterdam Norway Sørlandet Sykehus HF Kristiansand Sørlandet Sykehus HF Arendal Affiliated Institute with Sørlandet Sykehus HF Kristiansand

EBU Certified Sub-Speciality Centres

EBU honours Prof. Cutajar The European Board of Urology honoured Prof. Lino Carmel Cutajar (Malta) with the EBU golden pin and the Distinguished Service Award in formal ceremonies held during the EBU Board Meeting in Bruges, Belgium, last October 9 and 10.


Programme Director


University Hospital Leuven (Belgium) University Hospital Leuven (Belgium) St. Antonius-Hospital Gronau GmbH (Germany) Academisch Medisch Centrum Amsterdam (The Netherlands) Oxford University (United Kingdom)

Prof. H. Van Poppel Prof. D. De Ridder Dr. J. H. Witt

Prostate, Kidney & Bladder Cancer Female & Reconstructive Urology Prostate Cancer

Prof. J. De La Rosette Mr. J. Reynard

Stones Treatment & BPH Stones Treatment

His nomination by the Urological Association of Malta was confirmed at the EBU meeting in 1995 in Luxembourg. He was a dedicated board member. An active member of the EBU Certification Committee, he visited several training centres in Europe as part of the Residency Training Programme Certification programme. Briefly commenting on his 20-year experience with the EBU, he said: “Believe in the European Board of Urology.”


European Urology Today

EBU Online In-Service Assessment From left: Prof. Stefan Müller (President), Prof. Lino Cutajar and Prof. Arnaldo Figueiredo (Secretary)

Thursday 3 & Friday 4 March 2016 Registration now available at October/December 2015

EBU recertifies St. Gallen Hospital’s Urology Department A commitment to high quality standards Dr. Christoph Schwab Kantonsspital St. Gallen Urology Dept. St. Gallen (CH)


Prof. Dr. Hans-Peter Schmid Kantonsspital St. Gallen Urology Dept. St. Gallen (CH) hans-peter.schmid@ Kantonsspital St. Gallen is a very well-organised department, which covers the broad spectrum of urological conditions. It represents a tertiary referral centre and is the largest hospital in the eastern region of Switzerland with an estimated 600,000 population.

the weekly multidisciplinary tumour board meeting and during conferences with nephrologists and pathologists. Moreover, participants have to prepare lectures on special topics for weekly in-house presentation or reference, and they are also strongly encouraged to take active participation in national and international meetings and to publish articles. Furthermore, the Kantonsspital St. Gallen has an excellent interdisciplinary medical research centre where urologists have the opportunity to perform basic research.

urologist by the Foederatio Medicorum Helveticorum (FMH). Residency includes one year of general surgery and four to five years of urology (See Table 1). At the end of the residency, every candidate has to pass the official written examination of the EBU and a practical examination in the operation theatre and at the bedside, where a committee will check his operation ability and his clinical knowledge. In addition, most Swiss urologists also participate in oral European exams to become a Fellow of the EBU (FEBU).

Currently, several prospective randomized trials and clinical studies are on-going at the department. For example, the first randomized prospective trial in Europe to compare TUR-P vs. prostate-embolisation1. Another clinical study investigates the absorption of fluid in Thulium laser vaporisation of the prostate2. Both study protocols are published in BMC Urology in 2014 and 2015, respectively.

The Swiss residency training programme in Urology • Takes six years • One year in General Surgery • Surgery ‘Basis-Exam’ • At least one year urology training in an category B institution • At least two years urology training in an category A institution • One optional year in one of the following Structured resident training departments: obstetrics and gynaecology, Our eight residents and two medical students are endocrinology / diabetology, general surgery and regularly taught by seven board-certified staff traumatology, visceral surgery, vascular surgery, members. After completing medical school, a resident neurology, dermatology, nephrology or oncology has to conclude a training period of at least six years and pass two final exams to become a board-certified • Final exam (written EBU exam and practical exam)

EBU Recertification In May 2015 the title EBU Certified Training Centre was again granted to the Kantonsspital St. Gallen for another five years. Our urology department received EBU certification for the first time in 2003. Due to continuous efforts to maintain and update the quality of training and medical services, this led to repeated recertification by the EBU in 2009 and in 2015. This is a mark of excellence and a commitment to high residency training standards. Furthermore, the EBU certification process represents a valuable opportunity to gain external feedback. The department is given an opportunity to evaluate its programme, enabling it to closely examining questions such as institutional organisation and educational structure, amongst others. Currently, we are building up a special resident training centre at the Kantonsspital St. Gallen, which will allow candidates to train their operation skills as well as theoretical knowledge. A learning psychologist in consultation with experienced medical doctors develops the learning units. With this recent development we expect further improvements in patient care, staff training and research.

The department has a 36-bed capacity, a day care unit and an outpatient clinic with 8,500 patient admissions a year. Four well-equipped surgical theatres facilitate the surgical treatment of 2,700 inpatients every year. Outpatient surgery is also performed every day. Modern facilities and high surgical activity provide good conditions for training. The climate is highly professional and friendly. The head of the department is very committed in quality of education and is highly appreciated by the residents. Regular assessments, close supervision and personal logbooks ensure for educational progression and facilities for scientific activities are good.

References 1. Prostatic artery embolization versus conventional TUR-P in the treatment of benign prostatic hyperplasia: protocol for a prospective randomized non-inferiority trial Abt D, Mordasini L, Hechelhammer L, Kessler T M, Schmid H-P and Engeler D S. BMC Urology 2014, 14:94. 2. Is absorption of irrigation fluid a problem in Thulium laser vaporization of the prostate? A prospective investigation using the expired breath ethanol test Mordasini L, Abt D, Müllhaupt G, Engeler D S, Lüthi A, Schmid H-P and Schwab C. BMC Urology 2015, 15:35.

It is mandatory for all residents to participate in the annual in-service assessment of the EBU. They also have to present difficult or interesting cases during EBU Certified Centres

• The programme includes a plan, defining the knowledge and surgical goals for the residency. Every candidate has to write an e-logbook which is regularly discussed with the head of the department.

Staff members and residents of the Department of Urology

Hamburg hosts 67th German Urology Congress Third largest urology congress in the world with more than one hundred activities As host city of the four-day 67th Deutschen Gesellschaft für Urologie (DGU) Kongress or German Society of Urology Congress, urology came to Hamburg with 7,200 medical and professional visitors attending a varied scientific programme.

female urological diseases, and andrology. Dedicated sessions and forums discussed active surveillance, the treatment of nocturia, continent urine drainage and psycho-oncology, complementary medicine as well as specialised adolescent urologists.

The annual event, with the theme “Urology’s wider reach,” was held from 23 to 26 September at the Congress Center Hamburg (CCH) and has demonstrated the strength and growing influence of urology in Germany.

Among the highlight were the PREFERE-Study (one of the most important and largest German projects in prostate cancer research), paediatric urology and, not the least, the introduction of the association’s three new advisors. The DGU also presented the new education module “Assistants for urological continence therapy,” new media in urology, the forthcoming directive on living kidney donation and provided an outlook on the new S3-guidelines for bladder and renal cell carcinomas, with the latter having been just published. Together with the Professional Association of German Urologists (BDU), the society also discussed future prospects for urologists in surgical and clinical practice.

Considered as the third largest urological congress in the world in terms of attendance, more than 100 activities were organised with focus on skills training and scientific exchange. Thematically, the congress covered the full range of urology under the leadership of the German Society of Urology President, Prof. Dr. Stephan Roth. Among the topics were tumour diseases of the bladder, kidneys, prostate and testicles, stone diseases, benign functional and

“We look back on a very successful annual meeting with many international visitors,” said DGU SecretaryGeneral Prof. Dr. Oliver Hakenberg who stressed the significance of urology not only in treating benign and malignant diseases but also, and more importantly, their prevention.

The Hamburg Congress Centre hosted the 67th DGU Congress last September

October/December 2015

During the patient forum organised by the DGUPatient-Academy, visitors were informed about stone diseases, the weak bladder and cancer prevention. Prior to the patient forum, the Pupil Action Day with the slogan “Be a urologist for a day” attracted large numbers of visitors with around 100 high school students from Hamburg oriented into the world of medicine.

Prof. Dr. med. Susanne Krege (Essen) succeeded Prof. Dr. med. Jürgen Gschwend (Munich) in the board department guidelines and quality assurance. Prof. Dr. med. Axel Haferkamp (Frankfurt) was elected into the DGU board, taking over from Prof. Dr. med. Maurice-Stephan Michel as Head of the Section Training and Development.

Prof. Roth giving the opening speech

Also generating high attendance was this year´s Care Congress for urological care-givers and related professions with an estimated 1,100 participants. Held concurrently with the congress was the Industrial Exhibit showing the latest pharmaceutical products and medical technologies.

The traditional hand-over for the Office of the President ended the 67th DGU. Prof. Dr. med. Stephan Roth, Director of the Department of Urology and Paediatric Urology at Helios Clinic in Wuppertal handed over the 2015-1016 presidency to the former Vice President, Prof. Dr. med. Kurt Miller, Director of the Urological clinic and polyclinic, Charité – University Medical Center in Berlin. Prof. Dr. med. Tilman Kälble (Fulda) takes over from Miller as the DGU’s 1st Vice President. As the new president, Prof. Dr. med. Kurt Miller will lead the 68th annual meeting which will take place in Leipzig from 28 September to 1 October 2016.

Honours and new executives were also announced during the congress. Prof. Dr. med. Wolfgang Weidner (Gießen) was honoured with the highest DGU award, the Maximilian-Nitze Medal for Special Merits in Urology. PD Dr. med. Dr. med. univ. Arkadius Miernik (Freiburg) received with the Maximilian-Nitze Prize, the highest scientific honour given by the society. DGU members voted Prof. Dr. med. Paolo Fornara (Halle/Saale) as 2nd vice president on the board of the Society while Prof. Dr. med. Christian Wülfing (Hamburg) was also elected as new DGU board member, succeeding Prof. Dr. med. Sabine Kliesch (Münster) in her post as secretary and board member Prof. Weidner receives the Maximilian Nitze-Medaille, the for public relations. highest honour awarded by the DGU, from Prof. Roth European Urology Today


CEM15: Gains and diversity in Central European urology EAU 15th CEM focuses on young urologists and new challenges By Joel Vega

techniques should not rely on single-surgeon studies but should focus instead on disease and patient The challenges of urological diversity in Central Europe, characteristics. gains and contributions by researchers in the region and the crucial role of young urologists were among “These factors plus the hospital setting, clinical the recurring themes at the EAU 15th Central European pathways and outcome assessments should be Meeting (CEM) held from October 2 to 4 in Budapest, equivalent,” he said as he drove home the point that Hungary. citing single-surgeon experiences led to skewed conclusions which seem to favour robot-assisted RP. In more than a decade Budapest has hosted for the third time the EAU Regional Office’s frontline annual Prof. Gunter Janetschek (AT) offered a contrary view event, the first meeting in 2001 and later in 2005, with regards the technical benefits that surgeons derive making Hungary the only country to organise the CEM from the robotic procedure. But Lepor reiterated his the most number of times. arguments and said some studies even showed there is greater dissatisfaction rates shown by patients due to “CEM has returned to Hungary and this marks not only unrealistic expectations. the key role played by our colleagues here but also reflects the dynamism of urology in this region. It is an Speakers Peter Tenke (HU) and Janetschek discussed the inspiration to see the wonderful work being done by role of intraoperative frozen section analysis during urologists in Central Europe and it is important to laparoscopic RP and new techniques in pelvic node attract young urologists for them to present and share dissection in prostate cancer, respectively. “The their findings,” said Regional Office Chairman Bob oncological outcome of intrafascial nerve sparing Djavan (AT) in his welcome remarks. technique is a safe as the classical nerve-sparing Around 350 participants gathered for the three-day technique, and it has also improved early incontinence meeting for plenary discussions, update lectures, and potency,” said Tenke. “If the conditions are suitable abstract presentations, case discussions, debates, for nerve-sparing, intrafascial technique is workshops and laparoscopy training and a technical recommended.” exhibit. In his overview lecture on pelvic node dissection EAU Secretary General Prof. Chris Chapple underscored Janetschek said blind pelvic lymph node dissection the importance of supporting the education of young (PLND) should be replaced by targeted PLND. He also urologists. “We have to make the regional meetings as noted that indocyaningreen (ICG) is better than TC99 meaningful as possible to young urologists. At the when employing procedures such as fluorescencesame time, we have to cater to the diversity in urology targeted PLND for prostate cancer. and we have to change whilst looking at the needs of the next generation,” said Chapple. Rising antibiotic resistance Day 2 plenary sessions opened with the Young With Profs. Peter Tenke (HU) and Peter Nyiràdy (HU) as Urologists Competition, one of the most highly attended chairman and course directors the meeting kicked off sessions where promising, young urologists from with a lecture by Prof. Imre Romics (HU) on the various countries aim to get the nod of the 11-member contributions of urological pioneers in Hungary such as jury who were selecting the best presentation, research Geza Illyes, Gyula Minder and Geza Antal who all outcomes or insights on urological practices. A contributed to the treatment of kidney stones and other follow-up session organised by the European School of diseases. Urology (ESU) highlighted the increasing antibiotic resistance across Europe, with Florian Wagenlehner (DE), Franck Bruyere (FR) and Truls Erik Bjerklund Johansen (NO) discussing severe infections, antibiotic use and urological infections following biopsies. “The resistance to E.coli, for instance, is booming. Resistance all over Europe is increasing and the only way to stop this is to follow the Guidelines and decrease antibiotic consumption,” said Bruyere in his EAU Guidelines update on urinary tract infections. “Urologists are among the biggest users and misusers of antibiotics and implementing the Guidelines is the safest way to avoid the disaster of antibiotic resistance.” The 15th CEM attracted around 350 participants

