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specialities and beyond the traditional classroom training. We are already seeing the crucial role of digital-based learning programmes which offer distinct advantages in a region as far-reaching and diverse as Europe. New training systems need to be continually developed, updated or be made responsive to the technologies of today or in the future. This is a constant challenge for educators and mentors and in surgery, skills refinement and training certainly have a crucial role in reducing morbidity and complication rates.

European Urology Today Dr. Ben Van Cleynenbreugel, ESU Board Member

later (until 2014 ) I coordinated the training. The initial six laparoscopic training stations were gradually expanded to 15, and seven more endoscopic training stations were eventually added, three for TUR, and four stations for URS. Q: What are your goals for the European School of Urology?

Van Cleynenbreugel: With my work in the ESU’s minimally invasive training curriculum, we eventually developed the e-BLUS programme in collaboration with the EAU Section of Uro-Technology (ESUT). This programme was also the basis or constituted the core of the “training in urology group” developed in

Nijmegen, The Netherlands. The e-BLUS programme and exams, which systematically assess the laparoscopic skills of trainee surgeons, are now being offered and introduced in several countries.

Based on the success of this programme, we created the “ESU Training & Research Group” where I serve as chairman. In collaboration with the EAU Section on Urolithiasis (EULIS) and ESUT we are developing a training curriculum for endoscopy and laparoscopy. Q: What is your role in the ESU board?

Van Cleynenbreugel: Within the ESU Board I focus on hands-on training programmes, aside from the

Q: In a high-pressure career as a specialised surgeon and educator, how do you find time for family and recreational activities?

Van Cleynenbreugel: One needs to set aside quality time for family, not only out of responsibility but also to find the necessary energy for one’s work. One needs to re-charge every now and then after a week or days of constant work. I am happily married and the proud father of a six-year-old girl. In my free time I enjoy my motor bike and recreative shooting.

Official newsletter of the European Association of Urology

Vol. 28 No.1 - January/February 2016

ESU Courses and HOTs in Munich

Advances in laparoscopy

Pursuing training goals East Africa

Complete overview on page 18

For urological indications – Part 3

11th Jacob Lester Eshleman Workshop

18 omprehensive ESU programme in Munich



Prof. Magnus Grabe

EAU16: Anticipating future challenges

ESU Courses

Adrenals • Advanced course on upper tract laparoscopy (UPJ, adrenal and stones) • Adrenalectomy

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

• 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

Scientific Programme balances relevant core issues with new developments in urology

Andrology • Office management of male sexual dysfunction • The infertile couple - Urological aspects Female urology • Prolapse management and female pelvic floor problems • Advanced vaginal reconstruction

By Joel Vega

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

Reflecting emerging trends, onco-urology issues such as prostate, kidney and bladder malignancies will be Fulfilling its core goals, the 31st Annual EAU Congress examined. Focusing on themes such as Guidelines Male LUTS 16) from 11 to 15 March in Munich, Germany, implementation, evidence-based medicine, diseases • Management of BPO:(EAU From medical to surgical treatment Traumaof the world’s biggest urological • Post-surgical urinarywill incontinence in males to one of the elderly, and urothelial cancer, plenary and bring • Urinary tract and genital trauma Neurogenic and non-neurogenic voiding Unclassified and miscellaneous topics dysfunction events the best of clinical practices, scientific research thematic sessions will address the dilemmas and • A tool-kit for practising evidence based urology • Chronic pelvic pain in men and women • An introduction to social media: Why this is • General neuro-urology breakthrough developments in international challenges encountered in daily clinical practice. important for urologists • Lower urinary tract and dysfunction and • Evaluation of risk in comorbidity in uro oncology urodynamics • How to proceed with an hematuria • Video Urodynamics urology. The special Late Breaking News segment in Plenary • How to write a manuscript and get it published in European Urology Paediatric urology • Surgical anatomy • Paediatric urology for the adult urologist: A Session 1 will highlight the most recent developments • Ultrasound in urology practical update • Laparoscopy for beginners “Every year we not only a comprehensive in prostate cancer. Congress participants will get the • organise Update renal, bladder and prostate Guidelines Penis/testis 2016, What is changed? • Testicular cancer Basic surgical and endo urological skills • Penile diseases ESU Social media training programme of •scientific topics with international, latest updates on key developments that have taken expert lecturers as resource speakers but also aim toJanuary/February place in the last four months. 2016 identify what are the controversial issues, what is the new exciting work balanced with the most actual Challenges ahead developments in clinical practice,” said Prof. Arnulf “Another important feature will be the Souvenir Stenzl (DE), Chair of Scientific Congress Office (SCO). Session during Plenary Session 4 on Tuesday which The SCO is tasked to organise a complex agenda of four will provide an incisive overview of the challenges Plenary Sessions, 19 Thematic Sessions and around 91 ahead and future directions in the next three years. Poster sessions which present 1,189 abstracts. The various topics range from uro-oncology, transplantation, andrology to paediatric and functional urology,” he said. Aside from the Plenary and Thematic Sessions, participants can look forward to a dynamic meeting of Complementing the compact programme are the various urological specialists from around the world, specialised meetings of the EAU Section Office with representing 12 international and regional groups, eight meetings organised by the various Section during the Urology Beyond Europe sessions to be Offices, ranging from paediatric, reconstructive, held on the opening day, 11 March. Running concurrently on the same day is the 6th International transplant to andrology, to name a few. A main highlight of the section meetings is the seven-hour Live Congress on the History of Urology which highlights Surgery Sessions jointly organised by the EAU Section not only pioneering landmarks but also presents insights on how early discoveries continue to shape of Uro-Technology (ESUT), EAU Robotic Urology Section (ERUS) and the EAU Section of Urolithiasis (EULIS). and impact contemporary urology. Infections • Dealing with the challenge of infection in urology Kidney transplantation • Renal transplantation: Technical aspects, diagnosis and management of early and late urological complications

Stones • Percutaneous nephrolithotripsy (PCNL) • Update on stone disease • Flexible ureterorenoscopy and retrograde intrarenal surgery: Instrumentation, technique, tips and tricks, indications

ESU Hands-on Training Courses

Laparoscopy • E-BLUS • Basic laparoscopic training • Suturing and knotting (Anastomosis) Robot • Introduction to robotic surgery Diagnostics and follow-up • Urodynamics • Fluorescence imaging • MRI Fusion biopsy Functional urology • Women's health SUI • OnabotulinumtoxinA administration for OAB • Sacral neuromodulation Endoscopy Lower • TUR (b/p) • Enucleation techniques • Laser vaporisation • HoLEP Upper • URS semirigid and flexible

A new feature are the topic-oriented “Semi-Live” video sessions on surgical procedures on Day 4, Monday, with a thorough assessment by invited experts. The segment will feature minimally invasive “organ-sparing” procedures. Four Special Sessions will also be held on Saturday, 12 March, with the EAU Research Foundation, History Office, the Young Urologists Office and the annual General Assembly.

carefully select the meetings and focus on what is most useful to their interests and needs.”

Stenzl: “All together, the overarching goal is to provide practical and useful insights by critically looking into current procedures and the efficacy of treatment regimens, both medical and surgical. In a span of almost five days, the range of issues up for discussion is extensive, requiring participants to

“If we can provide insights, knowledge and share the necessary skills with congress participants, and make them fully aware of the challenges ahead and how best to anticipate and resolve potential issues in daily practice, then we can say we have again accomplished our aims,” added Stenzl.

Aside from taking into account the demands and needs of modern medicine and contemporary urology, Stenzl noted that insights and knowledge to be gained by congress participants from the annual event will prepare them for future developments.

Re-evaluating and restructuring our Assocation Changes in the EAU structure to reflect new policies for the future Prof. Chris Chapple EAU Secretary General Sheffield (UK)

Following on from a brainstorming session held over a year ago, the Executive has set in motion a number of changes which are aimed to provide the best service to members and, consequently, to our patients. This article reviews the changes that we have made, which reflect our altered policies relating to our activities.

C.R.Chapple@ sheffield.ac.uk

The Strategy Planning Office has been extremely successfully run by Prof. Didier Jacqmin and his colleagues, Drs. S. Buntrock, H. Hashim, and Prof. B. Malavaud and Ass. Prof. C. Surcel). The subject D. Jacqmin of strategy planning is inextricably linked with other EAU activities and with this in mind, and after extensive discussion, we do not feel that a separate office dealing with this is the most effective way of progressing our aims. This will give the opportunity for more EAU members, involved in the various offices, to directly contribute to our strategy planning activities via the EAU Board and Executive, and the discussions we hold there and, subsequently, at the board meetings of the various offices.

Dear Colleagues, May I take this opportunity of wishing everyone all the very best for the forthcoming New Year on behalf of my colleagues at the Executive and the Board of the European Association of Urology (EAU). As you know, the EAU is going from strength to strength, thanks to all of the hard work and support of the membership. In particular I would like to thank the members of all of the various offices for all that they have done and are continuing to do. I would strongly encourage members to review our website to access the benefits that are available to them and to get more involved in EAU activities. Those that are already involved will then inevitably, based on their level and degree of involvement, be in a strong position to become more involved in our activities.

D. Schultheiss

Gains and strategies Prof. Dirk Schultheiss has led another office which has made an enormous contribution to the EAU, namely the History Office. As the membership will know, this has been an extremely productive office, which over the last


Launched at EAU16- Dr. Johan Mattelaer's Forbidden Fruits: Sex, Eroticism, Art

Continued on page 2


The International Relations Office will also cease to exist. I was involved in chairing this office before my appointment to the Executive 18 months ago, succeeding Prof. Jacqmin. Clearly, international relations are also inextricably linked with the EAU’s strategic activities. In this context, the Executive and Board will be taking a more active role in discussing this with advice from a number of EAU members who will be co-opted on to an advisory board. I would also like to acknowledge the enormous work and support that has been provided by other members of the association who are now finishing their term as chairmen of offices. Prof. Luis MartinezPineiro has made an enormous contribution as

January/February 2016

Chairman of the Section Office and without doubt will continue to advise the association in the future. Prof. Martinez-Pineiro has a number of other key roles which he wants to devote more time to, and I would like to formally acknowledge his hard L. Martinezwork and contributions. Prior to Pineiro leading the Section Office, he had a pivotal role in establishing the Residents Office when he served as chairman.

For EAU members only: Abstracts available as of 11 February European Urology Today


Continued from page 1

years has produced a number of superb documents. Following the initial publication of De Historia Urologia Europaeae there have been a number of monographs that have been produced by the office, including the latest monograph which will be released at the Annual EAU Congress in Munich. This office has been very important in cataloguing and promoting the historical basis for urology within Europe. Dr. Schultheiss has served for 12 years and will continue to have an active role in the History Office. We are committed to supporting the highest standard of clinical and research practice in urology and are committed to increasing and strengthening our links with national associations in Europe and worldwide. A major emphasis of our activities is within continental Europe. The Regional Office was founded many years ago by Prof. Michael Marberger, and his successor Prof. Bob Djavan as Chairman of this office has done an excellent job in further developing those activities with the established regional boards. The activities of the Regional Office, as set out nearly two decades ago, have proved to be very successful and we want to further develop these activities in direct association with the regional national societies. There is clearly no single model which fits all needs. The situation as it existed 15 years ago, is clearly not the situation either politically, economically or academically, as today. With this in mind, the Regional Office (RO) activities will be restructured. Prof. Djavan has done an excellent job and will support this process. The RO, with its current structure will be dissolved in Munich. I and the Executive members will seek advice B. Djavan and guidance from the various national societies involved as to how we can work more closely and effectively with their organisations.

European Urology Today 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 EUT@uroweb.org

Whilst the RO meetings have proved to be very successful, the penetration they have to all of the members of the societies, particularly junior members, tends to be limited by the regional location of the meeting, and in the current structure significant costs are incurred. There are suggestions to offer specific schemes that are tailored to a cluster of countries to provide the same level of commitment that the EAU has done in the past, and the existing annual regional meetings (CEM and SEEM) may serve a role in further developing these ideas. We are aiming, by using the same resources, to try to increase the penetration of the EAU activities to the members of the societies without in any way acting to the detriment of our ongoing activities or to reduce our commitment to support urological societies within Europe. I would urge members of the Executives of these associations to provide feedback to me with regards the way they feel matters should develop. I look forward to discussing this with them at the Regional Office Executive board meetings in Munich and at the National Societies Meeting in Noordwijk. In relation to our European and international activities, we are also strengthening our involvement at the European Commission level with a number of initiatives underway in Brussels, and relating to both oncological and non-oncological practices, legislative issues, and development of research and practice development proposals. If you have any comments or suggestions relating to this, I would be most grateful if you could either contact me or Michelle Battye (m.battye@uroweb.org) of the EAU Office.

J. Rassweiler

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.

P. Van Kerrebroeck

I welcome our new chairmen, namely Prof. Jens Rassweiler who is the new chair of the Section Office and Prof. Phillip Van Kerrebroeck who will lead the History Office. It is their strong commitment and all of the other members which make our association what it is today. I acknowledge the hard work and support that has been provided to the activities of the Strategy Planning Office by Prof. Didier Jacqmin, the History Office by Prof. Dirk Schultheiss, the Section Office by Prof. Luis Martinez-Pineiro, and the Regional Office by Prof. Bob Djavan who will be leaving their positions as chairs in Munich.

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I very much look forward to meeting up with you, along with my colleagues on the Executive and Board in Munich. I know we can count on your strong support for future EAU activities. With best wishes and kind regards, Chris


European Urology Today

January/February 2016

Update from the Guidelines Office EAU16 Munich Next month will see the publication of the full text and pocket versions of the 2016 European Association of Urology Guidelines. As always, the Guidelines will be available to collect - free for EAU full members - from the Congress Booth at EAU16, Munich (F40) and they can also be ordered online at https://www. uroweb.org/publications/eau-guidelines/.

guidelines@uroweb. org www.uroweb.org #eauguidelines

European Assoc iat ion of Urology

EAU PO Box 30016 6803 AA Arnhem The Netherlands T +31 (0)26 389 0680 F +31 (0)26 389 0674

European Association of Urology


2016 edition

Richard Sylvester EAU Guidelines Office Board

concluded that a single immediate instillation of chemotherapy reduced the relative risk of recurrence after TURBT by 39%, odds ratio = 0.61, p < 0.0001. The number of patients needed to treat to prevent one recurrence was 8.52. In their guidelines, the American Urological Association also supported the use of an immediate postoperative instillation in patients with small volume, low grade pTa tumors3.


After the original publication of these guidelines, several additional RCTs assessing the efficacy of an immediate instillation were carried out, some of which questioned its efficacy, especially in intermediate risk patients4. One review even called for an immediate instillation to be abandoned5.