Uro-oncology topped the agenda of the plenary sessions with lectures on imaging techniques in prostate cancer (PCa), biochemical tests to identify aggressive disease, and choosing between targeted or template biopsies with speakers Ali Serdar Gözen (DE), Piotr Radziszewski (PL) and Anna Katarzyna Czech (PL). Gözen underscored the emerging role of multiparametric Magnetic Resonance Imaging (mpMRI) and PET/CT scan as promising tools, while Radziszewski presented an overview on biochemical test such as Decipher which analyses the expression of 22 biomarkers across the genome to generate a robust genomic score. Decipher uses the score to predict the probability of the patient developing a metastasis within five years of surgery or three years of biochemical recurrence. On the issue of targeted or template biopsies, Czech said: “MRI-targeted biopsies seems to better address the problem and the future seems to be for mpMRI and targeted biopsies instead of random, with the condition that there is radiologic expertise and cooperation.” Robotic radical prostatectomy In the follow-up session, the controversial topic of robot-assisted radical prostatectomy (RARP) was re-examined by Dr. Herbert Lepor (USA) with his critical look at the perceived benefits of robot-assisted radical prostatectomy (RP) compared to open RP. “The robot is a bad investment in terms of improving outcomes. The only benefit of robotic RP is less blood loss,” Lepor said as he noted that the practice of radical prostatectomy was “transformed not on the basis of outcomes but due to savvy marketing.” According to Lepor, the main bulk of current evidence shows no inherent advantage of robotic RP with regards length of stay or even pain. He said studies comparing the two 28

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Johansen gave a comprehensive overview on managing complications after prostate biopsies. “A 30-daymortality rate of 0.1% to 0.2% has been reported after prostate biopsies. A rate of 0.2% translates to 4,000 men dying from prostate biopsies in the US and Europe every year,” he said. Johansen: “Biopsies should not be performed unless histological findings will be of benefit to the patient.” He emphasised that several scenarios should first be considered such as the role of biopsies in radical treatment and focal therapy. In his take-home messages, Johansen said: “The benefit of diagnosing prostate cancer must be balanced against side effects before a biopsy is performed. The increasing antibiotic resistance makes prophylaxis and treatment difficult and adds to the severity of the situation.” In the Young Urologists Competition, presenter George Daniel Radavoi from Bucharest, Romania outraced other contenders from Croatia, Czech Republic, Slovakia, Hungary and Slovenia with his presentation regarding new work done on biomarkers for prostate and kidney cancers. Taking the second and third prizes were Boris Kollarik (Bratislava, Slovakia) and Uros Bele (Maribor, Slovenia), respectively, for their discussion of neoadjuvant chemotherapy in treating muscle invasive bladder cancer (Kollarik) and the endoscopic treatment of vesicoureteral reflux in children (Bele).

CEM15 Opening Session with (from left) Profs. B. Djavan, P. Nyirady and P. Tenke

their work on fusion of MR and transrectal ultrasound images in prostate cancer. A study titled “Decision making protocol for the management of complex renal cystic masses according to 10 years of clinical experience and meta-analysis of the current literature. Lesson learned from the multi-institutional analysis,” has won for P. Weibl and his team (Slovakia) the first prize for Basic Research from Berlin-Chemie (See Box for List of Winners). Kidney, bladder and testis cancers Functional urology and uro-oncology were taken up in other sessions with topics such as prolapse surgery, new drugs in overactive bladder and stress urinary incontinence (SUI) and managing failure after SUI surgery. In uro-oncology, metastatic kidney, bladder and testis cancers were examined by W. Loidl (AT), F. Greco (IT), Z. Kopa (RO), Z- Kastelan (HR) and C. Gingu (RO). Since not all patients with advanced kidney cancer would benefit from nephrectomy, experts consider other less radical or aggressive options such as partial nephrectomy or lymph node dissection. “Partial nephrectomy should be considered standard of care whenever possible even in cases of metastatic disease,” said Gingu as he cited recent studies that explored options such as lymph node dissection (LND) for patients with metastatic disease. He presented cases from his own practice where he conducted LND to gain survival advantages and cited the role of metastasectomy when there is poor response to treatment of metastatic kidney cancer.

“There is hope for mRCC patients to be cured through metastasectomy,” he said and added the shift to metastasectomy, instead of immediate systemic therapy for lung metastasis patients, must be considered. Kastelan discussed active surveillance in patients with small renal masses (SRMs). “Active surveillance is a safe and reasonable option for patients with renal tumours smaller than 4 cm (cT1a) and with competing health risks,” he said and added that SRMs have a slow growth rate and that progression to metastasis is rare. Kopa gave an overview on managing testis cancer, which has increased by 40% in the last four decades particularly in men younger than 35 years, a patient population that is at the peak of their reproductive age which prompts many doctors to consider organ-sparing options. “Patient assessment for organ-sparing in testis cancer is crucial, and patient and history-taking is very important not only in the diagnosis of testis cancer but also in patient selection for an organ-sparing option (OSS),” said Kopa. “There are strong arguments for organ-sparing such as the high accuracy in frozen section examination (FSE) which is around 100%, and the increasing attention paid to the cosmetic, functional and psychological outcomes of patients with testicular tumours,” he added, whilst noting the literature lacks studies with a high level of evidence in comparing OSS with radical surgery.

Best Abstract Winners Berlin-Chemie Awards for Basic Research First Prize: Decision making protocol for the management of complex renal cystic masses according to the 10-years of clinical experience and meta-analysis of the current literature. Lesson learned from the multi-institutional analysis; P. Weibl, M. Hora, P.A. Baltzer, S. Sevcenco, T. Pitra, M. Remzi, W. Hübner, B. Kollarik, K. Kalusova, M. Obsitnik, T. Klatte (Korneuburg, Vienna, Austria; Plzen, Czech Republic; Bratislava, Slovakia) First prize winner J. Stejskal (2nd from left) with Profs. Second Prize: Mutation analysis of EGFR signal transduction pathway in urachal carcinoma; Nyirady, Tenke and Djavan M. Orsolya, T. Szarvas, H. Reis, C. Niedworok, Karl Storz Awards for Clinical Research H. Rübben, A. Szendröi, AM. Szasz, P. Hollosi, K. Baghy, I. Kovalszky, K. Okon, T. Golabek, First Prize: Methods of performing a fusion of MR and transrectal ultrasound images in prostate biopsy; P. Chlosta, SF. Shariat, B. Peyronnet, R. Mathieu, P. Nyirády (Budapest, Hungary; Essen, Germany; J. Stejskal, M. Záleský, Z. Rýznarová, J. Votrubová, R. Zachoval (Prague, Czech Republic) Krakow, Poland; Vienna, Austria; Rennes, France) Second Prize: Changes in contemporary Third Prize: What urologists should know about the tuberous sclerosis complex; B. Novotna, J. Breza Jr., perioperative care in patients undergoing radical A. Bardos, J. Breza Sr. (Dresden, Germany; cystectomy; M. Oszczudłowski, M. Skrzypczyk, Bratislava, Slovakia) S. Szemplinski, D. Sujecki, J. Dobruch, A. Borówka (Warsaw, Otwock, Poland) Third Prize: Laparoscopic promontofixation for pelvic Best Video organ prolapse: A 3-year single center experience in Robot-assisted partial nephrectomy; V.Jr. Študent, a series of 60 patients; T. Mezei, B Köves, B Kovács, I.Hartmann, A. Vidlar, M. Grepl, V. Student (Olomouc, Czech Republic) P. Tenke (Budapest, Hungary)

Best abstracts and video winners Around 245 abstracts were submitted to the CEM with Romania, Czech Republic and Poland submitting the highest number of abstracts. Countries outside the region also joined, coming from as far as South Korea, Russia, Turkey and Iran. J. Stejskal and colleagues from the Czech Republic won the first prize (Clinical Research) from Karl Storz for

Berlin Chemie first prize winner P. Weibl (3rd from left)

Young Urologists Competition winner (left) G. D. Radavoi receives his prize from Profs. W. Loidl (m) and C. Chapple

October/December 2015

11th SEEM: The best of the EAU comes to Antalya Training, education, young urologists …and some friendly competition By Loek Keizer

and beyond. “We do this regularly at EAU Meetings and National Society The EAU 11th South-Eastern European Meeting was a meetings, when we are microcosm of the EAU itself: education, training, invited. The particular Education support for young urologists and diversity in The first day of the scientific programme immediately strength of an ESU course membership. Close to 300 participants joined up in is that the faculty is showcased the large variety of lectures, training Antalya, Turkey from 6-8 November to learn from programmes and expertise on offer in Antalya, Turkey. filtered: we know their Europe’s best urologists and to showcase their own quality and we are The morning’s sessions focused on prostate cancer talent in front of an international audience. while simultaneously the first ESU-ESUT Laparoscopic sure that their recommendations match Hands-on training session began. The hands-on Regional Office Chairman Prof. Bob Djavan (Vienna, the EAU Guidelines. This training sessions were free of charge to SEEM AT) welcomed the large and diverse crowd. “It’s my gives the courses quality delegates, and the room was packed to capacity. pleasure to welcome Turkish opinion leaders, and and consistency.” experts from all across South-Eastern Europe and Prof. Ali Gözen (Heilbronn, DE), the course director beyond. This is a scientific, political and social event, “The ESU course was revealed that this year would see the 25th E-BLUS The free ESU/ESUT hands-on training sessions on laparoscopy were well-attended and everybody getting together as we are today is relatively early, so it’s exam (European training in Basic Laparoscopic already an achievement.” also necessary to keep Urological Skills) taking place, which translates to a the audience involved with questions and discussion. missions, as well as the ESRU Quiz. Dr. Nevzat Can total of 500 exam participants. Gözen sees much Additionally, Prof. Djavan briefly outlined the various initiatives taking place under the banner of the EAU’s potential in the laparoscopic training and examination The local organisers or society request specific topics, Sener from Adana, Turkey won free admission to next year’s SEEM meeting in Sarajevo. programme: “perhaps less so in Western Europe, but and the ESU decides on the speakers and the talks. Regional Office, including the Central European and Baltic Meetings. He was especially pleased to particularly for audiences at the regional meetings, in In Turkey, in my experience, we have given a large announce the Regional Office’s aims to hold a meeting Central Asia and even Russia. In Western Europe, the variety of topics, there is no specific topic that is SEEM15 Prize Winners requested regularly.” target audience is the younger residents who are for the Central Asian region as soon as possible. starting their careers, but further East or in Africa, Young Urologists “Country Competition”: laparoscopic training is in demand for urologists of all A day for the young Dr. Mehmet Bülent Semerci (Izmir, TR), President of 1. L. Selmani, et al., Prishtina The second day of SEEM15 was also a day for the the Turkish Association of Urology also welcomed all experience levels. The EAU can play a central role in 2. I. Stojanoski, et al., Skopje young urologist. Indeed, meetings organised by the this education.” 3. O. Bayrak, et al., Gaziantep EAU Regional Office are designed to attract local Early risers on the second talent and help them prepare for participation in the Karl Storz Award for Best Poster day of SEEM could attend EAU (and its Annual Congress) at large. Presentation (Clinical) the ESU Course on 1. K.V. Mytilekas, et al., Thessaloniki endourology and related The Young Urologists Competition, a feature 2. M.M. Hosseini, et al., Shiraz, Jahrom, Bushehr oncology, chaired and for introduced to the regional meetings by EAU Regional 3. A. Ahmed, et al., Salmeya, Farwaniya a large part presented by Office Chairman Prof. Bob Djavan is a way for a region’s National Societies to put their most talented Prof. Evangelos Liatsikos Berlin Chemie Award for Best Poster (Athens, GR). Drs. Canda young members forward and to give a ten-minute Presentation (Basic Science) talk on any topic of their choosing. The urologists are and Balbay also spoke. 1. F. Veselaj, et al., Prishtina, Prizren then (intellectually) grilled by their peers and senior Prof. Liatsikos is a 2. A.E. Canda, et al., Ankara, Istanbul member of the ESU board expert judges. 3. V. Ismayil, et al., Baku and a veteran of the Further topics of note for residents and young courses that are Video: Discussion between Dr. Canda and Asst. Prof. Liatsikos at the latter’s ESU course on Endourology presented throughout the urologists were the Young Urologists Office session, M. Georgiev, et al., Sofia which outlined the YUO and ESRU programmes and year all across Europe and related oncology delegates, “young urologists starting out and older urologists looking to deepen their knowledge. We hope it will be a memorable experience for all.”

Patients first. At the end of the day, it’s all about our patients. We publish practicechanging research so that clinicians throughout our community can improve patient care. To involve patients in their treatment, we now publish summaries of each paper in language they can understand.

October/December 2015

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7th EMUC: Challenges and prospects in onco-urology Some gains in combination drugs, genomic research and new imaging By Joel Vega Returning to Barcelona for the seventh edition, the European Multidisciplinary Meeting on Urological Cancers (EMUC) assessed the latest gains and challenges in the treatment of urological cancers which included some headway in combination therapies, genomic research and prospects for better imaging. “Since 2007 when we had our first meeting, and through the years, this conference with its focus on multidisciplinary collaboration has become increasingly important and better. It is also important that we do not only speak to each other but also speak the same language,” said Prof. Cora Sternberg (IT) of the European Society of Medical Oncology (ESMO) at the end of the four-day event held in Barcelona from November 12 to 15. Co-organised with the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Association of Urology (EAU), ESTRO President Prof. Philip Poortmans (NL) and EAU Adjunct Sec. General for Education Prof. Hein Van Poppel both reiterated Sternberg’s statement regarding the need for extensive collaborative work.

Winners). The best six Oral Presentations were also presented on the second day with the audience asked to comment and critique. The European School of Urology (ESU) presented two courses on castrate-resistant prostate cancer and the medical treatment of metastatic renal cancer with faculty members L. Albiges (FR), N. Mottet (FR), Van Poppel (BE), K. Fizazi (FR) and S. Gillessen (CH), among others. Supplementing these educational activities are training skills on hands-on laparoscopic courses led by mentors from the ESU-ERUS, and a Falcon Workshop organised by ESTRO on MRI-based delineation in PCa treatment with focus on focal therapy. From grading systems to genomic research The first half of Day 1 focused on PCa with an update session followed by a clinical discussion. “Large global variations in rates reflect differences in both practice (PSA screening) and underlying risk,” said Ahmedin Jemal (USA) of the American Cancer Society in his lecture on PCa epidemiology. “Incidence continues to increase in several low-medium income countries and Eastern Europe, which may reflect increased detection as well as changes in risk factors.”

overall survival (OS), delayed time to symptomatic skeletal event (SSE) and has shown a highly favourable safety profile in the phase 3 ALSYMPCA clinical study in castration-resistant PCa patients with bone metastases,” he said as he noted that data from the iEAP support the ALSYMPCA results. Prostate cancer in younger patients was examined in five lectures with topics such as biomarkers (A. Vickers), the role of screening in younger men (M. Roobol), active surveillance in younger patients (L. Bokhorst), optimal curative treatment (R. Karnes), psychological and survivorship issues and updates on clinical trials (P. Ghadjar).

adjuvant studies are ongoing. The future is bright,” said Powles adding he is optimistic major gains will occur in about five years.

On testis cancer, radiologist M. Bertolotto (IT) highlighted the risk of radiation burden in testis cancer survivors and said computed tomography (CT) Roobol (NL) said retrospective data show that PSA can scan, a standard diagnostic tool, accounts for around > 98% of cumulative effective dose (CDE) in these be used for risk stratification at early mid-life and whether or not this would lead to a screening benefit patients. Bertolotto urged for radiation risk strategies such as reducing the frequency of CT scanning, “It is easy to say we have to continue with organising Jemal noted that Lithuania posted the highest increase (less metastatic-positive disease or lower PCa minimising the CT scan volume, limiting the length of EMUC since we need to have active contributions from in incidence in the last 10 years, while mortality rates mortality) remains unclear. Bokhorst (NL) argued for are up in 11 countries with the Philippines, Lithuania, follow-ups and exploring alternative imaging tools active surveillance in younger men saying it is not various disciplines. We can offer these ideas and Belarus and Russia posting higher mortality rates in such as MRI. risky as generally perceived but instead offer the insights to further improve our practice,” said the same period (2004 to 2013). benefit of delaying active treatment. Poortmans. “There is no radiation and no concern for radiationrelated cancer with MRI and there is no need for In kidney cancers, clinical scientist Dr. Samra Turajlic “Without the participation of a very active faculty and Prof. Rodolfo Montironi (IT) examined the new gadolinium contrast injection. And patients with (GB) reported on intratumour heterogeneity (ITH) the attendance of many specialists from across Europe grading recommendations, particularly the WHO system. “The new grading provides more accurate which she said dominates the evolutionary landscape germ-cell tumours are usually young people with no these meetings would not have been possible,” Van stratification of tumours than the Gleason system,” he in ccRCC at the genetic, transcriptomic and proteomic contraindications to MRI,” he explained. Poppel said as he extended the invitation to next said. “The classification simplify the number of levels. Researchers in her team have noted somatic year’s meeting in Milan. He noted the wider Urologist V. Matveev (RU) spoke on managing residual mutations are not observed in the multiple biopsies participation from across Europe and elsewhere with grading categories from Gleason scores 2- 10 to grades 1- 5. The lowest is 1 not 6 as in the Gleason masses after chemotherapy and post-chemo from the same primary tumour, but are instead nearly 1,300 participants from around 60 countries. system, with the potential to reduce overtreatment of shared from all primary regions. This implies that ITH Retroperitoneal Lymph Node Dissection (RPLND). He indolent cancer.” But Montironi noted that while the must be considered in the management of ccRCC with discussed the rationale and timing for RPLND and In the first plenary session, an automated headcount urologist and radiation oncologists welcomed the presented full bilateral templates including dissection regards diagnostic procedures, prognostic and registered that around 47% of the audience were new grading system, medical oncologists have techniques to preserve sexual functions. In his predictive biomarkers and drug development. Her urologists, followed by radiation oncologists (15%) withheld their support. team are now investigating questions such as concluding remarks, Matveev said majority of and medical oncologists (11%). Many of the retroperitoneal tumours may be completely excised, whether ITH has a predictive value, mechanisms of participants came from Western European countries On genomics, Prof. James Catto (GB) gave an overview tumour resistance and whether it’s possible to track and that extended PC-RPLND remains the only such as Germany, Belgium and the Netherlands, and provided updates on various biomarkers. He said clonal dynamics in plasma and urine. curative treatment for patients where other organs are while a growing number of participants were from genomic markers can guide patient choice, or can be affected. He also recommended that with the Russia, Scandinavia and Eastern Europe. employed as exit triggers for active surveillance and Systemic treatments in bladder and testis cancers potential complexity in the multidisciplinary approach In the paired sessions on bladder and testis cancers, for RPLND, these patients should be referred to As in previous years, prostate cancer (PCa) topped the have a role in adjuvant and salvage treatments. Professors Cora Sternberg, Maria De Santis (GB) and specialised centres. meeting agenda but topics such as metastatic kidney, “Predictive genomic panels exist but direct Thomas Powles (GB) provided updates on peribladder and testis cancers were also extensively comparisons have not been performed,” Catto said. operative chemotherapy, targeted and immune Optimal treatment and new approaches examined and discussed in the submitted abstracts, “The most useful clinical setting (active surveillance) therapies, respectively. Sternberg noted The Cancer Managing carcinoma in situ (CIS) and other updates oral poster presentations and plenary sessions. has not been directly tested. Although markers may Genome Atlas (TCGA), which is creating a genomic atlas on non-muscle invasive bladder cancer were Updates included systemic treatments, new findings help guide some patients, their additive benefits are of human cancer, has updated its list of significantly examined on Day 2 with an update on The Genome and prospects in pathology, strategies for optimal unclear over traditional measures.” mutated and potential targeted agents with trials now Cancer Atlas (TGCA) by Seth Lerner (USA). He therapies, assessments of tumour responses to new in development. Neoadjuvant and adjuvant trials with described the work on the comprehensive molecular drugs and patient’s quality of life. On whether magnetic checkpoint inhibitors (and in combination) are also characterisation of urothelial bladder carcinoma, and resonance imaging (MRI) being initiated. On neoadjuvant and adjuvant said that as of September this year, multiple “omic” is a real step forward, chemotherapy, Sternberg said there is “a convergence platforms on 412 high-grade muscle invasive bladder Caroline Moore (GB) gave of evidence in support of adjuvant chemotherapy and a tumours were performed. The team also observed a mixed answer although strong likelihood that there will be Level 1 data.” some high mutation rates. “There is a high she underlined that percentage of potentially targetable pathways and MRI-targeted biopsy, molecular subtypes reflect tumour heterogeneity and “Randomised trials (in bladder compared with standard suggest similarities to other cancers,” he said. TRUS biopsy, detects at cancer) to define survival are least as much clinically Fred Witjes (NL) reviewed the optimal treatment for expected soon and moreover significant disease while CIS and the role of Hexvix. He said that from the latest avoiding the meta-analysis with raw (unpublished) data, combination and adjuvant studies complications and (HAL) cystoscopy detects a are ongoing. The future is bright,” hexaminolevulinate invasiveness of biopsy. significant number of additional lesions and HAL-TURB reduces relative risk (RR) at least up to one Prof. Thomas Powles Two lectures provided year. “Cytology is important in CIS and markers will “Perioperative chemotherapy (neoadjuvant or some new insights, one come. Searching with white light (WL) and biopsies adjuvant) for bladder cancer should be standard of on pathology from are not always successful nor meaningful,” said care. Participation in clinical trials to investigate new leading experimental pathologist Prof. Carlos Witjes. According to Witjes, better alternatives for The EMUC was complemented and preceded by two therapies and biomarkers is imperative,” she stressed. biopsies include enhanced imaging such as Cordon-Cardo (USA), with his overview on nextsatellite meetings on 12 November with the 4th generation pathology, and Prof. Joan Carles who photodynamic diagnosis (PDD). Meeting of the EAU Section of Urological Imaging De Santis reviewed targeted therapies and pointed discussed the benefits and mechanisms of (ESUI) with “Imaging and Individualised Medicine” as out there is still no licensed new agents or targeted Radium-223 (Ra 223) in PCa patients. Pathologist Eva Comperat (FR) discussed pathology theme. For the first time the European School of therapies for bladder cancer. She discussed FGFR3, features and emphasised that it is also important to Oncology (ESO) held its day-long interdisciplinary HER- 1, 2 and VEGR, commenting on the current “We are treating most of the cancer patients with recognize and report premalignant lesions. “Every conference to gather insights on personalised status of ongoing trials on these targets. “Regarding focus of CIS has to be reported,” she added. approaches to prostate cancer management (See Full drugs that affect cell division because it’s a targeting angiogenesis in metastatic bladder cancer, characteristic and the symptomatology of cancer. But Story on the next page). Both pre-EMUC meetings overall benefit seems minimal, particularly with normal cells also divide. We have identified a On biomarkers, Maria Ribal (ES) hammered on the attracted sizeable attendance and triggered importance of achieving licensed biomarkers in enthusiastic discussions that re-visited questions such sub-population of cells that is different from the cells monotherapy,” said De Santis but added there is we have seen; it’s a cell that is very differentiated and encouraging preliminary data with bevacizumab and non-muscle invasive bladder cancer (NMIBC). “There as PSA screening, active surveillance and patient’s are no licensed biomarkers in clinical use for bladder perspectives on life expectancies and co-morbidities. doesn’t follow the regular rules that we are used to,” ramucirumab. Cordon-Cardo said as he urged researchers and cancers up to now and unlike in other malignancies. Powles discussed immune therapies and said doctors to adopt a new way of looking at cancer This calls for a more active, collaborative work to offer With its goal to encourage innovative research and immune checkpoint inhibitors are active in bladder growth. optimal healthcare to our patients,” said Ribal. prod more medical discoveries and insights, the cancer and that PD-L1 expressions, although Although there are many studies and publications EMUC awarded six unmoderated abstracts appearing of significance, implies the need for other examining a long list of biomarkers, none have yet submissions which investigated prostate, bladder and Carles provided an update on how Ra 223 has a new biomarkers. “Randomised trials to define survival are reach the point where it can be widely used in actual action tailored for patients with castration-resistant kidney cancers with winners coming from both expected soon and moreover combination and PCa with bone metastases. “Radium-223 improved clinical practice. academic and clinical institutions (See List of 30