2016 edition

In order to take into account these additional RCTs, two new literature based meta-analyses were undertaken, however they could not adequately answer the question of which patients benefited from The Guidelines Office (GO) is pleased to announce that an immediate instillation of chemotherapy after it will facilitate two European School of Urology TURBT6-7. courses at EAU16. The first course “What’s new in the 2016 EAU Guidelines”, Saturday 12th 12.00-15.00, will Because of the uncertainty concerning which patients focus on the major changes in the recommendations benefit from the instillation, an immediate instillation and text of the EAU Guidelines in the three major of chemotherapy after TURBT is not universally used oncological topics of renal, bladder and prostate in day to day clinical practice. cancer. A bird’s eye overview of changes and their relevance for clinical practice will be the main topic The main limitation of all of these meta-analyses was giving attendees a quick insight into how the different that they were not based on individual patient data. fields are progressing. Thus time to recurrence, prognostic factor and subgroup analyses could not be carried out and it was not possible to accurately identify which patients The second course “A Tool-Kit for Practicing Evidence benefited from the instillation. Based Urology”, Monday 14th 12.00-15.00, will focus on the fundamental concepts of evidence-based In order to finally answer the ongoing question of medicine. The primary focus of the EAU GO is to strengthen the methodological quality of the evidence which patients benefit from a single immediate instillation of chemotherapy, a new systematic review base underpinning EAU Guideline recommendations. During the past several years, the EAU Guideline Office and meta-analysis using individual patient data has has emphasised the use of Systematic Reviews (SR) as been carried out8. a transparent high-quality method to improve the RCTs which compared TURBT alone to a single quality of the conclusions and recommendations that immediate instillation of chemotherapy after TURBT in are provided. The aim of this course is to offer attendees a comprehensive overview of EAU Guideline patients with single or multiple, primary or recurrent stage pTaT1 urothelial carcinoma of the bladder were Methodology focusing on the practical application of eligible. However, trials which allowed additional research questions, using the PICO approach treatment prior to the first recurrence were not (Population, Intervention, Comparison, Outcome) in included. Time to first recurrence was the primary the design of and the development of SRs. endpoint while time to progression and the duration of both overall and bladder cancer specific survival In addition to the two exciting ESU courses the GO, were secondary endpoints. will for the first time, have a presence at the EAU16 exhibition. We would encourage everybody to please Thirteen RCTs published between 1985 and 2011 were stop by the Guidelines Office booth and meet our eligible for inclusion. Individual patient data were dedicated staff, who will be more than happy to obtained for all 2278 eligible patients entered in 11 of answer any questions you may have regarding the many activities of the GO. We would especially like to these studies. 1161 patients were randomized to promote the Guidelines Office Associates’ Programme. TURBT alone and 1117 to a single instillation after TURBT. Epirubicin was used in 5 studies, mitomycin C During the course of EAU16 a number of our very talented Guidelines Associates will be available at the in 4, pirarubicin in 1 and thiotepa in 1 study. GO booth to discuss the programme from their 1128 (49.5%) of 2278 patients recurred: 475 (42.5%) personal perspectives and answer all questions allocated to a single instillation and 653 (56.2%) to members may have regarding it. TURBT alone. As expected, the difference between treatments for the time to first recurrence was For the full programme of Guidelines Office coordinated events at EAU16, please see the GO booth schedule, which will be available to collect at the GO booth and displayed on screen at the Congress Booth. Highlight Session: EAU16 Guidelines Which patients with stage pTa-pT1 urothelial carcinoma of the bladder benefit from a single immediate instillation of chemotherapy after transurethral urethral resection? The EAU Non-muscle Invasive Bladder Cancer (NMIBC) Guidelines recommend a single immediate instillation of chemotherapy after complete transurethral resection (TURBT) in all low and intermediate risk pTa-pT1 patients1. The basis for this recommendation is a literature based meta-analysis of 7 randomized controlled trials (RCTs) comparing a single immediate postoperative instillation of chemotherapy to TURBT alone. This meta-analysis, which included 1476 patients from these 7 studies, Guidelines Office

January/February 2016

statistically significant in favor of an immediate instillation, with a reduction of 35% in the relative risk of recurrence: HR = 0.65, 95% CI: 0.58 – 0.74, p < 0.001. The five year recurrence rates were 44.8% (95% CI: 41.6% – 48.0%) on a single instillation and 58.8% (95% CI: 55.7% – 61.9%) on TURBT alone. The number of patients needed to treat to prevent 1 recurrence within 5 years was 7 eligible patients. There was no beneficial effect of an immediate instillation on the time to progression or on the duration of either overall or bladder cancer specific survival. However contrary to the previous literature based meta-analyses, we were now able to precisely identify which patients benefited and which patients did not benefit from the immediate instillation. The results are summarized in the accompanying Forest plot. An immediate instillation did not reduce the risk of recurrence in patients with a prior recurrence rate of more than one recurrence per year or in patients with an EORTC recurrence risk score of 5 or more. If you want to know more details and what the impact of this meta-analysis is on the 2016 EAU NMIBC guidelines, then come to the EAU Guidelines Point-Counterpoint Session at 9:05 AM on the morning of Tuesday, 15 March, in Plenary Session 4 (Urothelial Carcinoma) of the 2016 31st Annual EAU Congress in Munich where the following question will be debated: Single instillation of chemotherapy post TURBT: statistically significant and also clinically significant? We will be looking forward to seeing you in Munich.

EAU16: Anticipating future challenges. . . . . . . 1


Re-evaluating and restructuring our Assocation. . . . . . . . . . . . . . . . . . . . . . . . 1

1. Babjuk M, et al. EAU Guidelines on Non–Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2013. Eur Urol 2013; 64: 639. 2. Sylvester R, et al. A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: a meta-analysis of published results of randomized clinical trials. J Urol 2004; 171: 2186. 3. Hall MC, et al. Guideline for the management of non-muscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol 2007; 178: 2314. 4. Gudjonsson S, et al. Should all patients with non-muscle invasive bladder cancer receive early intravesical chemotherapy after transurethral resection? The results of a prospective randomized multicentre study. Eur Urol 2009; 55: 773. 5. Holmang S. Early single-instillation chemotherapy has no real benefit and should be abandoned in non-muscle invasive bladder cancer. Eur Urol Suppl 2009; 8: 458. 6. Abern MR, et al. Perioperative Intravesical Chemotherapy in Non–Muscle-Invasive Bladder Cancer: A Systematic Review and Meta-Analysis. JNCCN 2013; 11: 477. 7. Perlis N, et al. Immediate Post–Transurethral Resection of Bladder Tumor Intravesical Chemotherapy Prevents Non–Muscle-invasive Bladder Cancer Recurrences: An Updated Meta-analysis on 2548 Patients and Quality-ofEvidence Review. Eur Urol 2013; 64: 421. 8. Sylvester RJ, et al. Systematic review and individual patient data meta-analysis of randomized trials comparing a single immediate instillation of chemotherapy after transurethral resection with transurethral resection alone in patients with stage pTa-pT1 urothelial carcinoma of the bladder: which patients benefit from the instillation? Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2015.05.050

Update from the Guidelines Office . . . . . . . . . 3 In Munich: A Preview of Urology Beyond Europe. . . . . . . . . . . . . . . . . . . . . . 6-7 ESOU16: A look at the future of uro-oncology. . . . . . . . . . . . . . . . . . . . . . . . . 7 Residency Training Programme in Urology (RTPU). . . . . . . . . . . . . . . . . . . . . . 8 Reconstructive and functional urology . . . . . . 8 Clinical challenge. . . . . . . . . . . . . . . . . . . . . . 9 Key articles from international medical journals. . . . . . . . . . . . . . . . . . . . 10-13 Role of Hungarian urology in Europe. . . . . . 14 Benefits of en-bloc membership for young doctors. . . . . . . . . . . . . . . . . . . . . 15 ESU section: Masterclass on Female and functional reconstructive urology . . . . . . . . . . . . . . . . . 17 ESU Bladder cancer course. . . . . . . . . . . . . . 17 Who’s Who in the Board of the European School of Urology. . . . . . . . . . . . . 18 ESU to offer successful ICG course in Munich congress. . . . . . . . . . . . . . . . . . . . 19 YUO section: ESRU strategy on social media. . . . . . . . . . . Preparing for the EBU exam. . . . . . . . . . . . . Next level for the Young Academic Urologists. . . . . . . . . . . . . . . . . . . . . . . . . . . Standardisation in surgical training. . . . . . . YUO Board Meeting in Amsterdam. . . . . . . .

22 22 23 23 25

Advances in laparoscopy for urological indications – Part 3. . . . . . . . . . . . . . . . . . . . 24 The 11th Jacob Lester Eshleman Urology Workshop. . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Towards a urological European Reference Network. . . . . . . . . . . . . . . . . . . . 31 Preparing for the FEBU exams. . . . . . . . . . . 31 Book reviews. . . . . . . . . . . . . . . . . . . . . . . . 33 EAUN section: Delivery of survivorship . . . . . . . . . . . . . . . . Insights from the Prostate Cancer World Conference. . . . . . . . . . . . . . . . . . . . . EAUN fellowship report . . . . . . . . . . . . . . . . 2nd ESUN Course takes place in Rome. . . . .

34 35 35 36

European Urology Today


From robots to smart instruments Live Surgery sessions explore future technologies With an eye to exploring the potentials of future technologies, the Live Surgery sessions organised by the EAU Section of Uro-Technology (ESUT) during the Annual Congress will explore the potentials of new video technology, smart instruments and how these technologies improve or further expand minimally invasive procedures. “This year, with the theme “Robots, Videotechnology and Smart Instruments” we want to focus on novel technology improving the performance of video-assisted surgery and

diagnostics in all fields of endourology. This session is conducted in collaboration with the EAU Robotic Urology Section (ERUS) and the EAU Section of Urolithiasis (EULIS),” said ESUT chair Prof. Jens Rassweiler. The day-long surgery sessions, which present both live and pre-recorded surgical procedures, will be held on Saturday, 12 March, following the more than 10-year tradition of live surgery sessions organised by the ESUT.

In Munich the ESUT have the participation and full support of an international faculty and well-known experts serving as surgeons and moderators. “The procedures will be transmitted in high-definition and 3D-quality from Klinikum Rechts der Isar Technical University Munich, thanks to the efforts of its current Chair, Prof. Gschwend and his Vice Chair Dr. Straub,” added Rassweiler.

Expert moderators annotate the Live Surgery procedures

Back to the Saturday in eURO Auditorium

“We always aim to present novel techniques in percutaneous, endourological, laparoscopic, and robotic-assisted procedures. The programme we have prepared will focus on a direct comparison of robot-assisted versus classical endoscopic procedures of the kidney, prostate, and ureter. Since the sessions will be held on a Saturday, we do expect a high number of attendance,” said Rassweiler.

The programme will be divided in three parts with the first part presenting robot-assisted partial nephrectomies, and two retrograde intra-renal surgery (RIRS) procedures for the diagnosis of upper tract transitional-cell carcinoma (TCC).

The audience wore 3D glasses for the Live Surgery sessions in Madrid last year Part 2 will consists of both pre-recorded and live procedures in the upper urinary tract such as flexible ureterorenoscopy (FURS) using digital Cobra and Green light laser enucleation of the prostate. 3D-laparoscopic extraperitoneal radical prostatectomy and a robotic nerve-sparing radical prostatectomy using Da Vinci XI will also be transmitted live to the auditorium. This allows the delegates to compare state-of-the-art laparoscopic /endoscopic with robot-assisted procedures. The third and last part will present six procedures covering a range of techniques such

as supine percutaneous nephrolithotomy (PCNL) plus FURS of a renal stone using digital endoscopic technology (pre-recorded), MIP-L, which is a new concept of PCNL, and a laparoscopic radical prostatectomy using new technology, among others. The Live Surgery programme is supported by unrestricted educational grants from KARL STORZ, OLYMPUS, INTUITIVE SURGICAL, RICHARD WOLF, AMERICAN MEDICAL SYSTEMS, COOK, BOSTON SCIENTIFIC, SURGIQUEST, SIEMENS, COLOPLAST, LUMINIS, B&K-MEDICAL, ROCAMED and ELMED.

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• You can export it to your Outlook, Google Calendar or print it out

• It is fully integrated with the scientific programme of the congress • You can select your priority sessions

Visit the congress website for more information: http://eaumunich2016.uroweb.org/scientificprogramme/overview/

Who to Follow EAU Accounts European Association of Urology European Urology Journal European Association of Urology Nurses European School of Urology EUPatient ESRUrology EAU Young Urologists EAU Young Academics EAU Research Foundation ERUS Robotic Urology

@uroweb @EUplatinum @EAUNurses @urowebESU @EUPatient @ESRUrology @eauyoungurology @EAUYAUrology @EAUrf @ERUSrobotics

For more influencers to follow on Twitter, please visit uroweb.org/eau16twitter

congressesUrology and courses are accredited by the EBU in compliance with the UEMS/EACCME regulations 4 EAUEuropean Today

All you need to know about EAU16, right in your smartphone With the EAU16 app you have instant access to the most important information of the 31st Annual EAU Congress via your smartphone. You will be able to browse the complete scientific programme by day, topic, speaker, and create your own personal programme thanks to the planner. You can easily find the rooms and exhibitor stands on the floorplans and receive daily news. In your personal congress bag you can save all relevant information, which you can email after the congress so you can easily review all scientific content at a later stage. And you can use the EAU16 app offline. How to download the app and and access the app Step 1: Download the app from the iTunes store or Google Play – please search for “EAU16”. Step 2: When you have installed the app, you can access the content with the same login details as you used for the registration of the congress or your EAU member login. Step 3: Your app is ready to use! January/February 2016

ESU presents wider range of training courses In every Annual EAU Congress, the European School of Urology (ESU) offers its comprehensive Hands-on Training (HOT) courses. Each year, new techniques and procedures are either added or expanded to offer participants the best mentors and a one-on-one training experience. “The ESU offers innovative and effective Hands-on Training (HOT) courses in collaboration with the EAU sections. The main goal is allowing participants to develop , practise and improve individual surgical skills. Hands-on Training (HOT) courses are offered in many of our events. In Munich, we are organising several modules such as laparoscopy, robot assisted surgery, diagnostic procedures, techniques in urinary incontinence treatment, laser and endoscopy,” said Dr. Ben Van Cleynenbreugel, coordinator of the ESU’s HOT programme. Collaborating with the ESU are the EAU Section of Uro-Technology (ESUT), the EAU Section of Female and Functional Urology (ESFFU), the EAU Section of Urolithiasis (EULIS) and the EAU Robotic Urology Section (ERUS). Renowned mentors and experts from these sections provide direct mentorship to HOT participants. Van Cleynenbreugel said the HOT courses, offered in various levels, are not only given under the guidance of experienced tutors but also employ the latest modern training modalities. He mentioned the European

The Scientific Congress Office, led by Prof. Stenzl convened to make a selection from the 4,418 abstracts that reached us over the past months. I am pleased to announce that 1,268 were selected by the Committee, for an acceptance rate of close to 29%. These abstracts will be presented in 91 poster sessions, and there will be 10 video sessions in Munich to cover the 79 accepted videos. Abstracts will be online for EAU Members as of 11 February 2016. Congress delegates will have access to the abstracts from 11 March, the first day of the congress.

Take a front seat at the HOT programme training in Basic Laparoscopic Urological Skills (E-BLUS), a programme offered to residents and urologists who aim to improve basic skills in laparoscopy. “Among the novelties this year are the enucleation techniques and MRI fusion biopsy. Besides the HOT sessions, we have virtual reality and 3D printing techniques that you can find in the ‘Education in Innovation’ booth,” added Van Cleynenbreugel.

We thank everyone for their contributions. All-in-all, we are confident that the scientific standard of the Annual EAU Congress is as high as ever, and we hope you will feel the same when you join us in Munich!

Among others, the HOT courses includes training in suturing and knotting (anastomosis or pyeloplasty), introduction to robotic surgery, urodynamics, fluorescence imaging, MRI Fusion biopsy, Women’s Health (SUI), botulinumtoxin administration for OAB, TUR (b/p), enucleation techniques, Greenlight vaporisation and URS (semirigid and flexible).

Prof. Chris Chapple EAU Secretary General

A tip from Van Cleynenbreugel: “For many young urologists, it’s interesting to test and validate their skills in core surgical procedures. I would recommend the E-BLUS and the laparoscopic suturing exercises, for example, as a start. The training in (flexible) ureteroscopic lithotripsy (URS) has also attracted many participants in the past.” For details on the ESU Courses and HOT Programme, visit the congress website at eau16.org.

Pre-register now online! Deadline: 22 February 2016

Handy reminders

EAU Opening Ceremony & Networking Reception

You can register online until 22 February 2016, after this date you can still register onsite Abstracts are available online for EAU Members as of 11 February 2016 As of 11 March abstracts are available for delegates in the EAU16 Resource Centre, eau16.org/rc

On Friday 11 March the EAU launches the 31st Annual Congress with an official Opening Ceremony. During the 1,5 hrs programme, EAU Secretary General Chris CHapple will welcome everybody to Munich and give a general update on what to expect during the congress. Also prestigious EAU Awards will be handed out: the EAU Willy Gregoir Medal, EAU Frans Debruyne Award, EAU Hans Marberger Award, EAU Crystal Matula Award, EAU Innovators Award and the Prostate Cancer Research Award.

January/February 2016

EAU News will sent you daily updates and reports about the congress.

After the Opening Ceremony you will have the chance to catch up with your colleagues from all over the world and make new contacts and appointments during the EAU Networking Reception. Join us at the eURO Auditorium to celebrate the start of EAU16!

You can join the discussion via social media with the hashtag #EAU16 The Certificate of Attendance can be printed as of Wednesday 16 March, through the online system. e-Posters can be explored at the e-poster area, the EAU16 Resource Centre and UROsource.com

Opening Ceremony & Networking Reception Friday 11 March 2016 18.00 – 21.00 eURO Auditorium & Foyer

For photos taken at the congress, please check our Facebook page!

You are invited!

European Urology Today


In Munich: A Preview of Urology Beyond Europe Joint sessions tackle a wide variety of current best urological practices around the world The Annual EAU Congress aims to examine best urological practices from around the world, and through the Urology Beyond Europe sessions held on the opening day of the congress experts will assess management strategies in various countries. Emerging diagnostic and risk-assessment strategies in treating urological disease will be discussed by invited faculty and resource speakers. Twelve joint sessions with the EAU will be presented with speakers coming from almost every region of the world such as North & South America, Korea, Japan, China, India, Southeast Asia, Iran, Caucasus-Central Asia, the Société Internationale d’Urologie (SIU), Pan-African Urological Surgeons' Association (PAUSA), Arab Association of Urology and the Magreb Union countries.

upper tract urothelial cancer: Korean approach vs European approach,” and “Systemic treatment of metastatic urothelial cancer: upper tract versus bladder.” The follow-up session will focus on “Prostate cancer: biochemical recurrence after RP” to be moderated by Drs. A. Briganti, Milan (IT) and W.S. Kim, Seoul (KR). Among the topics are the “Role of blood tests and imaging studies in the diagnosis of BCR: Korean approach vs European approach,” and “Optimal management for BCR: Korean approach vs European approach.”

Dr. J.A. Witjes (Nijmegen, NL) and Dr. N. Clarke (Manchester, UK) will join as moderators of the bladder and the kidney sessions, respectively. In the bladder session, Prof. J. De La Rosette (Amsterdam, NL) will present the significance of narrow band imaging and photodynamic diagnosis for the diagnosis and treatment of NMIBC. Dr. T.R.W. Herrmann (Hanover, DE) will introduce the evidence on transurethral en-block resection of NMIBC. Dr. P. Gontero (Turin, IT) will summarise the prognostic factors and criteria that indicate aggressive treatment for patients with high-grade T1 bladder cancer. In the kidney session, Dr. U. Capitanio (Milan, IT) will present the current status and future perspectives of kidney biopsy for the preferred management of a small renal mass. Furthermore, Dr. R. A. Rendon (Helifax, CA), Dr. O. Rodriguez Faba (Barcelona, ES) and Dr. I. S. Gill (Los Angeles, US) will present the current status of active surveillance, cryoablation and robot-assisted partial nephrectomy, respectively, as a minimally invasive treatment for localised renal tumour. Updated concepts and technologies for the diagnosis and treatment of NMIBC and localised renal tumour will be introduced and discussed throughout this joint session, and we expect to go back home with some clear answers, and most probably, with some more new open questions. Joint EAU-Korean Urological Association During the EAU Annual Congress, the Joint EAUKorean Urological Association (KUA) Session will provide an overview of new approaches on two important oncology topics- the latest developments in upper tract urothelial cancer and biochemically recurrent prostate cancer. The invited faculty will discuss and examine various clinical applications of the new therapeutic modalities in Korea and Europe. The joint scientific session will be chaired by Drs. A. Stenzl, (DE) and Mario GT Sung (KR). Distinguished EAU faculty members are Drs. P. Albers, Düsseldorf (DE), A. Briganti, Milan (IT), M. De Santis, Coventry (GB), J. De la Rosette, Amsterdam (NL) and A. Stenzl, Tübingen (DE). Their counterparts from Korea are Drs. S.J. Kim (Suwon), J. Cho (Ahnyang), B.C. Jeong (Seoul), C.S. Kim (Seoul), S.J. Yun (Cheongju), W, K, Han (Seoul), J.Y. Joung (Goyang), and S.I. Seo (Seoul). The first session on “Urothelial cancer of the upper urinary tract” will be moderated by Drs. S.J. Kim, Suwon (KR) and S.F. Shariat, Vienna (AT). Topics include “Diagnosis and follow-up of Upper Tract Urothelial Cancer (UTUC): Korean approach vs European approach,” “Organ-sparing treatment of EAU International Relations Office


European Urology Today

Among the topics to be discussed are the technical aspects of minimally invasive urology, renal and prostate cancer surgery, as well as current therapeutic management for stones, BPH and urinary incontinence. Lectures will examine topics such as the methodology of randomised clinical trials in urologic research, multi-parametric MRI in the early diagnosis of prostate cancer and the principles and best practices in personalised medicine. The joint session will take place on Friday, 11 March from 9.30- 13.00 h with simultaneous translation into Spanish. The joint meeting provides a very good opportunity for both American and European urologists to exchange views and insights while strengthening their educational objectives and professional links.

Below are some of the highlights of the programme prepared by the participating national and regional urological associations: Joint EAU-SIU session There are always different issues to answer in oncology, and the EAU Congress provides a good opportunity to gather experts for a fruitful and balanced discussion of various views regarding a controversial topic. As part of the collaboration between the EAU and the Société Internationale d'Urologie (SIU), a joint session will be organised by SIU President Dr. S. Naito (Fukuoka, JP) and European School of Urology (ESU) Chairman Prof. Joan Palou (Barcelona, ES). The theme of the session will be “Optimal diagnosis and management of non-muscle invasive bladder cancer (NMIBC) and localised renal tumour.”

several presentations by opinion leaders who are highly regarded in their fields of expertise such as Professors H. Dávila Barrios (Caracas, Venezuela), H. Van Poppel (Leuven, Belgium) and H. Villavicencio Mavrich (Barcelona, Spain).

Arab Association of Urology: Collaborative synergies The last few years have witnessed a magnificent development and progress in the Annual EAU Congress. The number of urologists who are eager to attend the EAU is increasing each year and the reasons for the growing attendance varies. Moreover, the Congress examines a wide scope of scientific, educational, practical, technical, basic and clinical research topics in urology. These factors have made the Annual EAU Congress a much-awaited annual event not only by young doctors but also by senior urologists to refresh and renew their knowledge. With the Urology Beyond Europe programme, many of the regional urological associations are invited to actively participate. Each regional urological association has a European partner to organise the combined programme and carefully select the topics. Every year the Urology Beyond Europe has gained increasing attention is now an effective platform for many urologists around the world, with the Joint EAU-Arab Association of Urology Session in 2015 attracting more than 600 participants. The non-European participants are eager to see and evaluate their represented local speakers chairing, presenting, discussing, and debating their knowledge in an international setting. This approach encourages young urologists to come to the meeting and not to miss the important sessions and state-of-the-art lectures. We expect more attendees this year and our organisers have prepared a programme that not only examines major issues but also included topics which are highly relevant to local urologists who are looking for practical insights and guidance, and learn updates on the state of the art in urology from a European perspective. One important issue I have realised is some of the local urological association would merge the European guidelines together with their local guidelines to have practical lines of treatment compatible for their local patients, their facilities and culture. Last but not least these joint sessions should continue and be expanded with more time and more topics of interest. The dynamic exchange of knowledge and friendly relations seen in these sessions between Europe and the Middle East region will help strengthen the links and collaborative work in the coming years. Joint EAU-Confederación Americana de Urología (CAU) session The excellent collaboration between the EAU and the Confederación Americana de Urología (CAU) makes it possible to hold a joint session during the Annual EAU Congress. This year, the session will consist of

Joint EAU-Urological Society of India (USI) Session The Joint Session of the EAU and the Urological Society of India (USI) will take place on 11 March and this year’s session will be led by Prof. Vincenzo Mirone, representing the EAU, and Prof. Rajeev Sood, President of the Urological Society of India (USI). With a population of 1.29 billion versus Europe’s 851 million and 50% of its population under the age of 25 years, India’s current and future urological needs, experience and knowledge are of great value to all urologists worldwide. The programme’s focus will be on several major and actual topics of uro-andrology. These topics will be discussed and considered from a dual European and Indian scientific and cultural perspectives, and supported by clinical management modalities. A brief update of the European and Indian clinical guidelines will also be presented with the intent to compare both continents’ approaches and treatment procedures.

knowledge and foster friendships. We all look forward to seeing you at the JUA-EAU Joint Session! Joint Session of the European Association of Urology (EAU) and the Pan-African Urological Surgeons´Association (PAUSA) Update on uro-Oncology, Functional and Reconstructive Urology The aim of this meeting is to provide an update on current hot topics in the field of Uro-Oncology, Functional and Reconstructive Urology. The programme is very attractive and the Faculty is composed by outstanding experts that will make a challenging update on the different topics to cover. In the field of Uro-Oncology “Management of prostate cancer in Africans in the Diaspora” will be presented by Mr L. Ajayi from the Department of Urology at London´s Royal Free Hospital. Bladder cancer will be discussed in three different presentations. Prof. K. Bowa from the Copperbelt University in Zambia will present on “An argument for a different staging system for squamous cell carcinoma” Prof. A. Takure from University of Ibadan in Nigeria will analyse the “Epidemiology of bladder cancer and its implications for national health systems policies”. Finally, Prof. b. Schmitz-Dräger from the Schön Klinic Nürnberg Fürth in Germany, will provide an overview on the “Current state of bladder cancer therapy”. In the field of Functional Urology and Reconstructive Urology Prof. E.O. Olapade-Olaopa from University of Ibadan will present the challenging topic “Urodynamic studies in urological practice in a resource limited environment”. Reconstructive Urology will be focussed on the management of urethral stricture with three presentations. Prof. E. Kocjancic from University of Illinois will present on the “Role of minimally invasive therapy in the management of urethral stricture disease”; Prof. C. Chapple from the University of Sheffield will give a update on the “Current state of urethroplasty” while Prof. S.M. Gueye from the University Cheikh Anta DIOP from Dakar, Senegal, will present “Urethroplasty: An African perspective”. We are convinced that this session will meet attendant´s expectations. Challenging topics and an outstanding Faculty warrant the quality of the update. We encourage delegates to take part in this informative “Joint Session of the European Association of Urology (EAU) and the Pan-African Urological Surgeons´Association (PAUSA).

Amongst the topics are: Minimally invasive approach to Cystoprostatectomy: robotic vs. mini lap, Free PSA & PSA and whether they should be discriminated racially and geographically; The new wave in PCNL, Contemporary endoscopic management of Vesico Ureteric Reflux; Why men suffer more and die early: ED as sentinel marker, Genome and Metabolic milieu, Transplant in abnormal bladder and other special cases. Joint EAU-Japanese Urological Association (JUA) Session The Japanese Urological Association (JUA) and European Association of Urology (EAU) have long promoted collaboration and friendship among their members. Again this year, we are holding the joint session to be chaired by Shin Egawa (Tokyo, Japan) and Didier Jacqmin (Strasbourg, France).

The European-Iranian perspective Posterior urethral defect in male patients is a challenging clinical problem, especially when the stricture or the defect is long, close to the urethral striated sphincter or when a re-do surgery is needed. The surgical procedure is potentially related to several complications like incontinence, erectile dysfunction and recurrence of the stricture. To improve outcome in adult patients when the penile shaft is involved, reconstructive urethral surgeons have learned to apply the principles of delicate tissue handling, and the development of minimally invasive techniques Details of the recent data in these complicated fields will be discussed by Prof. G. Barbagli (IT) and Prof. S. J. Hosseini (IR) in the first session of the Joint EAU-Iran Meeting.

The second session chaired by Prof. M. Wirth (DE) and Prof. M.A. Zargar Shoshtari (IR) will take up the new findings in diagnosis and treatment of prostate cancer This year’s session focuses on three themes: Prostate (PCa) and the castrate resistant cases. Although a majority of patients with locally advanced and cancer – New horizon in the treatment of metastatic metastatic disease initially respond to ADT, most will cancer, renal cell carcinoma, and male LUTS. For prostate cancer, Dr. Tombal and Dr. Kamba will deliver eventually develop castrate resistance. Castrate presentations on: “Chemotherapy for newly diagnostic resistant PCa is a spectrum of disease ranging from patients without metastases to patients with extensive metastatic prostate cancer” and “Bone targeting symptomatic metastases. Thus, it is logical to adopt therapy in castration sensitive metastatic prostate different strategies for different patients. Although cancer,” respectively. For renal cell carcinoma, Dr. novel cytotoxic agents, AR blocking agents and Albiges and Dr. Mizuno will deliver presentations: immunotherapies represent effective therapy strategies “Back to the future? Reemerging of immunotherapy,” and “A prospective multicentre biomarker identification for mCRPC, important clinical questions remain and these will be examined during the session. trial for sunitinib in Japanese patients with metastatic RCC,” respectively. For male LUTS, Dr. Takahashi will Prof. Artibani (IT) and Prof. Basiri A (IR) will discuss speak on “How to maintain male pelvic health?” muscle invasive bladder cancer and modified radical Each theme includes a 30-minute panel discussion to cystectomy in the third session. Prostate-sparing cystectomy has comparable overall and disease-free enable participants to actively interact in lively survival rates as well as similar tumour control rates discussions and provide the audience with timely insights and information. The joint session is an ideal Continued next page opportunity to gain a meaningful exchange of January/February 2016

Continued from page 6

as with conventional radical cystectomy. Erectile function was significantly better after prostate-sparing cystectomy compared with conventional radical cystectomy. We hope to welcome you in this exciting joint meeting where insights and best practices are shared by experts to trigger a discussion and a more critical look into current urological practices. Joint EAU-World Chinese Urologists Meeting The Joint-EAU World Chinese Urology will cover topics such as prostate cancer, urolithiasis, small renal masses and men’s health. The joint session, held in collaboration with the Chinese Urological Association (CUA) and Taiwan Urological Association (TUA), has been held annually in the last three years and aims to improve scientific exchange, collaboration and friendship among European and Chinese urologists. Participants can expect not only updates but also a dynamic discussion of issues for wider consensus among experts. For each segment a European, Chinese and a Taiwanese urologist will share their perspectives regarding the prevalence, diagnosis and management

of urological diseases. In urolithiasis, new innovations will be presented ranging from retrograde intrarenal surgical techniques to a novel ureteroscope combining both rigid and flexible working modes using the Sun’s tip-flexible semi-rigid ureterorenoscope developed by CUA president Prof. Yinghao Sun. Prof. Yang (Taiwan) will share his experience with robotic radical prostatectomy, whilst CUA vice-president Prof L-P. Xie (Hangzhou, China) will speak about his team’s experience with ultrasound CT for prostate cancer diagnosis. The EAU-CUA/TUA joint session affirms the expanding collaboration among clinicians and researchers from various regions and the close cooperation between European and Chinese urologists. Joint EAU-Federation of ASEAN Urological Associations (FAUA) Session The joint session of the EAU and the Federation of the Association of Southeast Asian Nations (ASEAN) Urological Associations (FAUA) will feature invited speakers from Indonesia, Singapore, Vietnam, Philippines, Thailand and Malaysia who will tackle topics such as stones, infection, bladder and prostate cancers.