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October/December 2015

“Large-scale collaborative research, adoption of replication culture, the registration of studies and protocols and sharing of data, materials and software, are some of the research practices that may help increase the proportion of true research findings,” added Ribal. Regarding surgical management, Christian Stief (DE) said that in a contemporary series of radical cystectomies, tumour stage and grade, type of pathohistology, lymph node status, vascular and lymphovascular invasion showed a significant negative effect on cancer-specific survival. Incremental gains, steady progress Succeeding sessions tackled a motley of issues including rare kidney tumours, novel approaches in advance renal cancer such as vaccine therapies, checkpoint inhibitors, tumour-response assessment and neo-adjuvant and adjuvant therapies. A separate session on upper urinary tract transitional cell carcinoma was presented with discussions on organ-sparing, lymph node dissection and timing of chemotherapy. The concluding sessions concentrated on oligo-metastatic PCa covering topics such as cytoreductive approaches, management, surgical options, optimal radiotherapy, hormonal manipulation and the role of docetaxel. Key take home messages from medical oncology, urology, pathology, radiation oncology and radiology were summarized by Profs. Susanne Osanto (NL), Harriet Thoeny (CH), Alberto Briganti (IT), Berardino De Bari (IT) and Antonio LopezBeltran (PT). In radiology Theony noted the various imaging techniques and standard procedures for prostate, kidney, testis, bladder and renal cancers. She underlined the need for reducing radiation dosage by reducing the frequency of CT-scanning and limiting the length of follow-ups, particularly in testis cancer patients. In urology, Briganti highlighted developments in genomics for PCa, the role of PSA for younger patients, the role of surgery in oligometastatic PCa, optimal treatment for muscle-invasive bladder cancer and risk stratification for urethelial carcinomas.

New insights in the best posters and oral abstracts The EMUC recognises innovative and pioneering work in onco-urology. Below is the list of winners for the best unmoderated abstracts and the six best oral presentations: Six Best Oral Presentations • Bellmunt J. et al., “First-line randomized phase 2 study of gemcitabine/cisplatin plus apatorsen or placebo in patients with advanced bladder cancer: The international Borealis-1™ trial” • Dearnaley D. et al., “Phase 2 study of investigational oral GnRH antagonist TAK-385 (relugolix) in patients with intermediate risk localized prostate cancer requiring neoadjuvant and adjuvant androgen deprivation therapy (ADT) with external beam radiation therapy (EBRT): Results from the 12-week interim analysis” • Cozzarini C. et al., “Clinico-dosimetric factors predicting long-term severe urinary incontinence after post-prostatectomy RT. Results of a longitudinal observational study” • Bokhorst L.P. et al., “Should we start screening men for prostate cancer before the age of 55?” • Carles J. et al., “Effect of baseline characteristics on overall survival in metastatic CastrationResistant Prostate Cancer (mCRPC) patients treated with radium-223 in an international early access program (EAP)” • Lara P. et al., “SWOG 0421: Impact of circulating markers of bone metabolism on overall survival in men with metastatic Castration Resistant Prostate Cancer (CRPC)” Best Unmoderated Poster (Prostate cancer) • First Prize: Venderbos, L. D. F. et al., “Quality of life of men on active surveillance for prostate cancer versus men without prostate cancer: Are there any differences?” • Second Prize: Oderda M. et al., “Natural history of prostate widespread HGPIN and ASAP: When to rebiopsy?” • Third Prize: Cozzarini, C. et al., “Toxicity and efficacy of salvage tomotherapy Choline PET/CT guided in patients with prostate cancer lymph nodal recurrence” Best Unmoderated Posters (Bladder and kidney cancers) • First Prize: Necchi, A, et al., "Neoadjuvant sorafenib, gemcitabine and cisplatin (SCC) for muscle-invasive urothelial bladder cancer (UBC): Updated clinical and transitional findings of an open-label, single group, phase 2 study" (Italy) • Second Prize: Keizman, D, et al., "Metformin (met) use and outcome of sunitinib (Su) treatment (tx) in diabetic patients (pts) with metastatic renal cell carcinoma (mRCC)" (Israel) • Third Prize: Elsen, S, et al., "Evans blue as a diagnostic tool for non-muscle invasive bladder cancer." (Belgium)

Osanto highlighted developments such as Ra-223 in prostate cancer, initial findings on intratumoural heterogeneity in kidney cancer, the role of immune oncology in bladder cancer (BCa), progress in The Cancer Genome Atlas Project, and understanding the role of checkpoint inhibitors in kidney cancer, among others.

De Bari reaffirmed the crucial role of multidisciplinary strategies and pertinent issues in survivorship, and noted the importance of integrating new imaging techniques such as MRI in prostate delineation. Finally, Lopez-Beltran commented on the new grading system for prostate cancer as contained in the WHO 2016 recommendations. While urologists and

radiation oncologists have welcomed and adapted the grading system, he expressed his hope that the grading will find its place despite the cautionary stance from medical oncology. He also discussed the heterogeneity of kidney and prostate cancer tumours where precision imaging and further research are certainly needed.

ESO Interdisciplinary Conference on Prostate Cancer Patient’s perspectives and achieving optimal care take centre stage in Barcelona By Joel Vega Experts recognise the crucial role of a patient-centred approach to achieve optimal treatment for men with prostate cancer but the road to this goal is fraught with obstacles that range from lack of convincing data, less than accurate predictive tools and drugs with dire side-effects that heavily impact on quality of life. These were the recurring concerns voiced by both experts and representatives of patients’ groups who gathered in Barcelona on 12 November to attend the European School of Oncology (ESO) Interdisciplinary Conference held in conjunction with the 7th European Multidisciplinary Meeting on Urological Cancers (EMUC). With “Personalized approach to prostate cancer management” as theme, the meeting was charged with expectations particularly from patient’s representatives who are closely monitoring the advances, or lack of it, in prostate cancer management.

Uomo - the European Prostate Cancer Coalition, to complement the EMUC by organising the ESO conference. “More expert consultations are needed since they offer the chance for researchers and clinicians to align their strategies and look into opportunities where they can improve the management of prostate cancer,” Van Poppel said. Doing away with hype In the plenary session, Touijer spoke on paradigm shifts in PCa, followed by lectures on androgenregulated transcriptions on PCa and population screening by Franck Claessens (BE) and Monique Roobol (NL), respectively.

“We have to realise that prostate cancer screening has its role and benefits but we need to take it out from the clinical setting and move it to specialised centres,” said Roobol. According to Roobol, by focusing in the current debate on the drawbacks of screening tools such as the prostate specific antigen Dr. Riccardo Valdagni (IT), co-chair of the ESO (PSA), doctors might eventually lose a useful tool in conference and coordinator of the ESO Prostate Cancer detecting aggressive disease particularly in younger Program, set the tone for the meeting when he patients. “PSA testing will remain the mainstay of remarked in the opening session that prostate cancer screening,” she added while noting multidisciplinary efforts can be the most efficient way the importance of how doctors define risk and how it to achieve optimal care if it is anchored on relates to the urgent need for risk-stratification. She individual’s needs and characteristics, and underscored that combine PSA testing with other considering the fact modern medicine relies on various expertise. With EAU Adjunct Sec. General for Education Prof. Hein Van Poppel (BE) and Prof. Karim Touijer (USA) as co-chairmen, the meeting tackled the whole range of provocative issues in prostate cancer (PCa) management in topics such as developing accurate diagnostics, the role of systemic and localised therapies, personalising healthcare, advanced disease, quality of life and supporting survivorship. ESO, which aims to coordinate and provide a platform for cancer specialists for them to pursue and improve healthcare initiatives, have collaborated with Europa October/December 2015

relevant information is the next step. “Populationbased, individualised screening will be feasible but needs to be regulated to avoid misuse,” Roobol said while pointing out that doctors should not be carried away by hype particularly with regards new technology. Touijer spoke on the changing role of surgery particularly with regards advance or metastatic prostate disease. He commented on screening and said that aside from risk-adjust screening by age and PSA, additional markers are needed to increase specificity. “Active surveillance for low-risk cancers and treatment by high-volume physicians and centres to reduce the harms of necessary treatment are also among the measures we need to increase the benefits,” he said. Caroline Moore (GB) tackled the role of multiparametric MRI and highlighted the gains such as the detection of significant tumours (85% to 95%), its use for re-classificative and repeat assessments in men on surveillance and its use in combination with other information such as biopsy and PSA kinetics. Patient’s perspectives The succeeding sessions also focused on the views of patients with psychologist Dr. Lara Bellardita (IT) and Europa Uomo Chairman Ken Mastris (GB) giving a detailed assessment and overview of how patient’s cope with cancer and decision-making. “We have to improve the communication on both sides (patient and doctor) and have a named individual for contact,” Mastris said as he added the need to break down barriers in Europe and find a common standard to reduce inequality in some parts of the region.

Meanwhile, Bellardita provided insights to shared decision making processes. “Patient’s decision is strong influenced by the role of the physician… Patients might be reluctant to be actively engaged in a Prof. Claessens presenting on Androgenregulated transcriptions in shared decision-making process if they experience the a session chaired by Dr. Valdagni, Profs. Touijer and Van Poppel burden of decision making-related stress,” she said

Prof. Riccardo Valdagni explains the challenges in active surveillance

and recommended that doctors should get more training to gain knowledge on the various styles of decision making and identify how patients coping mechanisms and feelings influenced their decisions. Using Big Data One of the concluding lectures was on transforming cancer care through the use of Big Data by Peter Boyle of the University of Strathclyde Institute of Public Health at iPRI (International Prevention Research Institute). “To the question ‘Can we transform cancer care through big data?’ my response would be yes, it’s possible. But there is a lot of work that needs to be done, and we should come and work together if we have to reap the benefits of Big Data,” said Boyle. He said there are factors blocking the efficient use of Big Data such as the academic tenure system which is driven by data hoarding, worries of patients about privacy, confidentiality issues, consent and ethics concerns. In the corporate sector there are also IP and Competition Law concerns. In his concluding remarks, he emphasized that changes within the healthcare sector itself should be initiated. “If Big Data is to succeed then the initial requirement is to have data sharing. For example, pathologists could be reluctant to share data with other clinicians and basic scientists,” said Boyle. European Urology Today


4th ESUI Meeting in Barcelona Well-attended meeting assesses new challenges in imaging Dr. Jochen Walz Chairman, EAU Section of Urological Imaging (ESUI) Marseille (FR)

walzj@ Leading international experts active in imaging and image-guided treatment in urology gathered in Barcelona on 12 November for the 4th Meeting of the EAU Section of Urological Imaging (ESUI) which was held in conjunction with the 7th EMUC meeting.

fields such as stone and upper urinary tract diseases. It is clear that the main advances in cancer management in the future will be driven by better imaging. Providing better detection, better staging, better follow up and salvage treatments will lead to improved and individualised treatment strategies. This observation was also reflected in the meeting’s theme “Imaging and individualised medicine.”

New imaging technologies on the horizon The fascinating session on new technologies proved that in the near future even better performances in diagnostics and treatment could be expected. Especially ultrasound-based imaging tools for prostate cancer such as ultrafast ultrasound and ultra-high frequency ultrasound will open up major possibilities for improvements.

Outstanding presentations addressed key topics. Panel discussions and audience feedback also generated a number of interesting conclusions and participants went home with a set of actionable take-home messages and summaries, some of which are listed below:

Joint ESUI and EANM session As in 2014 one of the highlights of the meeting was the joint meeting between the European Association of Nuclear Medicine (EANM) and the ESUI. The role of PET/CT in the different urological malignancies was critically assessed and clarified the value and limits of PET/CT in managing individual pathology. It became obvious that nuclear medicine is very rapidly evolving with a large number of new tracers coming up, particularly for prostate cancer. PSMA, in its derivatives, as well as Bombesin needs to be cited. The ESUI 2016 meeting will definitely continue this joint meeting to offer updates on new developments.