There is a prevailing opinion that science hypothesis generation, methods of analysis and discussion of results are universal, and that the same is true in urology. However, forums such as the Urology Beyond Europe show the differences in approaches and perspectives among urologists coming from various countries and cultures! Differences in local epidemiology, pathogens and disease susceptibility due to ethnic reasons, as well as different approaches to diagnosis and therapy including the principles of traditional medicine, will inform the discussions in this joint session.

training opportunities offered by the EAU to young European urologists.

Join us for a scientific discussion that highlights the Asian perspective and learn about the unique challenges encountered by your Asian colleagues regarding urological diseases, diagnosis and therapies.

Treatment of bladder tumours will also be taken up such as the benefits of TUR. Complex urinary reconstructions that follow radical cystectomy will also be reviewed. Recent advances in the control of prostatic diseases, BPH and prostate cancer, will also be discussed. Treatment of metastatic prostate cancer is rapidly evolving and this pertinent topic will be examined by no less than a renowned expert, Prof. B. Tombal, who will offer an update.

Accordingly, the Joint Session of EAU and CaucasusCentral Asia will exchange information regarding urological training and education, quality of urological practice and recent advances in urological treatment. Lectures will be given by expert speakers and young promising talents from both societies. Laparoscopy training and advanced endoscopic techniques will open the session, which are key topics for young urologists.

The Joint Session of the European Association of Urology (EAU) and Caucasus-Central Asia We believe the joint sessions of EAU and other urological societies should pursue three main objectives: To reinforce friendships among urologists, to examine urological practices from various countries We hope to see you at the EAU- Caucasus-Central and to inform representatives of National Societies the Asia session!

ESOU16: A look at the future of uro-oncology Record number of participants come to Warsaw for intensive three-day programme By Loek Keizer Multidisciplinary panel discussions, state-of-the-art lectures and special guest lectures from nonurologists were just some of the highlights of this year’s meeting of the EAU Section of Oncological Urology. ESOU Chairman Prof. Maurizio Brausi (Milan, IT) and Chairman of the Polish Urological Association and local host Prof. Piotr Chlosta (Cracow, PL) were both extremely pleased by both the scientific contents and the organisation of the well-attended meeting. The 13th ESOU meeting took place in the Polish capital on 15-17 January, 2016, making it the EAU’s first scientific meeting of 2016. “It was an honour and a privilege, also on behalf of the Polish Urological Association, to have hosted this fantastic meeting. We welcomed the biggest

Profs. Brausi and Chlosta close the successful meeting

international names to Warsaw and managed to give delegates a cutting-edge scientific programme,” Prof. Chlosta said on the final day. He also hailed the close cooperation between the EAU and the Polish Urological Association, and how ESOU16 highlighted Poland’s important role in European urology in general. Prof. Brausi emphasised the record attendance figures, making this ESOU meeting the largest in its 13-year history. “We welcomed over 1000 delegates from 44 countries: a huge achievement for the organisers and our meeting’s sponsor, Ipsen.” PCa and imaging The meeting’s scientific programme had a heavy emphasis on the diagnosis and treatment of prostate cancer. The use of MRI in PCa-diagnosis was heavily discussed during the first session of Friday, particularly thanks to the presence of radiologist Prof. Jelle Barentsz (Nijmegen, NL). He painted a picture of a near future in which urologists were intimately familiar with PI-RADS (Prostate Imaging Reporting and Data System), in which they worked together closely with speciallytrained radiologists, and in which a 10-minute “manogram” was achievable. Prof. Brausi is also enthusiastic about the adoption of MRI for PCa diagnosis and active surveillance: “MRI has improved in recent years, and urologists are learning to make better use of it. We are coming around to the idea that MRI is the best first step. Following a positive MRI scan, we should look to

fusion biopsy. This reduces possible complications for our patients. I think MRI will become a standard procedure, and today we learned a lot about the follow-up for these patients.” Friday also saw a session on urothelial and bladder cancer, with updates on robotic radical cystectomy and regenerative medicine following radical cystectomy. Prof. Brausi announced the Bladder Cancer Prevention Programme, an international effort to get urologists to take the lead in bladder cancer prevention, in addition to its treatment. “Smoking cessation is the single most cost-effective health intervention in the entire armamentarium of medicine,” Brausi told the audience.

steering committee is currently drawing up plans and materials for the effort and welcomes participation from uro-oncological societies like ESOU. Multidisciplinary approach The second day of ESOU16 featured, among many other topics and presentations, a six-way multidisciplinary panel discussion led by Prof. Levent Türkeri (Istanbul, TR). The urologists, radiologist and oncologist on the panel together debated on different treatment options for a case of urothelial cancer.

“Even in the simplest case you will see a difference of opinion between experts,” Prof. Türkeri explained afterwards. “The audience can learn a lot from The initiative comes from the World Urologic Oncology sessions like this, and apply the lessons to best fit Federation (WUOF), and asks for urologists to take a their environments, hospitals and of course specific more active role in reaching patients directly. A cases.” When asked what urologists (the majority of the audience) could learn from an oncologist like Prof. Osanto, Türkeri pointed to their systemic perspective and, often, approach. “Urologists are still more focused on local and regional treatment. We need to learn to combine, as adding chemotherapy before or after surgery can make a real difference for the patient.”

The room was at full capacity for a vast majority of the time

Full coverage of ESOU16 can be found on the meeting website, www.esou16.org. Webcasts are available for delegates and paying subscribers on www.UROsource.com.

Urology beyond Europe Programme 2016 Friday, 11 March Joint Session of the European Association of Urology (EAU) and the Arab Association of Urology (AAU) Timeslot: 10.30 - 13.00 Location: Room Madrid (Hall B2, Level 0) Chairs: H. Abol-Enein, Mansoura (EG) C.R. Chapple, Sheffield (GB) Joint Session of the European Association of Urology (EAU) and the Maghreb Union Countries Timeslot: 13.15 - 15.45 Location: Room Madrid (Hall B2, Level 0) Chairs: A. Belaidi, Boufarik Blida (DZ) P. Coloby, Cergy Pontoise (FR) Joint Session of the European Association of Urology (EAU) and World Chinese Urologists Timeslot: 09.30 - 12.40 Location: Room 14a (ICM, Level 1) Chairs: H-C. Kuo, Hualien (TW) J. N'Dow, Aberdeen (GB) Y-H. Sun, Shanghai (CN)

Joint Session of the European Association of Urology (EAU) and the Pan-African Urological Surgeons' Association (PAUSA) "Update on uro-oncology, functional and reconstructive urology" Timeslot: 13.15 - 15.45 Location: Room 14a (ICM, Level 1) Chairs: D.M. Castro-Diaz, La Laguna Santa Cruz Tenerife (ES) E.O. Olapade-Olaopa, Ibadan (NG) Joint Session of the European Association of Urology (EAU) and the Confederación Americana de Urología (CAU) "Urologic hot topics in 2016" Timeslot: 09.30 - 13.00 Location: Room 14b (ICM, Level 1) Chairs: H. Davila Barrios, Caracas (VE) H. Van Poppel, Leuven (BE) H. Villavicencio Mavrich, Barcelona (ES) Joint Session of the European Association of Urology (EAU) and the Iranian Urological Association (IUA) Timeslot: 10.30 - 13.00 Location: Room 14c (ICM, Level 1) Chairs: S.J. Hosseini, Tehran (IR) M. Wirth, Dresden (DE)

Joint Session of the European Association of Urology (EAU) and the Société Internationale d’Urologie (SIU) "Optimal diagnosis and management of non-muscle invasive bladder cancer and localised renal tumor" Timeslot: 13.15 - 15.45 Location: Room 14b (ICM, Level 1) Chairs: S. Naito, Fukuoka (JP) J. Palou, Barcelona (ES) Joint Session of the European Association of Urology (EAU) and Caucasus - Central Asia countries Timeslot: 13.15 - 15.45 Location: Room 14c (ICM, Level 1) Chairs: F. Cruz, Porto (PT) N. Turmanidze, Tbilisi (GE) F.A. Akilov, Tashkent (UZ) A.M. Grabsky, Yerevan (AM) Joint Session of the European Association of Urology (EAU) and the Japanese Urological Association (JUA) Timeslot: 13.15 - 15.45 Location: Room Paris (Hall B2, Level 0) Chairs: S. Egawa, Tokyo (JP) D. Jacqmin, Strasbourg (FR)

European Urology Today To find out more about the Urology beyond Europe programme, please visit www.eau16.org/scientific-programme/overview

January/February 2016


Residency Training Programme in Urology (RTPU) RTPU programme boosts training goals at University Clinic of Navarra Prof. J. Ignacio Pascual Piédrola Dept. of Urology University Clinic of Navarra Pamplona (ES)

During the last academic year of 2014-2015, the Urology Department carried out a total of 5,385 outpatient consultations and 717 hospital admissions. It also carried out 535 surgical procedures, and recorded 2,600 hospital stays, with an average duration or stay of 4.1 days.


Training programme for residents The Spanish RTPU takes five years. The RTPU is under the supervision of the programme director, Dr Fernando J. Díez-Caballero. At CUN, first-year rotations include general surgery, intensive care unit, radiology and nephrology.

Prof. Jose E. Robles Dept. of Urology University Clinic of Navarra Pamplona (ES)

jerobles@unav.es The Clinica Universidad de Navarra (CUN) is a private hospital of the University of Navarra founded in 1962. The CUN has been accredited by the Joint Commission International (JCI) since 2004, and in February 2014 was the first centre in Spain to gain accreditation from JCI for University Hospitals. The Residency Training Programme in Urology (RTPU) at CUN began in 1974 under the direction of Prof. Jose M. Berian. Since 2008, Prof J. Ignacio Pascual Piedrola is the chairman. The European Board of Urology (EBU) has granted the full certification of the RTPU for the first time in 2010. The programme has been certified for a second period of five years in October 2015. The urology faculty consists of four academic and clinical urologists, including recognised leaders in urologic oncology, endoscopy, laparoscopic and robotic surgery, functional and female reconstructive urology. Since the very beginning, the Urology Department has a renal transplantation unit which is responsible for the Navarre Autonomous Community’s kidney transplants. EBU Certified Centres

The CUN maintains close ties with the Centre of Applied Medical Research (CIMA), the Faculty of Medicine and the University of Nursing, with which it shares teaching and research activities, and collaborates with the Science and Pharmacy faculties.

This academic focus on the practical aspects of investigation aids the more successful treatment of patients, which further encourages the residents to participate in research projects, maintain contact with specialists from around the world and participate in courses and congresses. Thus, residents are motivated The staff and residents of the Urology Department of CUN to get updates regarding the latest advances in Pamplona, 2015 disease treatment. Interestingly, seven out of 10 residents have completed their doctoral diploma, Purpose and advantages of RTPU some of them with European Mention. courses are also provided. Additionally, final-year The Christian identity that the CUN shares with the residents make use of the opportunity to attend the university is reflected in our healthcare in the way Clinical and theoretical training EAU’s EUREP and actively take the written part of the that healthcare professionals view their patients and Multidisciplinary meetings with Pathology, Radiology, FEBU exam. emphasise human dignity. The first objective is to offer the patient and their family the best medical and Nephrology, journal club reviews, and morbidity and mortality “sessions” are regularly scheduled, covering Training portfolio personal treatment possible. Residents are required to maintain an electronic the majority of topics suggested in the official logbook as record of their training to contribute The residents are also committed to accomplish their theoretical programme. towards professional growth and concise planning work in the most professional and humane manner during their residency. This also facilitates greater possible. This philosophy encourages each individual Residents are also encouraged to publish papers both for clinical and basic research publications and involvement in knowledge acquisition, basic skills to work in a team to achieve the highest levels of development and enhances the trainee’s initiatives excellence, serve others and to assume responsibility to submit abstracts to the major urological congresses. Facilities to attend meetings and specific and ability to accept supervision. Moreover, this for their professional decisions and actions. training strategy aims to identify how learning urology can be applied to a wide range of subjects and activities. The training programme at the Clinica Universidad de Navarra Year of training 1st year

Rotations including: general surgery, intensive care unit, radiology and nephrology.

2nd year

Focused on: • gaining experience in common adult urologic diseases • learning the appropriate selection and interpretation of urologic imaging tests • practising basic endoscopic and open surgical procedures

3rd year

Primary objectives: to learn skills and standard practice in endoscopic, percutaneous and open surgical procedures. The resident assists the faculty in the outpatient evaluations and gains experience in the laparoscopic procedures. An external rotation in Vascular Surgery is scheduled during this year.

4th year

• general urological procedures • open and laparoscopic surgery • external rotation devoted to endoscopic and percutaneous procedures • training to develop clinical and basic research projects

5th year

• specific urological subspecialties such as oncologic surgery and renal transplantation. • international rotations are strongly encouraged before the end of this period.

Some of the goals in logbook-taking are: selfobservation/evaluation of one´s own practice, identification of skills gaps, strategies for improving competence deficiencies, application of consolidated skills and improvement of evaluation system. Future With the complex and demanding urology procedures involved in every day practice, only a few specialised centres have the accumulated expertise and validated knowledge to cover the opportunity to get updated on various topics ranging from male and female incontinence to robotic surgery, reconstructive surgeries and more. Certainly, we expect to stay in the forefront of such progressive developments. In this way, the EBU RTPU certification is a commitment to improve the teaching and learning of our specialty, and allow residents following RTPU at CUN to become highly professional and ‘all-rounder’ urologists.

Reconstructive and functional urology Specialty training in EUSP Clinical Visit at Royal Hallamshire Hospital in Sheffield, UK Dr. Marta Sochaj 1st Dept of Urology Medical University of Lodz Lodz (PL)

msochaj@ doctors.org.uk

across the world representing the EAU. It was a great honor for me to join Prof. Chapple in his department at the Royal Hallamshire Hospital in Sheffield, UK from September 7 to December 6 last year.

Royal Hallamshire Hospital is also where Prof. James Catto works, and he welcomed us to observe his clinical activity and was available to discuss our plans concerning writing and submitting papers.

Sheffield is an interesting city in South Yorkshire located on seven hills and with a population of around 440,000. There are two universities: Sheffield Hallam University and University of Sheffield, both attracting a high number of students. Among other things, Sheffield is famous for its powerful steel industry, which includes the production and worldwide export of quality surgical scalpel blades and handles by Swann-Morton.

I was also interested in andrology and attended the Sexual Medicine/ Andrology clinics under the supervision of Prof. Kevan Wylie, who kindly accepted me for a ‘crash course.’