Imaging and individualised medicine in urology One of the main observations with regards to imaging technologies was that new developments added to The meeting critically addressed the most recent developments in imaging technologies and their clinical the baseline technology will improve and increase the information generated with the “conventional” tool. application in clinical practice. The ESUI meeting not This is especially true for stone disease when using only complemented the EMUC meeting but also gave the DYNA-CT, as well as for the management of upper ESUI the opportunity to offer a comprehensive urinary tract urothelial cancer when using NBI, SPIES programme with a high scientific quality. and PDD. Moreover, high-resolution added to functional imaging allows for an individualise the The sessions were all marked by a very lively treatment of bladder and kidney cancers. discussion and excellent interaction, proving that the idea of combining an imaging and multidisciplinary oncology meeting responds to the needs and demands of physicians active in urological oncology. Indeed, not only urologists participated in the meeting but also radiologists, oncologists, nuclear medicine physicians and engineers. The meeting also had the support and participation of the European Society of Urogenital Radiology (ESUR) and the European Association of Nuclear Medicine (EANM). The programme, aside from complementing to the EMUC programme, offered key lectures that addressed the value of imaging in the management of urological malignancies and also other urological EAU Section of Urological Imaging (ESUI)

Best poster session and best poster award The meeting also presented a successful poster session, with the prize for the best poster granted to Dr. M. Hekman from Nijmegen (NL) for her study entitled “Targeted dual-modality imaging in renal cell carcinoma: An ex vivo kidney perfusion study.” The number of abstracts submitted and published during the meeting increased substantially and the quality can be commended. We are confident future meetings will attract even more talented physicians, interested in urological imaging, to submit their latest research to our meetings.

Best Poster winner Marlène Hekman (NL) with Dr. G. Salomon (left) and Prof. P. Martino (right)

How can imaging individualise and optimise PCa management? Another highlight was the session

Dr. Christian Pavlovich (Baltimore, USA) speaking on High resolution ultrasound in urology

which addressed PCa imaging, clearly one of the hottest topics in urological imaging. The session was opened by an excellent point-and-counterpoint discussion between Hashim Ahmed (UK) and this author who took pro and con positions regarding the capabilities of multiparametric MRI to detect or rule out significant prostate cancer. The debate followed by an in-depth assessment of new perspectives in ultrasound- based imaging tools and their combination of multiparametric ultrasound as well as in the critical assessment of multiparametric MRI and its use in diagnosis, staging and treatment decision making. Finally, the role of imaging in diagnosing and monitoring metastatic prostate cancer was assessed. Future ESUI meetings With the success of the 4th ESUI meeting, the 2016 meeting is scheduled with the theme “Imaging and shifting paradigms in urology” which will be held on 24 November, again in conjunction with the 8th EMUC in Milan. Save the date and see you in Milan!

ESUI16 5th Meeting of the EAU Section of Urological Imaging

Abstract submission deadline 1 July 2016

In conjunction with the 8th European Multidisciplinary Meeting on Urological Cancers

24 November 2016, Milan, Italy

Imaging and shifting paradigms in urology

EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations

24-27 November 2016, Milan, Italy

Consolidating multidisciplinary strategies

8th European Multidisciplinary Meeting on Urological Cancers In conjunction with • European School of Urology (ESU) • 5th Meeting of the EAU Section of Urological Imaging (ESUI) • EAU Young Academic Urologists Meeting (YAU) 32

European Urology Today

October/December 2015



3rd EAU Baltic Meeting

14th European Urology Residents Education Programme

27-28 May 2016, Tallinn, Estonia EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations

2-7 September 2016 Prague, Czech Republic

Call for Abstracts Deadline 1 April 2016

ESOU16 More information about the scientific programme at

13th Meeting of the EAU Section of Oncological Urology (ESOU) 15-17 January 2016, Warsaw, Poland


Prof. Piotr Chlosta Local organiser

Highlights from the scientific programme According to local organiser, Prof. Piotr Chlosta (Crakow, PL) ESOU16 will offer the most up-to-date lectures on onco-urology surgery. For its 13th meeting, the EAU Section of Oncological Urology can draw on a wealth of experience in organising cutting-edge scientific meetings. The annual ESOU Meeting is set to present the current state of the art in onco-urology, with particular emphasis on the diagnosis and treatment of cancer. The meeting will give delegates a unique opportunity to meet international experts in the field of onco-urology and to actively participate in lively discussions and debates. A multidisciplinary approach to cases will be maintained together with debates and videos of surgical procedures. Prof. Maurizio Brausi, ESOU Chairman (Modena, IT) emphasises the many opportunities on offer for participating young urologists: “For a start, we offer two days of ESU-ERUS intensive hands on training in robotic surgery. Eight 90-minute slots are available for participants to get started on simulators.” Another truly unique opportunity for young urologists is the STEPS programme, closed-door case discussions led by experts in the oncology field. Brausi: “We are happy to introduce these young doctors to senior experts, and help them expand their learning and professional opportunities.” A record number of applications were received and 20 young urologists have been selected to participate in this important teaching element of the ESOU programme. The scientific programme features no fewer than four separate sessions on prostate cancer, two on urothelial and bladder cancer, and one each on renal cancer and testis and penile cancer. Prof.

October/December 2015

Prof. Maurizio Brausi ESOU Chairman

Chlosta: “As with every year, all the latest approaches for oncourology will be covered. This year, we are offering talks on new diagnostic modalities in prostate cancer.” Extensive time for discussion has been included in all of these sessions, in addition to the formally structured debates and Pro/Con talks. “Our aim is to provide delegates with the most up-to-date talks on minimally invasive onco-urological surgery from international leaders in their respective fields, including robotics, laparoscopy and oncology.” The presence of these speakers is a tribute to the multidisciplinary nature of the programme, involving key speakers from other EAU Sections like Prof. Zoran Culig (Innsbruck, AT) on behalf of ESUR and Prof. Alex Mottrie (Aalst, BE) speaking for ERUS and robotic surgeons in general. “The programme is designed with an international audience in mind, and we are anticipating many visitors from across the globe. Polish urologists represent the single largest group (40%) of Fellows of the European Board of Urology (FEBU), a result of the Polish Urological Association’s decision to adopt the EBU exam as compulsory for its members. Four Polish academic departments hold EBU accreditation as training centres, with three more preparing to apply. We look forward to welcoming you in Warsaw for what promises to be an interesting, fruitful and interactive meeting.

Register now online!

European Urology Today


EULIS15 tackles challenges and prospects in stone disease Technology, training issues top EULIS meeting agenda in Alicante By Joel Vega Challenges posed by new technology, new research outcomes, gaps in training and in the healthcare system were among the key issues discussed and examined by urolithiasis specialists during the biennial meeting of the EAU Section of Urolithiasis (EULIS) in Alicante, Spain.

Liatsikos noted there is some evidence that in smaller tracts cases there are less bleeding complications, but further studies need to evaluate this issue. Saying that his view may sound too provocative, he underscored the need for evidence-based medicine. Regarding lower blood loss, the question remains unresolved since studies that looked into this issue were burdened with selection bias.

“It is important for specialists in this field to face both the challenges and prospects in urolithiasis. Not only are we addressing the basic issues but we are also improving service delivery to patients,” said EULIS chairman Prof. Kemal Sarica (TR) during the opening session of the 3rd EULIS meeting. Sarica and local organiser Dr. Juan Galan welcomed almost 300 participants. Update lectures, panel discussions, workshops, skills training, abstract presentations and a technical exhibit were part of the three-day event held from September 10 to 12. Speaker Dr. Noor Buchholz (AE) presented his view on stone formation and its link to metabolic syndrome. “A significant proportion of stone-forming patients are overweight and obese…the prevalence of stone disease in the last three decades has doubled and there is a strong link between MS (metabolic syndrome) and stone formation,” said Buchholz as he noted that overweight and obese patients excrete “larger amount of stones promoters” making them more prone to stone disease. Besides the medical management of the underlying cause of MS, Buchholz said lifestyle and diet changes are recommended for these patients as well as regular physical exercise and achieving normal Body Mass Index (BMI). Prof. José M. Reis Santos (PT) discussed optimal healthcare delivery for stone patients, and focused on the inability of developing countries to use nonsurgical treatment due to the lack of new hospital equipment and poor access to minimally invasive technology. “Open surgery can be justified in poor countries where the scarcity of necessary equipment is a problem,” said Reis Santos, adding that in cases when there is an acute lack of resources, procedures such as Shock Wave Lithotripsy (SWL) can easily be made available in remote places since SWL requires non-invasive procedures, less anaesthesia and has lower complication rates. Prof. Hans-Goran Tiselius (SE) summarised the achievements and development of urolithiasis groups in Europe and their activities. He noted the gains made in previous decades particularly in the evolution from invasive to non-invasive treatment strategies and emphasised that a lot more needs to be done particularly in bio-chemical research for accurate diagnosis and stone recurrence prevention.

Prof. Sarica (TR) and Dr. Galan (ES) chairing the Opening Session

Is new always better? Ass. Prof. Evangelos Liatsikos (GR) gave the Endourological Society Lecture with a provocative talk titled “Standard, mini, ultra-mini, super mini, micro PCNL. Do we need all this stuff?”. He discussed the benefits and drawbacks of minimally invasive technology and stressed that enthusiasm for new technologies should be balanced with actual clinical evidence. “Micro PCNL has significantly higher intrarenal pressures compared to standard PCNL. The complication rates, however, are similar,” said Liatsikos. “The efficacy of miniaturised seems high, but longer operating times apply and benefit, compared to standard PCNL, for selected patients has yet to be demonstrated.” EAU Section of Urolithiasis (EULIS)


European Urology Today

Minimal invasive techniques The benefits for the surgeon using robot-assisted surgical procedures in kidney stone diagnosis and removal were discussed during a session on new trends in surgical training. Petrisor Geavlete (RO) lectured on the advantages for surgeons of robotassisted procedures like the Avicenna robot. “Flexible ureteroscopy is nowadays one of the major indications in upper urinary tract pathology therapy and have significantly improved our ability to effectively treat a great number of this pathology,” said Geavlete. He listed the benefits such as a “surgeon-perfect” position which provides better ergonomic and better control of instruments, less irradiation for the surgeon, dexterity in instrument handling and less damage on surgical equipment, among others.

But session chairman Dr. Alberto Breda (ES) cautioned that the gains for the Andrea Bosio (IT) receives the prize for Best Paper in Clinical Research patient have yet to be proven and should be closely examined. “I’m not against evolution or progressive “MI-PCNL demonstrates superior outcomes in smaller changes in technology but before we give strong conclusions on benefits, we have to consider the stones but standard PCNL should be regarded as the gold standard treatment option for large renal calculi benefits for the patients. Stone-free results are the same and we still have to examine potential as it combines acceptable morbidity with excellent complications or adverse effects,” Breda said. stone-free rates,” said Liatsikos in his take-home messages. Moreover, flexible ureteroscopy should be During the open discussion, the main critique focused preferred over minimally invasive PCNL in small on the clear benefits for the patient and the high costs burden stones as it has less morbidity and higher of robotic instruments. stone-free rates. Speakers James C. Williams (US) and Prof. Dirk Kok (NL) discussed the analysis and origin of various stone conditions with Williams looking into imaging techniques and Kok discussing stone growth characteristics. Saeed Khan (US) discussed stone analysis and the evidence from animal studies. “Stone morphology is a simple, rapid, cheap and useful tool in addition to X-ray diffraction or FTIR analysis for understanding the aetiology of kidney stones,” said Khan. Updates on stone disease In the Friday sessions, topics on stone diseases included lectures and discussions on the emerging role of genetics in stone formation, the risk for bone diseases among stone patients, the role of urinary saturation in urolithiasis, management of stone patients after bariatric surgery and the importance of diet and lifestyle habits for high-risk patients.

“I agree there are concerns about the costs and surgical outcomes, and we could not at this point say conclusively that robotics deliver better surgical results. But I do feel that in terms of physical comfort for the surgeon and with regards the evolutionary development of minimally invasive surgery, we do have something to gain,” said Geavlete. He said more

studies have to be done to monitor the efficacy of new technologies. “Pilot centres are now working on these technologies and we need more data," he added. Abstract winners The EULIS also awarded three prizes for clinical and research work and the best paper in literature. A. Rodriguez, et al. (ES) won the Basic Research Award for their work titled “Magnesium, citrate and phytate: Effect of their binary mixtures as calcium oxalate crystallization inhibitors in urine.” Their research examined the synergistic effect between magnesium and phytate in preventing calcium oxalate crystallisation and suggested that a “combination of these two compounds may be highly useful” in treating stone disease. A. Bosio et al. (IT) collected the Clinical Research Award for their work “Double J ureteral stent symptoms evaluation using a validated questionnaire (USSQ) after ureteroscopy: a prospective, single-institutional study.” J. Anudu and colleagues (DE) bagged the Best Paper in Literature prize for their work titled “Minimal Invasive PCNL (MPCNL)- Update on efficacy and safety after 1048 consecutive patients.” Their conclusions confirmed that MPCNL is a reliable and effective technique for percutaneous surgery.

The 3rd EULIS Meeting welcomed almost 300 participants

One-week intensive Endourology and Laparoscopic Hands-on Training (HOT) 2-5 February 2016, Cáceres, Spain

Nephrologist Robert Unwin (GB) examined the role of genetic predisposition among stone formers and discussed the role of specific genes and why some people are prone to develop the disease. “There are still a lot of questions that need to be answered and the challenge is for researchers to integrate their studies, link up or pool their efforts in order to look into specific patient characteristics,” he explained. He said there are several studies on genetics but what is going to advance the work is to have well-defined patient populations and the ability to characterise them in a more refined way. “There would be study progress in the next few years, but I don’t expect dramatic breakthroughs. What has been limiting these studies is because we’re looking at large populations, when in fact the underlying (patient) populations are more heterogeneous,” said Unwin. The role of good diet and physical exercise was examined by Roswitha Siener (DE). “Balanced diet, appropriate fluid intake, reduction of overweight and physical activity are among the recommendations for patients to avoid the risks of stone formation,” Siener said. Studies showed the increasing prevalence of kidney stones in many countries and in Germany the incidence of stone disease over two decades grew from 0.5% to 1.5%, while the prevalence rate grew from 4% in 1979 to 4.7% in 2001. In comparison, the prevalence rate in the US from 1988 to 1994 was recorded at 5.2%, which jumped to 8.8% in the period 2007 to 2010. Affluent countries are known to record a range of lifestyle diseases among their populace due to dietary habits. Among women with recurrent stone disease, experts noted that their diet lack a regular intake of fruits and vegetables. “A diet high in fruits, fibre and vegetables may reduce stone risk by increasing urinary citrate,” said Siener.

Try your hardest at the EAU HOT events! An important step to improve your work in the future! • The highest-scoring HOT participants can look forward to an invitation for a one-week high-level programme on laparoscopic and endourology Hands-on Training • Training at Jesus Uson Minimally invasice Surgery Centre (Cáceres, Spain); One of the best laboratory facilities in this type of simulated training workshop in Spain • Each participant will receive individualised mentoring, training and skills assessment by seasoned laparoscopy and endoscopy teachers For more information:

Supported by an unrestricted educational grant from

October/December 2015

ERUS15: A focus on education in robotic surgery Helping young urologists with training, courses and live surgery demonstrations By Loek Keizer The EAU Robotic Urology Section held its twelfth annual meeting in Bilbao on 15-17 September, attracting over six hundred participants from 44 countries from all six continents. The largest single group of participants (70) came from Spain, closely followed by Italy and the United Kingdom (69 and 39, respectively). These delegates, urologists and residents alike, were drawn to the Basque Country for a comprehensive update on robotics in urology, and the meeting’s unique live surgery sessions in particular. The two days of live surgery sessions were fully endorsed by the EAU according to its strict, patient-focussed Policy on Live Surgery Events. The first Live Surgery session went off without a hitch, with the audience being treated to a robotic partial nephrectomy courtesy of Prof. Alex Mottrie (Belgium), and a robot-assisted radical prostatectomy by Dr. Jörn Witt (Germany). Procedures were carried out at the IMQ Zorrotzaurre Clinic and the University Cruces Hospital, both in Bilbao. Dr. Henk Van Der Poel (Netherlands), who was the local organiser at last year’s ERUS meeting in Amsterdam started proceedings by giving a one-year follow-up for the patients of last year’s live surgery patients. Of the eleven procedures, only one patient had complications (Grade-II), and the patient advocate did not have to intervene at any point. Of the oncological cases, 2 out of 7 showed recurrences. Prof. Walter Artibani, former EAU Adjunct Secretary General and closely involved in the establishment of the EAU’s stringent Live Surgery Policy, reiterated the importance of compiling live surgery data to compare the outcomes to those of regular procedures. Please visit for more articles on the meeting’s live surgery, an interview with the chairman of the local organising committee and a report from the Junior ERUS – Young Academic Urologists Meeting. Introducing the ESU-ERUS Maestro HOT Course One of the big innovations at ERUS15 was the introduction of the “Maestro” edition of the ESU-ERUS Hands-on Training in Robotic Surgery. For years, the ERUS-ESU Hands-on Training Course was offered as an introductory course, allowing novice surgeons to get used to robotic surgery through simulated exercises. The Maestro course takes training to another level, for the more experienced participant.

The first course, prepared by Mimic in collaboration with ERUS and the University of Southern California takes participants through a partial nephrectomy using augmented reality. A video of the procedure is overlaid with computer animations to help navigation and indicate the different steps. The procedure is performed and narrated by Prof. Inderbir Gill (USA), and it is paused at regular moments to allow the participant to answer questions and mimic the motions of Prof. Gill. The course finishes with a suturing exercise. Dr. Jan Schraml (Czech Republic), who acted as a tutor for the participants called the maestro course a “wonderful programme, and very clever. This is the education of the future, a perfect collaboration.” On the participants, Dr. Schraml noticed a broad range. “Each participant is different. We’ve welcomed surgeons without previous robotic experience: they like to learn how to do this kind of procedure for their personal development. Some participants are residents who are working at the patient bed, but would like to do the actual procedure.” One of the Maestro course participants at ERUS15 was Dr. Yannick Cerantola (Switzerland). Cerantola was drawn to the course not to hone his skills, but because he was interested in simulation in itself: “I’m trying to develop e-learning at my own hospital, so I’m interested in seeing the latest developments. This is an innovative way of learning, it’s very interactive, with Gill talking us along and asking questions. It really prepares you for the real thing. I think I did quite well in this particular exercise, but I should do it again to see a proficiency score.” Dr. Cerantola was also closely following ERUS’s steps in developing its standardised robotic training curriculum. “I would like to send some of my residents. It seems that the first fellows who took part are doing well afterwards at their home hospital.”

The audience was treated to a robotic partial nephrectomy, courtesy of Prof. Alex Mottrie, and a robot-assisted radical prostatectomy by Dr. Jörn Witt. Procedures were carried out at the IMQ Zorrotzaurre Clinic and the University Cruces Hospital, both in Bilbao

“Standardised learning is really the way to go as it’s a bit of a jungle right now. There have been cases of inexperienced surgeons causing complications and even deaths. Training must be validated, and follow a set curriculum.” Robotic simulation technology Mr. Todd Larson (USA) is Executive Director of Medical Education & Development at Mimic Technologies Inc. He was present at the ERUS15 hands-on training sessions and explained some of the technology and potential of the Maestro course. “The partial nephrectomy is the first course of this sort that we’ve ever done. There are three more in development. A lot of people and institutions have been pushing for procedural-based simulation. We’ve used the augmented reality approach because a completely virtual environment cannot yet be rendered realistically enough. Moving to a completely virtual environment, which would be the final goal, depends on hardware, software and design restrictions.”

ERUS16 13th Meeting of the EAU Robotic Urology Section

Robotic Live Surgery

14-16 September 2016, Milan, Italy EAU meetings and courses are accredited by the EBU in compliance with the UEMS/EACCME regulations

There are notable advantages to using the Mimic simulator equipment on which the Maestro course was given, the main one being cost: “The costs for a department or training centre to use a Mimic simulator as opposed to the DaVinci Skills Simulator ‘backpack’ or models with the actual robot are substantially lower. Not only is the unit cheaper, but it allows the centre to use every robot for actual surgery. Integrating these simulators into a curriculum can sometimes be a challenge so we help them with that.”

Prof. N’Dow, Chairman of the EAU Guidelines Office speaks passionately on the need for transparency and ethics in the establishment of guidelines for robotic urology, as well as the importance of randomised clinical trials

October/December 2015

Next year, the ERUS meeting will be held in Milan, on 1416 September. Registration opens on February 1st. More information can be found on European Urology Today


World Congress on Urological Research examines recent gains Experts, top researchers and young talents gather in Nijmegen Prof. Jack Schalken Radboud University Medical Center Nijmegen Nijmegen (NL)

jack.schalken@ Local co-organisers: Gerald Verhaegh, Egbert Oosterwijk, Radboud University Medical Center Nijmegen (NL) Nijmegen hosted the 11th World Congress on Urological Research, a joint meeting of the EAU Section of Urological Research (ESUR) and the Society for Basic Urological Research (SBUR).

detection, grading and staging of urological malignancies is now close to reality. The ‘classic’ uro-pathology still proves enormously valuable as evidenced by the research presented by Dr. Arno Van Leenders (Rotterdam, NL). He subclassified Gleason grade 4 tumours into tumours with or without so-called cribriform growth patterns, and he showed that cribriform growth is a strong prognostic marker for distant metastasis and for disease-specific death in patients with a Gleason score 7 prostate cancer. A dogma in prostate cancer management is that advanced and metastatic disease should be treated by androgen deprivation therapy that targets androgen receptor signalling. Drs. John Isaacs and Samual Denmeade (both from Baltimore, USA) have challenged this dogma. They acquired the funding of the One-in-Six Foundation to carry out a pilot clinical trial with so-called bipolar androgen therapy for

From 10 to 12 September, experts from both sides of the Atlantic presented and discussed their most recent findings and progress in their field with the Netherlands’s oldest city as backdrop of the scientific event.

Awards Annual highlights of the meeting included the presentation of the research awards. Prof. Jack Schalken (Nijmegen, NL) received the Dominique Chopin Research Award for his contributions to urological research, his mentoring and successful acquisition of research funding and contribution to the establishment of the European urology research networks. His award lecture highlighted the ‘…long and winding road for the clinical introduction of a [prostate cancer] biomarker.’

Jack Schalken (Nijmegen, NL) receiving the Dominique Chopin Research Award from outgoing ESUR chairman Zoran Culig

patients that have progressed to CRPC, i.e. alternating between administration of supra-physiological testosterone doses and castration therapy. The trial showed this therapy is safe and well tolerated; many men even preferred the testosterone treatment and in 50% of the patients a sharp PSA decline was observed. Larger trials are needed to further develop this new concept for therapy.

Recent advances in the molecular classification of urological cancers, tissue engineering, andrology, exosomes and metastasis were taken up with young researchers presenting short oral and poster presentations. The poster sessions were well attended and there were lively discussions. Young researchers appreciated the feedback from experienced colleagues and their fellows. Urological malignancies For urological cancers, a number of novel biomarkers are on the horizon as reviewed by Drs. Sven Perner (Bonn, DE) and Lars Dyrskjot (Aarhus, DK). In the keynote lecture, Dr. Klaus Pantel (Hamburg, DE) discussed recent advances in technologies to detect nucleic acids and circulating tumour cells in body fluids. Liquid biopsies for the

engineering approaches in large animal models. Translation of their findings into clinical practice will be the next challenge for this burgeoning field of research.

Tissue engineering This year the conference focused not only on research on urological malignancies. There were also sessions on andrology and urological tissue engineering. Prof. Karl-Dietrich Sievert (Salzburg, AT) discussed the current state-of-the-art of tissue engineering in urology, focussing on the possibility to use stem cells in combination with artificial templates for a variety of indications, ranging from lower urinary tract dysfunction to repair of tissues after trauma. MSc. Vicky Luna-Velez (Nijmegen, NL) receives the Association pour la Recherche sur les Tumeurs de la Prostate (ARTP) award from J. Ceraline

Several posters were presented dealing with the use of different material and describing tissue

The Association pour la Recherche sur les Tumeurs de la Prostate (ARTP) award was given to MSc. Vicky Luna-Velez (Nijmegen, NL). Vicky was awarded for her research on androgen receptor splice variants. She has unravelled a part of the mechanism which is responsible for the constitutive nuclear import of these variants. The World Congress coincided with the 50th anniversary of the Urology Department of the Radboud University Medical Center in Nijmegen. Head of Urology, Prof. Peter Mulders had invited all the participants of the World Congress to jointly celebrate the anniversary. The party, held at a local theatre, began with a percussion-led performance and followed by a buffet dinner and dancing.

Prof. Kerstin Junker, ESUR Chair

At the end of the meeting, attendees thanked Prof. Zoran Culig (Innsbruck, AT) for his dedicated work and welcomed Prof. Kerstin Junker (Homburg/ Saar, DE) as the new ESUR Chair.

ESUR16 23rd Meeting of the EAU Section of Urological Research

Featuring the Joint SIU-ICUD Consultation on Urologic Management of the Spinal Cord InjuredCongress Patient 36th of the

20-22 October 2016, Parma, Italy

36th Congress of the

Société Internationale d’Urologie d’Urologie Société Internationale Hilton Buenos Aires Hilton Buenos Aires

EAU meetings and courses are accredited by the EBU in compliance with the UEMS/EACCME regulations

October 20–23, 2016 20–23, 2016 Why You October Should Attend • SIU is a close-knit community of international urologists, all dedicated to improving urological care around the world by sharing relevant and high-quality urological education.

• Buenos Aires is known as the “Paris of South America”: it is a cosmopolitan metropolis with a truly unique Latin flavor and a style like no other. • The condensed format of SIU Congresses gives you a one-of-a-kind opportunity for more highquality interactions with leaders in urology.