After completing my specialty training I dedicated three months to learn about reconstructive and functional urology, a sub-specialty less familiar to me than mainstream oncology and endourology. The Urology Department is based at Royal Hallamshire Hospital, an 18-floor building with 20 operating theatres. My main goal was to explore One of the many talents of Prof. Chris Chapple is to invite junior urologists for training when he travels reconstructive subspecialty including diagnosis, investigations, surgical techniques and follow-up for patients suffering urethral strictures, fistulas or diverticula.

To assist in operations and take part in clinical care I registered in advance at the General Medical Council to obtain a license to practice in the United Kingdom. I believe simple observership has too many limitations.

Prof. Chapple and the international trainees


European Urology Today

Prof. Chapple and Mr. Inman led me and other international trainees through the clinical activities. I remained focused on operating theatre and outpatient clinics.

I learned a great deal about reconstructive urology including the principles, investigations, tissue handling, sophisticated steps, surgical ‘tips and tricks’ and its boundaries. I am planning to implement new

knowledge and skills in local settings in Poland with the necessary help from senior urological surgeons. In summary, it was a very valuable visiting experience early in my career. I am very thankful for the training I received from Prof. Chapple, Mr. Inman and Prof. Wylie, their support and advice. I am grateful to all the urology team members, the Specialty Registrars, the Sexual Medicine Team and the theatre and nursing personnel for their help and guidance. I would like to recommend this challenge to other junior urologists for them to broaden their horizons by moving out of their urological comfort zones.

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 May 2016! For more information and application, please contact the EUSP Office – eusp@uroweb.org or check our website http://www.uroweb.org/education/scholarship/

January/February 2016

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

Oliver.Hakenberg@ med.uni-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 h.lurvink@uroweb.org

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.

Fig. 1: Yellowish intratesticular tumour

Case study No. 46 A 51-year-old man presented with right lumbar pain and gross total haematuria. There were no other voiding symptoms. He works as a police officer and has a history of 30 years of cigarette smoking. Also, a previously asymptomatic 2 cm stone in the right renal pelvis has been present for 15 years. There had been two unsuccessful ESWL sessions several years ago. Due to the lack of effect the patient had decided not to have any more treatments and discontinued follow-up. Physical examination and routine clinical chemistry was normal. On urinalysis, marked leukocyturia as well as gross haematuria were seen. Urine culture and urine cytology were negative. A plain x-ray (KUB) shows a 25 mm dense opacity projecting on to the right renal area. In addition, a CT scan was performed (Figure 1).

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. 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. Fig. 2: Left adrenal mass on CT scan

Unusual endocrinological disorder mimicking Leydig cell tumour? Comments by Maximilian Burger Regensburg (DE)

rare phenomenon in congenital adrenal hyperplasia. The existing CYP21- deficiency in this disorder affects the adrenal steroid synthesis, reducing that of cortisone and aldosterone. The resulting oversecretion of pituitary ACTH leads to adrenal hyperplasia potentially with Addisonian crisis and early puberty.

In a 15 year-old boy who presents with a testicular mass which he described as “growing for some days,” one thinks of testicular cancer. This presumptive diagnosis is supported by the clinical finding of a palpable solid testicular mass and the ultrasound finding of an inhomogenic and hypoechoic testicular mass. Thus, most likely, radical orchiectomy will have to be performed and the histopathological result of the described case suggesting a Leydig cell tumour would be unusual. Leydig cell tumours represent between 1% and 3% of all testicular tumours.

With this scenario, aberrant adrenal cells present in the testes may grow, forming tumours consisting of large, eosinophilic cells resembling Leydig cell tumours. The differentiation cannot be made by histopathology, but is suggested by the clinical features of a history of congenital adrenal hyperplasia and early onset puberty. In most TART cases described, the testicular tumours are bilateral. TART is found in perhaps half of all male adults with this disease and the testicular tumours are never malignant.

Researching this case, I came across the acronym TART. Frankly, I would not have thought of it. TART stands for “Testicular Adrenal Rest Tumor” and is a

Bilateral occurrence is, however, rare in true Leydig cell tumours. Was orchiectomy avoidable in this case? Intensified glucocorticoid treatment has been

suggested to reduce the testicular tumours in TART. For urologists, TART is a very rare disorder in patients with congenital adrenal hyperplasia. Testicular masses in such patients would require discussion with an endocrinologist. Literature: Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, Horwich A, Laguna MP, Nicolai N, Oldenburg J. Guidelines on Testicular Cancer: 2015 Update. Eur Urol. 2015 Dec;68(6):1054-68. Claahsen-van der Grinten HL, Hermus AR, Otten BJ. Testicular adrenal rest tumours in congenital adrenal hyperplasia. Int J Pediatr Endocrinol. 2009 Yu MK, Jung MK, Kim KE, Kwon AR, Chae HW, Kim DH, Kim HS. Clinical manifestations of testicular adrenal rest tumor in males with congenital adrenal hyperplasia. Ann Pediatr Endocrinol Metab. 2015 Sep;20(3):155-61.

Figure 1 A and B: Abdominal CT scan before (left) and after (right) injection of contrast material. The thickened wall of the renal pelvis measured less than 10 Hounsefield units.

Discussion points: 1. What differential diagnosis should be considered? 2. Are further investigations needed? 3. Which treatment is appropriate? Case provided by Dr. Rami Boulma and Dr. Hassen Khouni, Dept. of Urology, Internal Security Forces Hospital, Marsa, Tunisia, email: rboulma@hotmail. com and khouni_has2002@yahoo.fr.

Nephrectomy and adrenalectomy needed Comments by Philippe Sèbe Paris (FR)

The initial description of this case suggests the diagnosis of Leydig cell tumour in a young patient with congenital adrenal hyperplasia (CAH). The diagnosis of a testicular tumour in patients with CAH is frequent and is initially caused by testicular adrenal rest tumours (TART) which develop from ectopic remnants of intratesticular adrenal tissue. These lesions are typically bilateral, nodular and multiple. TART can lead to testicular structural damage, mass-forming lesions that could be mistaken for Leydig cell tumour. In rare cases, Leydig cell tumours can be associated with TART.

The CT scan shows a malignant tumour of the left adrenal gland suggesting an adrenocortical carcinoma, which is also a rare tumour at this age. A surgical treatment combining left adrenalectomy and nephrectomy should be performed and, depending on the pathology, an outpatient adjuvant treatment could be considered.

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Case Study No. 45 continued Surgery was performed showing the large suprarenal tumour and an extensive lymph node conglomerate around and adherent to the left renal vein. En-bloc resection of the whole tumour mass including the left kidney was performed. Histopathology showed malignant proliferation which was reported as being compatible with a metastatic Leydig cell tumour. Recovery was uneventful and the first follow-up CT scan at three months was normal.

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January/February 2016


European Urology Today


Key articles from international medical journals Prof. Oliver Hakenberg Section Editor Rostock (DE)

Oliver.Hakenberg@ med.uni-rostock.de

Antimicrobial Resistance in Urosepsis: Outcomes from the GPIU Study The primary objective of this study was to identify the (i) relationship of clinical severity of urosepsis with the pathogen spectrum and resistance, and (ii) appropriateness of using the pathogen spectrum and resistance rates of health care associated urinary tract infections (HAUTI) as representative of urosepsis. The secondary objective was to provide an overview of the pathogens and their resistance profile in patients with urosepsis. A point prevalence study was carried out in 70 countries (2003-2013). The population studied included; 408 individuals with microbiologically proven urosepsis, 1,606 individuals with microbiological proof of HAUTI and 27,542 individuals hospitalized in urology wards. Main outcomes were pathogens and resistance identified in HAUTIs and urosepsis including its clinical severity. A statistical model that included demographic factors (study year, geographical location, hospital setting) was used for analysis.

The authors concluded that it is not appropriate to use the pathogen spectrum and resistance rates of other HAUTIs as representative of urosepsis to decide on empirical treatment of urosepsis Amongst urology practices the prevalence of microbiologically proven HAUTI and urosepsis was 5.8% and 1.5% respectively. Frequent pathogens in urosepsis were E. coli (43%), Enterococcus spp. (11%), P. aeruginosa (10%) and Klebsiella spp. (10%). Resistance to commonly prescribed antibiotics was high and rates ranged from 8% (imipenem) to 62% (aminopenicillin/ β lactamase inhibitors); 45% of Enterobacteriaceae and 21% of P. aeruginosa were multidrug-resistant. Resistance rates in urosepsis were higher than in other clinical diagnosis of HAUTI (Likelihood ratio<0.05).

resistant bacterial strains and healthcare costs during a period of adherence to EAU guidelines in a tertiary urological institution. A protocol of adherence to EAU guidelines on antibiotic prophylaxis for all urological procedures was introduced in the Department of Urology, Santa Chiara Regional Hospital in Trento, in Italy in January 2011. Data from 3,529 urological procedures performed between January 2011 and December 2013 were compared with 2,619 procedures performed between January 2008 and December 2010 before protocol introduction. The prevalence of bacterial resistance and healthcare costs were compared between the two periods. The proportion of resistant uropathogens and the costs related to antibiotic consumption and symptomatic post-operative infection were the outcome measurements. Chisquare or Fisher’s exact tests were used to test for statistical significance (p < 0.05).

…adherence to European Association of Urology guidelines on antibiotic prophylaxis reduced antibiotic usage without increasing post-operative infection rate and lowered the prevalence of resistant uropathogens The proportion of patients with symptomatic post-operative infection did not differ [180/3,529 (5.1%) vs 117/2,619 (4.5%); p = 0.27]. A total of 342 isolates from patients with symptomatic postoperative infectious complications were reported and analysed. The resistance rates of E. coli to piperacillin/ tazobactam (9.1% vs 5.4%; p=0.03), gentamicin (p=0.02) and ciprofloxacin (32.3% vs 19.1%; p=0.03) decreased significantly after protocol introduction. The use of ciprofloxacin fell from 4.2 DDD per 100 patient days prior to implementation to 0.2 DDD per 100 patient days after (p < 0.001). The antibiotic drug costs (76,980 Euro vs 36,700 Euro) and the costs related to post-operative infection (45,870 Euro vs 29,560 Euro), were reduced following introduction of the protocol (p < 0.001). The authors concluded that adherence to European Association of Urology guidelines on antibiotic prophylaxis reduced antibiotic usage without increasing post-operative infection rate and lowered the prevalence of resistant uropathogens.

Source: Adherence to European Association of Urology guidelines on prophylactic antibiotics: An important step in antimicrobial stewardship. Tommaso Cai, Paolo Verze, Anna Brugnolli, Daniele Tiscione, Lorenzo Giuseppe Luciani, Cristina Eccher, Paolo Lanzafame, Gianni Malossini, Florian M.E. Wagenlehner, Vincenzo The authors concluded that it is not appropriate to use Mirone, Truls E. Bjerklund Johansen, Robert the pathogen spectrum and resistance rates of other Pickard, Riccardo Bartoletti. HAUTIs as representative of urosepsis to decide on empirical treatment of urosepsis. Resistance rates in urosepsis are high and precautions should be made to avoid further increase.

Source: Antimicrobial Resistance in Urosepsis: Outcomes from the Multinational, Multicenter Global Prevalence of Infections in Urology (GPIU) Study 2003 to 2013. Zafer Tandogdu, Ricardo Bartoletti, Tomasso Cai, Mete Cek, Magnus Grabe, Ekaterina Kulchavenya, Bela Koves, Vandana Menon, Kurt Naber, Tamara Perepanova, Peter Tenke, Bjorn Wullt, Truls Erik Bjerklund Johansen, Florian Wagenlehner. World J Urol DOI 10.1007/s00345-015-1722-1.

Adherence to European Association of Urology guidelines on prophylactic antibiotics Antimicrobial resistance is a worldwide health crisis. Adherence to European Association of Urology (EAU) guidelines on antibiotic prophylaxis may be an important way to improve antibiotic stewardship and reduce patient harm and costs. The objective of the present study was to evaluate the prevalence of Key articles


EUROPEAN UROLOGY 6 9 (2 01 6) 2 7 6 – 2 8 3; DOI: 10.1016/j.eururo.2015.05.010

Procalcitonin as a diagnostic marker for sepsis Procalcitonin is a promising marker for identification of bacterial infections. The authors assessed the accuracy and clinical value of procalcitonin for diagnosis of sepsis in critically ill patients. Medline, Embase, ISI Web of Knowledge, the Cochrane Library, Scopus, BioMed Central, and Science Direct, were searched from inception to February 21, 2012, as well as reference lists of identified primary studies. Articles included were those written in English, German, or French that investigated procalcitonin for differentiation of septic patients—those with sepsis, severe sepsis, or septic shock—from those with a systemic inflammatory response syndrome of non-infectious origin. Studies of healthy people, patients without probable infection, and children younger than 28 days were excluded. Two independent investigators extracted patient and study characteristics; discrepancies were resolved by consensus. Individual and pooled sensitivities and specificities were calculated. Heterogeneity was

tested with I2 test and the source of heterogeneity was investigated by meta-regression.

It was concluded that procalcitonin is a helpful biomarker for early diagnosis of sepsis in critically ill patients Authors` search returned 3,487 reports, of which 30 fulfilled the inclusion criteria, accounting for 3,244 patients. Bivariate analysis yielded a mean sensitivity of 0·77 (95% CI 0·72–0·81) and specificity of 0·79 (95% CI 0·74–0·84). The area under the receiver operating characteristic curve was 0·85 (95% CI 0·81–0·88). The studies had substantial heterogeneity (I2=96%, 95% CI 94–99). None of the subgroups investigated—population, admission category, assay used, severity of disease, and description and masking of the reference standard—could account for the heterogeneity. It was concluded that procalcitonin is a helpful biomarker for early diagnosis of sepsis in critically ill patients. Nevertheless, the results of the test must be interpreted carefully in the context of medical history, physical examination, and microbiological assessment.

Source: Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Christina Wacker, Anna Prkno, Frank M Brunkhorst, Peter Schlattmann. The Lancet, Infectious diseases, Volume 13, No. 5, p426–435, May 2013.

Extent of lymph node dissection: No impact on functional outcomes after RP According to different guidelines, the standard template for lymph node dissection (LND) in prostate cancer is the extended one, including the common and internal iliac areas in addition to the limited template. Nevertheless, the debate between limited versus extended lymph node dissection when performing RP is still active. The curative role of an extended template is not yet proven and some authors have suggested a potential impact of extended dissection on functional outcomes. Damages to the vegetative pelvic plexus could increase the risk of post-operative incontinence and erectile dysfunction without any firm results already published.

The limitations of this study are multiple, including the retrospective design or the significant differences between groups in terms of oncologic features In the present article, the authors have compared continence and erectile function recovery rates after bilateral nerve-sparing radical prostatectomy according to the LND template. Consecutive patients were included: 262 undergoing an extended LND versus 198 undergoing a limited LND. The decision of limited versus extended LND template was not randomized and only depended on the PCa risk category: limited LND if low-risk PCa, extended LND if intermediate/high risk PCa. All patients underwent a retropubic radical prostatectomy and those receiving post-operative phosphodiesterase type 5 inhibitors were excluded from analysis. The continence status was assessed by the number of daily pads (continence defined by 0 pad or one dry pad at the end of the day). Erectile function was evaluated by the IIEF-5 score. Mean follow-up was 53 months.

Prof. Oliver Reich Section editor Munich (DE)

oliver.reich@ klinikummuenchen.de

Regarding continence recovery, no significant differences were noted after stratification by the extent of LND. The 12-month continence recovery rates were 90% and 93% in limited versus extended LND groups (p =0.204). No difference appeared after a longer follow-up. Similar findings were reported regarding the potency recovery. The 12-month erectile function rates were 40% and 47%, respectively, without any significant difference (p = 0.534). Multivariable analysis was performed revealing that age, preoperative erectile status and the extent of the disease on pathological report were the independent predictor of erectile function recovery. An additional analysis also showed that the trifecta rate was not affected by the extent of LND. The limitations of this study are multiple, including the retrospective design or the significant differences between groups in terms of oncologic features. Nevertheless, to date, no prospective comparative trial is available to compare oncologic and functional outcomes according to the LND extent. Thus, given the findings from this article and the literature data, the decision of using a nerve-sparing technique and of improving continence and erectile function preservation should not influence the type of LND.

Source: Extended versus limited pelvic lymph node dissection during bilateral nerve-sparing radical prostatectomy and its effects on continence and erectile function recovery: long-term results and trifecta rates of a comparative analysis? Hatzichristodoulou et al. World J Urol; 2015 ; doi 10.1007/s00345-015-1699-9.

Two days is enough: Early catheter removal after radical prostatectomy The robotic approach, thanks to an improved dissection of the apical region allows a good preservation of rhabdospincter structures. Moreover, the anastomosis is eased as compared with pure laparoscopic approaches. The use of unidirectional barbed sutures has also shown to ease and shorten anastomosis time. Apical reconstruction techniques (posterior, anterior, or both) may play a role in improving post-operative continence and leakage rates after catheter removal. To date, most surgeons use of posterior reconstruction aiming at avoiding undue tension on the vesicourethral anastomosis, facilitating effective sphincter contraction. Pooled together, all these factors improve the quality of suture and apical dissection. The question of the ideal duration of bladder catheterization remains open. In the present study, authors compared a standard catheter removal at Day 6 versus an early removal at Day 2. Few patients were included (37 into each arm) but the design was prospective. All patients underwent a nonextrafascial robot-assisted radical prostatectomy. Pre-existing disease of the anterior urethra, bladder disorders, and prolonged preoperative bladder catheterization were exclusion criteria. The bladder catheter was removed at Day 2 or 6 according to the treatment arm. A cystogram was systematically performed in all cases before bladder catheter removal. All patients were discharged the day following this removal in case of spontaneous voiding and after a uroflowmetry measure. Selfadministered questionnaires were given to assess lower urinary tract symptoms and pain. A pad test was also performed seven and 21 days after catheter removal.

As awaited by the non-randomized design, PSA, clinical tumor stage, and Gleason score were different between both groups. The median number of nodes removed was six in the limited LND group as compared with 18 in the extended LND group. The preoperative functional status was strictly comparable between both groups. All patients were preoperatively Baseline characteristics were strictly comparable continent. Mild, moderate, severe erectile dysfunction between both groups as well as baseline IIEF-5, ICIQ, and IPSS scores. No difference in perioperative was reported in 22%, 8%, and 34% of patients.


European Urology Today

January/February 2016

Prof. Truls Erik Bjerklund Johansen Section editor Oslo (NO)


prostatectomy between both groups. Nevertheless, a preoperative PFME significantly improved the three-month continence rate in the meta-analysis. The odd ratio of being incontinent was 0.64 (p = 0.005) in the preoperative PFME group. These findings were in line with quality of life results showing a comparable improvement at month three in the preoperative PFME group.

This prospective series demonstrates the feasibility of early catheter removal after robotic radical prostatectomy. The rates of continence and complications were not negatively influenced as well as functional and pain scores by the duration of bladder catheterization. However, the difference of nerve-sparing procedures between both groups could have a significant influence on early continence rates. Nevertheless, such an early catheter removal could decrease hospital stay, costs, and improve patient comfort. A randomized controlled trial could be interesting to confirm these findings.

Source: Early Catheter Removal after Robotassisted Radical Prostatectomy: Surgical Technique and Outcomes for the Aalst Technique (ECaRemA Study). Gratzke C et al. Eur Urol, 2015, In Press.

Preoperative pelvic floor muscle exercise improves early continence rates after prostate surgery May pre-operative pelvic floor muscle exercise (PFME) play a role in early continence recovery after radical prostatectomy? The ability to recover urinary continence after surgery is for sure multifactorial. Anatomical and surgical factors are fundamental; however, a preoperative PFME with or without biofeedback could have a not negligible impact. In an article, the authors performed a systematic review and meta-analysis to determine the effectiveness of this approach. The PRISMA statements were followed. The intervention had to involve a form of PFME with or without guidance or biofeedback. Based on selection criteria, 11 studies were included involving 739 patients. Only seven studies had sufficient quantitative data for meta-analysis. Nine articles were randomized controlled trials, and only three had both surgeons and assessors blinded. The authors highlighted the lack of consensus on continence definition. Various definitions were used: number of pad, pad weight, patients’ self-reporting and continence questionnaires. There was also a great heterogeneity among the quality of life tools used.

Source: Preoperative pelvic floor muscle exercise and postprostatectomy incontinence: a systematic review and meta-analysis. Chang JI et al. Eur Urol, 2015; In Press

Minimally invasive prostate convective Water Vapor Energy Ablation This is a multicentre randomized-control study utilizing transurethral prostate convective water vapour thermal energy to treat lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). Men 50 years old or older with International Prostate Symptom Scores (IPSS) 13 or greater, maximum flow rate of 15 ml per second or less and prostate size 30 to 80 cc were randomized 2:1 between thermal therapy with the so called “Rezüm” System and control. Thermal water vapour was injected into the transition zone and median lobe as needed. The control procedure was rigid cystoscopy with simulated active treatment sounds. The primary endpoint compared IPSS reduction at three months. Treatment subjects were followed for 12 months. There were 197 men randomized (active 136, control 61). Thermal therapy and control IPSS was reduced by 11.2 ± 7.6 and 4.3 ± 6.9 respectively (p < 0.0001). Treatment subject baseline IPSS of 22 decreased at two weeks (18.6, p = 0.0006) and by 50% or greater at three, six and 12 months, p < 0.0001. Peak flow rate increased by 6.2 ml per second at three months and was sustained throughout 12 months (p < 0.0001). No de novo erectile dysfunction was reported. Adverse events were mild to moderate and resolved quickly.

…convective water vapour thermal therapy treatment provides rapid and durable improvements in BPH symptoms and preserves erectile and ejaculatory function

The authors concluded that convective water vapour thermal therapy treatment provides rapid and durable improvements in BPH symptoms and preserves No consensus was achieved regarding the PFME erectile and ejaculatory function. According to the regimens. A great variety of exercise regimens were investigators, treatment can be delivered in an office reported: verbal or visual feedback, use of rectal setting using oral pain medication and is applicable probe, digital palpation, surface electrode, nurse or physiotherapist-guided exercises. Most studies carried to all prostate zones including median lobe. out the first session two to four weeks prior to the Source: Minimally Invasive Prostate Convective operation. Nevertheless, in one study, PFME was Water Vapor Energy (WAVE) Ablation: A performed the day before the surgery. Overall, no continence rate difference was reported at one month and at six months after radical Key articles

January/February 2016

Multicenter, Randomized, Controlled Study for Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.

Dr. Guillaume Ploussard Section editor Toulouse (FR)

J Urol. 2015 Nov 22. pii: S0022-5347(15)05258-1. doi: 10.1016

Vascular and chronological The lack of difference regarding early continence recovery rates may age in men with erectile be explained by the low number of dysfunction patients who have been evaluated Vascular age, as derived from the SCORE project at month one algorithm for cardiovascular (CV) risk estimation, is an

outcomes and pathologic features was reported. The only differences were the bladder catheter duration (two versus six days) and the hospital stay (three versus six days). It is worthy to note that significantly more patients with early catheter removal underwent bilateral nerve-sparing procedures compared with the Thus, this meta-analysis showed a 36% reduction of standard group (p=0.008). three-month postoperative incontinence after radical prostatectomy if preoperative PFME was undertaken. Urinary retention rates were comparable between both groups: 8% and 11%. Interestingly, patients with However, one-month and six-month rates were not influenced by these exercises. The lack of difference early catheter removal had more likely a lower flow rate (10 ml/s) compared with patients discharged from regarding early continence recovery rates may be explained by the low number of patients who have bladder catheter at Day 6 (21 ml/s, p < 0.001). Early been evaluated at month one. Given the comparable continence rates were equal as well as rates at six months, the meta-analysis supported the questionnaires-based assessments. Complication potential absence of benefit of PFME on mid-term rates were low in both groups. continence outcomes. This review is limited by the number of patients included in well-designed studies …such an early catheter removal as well as the great importance of other factors on could decrease hospital stay, costs, continence (surgeon experience, patient age, surgical approach, apical reconstruction, nerve-sparing and improve patient comfort. A procedures) that were not recorded in included randomized controlled trial could be studies.

interesting to confirm these findings

McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, Levin RM, Rousseau M, Beahrs JR, Kaminetsky J, Cowan BE, Cantrill CH, Mynderse LA, Ulchaker JC, Larson TR, Dixon CM, Roehrborn CG.

effective way for communicating CV risk. However, studies on its clinical correlates are scanty. The authors aimed to evaluate if the difference between vascular and chronological age (Δ age), in a population of subjects with erectile dysfunction (ED), can identify men with a worse risk profile. A consecutive series of 2,853 male patients attending the outpatient clinic for erectile dysfunction (ED) for the first time was retrospectively studied. Among them, 85.4% (n = 2,437) were free of previous Major Adverse Cardiac Events (MACE) and were analysed. Several clinical, biochemical, and penile colour Doppler parameters were studied. Vascular age was derived from the SCORE project algorithm, and the age was considered.

Age provides a simple method for identifying high-risk men that must undergo significant modification in their lifestyle and risk factors Higher age is associated with several conventional (family history of CV diseases, hyperglycaemia, elevated triglycerides, and increased prevalence of metabolic syndrome) and unconventional (severity of ED, frequency of sexual activity, alcohol abuse, lower education level, fatherhood, extramarital affairs, compensated hypogonadism, and low prolactin levels) risk factors. Age is inversely related to penile color Doppler parameters, including flaccid and dynamic peak systolic velocity and flaccid acceleration (β = -0.125, -0.113, and -0.134, respectively, all p < 0.0001). In subjects referring for ED without a personal history of CV events, age is associated with an adverse cardio-metabolic profile and worse penile colour Doppler ultrasound parameters. Age provides a simple method for identifying high-risk men that must undergo significant modification in their lifestyle and risk factors. In addition, it can be considered a simple, inexpensive, and safe surrogate marker of penile arterial damage.

Source: Vascular and Chronological Age in Subjects with Erectile Dysfunction: A CrossSectional Study. Rastrelli G, Corona G, Mannucci E, and Maggi M.

g.ploussard@ gmail.com non-pelvic-irradiated cohort, 328 sexually active men part of an unselected, population-based study conducted in 2008. The treated subjects were prescribed primary/salvage external-beam RT to 70 Gy@2.0 Gy/fraction. Absorbed RT doses (Dmean and Dmax ) of the corpora cavernosa (CC), the penile bulb (PB), and the total penile structure (CC + PB) were related to 13 patient-reported symptoms on sexual dysfunction by means of factor analysis (FA) and logistic regression. Three distinct symptom domains were identified across all cohorts: "erectile dysfunction" (ED, two to five symptoms), "orgasmic dysfunction" (OD, two to four symptoms), and "pain" (two to three symptoms). The strongest predictor for ED symptoms was CC + PB Dmax (p = 0.001-0.03), CC and PB Dmean predicted OD symptoms equally well (p = 0.03 and 0.02-0.05, respectively), and the strongest predictor for pain symptoms was CC + PB Dmean (p = 0.02-0.03). Sexual dysfunction following RT was separated into three main domains with symptoms related to erectile dysfunction, orgasmic dysfunction, and pain. Chances for intact sexual functionality may be increased if dose to the total penile structure can be restricted for these domains in the planning of RT.

Source: Radiation Dose to the Penile Structures and Patient-Reported Sexual Dysfunction in Long-Term Prostate Cancer Survivors. Thor M, Olsson CE, Oh JH, Alsadius D, Pettersson N, Deasy JO, and Steineck G. J Sex Med. 2015 Nov 13. doi: 10.1111/jsm.13031.

Clinical effects of residual stone fragments after ureteroscopy for the treatment of renal stones Residual fragments after active treatment for renal stones may affect surgical outcomes and follow up of patients. Clinical Insignificant Residual Fragments (CIRF) has been a concept introduced to define patients who were not rendered stone-free after the relevant procedure but whose residual fragments were deemed unlikely to cause any clinicallysignificant event. However, there is no consensus on the threshold that should be used to define CIRF and authors select it arbitrarily. CIRF has been previously investigated for kidney stones undergoing SWL or PCNL; more recently this topic has been focused on the ureteroscopy (URS) for renal stones.

J Sex Med. 2015 Dec 3. doi: 10.1111/jsm.13044.

Patient-reported sexual dysfunction in long-term PCa survivors The involvement of various penile structures in radiotherapy (RT)-induced sexual dysfunction among prostate cancer (PCa) survivors remains unclear and domains beyond erectile dysfunction such as orgasm, and pain have typically not been considered. The purpose of this study was to investigate sexual dysfunction post-RT for localized prostate cancer and to examine whether radiation dose to different penile structures can explain these symptoms.

A cohort study retrospectively analysed data from six referral centres of North America involving 232 patients with residual fragments of any size after URS for renal stones. They could record patients’ characteristics (gender, age, BMI, past medical history of renal stones) stones’ characteristic (size, site, side) and intervention method (dusting vs. basketing) and correlated them to the clinical outcomes. Overall, they found an incidence of 44% for stone events which included a 29% of patients requiring re-intervention and a 15% of patients who experienced complications (recurrence of symptoms, attendance to A&E, hospital admission or renal function impairment) without the need for re-intervention. On the other hand, they found that patients after URS had a 26% of likelihood to pass spontaneously the residual stone fragments, regardless their size.

Chances for intact sexual functionality may be increased if …the authors could conclude that all dose to the total penile structure can patients harbouring stone fragments be restricted for these domains in are at risk of grow and stone events the planning of RT The authors investigated sexual dysfunction in two treated prostate cancer cohorts and in one

By using 2 and 4 mm cut offs, they found for both fragments > 2 mm and > 4 mm a higher likelihood for residual fragments to grow over time; however, only


European Urology Today


Dr. Francesco Sanguedolce Section editor London (UK)

fsangue@ hotmail.com fragments > 4 mm were associated to a higher chance of experiencing re-intervention (18 vs. 38%; p = 0.001) or complications (27.8 vs. 59.2%; p = 0.039). No difference was found at multivariate analysis between dusting vs. basketing techniques with respect to risk for stone events. However, at KaplanMeyer survival analysis, authors reported a shorter time of receiving an ancillary procedure for patients undergoing the dusting respect to basketing techniques. Nevertheless, these results have been reported only in the Discussion section of the paper and are not better specified in the Results one, which makes somehow awkward the understanding of the relevant message. Regardless of the limitations of the study (which include the retrospective nature of data collection, the unknown overall incidence of the 232 cases included in the study in the relevant cohorts, the inconsistency of post-operative imaging modality, the inability to identify the reasons for re-intervention), the authors could conclude that all patients harbouring stone fragments are at risk of grow and stone events; all these patients should be counselled post-operatively for risk of complication or re-intervention and should be actively monitored, especially patients with fragments > 4 mm whom may benefit from prompt re-intervention.