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European Urology Today

October/December 2015

Telling the story of Urology through instruments European Museum of Urology unifies continent’s collections on new website The culmination of many years of development, the EAU History Office’s European Museum of Urology was launched in the summer of 2015. The online museum brings together different European collections of urological objects, from private and public collections alike. By combining relatively small and geographically diverse collections, the European Museum of Urology tells the story of urology on the continent in a way that a physical museum would not be able to. The museum features an archive with pictures of individual instruments, mementos and other objects of historical value. The “Story of Urology” is told through new research and material adapted from previous EAU History Office publications, and it is illustrated with the new photos from the Museum’s collections. (Fig. 1)

this milestone achievement.

Rather than simply displaying items from a single collection, the European Museum of Urology truly spans the continent. At the moment, it features collections from Austria, Germany, The Netherlands, Belgium, France and Finland. Future additions are expected from Central Europe. (Fig. 2) Having an online museum clearly has its advantages according to Zykan: “Aside from several national urological societies who manage their own urological collections, there are a lot of enthusiastic private collectors all over Europe. Whether they are exhibited by the society or the private collector, all those instrument collections only attract very local attention. In the age of the internet, the problem of limited dissemination can easily be solved by uniting all these collections on one platform. This platform is provided by the EAU’s European Museum of Urology.”

Fig 1: The “Story of Urology” is told based on the collection’s more notable items, in this case an antique Porges catheter measurement tool from the Erik Felderhof Collection.

Curated by Mrs. Michaela Zykan, who is based in Vienna (AT), the past three years has seen the collection grow to feature 843 items, in nine collections from five countries. Mrs. Zykan is a graduate from the University of Vienna, Austria, and has has been affiliated with the EAU History Office for the past 15 years, arranging historical exhibitions on a variety of urological topics. Michaela Zykan is also the curator of the Endoscopy Museum of the Nitze-Leiter Research Society for Endoscopy which is located at the Josephinum in Vienna. European Urology Today spoke to her about EAU History office

The Jos De Vries Collection

The Origins and goals The initial concept behind the Museum was wildly ambitious: “I wanted to establish a ‘House of Urology’, which would have been a museum shaped like the urinary tract with all its belonging organs,” Mrs. Zykan explains. “It would’ve been a highly detailed museum depicting the history of urology. At the same time, it would illustrate the topography, the functioning and malfunctioning of the urinary system in a vivid and clear way to any non-medical visitors. Clearly, creating a virtual ‘House of Urology’ is bit easier to realise, while at the same time reaching people from all across the world.”

Primarily, the museum presents a unique achievement in unifying a variety of urological museums or collections from across Europe in one digital museum. Zykan: “Another goal of course is to show the history of urology with all its main personalities and pioneers in the most comprehensive way possible. The History of urology, paired with specific instruments are the ideal foundation of this comprehensive endeavour. All historically-minded urologists are invited to contribute!” Assembling the museum The first step of adding a collection to the digital museum is travelling to the physical location of the collection and inspecting it. “How many instruments are there, in what condition are they, have they already been provided with an inventory number?” Zykan asks herself. “In some cases we have to start from scratch. The next step is to take pictures of the collection’s instruments. To guarantee a uniform way of presentation I position the instruments in a photo tent and add special lighting.”

The EAU has its own collection of urological artefacts, and a large proportion of these come from donations from individuals. In September 2015, the EAU acquired a sizeable collection of a prominent Dutch urologist, the late Associate Professor Jos de Vries.

Fig 2: The European Museum of Urology features around 850 items in its virtual collections. Visitors can categorise, browse and search for specific items.

The EAU uses museum-grade professional archiving software to manage the European Museum of Urology’s ever-expanding collections. In addition to acting as an image bank for the website, the software documents each item’s location, contact data, the origin, whether they were purchased, donated or on loan, and so forth. Future additions to the museum’s collection include the recently-acquired Jos de Vries Collection (see inset) and potential accessions from Southern and Central Europe. Highlights and desired additions At the moment, the EAU’s European Museum of Urology features many rarities, but its curator is still on the lookout for certain iconic instruments.

Fig 3: One of the highlights from the collections according to the curator is the Desormeaux Endoscope, created by Charrière, Paris in the mid-19th century. From the collection of the German Society of Urology (DGU).

De Vries was an avid collector and kept a large room in his house dedicated to his collection. It includes many dozens of urological instruments like cystoscopes, lithotripters and surgical kits. Additionally, the collection features many early prints of medical books, spanning many centuries of knowledge. Other medical rarities, artefacts and several works of art complete the Jos de Vries Collection. As part of the arrangement, the EAU has promised to preserve the collection as one whole, dedicated to Jos de Vries. The Jos De Vries collection will be digitized for inclusion in the European Museum of Urology as soon as possible, and small selections from the collection will be displayed at the EAU Central Office in Arnhem and at EAU events like the upcoming Annual EAU Congress in Munich.

“After viewing quite a number of collections I may say that almost each collection keeps one to two special ‘treasures’, which you may admire per mouse click any time on your computer: The proto- endoscope, the “light-conductor” by Philipp Bozzini, dated 1805; the first endoscope by Antoine Desoremaux of 1857 (Fig 3); surgical instruments by the famous French instrument maker Benoît Charrière from the 19th century; early blind lithotriptors from the 19th century and of course the first cystoscopes constructed by the Austrian manufacturer Josef Leiter as well as early photo-endoscopes. One of my favourite object is Gustave Trouvé’s polyscope of 1873, a little case for different endoscopic procedures. Not to forget a wonderful collection of bladder stones.” “It would be great to have ancient surgical, urological instruments included in our collection. Maybe we could also trace surgical-urological instruments dating from the times of Ambroise Paré of the 16th century and include them in our Museum.” The European Museum of History can be accessed through

6th International Congress on the

History of Urology In conjunction with EAU16 11 March 2016, Munich, Germany

Meet the pioneers of urology! Every few years, the EAU History Office prepares a full-day Congress on the History of Urology. In 2016, this meeting will be held on March 11th, in conjunction with the Annual EAU Congress in Munich. This being an International Congress, expert speakers were attracted from all across the world, including Asia, North and South America and Africa. The participation of retired EAU Secretary Generals Prof. Frans Debruyne (Honorary President and speaker) and Prof. Per-Anders Abrahamsson (moderating the session on Politics and Urology) also contribute to the Congress’s stature. Expect a full day of in-depth lectures about the very roots of urology, the important breakthroughs in

in conjunction with

October/December 2015

technique and technology, and the pioneers of the field- some of whom will be speaking on their own experiences! If you are attending EAU16, you are free to attend the 6th International Congress on the History of Urology, so get the most out of your trip to Munich!

Special rates are available for visitors who are interested in the History Congress alone. All the latest information, including the speakers and preliminary scientific programme can be found on:

Prof. F. Debruyne Honorary Congress President European Urology Today


Minimally Invasive Percutaneous (MIP) Stone Workshop ESUT joins comprehensive course in Hall, Tirol, Austria Theodoros Tokas MD, FEBU Consultant Urology Hall in Tirol General Hospital Hall (AT) Currently, percutaneous nephrolithotripsy (PCNL) is the gold standard for the removal of large renal stones (> 2 cm)1. There has been a great evolution of PCNL into new MIP techniques which offer excellent stone-free rates2-5. Miniaturising the renoscopes has led to a further reduction of intra- and postoperative morbidity6. Hence, MIP is gaining wider international acceptance. In our clinical practice, the current spectrum of MIP starts from a stone diameter of 6 mm for lower calyceal stones, and 12 mm for non-lower pole renal stones, diagnosed by using the bone window of a

Live procedures (Fig 4) Two to three cases are carefully selected to cover the whole spectrum of MIP surgery (e.g. stone size, location, complexity). The participant has the opportunity to see “how the job is done” by an experienced surgeon. Moreover, a trainee interacts with a highly qualified and coordinated team (Figure 5) composed of urologists, anaesthesiologists and scrub nurses who are capable of doing procedure at maximum speed and adequately handle possible complications, which demonstrates precision and efficacy. Laboratory training Inanimate pig models (Fig. 6) Each model consists of two layers of porcine abdominal wall (skin, subcutaneous tissue, fascia, musculature), one superior and one inferior. The porcine kidneys are placed between the two layers (sandwich model)7. The model is stabilised in a metal box with an open top which exposes the superior porcine abdominal wall. The preparation of the kidneys includes the isolation of the ureters entering the renal sinus, the introduction of small stones in the pelvi-calyceal system, and the catheterisation of the renal pelvis with a small (12Ch) balloon catheter.

Fig. 2: MIP Instrumentation

The trainee performs an ultrasound on the upper abdominal wall, identify the kidney and its anatomic landmarks, and visualise the stones. He can then make an incision and a punction using a nephrostomy needle. Methylene blue dye can be inserted through the renal catheter to verify the correct position of the punction. The trainee can then insert a metal dilator using a guide wire; insert the metal sheath and, finally, the mini-nephroscope. Using the vacuum effect8 or a Dormia-basket, the stones can then be removed. This model simulates the “real thing” at a surprisingly high level. Workshop benefits Attending this workshop provides trainees to learn everything they need to know regarding MIP in theory and practice. The trainees can also directly discuss with the experts. Finally, one gains all these benefits with minimal expense. References

non-contrast computer tomography (NCCT). These sizes correlate with stones of 8 mm and 15 mm in a normal NCCT window respectively (Figure 1). It has been proven that NCCT using the bone window is more accurate in diagnosing and estimating the size of urinary stones. The two-day intensive MIP workshop, one of the few courses in this very specific section of minimal invasive urology, was supported by the ESUT and organised by the Department of Urology and Andrology, General Hospital of Hall in Tirol (Prim. Prof. Dr. Udo Nagele is current director). The course aims to provide the theoretical background of the technique and instrumentation (Figure 2), as well as offer onsite training to interested urologists using inanimate pig models. In this way, urologists can reproduce the technique in their home countries and institutions. The project is running four to six times every year and will celebrate its 10th anniversary in 2016. A big number of urologists, from many countries and with different Fig. 3: Trainees participating in a MIP lecture levels of experience, have participated so far.



1. Türk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C EAU guidelines on urolithiasis 2011 uroweb 2011 2. Lahme S, Bichler KH, Strohmaier WL, Götz T (2001) Minimally invasive PCNL in patients with renal pelvic and calyceal stones. Eur Urol 40(6):619–624 3. Nagele U, Schilling D, Anastasiadis AG, Walcher U, Sievert KD, Merseburger AS, Kuczyk M, Stenzl A (2008) Minimally invasive percutaneous nephrolitholapaxy (MIP). Der Urologe Aus A 47(9):1066, 1068–1073. 4. Nagele U, Horstmann M, Sievert KD, Kuczyk MA, Walcher U, Hennenlotter J, Stenzl A, Anastasiadis AG (2007) A newly designed amplatz sheath decreases intrapelvic irrigation pressure during mini-percutaneous

Fig. 1: Renal stone treatment algorithm in Hall General Hospital

Prim. Prof. Dr. Udo Nagele, Co-author



nephrolitholapaxy: an in vitro pressuremeasurement and microscopic study. J Endourol Endourol Soc 21(9): 1113–1116. Nagele U, Schilling D, Sievert KD, Stenzl A, Kuczyk M (2008) Management of lower-pole stones of 0.8 to 1.5 cm maximal diameter by the minimally invasive percutaneous approach. J Endourol Endourol Soc 22(9):1851–1853; (discussion 1857). Desai MR, Sharma R, Mishra S, Sabnis RB, Stief C, Bader M (2011) Single-step percutaneous nephrolithotomy (microperc): the initial clinical report. J Urol 186(1): 140–145. Jutzi S, Imkamp F, Kuczyk MA, Walcher U, Nagele U, Herrmann TR. New ex vivo organ model for percutaneous renal surgery using a laparoendoscopic training box: the sandwich model. World J Urol. 2014 Jun;32(3):783-9. Nicklas AP, Schilling D, Bader MJ, Herrmann TR, Nagele U; Training and Research in Urological Surgery and Technology (T.R.U.S.T.) Group. The vacuum cleaner effect in minimally invasive percutaneous nephrolitholapaxy. World J Urol. 2015 Nov;33(11):1847-53.