Source: Clinical effects of residual stone fragments after ureteroscopy for the treatment of renal stones. B.H. Chew, H.L. Brotherhood, R.L. Sur, et al. J Urol, 3 Nov. 2015 DOI: 10.1016/j.juro.2015.11.009

Robotic living donor nephrectomy: A new frontier for robotic surgery in urology Renal transplantations from living donors are associated with better long-term outcomes and have become more and more popular thanks also to the introduction of new programmes to foster altruistic donation (Ref. 1-2). However, living donor transplantation implies major pressure to surgeons as there is the need to minimise donors’ morbidities and optimise graft extraction, besides the need to maximise the renal function of recipients. Living Robotic Donor Nephrectomy (RDN) has been the latest technique introduced as potential alternative to Laparoscopic Donor Nephrectomy (LDN); a recent randomised controlled trial has investigated safety and benefits of RDN over LDN (Ref. 3). They calculated a sample size of 45 patients randomised 1:2 to RDN and LDN respectively to prove a decrease of one unit of mean pain score (Visual Analogue Score) with a study power of 87%. Other primary end points included analgesic requirement and hospital stay of the donors. 1:2 ratio was also respected for the site of donor nephrectomy with a total of nine right RDN vs. 18 LDN and 6 left RDN vs. 12 LDN. Secondary end points involved both donors’ (haemoglobin drop, preserved graft arterial and venous length, total operative time, retrieval time, warm ischemia time, number of ports, donor creatinine at one-month follow up, intraoperative and postoperative complications rates) and recipients’ (eGFR at 7 days, 1, 3, 6, 9 months; graft related complications and graft loss) parameters. They also recorded difficulty scores for the different steps of surgery involving patient’s and console’s side surgeons for RDN and laparoscopic surgeon for LDN, respectively. Results showed that the null hypothesis of primary end point was rejected, with donors’ pain VAS significantly higher > 1 unit for LND: this result was consistent either when considering the whole cohort of patients and also for site subgroup analysis at six, 24 and 48 hors post op. Key articles


The same results were recorded for the other end-points, with less analgesic requirement (46.67 vs. 83.3 mg of Tramadol, p: 0.001) and hospital stay (72 vs. 96 hrs, p: 0.001) needed for RDN patients. As highlighted by other reports and the authors themselves, this may be the consequence of a lower pressure on the ports sites caused by the robot arms respect to the instruments manipulation manoeuvred by the laparoscopic surgeon at patients’ side. Even though secondary endpoints results were underpowered, interestingly they showed a longer length preserved for right renal artery in RDN group; moreover, RDN surgeons reported a more comfortable ease in performing most of the surgical steps respect to LDN surgeons, with only the exception of the graft retrieval which was more difficult for the RDN patients’ side surgeon because of the need to undock the fourth robotic arm during retrieval.

Overall, RDN showed to be beneficial for living donors providing less morbidities; surgeons’ ease also has been highlighted, especially when it comes to donor nephrectomies on the right side where preservation of sufficient length of renal artery may be more challenging

operated between 2009 and 2013 were deemed suitable for inclusion in the study; tumour size and R.E.N.A.L. score were 2.8 cm and 6 for cT1a RCC, and 5 cm and 8 for cT1b lesions, respectively.

It is worthwhile to note the high rate of trifecta and MIC PNs achieved by the centres involved either in cT1a and cT1b subset of patients The rate of “trifecta” and MIC differed within the tumours subgroups: achievements of trifecta and MIC for cT1a tumours were 78.9% vs. 60.3%, and 60.6% vs. 31.7% for cT1b, respectively. However, the more restrictive definition of MIC did not affect or undermine a finer predictor of renal function preservation: in cT1a tumours, difference of median split function preservation was minimal between patients with PNs having achieved trifecta and MIC criteria (90% vs. 91.8%, respectively); in cT1b the difference was slightly more pronounced (87.2% vs. 90.7%, respectively) even though –as mentioned above- the surgeries fulfilling MIC criteria were almost the half of trifecta ones in this subgroup of patients.

Mr. Philip Cornford Section editor Liverpool (GB)

philip.cornford@ rlbuht.nhs.uk only and 118 (51%) had had a CT scan. The median PSA level before the diagnosis of mCRPC was 48.9 ng/ml. PSADT was greater than nine months for 22% of the patients, three to nine months for 40% and less than three months for 19% of the patients with 19% lacking sufficient PSA data to calculate PSADT. PSADT is a strong predictor of bone metises (OR 0.53, p < 0.001).

In this retrospective analysis of men who developed mCRPC 44% had soft-tissue metastases at the time of first metastases suggesting this might be much more common than currently recognised

More importantly, at multivariate analysis adjusted for Charlson Comorbidity Index (CCI) either tools were Of the patients who underwent CT 9% had liver found to be significant predictors of post-operative metastases, 3% had lung metastases, 8% had other renal function preservation. metastases, 35% had lymph node metastases and This same issue may be the reason why a longer 30% had no bone involvement. There were no These results led to a two-fold conclusion: warm ischaemia time (significantly different on left significant predictors of visceral metastases. A higher 1) Both trifecta and MIC should be considered nephrectomies) and retrieval time was necessary for reliable surrogates of renal function preservation, PSA was associated with an increased risk of lymph RDN patients. However, these factors did not translate node metastases (OR 1.38 p = 0.014), whereas besides being regarded as markers of surgical to any difference in renal function by observing either receiving primary localised treatment was associated quality; creatinine or eGFR values at different time of with a decreased risk of lymph node metastases (OR 2) Trifecta may be accounted as a more inclusive follow-up. outcome measurement tool without undermining 0.36, p = 0.015). its power in predicting the functional outcome. Overall, RDN showed to be beneficial for living donors In this retrospective analysis of men who developed providing less morbidities; surgeons’ ease also has mCRPC 44% had soft-tissue metastases at the time of It is worthwhile to note the high rate of trifecta and been highlighted, especially when it comes to donor first metastases suggesting this might be much more MIC PNs achieved by the centres involved either in nephrectomies on the right side where preservation common than currently recognised. It was thought cT1a and cT1b subset of patients: however, when of sufficient length of renal artery may be more that < 10% of cases had soft-tissue metastases. This introducing the variable “centre” itself in the challenging. Last but not least, economic comparison multivariate model this was found also to be a study suggests a CT scan should be routinely used for was not performed leaving unresolved the question significant predictor of functional outcomes (data not the evaluation of men with CRPC to avoid missing whether benefits provided by RDN counteract higher soft-tissue metastases. showed). This finding –once again- underlines that costs associated. the main factor that can impact surgical and function Source: Is computed tomography a necessary outcomes during and after a PN is the centre where Sources: 1) Living-donor kidney transplantation: the procedure is performed as a surrogate of part of a metastatic evaluation for castrationa review of the current practices for the live resistant prostate cancer? Results from the surgeons’ skills and adequacy of patient care.

donor. Davis CL1, Delmonico FL.

J Am Soc Nephrol. 2005 Jul;16(7):2098-110. Epub 2005 Jun 1.

2) Expanding the live kidney donor pool: ethical considerations regarding altruistic donors, paired and pooled programs. Patel SR1, Chadha P, Papalois V. Exp Clin Transplant. 2011 Jun;9(3):181-6.

3) Robot-Assisted Laparoscopic Donor Nephrectomy vs Standard Laparoscopic Donor Nephrectomy: A Prospective Randomized Comparative Study. Amit Satish Bhattu, Arvind Ganpule, Ravindra B. Sabnis, Vinodh Murali, Shashikant Mishra, Mahesh Desai. J Endourol Dec. 2015: 1334-1340.

Trifecta and MIC as surrogate tools predicting renal function outcomes after partial nephrectomy Composite outcome measurement tools have been introduced to define quality of Partial Nephrectomy (PN) and standardize their reporting for comparison; most common tools are the “trifecta” and “MIC (margin, ischaemia, complication)”: the former identifies PN with no peri-operative complications, ≤ 25 mins of warm ischaemia time (WIT) and negative surgical margins, while the latter includes no major peri-operative complications, < 20 mins of WIT and negative surgical margins. Apparently, the differences between the two systems may appear small but cumulated small differences may identify different group of patients. This has been the case with a recent multicentric study where the two tools were tested as predictors for renal function changes after robotic or laparoscopic PN. The authors retrospectively reviewed the results from PNs performed on cT1 RCC patients who received a MAG3 test one to two weeks prior to surgery and three to six months post-operatively. 351 patients

Sources: Achievement of trifecta in minimally invasive partial nephrectomy correlates with functional preservation of operated kidney: a multi-institutional assessment using MAG3 renal scan. Zargar H, Porpiglia F, Porter J, Quarto G, Perdona S, Bertolo R, Autorino R, Kaouk JH. World J Urol. 2015 Nov 6. [Epub ahead of print]

Metastatic evaluation of castration-resistant prostate cancer As bone is the most common site for prostate cancer metastases, bone scans have played a central role in prostate cancer metastatic evaluation. However, recently there has been a growing awareness of the importance of visceral metastases. There is little published data regarding the prevalence of soft-tissue metastases although there has been a suggestion that new life-prolonging therapies may increase the rate. This matters as the median survival of men with visceral metastases is significantly shorter and also may influence treatment decisions. This study examined the prevalence of soft-tissue metastases at the diagnosis of mCRPC. Of 457 men with M0 CRPC with at least one imaging test 255 men developed evidence of metastases. Of which 232 were detected by bone scan or CT scan. Lymph nodes were considered metastatic if they were outside the pelvic region and greater or equal to 2 cm. Visceral metastases were any soft-tissue metastases excluding lymph nodes. All bone scans and CT scans within the 30 days before or after the diagnosis of mCRPC were reviewed. Then predictors of visceral and lymph node metastases were identified. Of the 232 men who had M0 CRPC and then developed metastases 114 (49%) had a bone scan

shared equal access regional cancer hospital database. Hanyok BT, Howard LE, Amling CL, et al. Cancer 2015 DOI: 10.1002/cncr.29748

Patient reported outcomes for hypofractionated radiotherapy for prostate cancer In prostate cancer the lack of head-to-head studies means that treatment choices are often affected by potential treatment related toxic effects. Patient reported outcomes (PROs) have been shown to detect treatment side-effects more reliably than do clinician reported measures and might be a better guide treatment decisions. This paper reports PROs from a quality of life sub-study with in the CHHiP trial. The CHHiP trial randomly assigned men with localised prostate cancer to a standard fractionation schedule or to one of two hypofractionated regimens. Men were eligible if they had histologically confirmed T1b–T3aN0M0 prostate cancer, an estimated risk of seminal vesicle involvement less than 30%, prostatespecific antigen concentration less than 30 ng/mL, and a WHO performance status of 0 or 1. Participants were randomly assigned (1:1:1) to receive a standard fractionation schedule of 74 Gy in 37 fractions or one of two hypofractionated schedules: 60 Gy in 20 fractions or 57 Gy in 19 fractions. Men with intermediate or high-risk disease received androgen suppression for three to six months before and during radiotherapy. UCLA Prostate Cancer Index (UCLA-PCI), including Short Form (SF)-36 and Functional Assessment of Cancer Therapy-Prostate (FACT-P), or Expanded Prostate Cancer Index Composite (EPIC) and SF-12 qualityof-life questionnaires were completed at baseline, pre-radiotherapy, 10 weeks post-radiotherapy, and


European Urology Today

January/February 2016

6, 12, 18, and 24 months post-radiotherapy. Analysis was on an intention-to-treat basis. The primary endpoint of the QoL substudy was overall bowel bother and comparisons between fractionation groups were done at 24 months post-radiotherapy.

months, 12-weekly to two years, six-monthly to five years, then annually. PSA was measured at every follow-up; further tests were at the clinician’s discretion. Toxic effects and symptoms were reported at regular follow-up visits.

2,100 participants consented to be included in the QoL substudy. All groups saw an increase in bother from bowel symptoms at 10 weeks, which had returned to the pre-radiotherapy scores by six months. At two years there was no difference in bowel symptoms as shown in the table below.

Zoledronic acid showed no evidence of survival improvement and should not be part of standard of care for this population

Overall bowel bother None Very small Small Moderate Severe

74 Gy in 37 66% 22% 6% 5% < 1%

60 Gy in 20 65% 22% 7% 6% < 1%

57 Gy in 19 65% 21% 9% 5% < 1%

Radiotherapy treatments need to balance the potential increased efficacy of biologically increased doses with the risk of increased side-effects The pattern for overall urinary bother was similar but the baseline incidence of overall sexual bother was higher 57% and increasing to 68% and failed to return to baseline.

2,962 men were randomly assigned to four groups between Oct 5, 2005, and March 31, 2013. 1817 (61%) men had M+ disease, 448 (15%) had N+/X M0, and 697 (24%) had N0M0. 165 (6%) men were previously treated with local therapy, and median PSA was 65 ng/mL (IQR 23–184). Median follow-up was 43 months (IQR 30–60). Of patients allocated to receive docetaxel as part of trial treatment, 456 (77%) patients assigned to SOC + Doc and 422 (71%) to SOC + ZA + Doc received the full six cycles, whereas 477 (81%) assigned to SOC + Doc and 446 (75%) to SOC + ZA + Doc received at least five cycles. When five or fewer cycles were reported, toxic effects were the most common reason for stopping Grade 3–5 adverse events were reported for 399 (32%) patients receiving SOC, 197 (32%) receiving SOC + ZA, 288 (52%) receiving SOC + Doc, and 269 (52%) receiving SOC + ZA + Doc. There were 415 deaths in the control group (347 [84%] prostate cancer). Median overall survival was 71 months (IQR 32 to not reached) for SOC-only, not reached (32 to not reached) for SOC + ZA (HR 0·94, 95% CI 0·79–1·11; p =0·450), 81 months (41 to not reached) for SOC + Doc (0·78, 0·66–0·93; p = 0·006), and 76 months (39 to not reached) for SOC + ZA + Doc (0·82, 0·69–0·97; p = 0·022).

In this QoL substudy PROs were not significantly different between treatment groups. The instruments used were sensitive because acute toxic effects were clearly distinguished using both individual items and bowel, urinary, and sexual domain scores. However, level of bowel and urinary symptoms were lower than Zoledronic acid showed no evidence of survival previously reported studies. improvement and should not be part of standard of care for this population. Docetaxel chemotherapy, Radiotherapy treatments need to balance the given at the time of long-term hormone therapy potential increased efficacy of biologically increased initiation, showed evidence of improved survival doses with the risk of increased side-effects. So far, accompanied by an increase in adverse events. these results show that the bowel and urinary Docetaxel treatment should become part of standard side-effects of moderate hypofractionation (3Gy per of care for adequately fit men commencing long-term fraction) for prostate cancer delivered with modern hormone therapy. radiotherapy techniques are low and similar to those of standard fractionation. Source: Addition of docetaxel, zoledronic acid or

Source: Hypofractionated radiotherapy versus conventionally fractionated radiotherapy for patients with intermediate-risk localised prostate cancer: 2-year patient reported outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Wilkins A, Mossop H, Syndikus I, et al.

both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive multiarm, multistage, platform randomised controlled trial. James ND, Syders MR, Clarke NW, et al, for the STAMPEDE investigators. Lancet 2015 DOI: 10.1016/S0140-6736(15)01037-5.

allografts pre-transplant, using just three senescenceassociated microRNAs combined with donor age and type of organ donation. These results demonstrate a relationship between pre-transplant microRNA expression levels, cellular biological ageing pathways and clinical outcomes after renal transplantation. Thus, a relatively simple quantitative molecular pre-transplant assay can be used to predict post-transplant allograft function, requiring, however, an allograft biopsy. The results also demonstrate the involvement of senescence pathways in ischemic injury during the organ transplantation.