Fig. 4: Professor Udo Nagele performing a live MIP procedure

Lectures (Figure 3) The trainee can gain knowledge by interactively participating in lectures held by experts. The various subjects include indications, mechanisms, OR setting, instrumentation, controlling irrigation flow pressure, different techniques, tips and tricks. The participant can share his knowledge and experience with the presenters, making the sessions highly interactive and productive. Interactive sessions The participants also have the opportunity to discuss with the speakers and exchange opinions and ideas regarding MIP. Moreover, they can get first-hand information from representatives of various companies regarding how to deal with problems of MIP distribution to different countries. Furthermore, everyone has the chance to relax and enjoy Tirol. 38

European Urology Today

Fig. 5: Teamwork between surgeon and scrub nurse

Fig. 6: Trainee performing a renal punction in an inanimate (sandwich) model with sonographic guidance

October/December 2015

EAUN at SIU Conference Informative, inspiring meeting in Melbourne, Australia Lawrence DrudgeCoates Urological Oncology Clinical Nurse Specialist Chair EAUN London (UK) l.drudge-coates@

As part of the organising committee, it was a pleasure to attend and support this inaugural nurses meeting at the Societé International d’Urologie (SIU) in Melbourne.

hormone therapy in metastatic castrate resistant prostate cancer (mCRPC), from biological treatment principles, changing treatment modalities, practical day-to-day considerations when looking at treatment options, and the importance of survival alongside health related quality of life. In addition Prof. Klotz addressed the area of the androgen receptor gene and how various molecular mechanisms played a role in the development of resistance to androgen deprivation therapy in mCRPC, including AR mutations, amplifications and splice variants. A topic common to all urology nurses working in bladder cancer was discussed by Kath Schubach – chair VUNS, that being the shortage of BCG therapy for patients with newly diagnosed High-Risk Non-Muscle Invasive Bladder Cancer (HR NMIBC) and those who are already undergoing BCG treatment. General recommendations included: that all patients with HR NMIBC be counselled appropriately and reassured that their care would not be substantially compromised and in general terms: • management of HR NMIBC with TURBT and cystoscopic surveillance alone is not appropriate, even if local BCG supplies have run out and patients should always be offered an alternative

The meeting, supported by the Victorian Urological Nurses Society (VUNS), the Australia and New Zealand • patients should not be counselled that radical Urological Nurses Society (ANZUNS) and the EAUN, cystectomy (RC) is the only safe option in this provided the SIU the very first opportunity to involve setting. urology nurses in their programme, an idea supported by SIU Congress Director Valérie Guillet. The objective of the nurses programme was to “snap shot” a number of topics in urological care with a global perspective, with many of the sessions offering a multi-professional perspective involving urologists and urology nurses.

For our mid-programme break, we had high tea supported by Bard which gave a great opportunity for networking and to catch up with old colleagues and, of course, the obligatory photo opportunity.

Professor Laurence Klotz – discussing AR gene variants

• as should already be the case, all patients with HR NMIBC should be discussed at the bladder MDT meeting. In addition, further guidance suggesting where possible, patients should be offered 1/3 dose BCG for induction courses and maintenance up to one year. This is based on an EORTC randomised trial, which showed no difference in progression rates between full dose and 1/3 dose BCG. In the area of Catheter Acquired Urinary Tract Infection (CAUTI), Trish White, nurse practitioner from New Zealand, discussed the management of urinary catheters and provided a key insight in urinary tract infections, which account for 40% of all hospitalacquired infections, with 80% being catheter related. Trish highlighted the fact that urinary catheterisation when hospitalised and insertion could be unjustified in up to 50% of cases. Of note, as was clear to the audience, was the risk of CAUTI increased with the duration of catheterisation, with evidence suggesting that 26% of patients with an urinary catheter in-situ for between 2 to 10 days will develop bacteriuria, with 25% of these patients developing a CAUTI. Other risk factors to consider also included catheter care violations and older age. The key take home messages from this session were that there are many opportunities for nurses to reduce the incidence of CAUTI by applying best practice to the insertion, maintenance and removal of catheters. Urology nurses are in an ideal position to bring about the changes required and that CAUTI prevention is a quality and safety initiative.

In the opening presentation, the author and co-speaker Prof. Laurence Klotz outlined the role of European Association of Urology Nurses

toxin injections to treat urge incontinence and overactive bladder syndrome.

Welcoming address – Kay Talbot: Chair

Organizing committee – From left : Kath Schubach : VUNS Chair, Kay Talbot –SIU Nurses Meeting Chair, Lawrence Drudge-Coates: EAUN Chair

The highlight of the day for me was a very thought provoking and quite humbling talk regarding volunteer teaching in developing counties and career opportunities. Kate Newell, senior project officer from the Royal Australasian College of Surgeons (RACS) gave an initial overview of the Colleges Pacific Island Programme, which provides specialist surgical and medical services, education and training to local surgeons, anaesthetists, nurses and allied health workers in 11 Pacific countries. Chris Redpath and Stu Wilder, two Australian urology nurses involved in volunteer work in the South Pacific islands, and also in Pakistan during the earthquakes, shared their experience of what it was like to work as a volunteer and nurse educators, which was truly fascinating. It gave me a real insight into what we take for granted regarding access to health care in the western world, and what people have to endure. I had the utmost respect for their work and their ‘can-do’ attitude. Being a “jack-of-all-trades” and making the best of what you have in these far-flung and remote places is so essential.

Fellowship Programme European Association of Urology Nurses What you need to be an aid worker

In the management of female urinary continence, Chris Murray, nurse consultant (Australia) and Dr. Eva Fong (New Zealand) provided a key insight from assessment to treatment including sling procedures, sacral nerve stimulation and the use of Botulinum

Apply for your EAUN membership online!

Visit a hospital abroad! 1 or 2 weeks - expenses paid

Would you like to receive all the benefits of EAUN membership, but have no time for tedious paperwork?

Application deadline: 31 January 2016 • Only EAUN members can apply, limited places available • Host hospitals in Belgium, Denmark, the Netherlands, Sweden, Switzerland and the United Kingdom • A great way of widening your horizon For Fellowship application forms, rules and regulations and information on which specialities the hosting hospitals can offer please visit the EAUN website. T +31 (0)26 389 0680 F +31 (0)26 389 0674

October/December 2015

I look forward to SIU 2016.

Becoming a member is now fast and easy!

Trish White’s rules for catheter insertion

I would like to take this opportunity to thank personally the following for making this event and my participation possible: SIU congress director Valérie Guillet, Lynda Rigby and Michelle Commane (Astellas Australia), Maryanne Sinon (ANZUNS president), my delightful co-chairs, Kath Schubach and Kay Talbot and, lastly but by no means least, my nursing colleagues from Australia and New Zealand for making me feel so welcome.

Go to and click EAUN membership to apply online. It will only take you a couple of minutes to submit your application, the rest - is for you to enjoy! European Association of Urology Nurses

European Association of Urology European Nurses Association of Urology European Urology Today 39 Nurses

EAUN participates in Dubai conference EAUN guidelines on catheterisation examined in well-attended workshop Stefano Terzoni, Rn EAUN Chair Elect Chair EAUN Scientific Committee Milan (IT)

to ensuring quality and safety in urinary catheterisation. The workshop examined the use of guidelines in everyday nursing practice such as evidence-based indications and contraindications for catheterisation, how to choose the appropriate catheter and technique, frequent and rare complications, and troubleshooting. The delegates actively discussed their habits and procedures with the panel, using both clinical expertise and scientific evidence, through wellfocused questions on specific conditions and rare cases, as well as the “tips and tricks” for this frequently overlooked procedure. The guidelines and the most up-to-date literature provided solid foundations for evidence-based practice.

The Emirates International Urological Conference (EUSC) took place in Dubai, United Arab Emirates, from 5 to 7 November 2015. The EAUN had been invited by Dr. Fariborz Bagheri, Acting President of the Emirates Urological Society (EUS) and President of EUSC2015, to give a full-day hands-on workshop on In the afternoon, four stations with models for intermittent and indwelling catheterisation, based on catheterisation were prepared, and the participants the EAUN guidelines. performed the procedure on realistic male and female mannequins, with different types of indwelling and On November 6, Susanne Vahr (chair of the guidelines intermittent catheters, under the guidance of the group), Veronika Geng (former chair of the guidelines teachers. group) and the author held a very successful workshop in Dubai, attended by approximately 60 nurses. Forty-eight had originally enroled, but on the day of the workshop 12 more asked to participate and were admitted to the workshop.

Award in appreciation of the EAUN contribution received at the Opening Ceremony

to continue the collaboration with the Emirates Urological Society in the future. It will be our pleasure to welcome the participants of the workshop in Dubai in Munich 2016 See you in Germany! Note: The hands-on training was supported with equipment from Coloplast, Wellspect HealthCare and Dubai Hospital. Wellspect HealthCare DENTSPLY IH sponsored the iPad that was awarded to the nurse who scored highest in the test.

The level of knowledge and practical ability reached by the participants was assessed through a written test and observation during the practical session. At the end of the day, the delegate who scored the highest marks was awarded with an iPad donated by one of the sponsors. The EAUN representatives were formally acknowledged during the opening ceremony of the congress, in the presence of members of the Dubai Government, as well as individual acknowledgements by Dr. Bagheri. This exciting experience has been very important and significant to the EAUN, and we hope

Dr. Fariborz Bagheri opened the workshop and Fouad Hussein Chehab, director of Nursing at Dubai Hospital gave the first lecture. He is an expert in the Joint Commission International Accreditation and made an excellent introduction

European Association of Urology Nurses

EAUN Board

Ms. Veronika Geng, author, and Ms. Susanne Vahr with the EUS award

Chair Chair Elect Past Chair Board member Board member Board member Board member Board member Board member

Lawrence DrudgeCoates (UK) Stefano Terzoni (IT) Kate Fitzpatrick (IE) Paula Allchorne (UK) Simon Borg (MT) Erica Grainger (DK) Corinne Tillier (NL) Susanne Vahr (DK) Giulia Villa (IT)

Munich, Germany 12-14 March 2016 Register now for the early bird fee! Deadline: 15 January 2016 • One, two and three-day registration fees • Register for the Nurses’ dinner, Hospital visits and Urowalk through the online registration system The workshop included hands-on training on mannequins

in conjunction with

Early registration deadline: 15 January 2016

12-14 March 2016, Munich, Germany


Lawrence Drudge-Coates, Chairman EAUN

Saturday, 12 March

09.15 - 10.30

09.00 - 10.15

10.45 - 11.45

10.30 - 12.30

10.30 - 11.15

11.30 - 12.30 12.45 - 13.45 12.45 - 13.45

14.00 - 15.45 14.00 - 16.00 16.00 - 17.00 16.15 - 17.00 17.15 - 18.15

Plenary session Revisiting the future of urological nursing Thematic session Challenges with teenagers in transition to adulthood Thematic session Tobacco and cancer: Is there something we still don’t know? Special session Nursing Research Competition Hot Topic lecture Nurse-led cystoscopy and urodynamics for nurses EAUN Industry session e-Learning in healthcare – does it make any difference? Poster session 1 Thematic session Perspectives in prostate cancer care Thematic session Sexuality and cancer Special session Guidelines presentation: Male External Catheters EAUN Industry session

09.00 - 10.30

Thematic session Evidence informed practice: Present and future Thematic session Neoadjuvant treatments for bladder cancer

in conjunction with


European Urology Today

10.45 - 12.30 12.00 - 14.30

12.30 - 13.15 13.45 - 14.30 14.45 - 15.30 15.45 - 16.45 15.45 - 17.10 17.00 - 18.00

Monday, 14 March 09.00 - 10.00 09.00 - 10.00

Sunday, 13 March 08.30 - 09.00

Thematic session Session in cooperation with other association Thematic session Self-care and quality of life in the urostomy patient Poster session 2 EAUN ESU Course 1 Instillations in NMIBC: Indications and practical aspects Special session Nursing solutions in difficult cases State-of-the-art lecture Ethics in urology State-of-the-art lecture Female genital mutilation Thematic session Rare cases and diseases in urology Special session Market place session Video session Nursing in motion


10.15 - 10.45 10.15 - 12.30

Special session Primary care challenges in urology Thematic session Enhanced recovery after surgery - international perspectives State-of-the-art lecture Probiotics in urology care EAUN ESU Course 2 Urinary stones: From start to finish

10.45 - 11.30 11.45 - 12.45 12.45 - 13.15 13.15 - 14.00 14.00 - 14.15

Stefano Terzoni, Chairman SCO

Debate MDT in urology:. Good in theory, bad in practice? Thematic session Painful bladder syndrome: Where do we stand? Special session Launch of patient information on bladder cancer General Assembly Award session Prizes sponsored by AMGEN & WELLSPECT HEALTHCARE

Hospital visits LMU University Hospital Munich Friday, 11 March, 13.00 - 16.00 hrs Monday, 14 March, 10.00 - 12.00 hrs Registration through the online registration system. Scientific Committee: Stefano Terzoni (IT), Chair Bente Thoft Jensen (DK) Jerome Marley (IE) Lisette Van De Bilt (NL) Rita Willener (CH)

For detailed information and updates of the Scientific Programme, visit the EAUN’s meeting website at: October/December 2015

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