Source: Identification of Molecular Markers of Delayed Graft Function Based on the Regulation of Biological Ageing. McGuinness D, Leierer J, Shapter O, Mohammed S, Gingell-Littlejohn M, Kingsmore DB, Little AM, Kerschbaum J, Schneeberger S, Maglione M, Nadalin S, Wagner S, Königsrainer A, Aitken E, Whalen H, Clancy M, McConnachie A, Koppelstaetter C, Stevenson KS, Shiels PG. PLoS One. 11(1):e0146378, 2016

Transplantation of extended donor criteria kidneys carries additional cardiovascular mortality for younger recipients The quality and age of donor organs have a major effect on patient and graft outcomes, but it is uncertain whether this association is uniform for all recipients. The authors aimed to determine whether the use of expanded criteria deceased donor (ECD) kidneys for transplantation, compared with standard criteria deceased donor (SCD) kidneys, had a different association with survival in younger (age < 60 years old) compared with older (age ≥60 years old) recipients. Using data from the Australian and New Zealand Dialysis and Transplant Registry (1997-2009), the risk of all-cause mortality and death with functioning graft among younger and older recipients who had received either an SCD or an ECD kidney were compared using the adjusted Cox proportional hazard models. In total, 3822 patients had been transplanted between 1997 and 2009. Over a follow-up period of 21,249 person-years (a median duration of 5.3 years [interquartile range, 2.22-8.6 years]), 567 recipients (n=385 for those age < 60 years old; n = 182 for those age ≥ 60 years old) died.

Lancet Oncology 2015; 16: 1605-16.

New standard of care for metastatic prostate cancer Long-term hormone therapy has been the standard of care for men with advanced prostate cancer since the 1940’s. A number of new drugs have been shown to be effective over the last 10 years in CRPC but this study enrolled men with newly diagnosed metastatic (M1), high-risk localised (with at least two of T3/4, Gleason score of 8-10 and PSA > 40 ng/ ml [N0]) or node positive (N+) or high-risk recurrent disease following previous local therapy. It used a multi-arm, multi-stage platform design to test whether the addition of treatments at the time of long-term hormone therapy initiation improves overall survival. Standard of care was hormone therapy for at least two years; radiotherapy was encouraged for men with N0M0 disease to November 2011, then mandated; radiotherapy was optional for men with node-positive nonmetastatic (N+M0) disease. Stratified randomisation (via minimisation) allocated men 2:1:1:1 to standard of care only (SOC-only; control), standard of care plus zoledronic acid (SOC + ZA), standard of care plus docetaxel (SOC + Doc), or standard of care with both zoledronic acid and docetaxel (SOC + ZA + Doc). Zoledronic acid (4 mg) was given for six three-weekly cycles, then four-weekly until two years, and docetaxel (75 mg/m²) for six three-weekly cycles with prednisolone 10 mg daily. There was no blinding to treatment allocation, as this was impracticable. Trial therapy was discontinued after disease progression or intolerable adverse events. Patients were followed up six-weekly to six

MicroRNA panel determined This study retrospectively in allograft biopsy can predict demonstrated an excess risk of delayed graft function all-cause mortality and death with functioning graft for younger The importance of microRNAs (miRNAs), a specific recipients of ECD kidney allografts subclass of small RNA, have been clearly demonstrated to influence many pathways in health and disease. Delayed graft function is a prevalent clinical problem in renal transplantation for which there is no objective system to predict its occurrence in advance. It can result in a significant increase in the necessity for hospitalisation post-transplant and is a significant risk factor for other post-transplant complications. To investigate the influence of miRNAs on renal allograft performance post-transplant, the expression of a panel of miRNAs in pre-transplant renal biopsies was measured using qPCR. Expression was then related to clinical parameters and outcomes in two independent renal transplant cohorts.

These results demonstrate a relationship between pre-transplant microRNA expression levels, cellular biological ageing pathways and clinical outcomes after renal transplantation It was demonstrated in two independent cohorts of pre-implantation human renal allograft biopsies that a pre-transplant renal performance scoring system (GRPSS) can predict the occurrence of DGF with a high sensitivity (> 90%) and specificity (> 60%) for donor

Recipient age was an effect modifier between donor types, all-cause mortality and death with functioning graft (P values for interaction were 0.05 and 0.04, respectively). In younger recipients, there was an excess risk of all-cause mortality (adjusted hazard ratio [HR], 1.55; 95% confidence interval [95% CI],

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1.23 to 1.97) and death with functioning graft (adjusted HR, 1.72; 95% CI, 1.28 to 2.29) after transplantation with ECD kidneys compared with SCD kidneys, but there was no statistically significant association among older recipients (adjusted HR, 1.11; 95% CI, 0.80 to 1.54 and adjusted HR, 1.30; 95% CI, 0.89 to 1.89, respectively). This excess risk was largely caused by death from cardiovascular disease. This study retrospectively demonstrated an excess risk of all-cause mortality and death with functioning graft for younger recipients of ECD kidney allografts. These findings strongly suggest that caution is needed in allocating ECD kidneys to younger recipients

Source: Mortality among Younger and Older Recipients of Kidney Transplants from Expanded Criteria Donors Compared with Standard Criteria Donors. Ma MK, Lim WH, Craig JC, Russ GR, Chapman JR, Wong G. Clin J Am Soc Nephrol. 11(1):128-36, 2016

Incidence of posttransplantation lymphoproliferative disease (PTLD) is above 3% Post-transplant lymphoproliferative disorder (PTLD) incidence is difficult to determine, mainly because both lesions may go unrecognised and unregistered. Few studies have included systematic pathology review to maximise case identification and decide more accurately PTLD frequency after long term post-transplantation follow-up. A retrospective population-based cohort study including all kidney transplant recipients at two Danish centres (1990 - 2011; population covered 3.1 million; 2,175 transplantations in 1,906 patients). Pathology reports were reviewed for all patient biopsies to identify possible PTLDs. Possible PTLD specimens underwent histopathological review and classification.

These findings indicate that the incidence of PTLD is rather higher than previously thought Seventy PTLD cases were identified in 2,175 transplantations (3.2%). The incidence rate (IR) after first transplantation was 5.4 cases per 1000 patientyears (95% CI: 4.0-7.3). Most PTLDs were monomorphic (58.5%) or early lesions (21.5%). Excluding early lesions and patients < 18 years, IR was 3.7 (95% Cl: 2.9-5.5). Ten PTLD patients were re-transplanted, two developing further PTLDs. Post-transplant patient survival was inferior in PTLD patients, while death-censored graft survival was not. These findings indicate that the incidence of PTLD is rather higher than previously thought.

Source: Post-transplant lymphoproliferative disorder following kidney transplantation: a population-based cohort study. Maksten EF, Vase MØ, Kampmann J, d'Amore F, Møller MB, Strandhave C, Bendix K, Bistrup C, Thiesson HC, Søndergaard E, Hamilton-Dutoit S, Jespersen B. Transpl Int. 2016 doi: 10.1111/tri.12744. [Epub ahead of print]

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Key articles

January/February 2016

European Urology Today


Role of Hungarian urology in Europe Impact and influence of pioneer Hungarian urologists Prof. Imre Romics Dept. of Urology, Semmelweis University Budapest (HU)

romics.imre@med. semmelweis-univ.hu

The urological department of Péter Pázmány University (known as Semmelweis University since 1968) was founded in 1920. Its first professor was Géza Illyés (Fig. 2) who was elected as member of the French Urological Society in 1908. In 1910 he became a member of the American Association of GenitoUrinary Surgeons, which even today has only few and selected members, and only very few Europeans. From the well-preserved guest book used from 1922 to 1939, 106 surgeons (f.i. Ch. Mayo) and urologists visited his department from the USA and more than one hundred others from other countries (Fig. 3).

When studying historical events, we ought to know the political, social and cultural background. And sometimes we have to be aware of the history of neighbouring countries as well. Hungarian “urology,” which was mostly crushing bladder stones, began in the 16th-17th century just 150 years after the Turkish-Ottoman troops left Hungary (1668). In this period Hungary was divided into three parts. The middle was occupied, the northern part was controlled by the Habsburgs, and Transylvania – the third part – was more or less independent.

Fig. 3: Ch. Mayo’s signature in the guestbook Fig. 6: 1st CEM in 2001, Budapest

In the 18th-19th centuries there was a prolonged struggle for independence, which peaked into the Revolution of 1848-1849. The Habsburgs defeated the independence movement with the help of the Russian Tsar. Retaliation followed the surrender: the prime minister and 13 generals of the Hungarian army were executed and thousands were imprisoned in Olmütz, Kufstein and Pest. Urology books In the 19th century there was a persistent movement for the official use of the Hungarian language in science, education and office. However, the first Hungarian urological book was written in German by Viktor Ivánchich, and published in Vienna in 1842. The topic of the book was treatment of bladder stones (Kritische Beleuchtung der Blasensteinzertrümmerung). The book is proof that the Hungarian language in the middle of 19th century was not totally accepted. Ivánchich was born in Pest, the first to be awarded the “venia legend” in Vienna. Michael Marberger stated several times that Ivánchich was the first urologist in Austrio-Hungary.

In Hungary we have had qualification exams for urology since 1924! And all the names of examinees are recorded! The first textbook of urology written by Illyés was published in 1930 in Hungarian, and in English in 1939. Urology has been a subject for medical students since 1936. Gyula Minder (1895-1982) was Illyés’s successor between 1942 and 1944 and founded the journal of Magyar Urológia (Hungarian Urology) in 1938 (Fig. 4). Minder fled to Switzerland in 1944.

Antal Babics (1902-1992) chaired the department from 1946 to 1974 and maintained excellent ties to Austrian and German urologists and was an honorary member of the Austrian and German Urology Societies. Professors P. Alken and M. Marberger visited him in Budapest. He was the Minister of Health during the Revolution of 1956.

Ferenc Balogh (1916-2004) succeeded Babics and was The result of the 1848-1849 war for independence was one of the founders of the EAU, and helped in organising the 1986 EAU Congress in Budapest (Fig. 5). the Austrian-Hungarian Compromise in 1867. The Habsburgs’ decision was also strongly influenced by their lost war in 1866 at Königrätz (today Hradec Kralové). From 1867 the Austro-Hungarian Empire (dualism) lived on until 1920.The price of the compromise was the Peace Treaty in 1920 in Paris. Hungary lost 73% of its territory and a third of the Hungarian population and the Austro-Hungarian Empire disintegrated. Pioneering urologists In all parts of the Habsburg Empire, and despite the political control, science and medicine developed. János Balassa (1818-1868) was professor of surgery of the university in Pest (Buda and Pest united in 1873). His main interest was the surgery of urogenital organs and he treated vesico-vaginal fistulas and urethral strictures. He applied the first ether narcosis in 1847, six months after it was introduced in Boston. In 1857 he founded the Hungarian journal of Orvosi Hetilap (Medical Weekly), considered the sixth oldest journal in Europe and which has been published uninterruptedly ever since.

Fig. 2: Géza Illyés


The first professor of Hungarian urology was Géza Antal (1846-1889) who is credited for constructing an aerourethroscope and who took intravesical photographs of bladder neoplasms (Fig. 1).

European Urology Today

Ottó Zuckerkandl (1861-1921) was born in Györ, Hungary. In 1912 he became the head of the Urology Department in Vienna and was the first president of Austrian Urology Society (1919), and founder and president of the German Urological Society. Róbert Ultzmann (1842-1889) was born in Kassa and studied in Vienna. He was the head of the Urological Department of the Wiener Allgemein Poliklinik, the first urological department in the German-speaking area.

Fig. 4: 1st issue of Magyar Urológia

Fig. 1: Aero-urethroscope

Imre Ullmann (1861-1937) born in Pécs, studied in Vienna. He dealt with the problem of renal transplantation and performed the first dog kidney transplantation in 1902.

Fig. 5: Book of abstracts EAU 7th Congress, Budapest

The author chaired the department between 1997 and 2012 and helped organise the 1st and 5th CEM in Budapest (Fig. 6). He also served the EAU as a member of the ESU Board, Scholarship Committee and Historical Committee. Romics helped organise the Association of Academic European Urologists (AAEU) Congress in 2010 in Budapest. Between 1997 and 2012, 240 visitors signed the guest book. He is an honorary member of EAU and urological societies of neighbouring countries (German, Slovakian, Czech, Polish, Romanian) and the Croatian Medical Association. Hungarian-born urologists Some urologists born in Hungary were Hungarian, but became known as Austrian or German urologists. József Grünfeld (1840-1910), born in Györke, was an active pioneer of endoscopy.

Sándor Lichtenberg (1880-1952) was born and studied medicine in Budapest. He first published on topics such as cystography and retrograde pyelography. He served in the Austro-Hungarian army in World War 1. In 1922 he became the head of the largest urological department in Berlin (St. Hedwig). He was the founder of the Zeitschrift für Urologische Chirurgie. In 1932 he returned to Hungary and worked in a private sanatorium until he left for Mexico in 1941. Without a doubt the French, German, Spanish, Italian, Polish and even Russian and urologists from other nations have all significantly contributed to the development of European urology. But we can modestly say Hungarian urologists have played a key and influential role in both international and European urology.

- 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 www.siu-urology.org 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 central.office@siu-urology.org

January/February 2016

Benefits of en-bloc membership for young doctors EAU-RSU links get boost from young urology recruits Prof. Igor Korneyev Chair Membership Office St. Petersburg (RU)

iakorneyev@ yandex.ru

The European Association of Urology (EAU) consists of more than 15,000 members in 2016, including certified urologists and urologists-in-training as well as scientists in urology and related specialties in Europe and beyond. The EAU provides active, junior and affiliate membership. These categories were also supplemented by a special “en-bloc” membership option, which is open for national urological societies interested in providing both national and EAU membership simultaneously. For this purpose, the EAU and the national societies sign a membership agreement, an option which has increasingly gained wide acceptance. Since 2015 the EAU offers membership to medical students, offering them a unique option to specialise in urology during the very first years of their medical career.

Professor Tkachook, chairman of the St. Petersburg Fedorov Urological Society, noted the long history of partnership with the EAU, which started in 1996 with the first EAU/EBU East-West Programme Symposium. For years, talented and career oriented young urological trainees have joined both the EAU and RSU to gain membership benefits. Thus, we recognised the practical advantages of offering combined EAU/ RSU membership status. There is continued interest from every generation of residents to avail of this membership, and this year we are happy to welcome medical students into the EAU-RSU bloc. There are strong academic traditions in medical universities in St. Petersburg to have elective training in medical specialties, particularly in urology. This new membership option provides the benefit of scientific and practical background for continuous education, starting early at medical school and lasting throughout their career in urology. Since both the EAU and RSU have share similar goals in providing the highest level of knowledge and professional skills, I expect our trainees to maintain their interest in having active membership in both associations even after they are certified.

Here are some comments by senior residents from our Ph.D. research programme:

the chance to meet faculty members and other European residents.

Irina Ananiy I appreciate en-bloc membership as the option for a strong medical information support both in Russian and European urology. Professional urology means being aware of new technical developments and new pharmacological options as well as the role of new evidence-based clinical data. The EAU is to be commended for its efforts to make available current and updated recommendations and opinions in key urological topics, which helps me in my daily practice.

Yuri Ignashov I have joined the EAU and RSU in 2014. This year I focus on my research while acquiring knowledge in specific areas. Every month I attend meetings of the Fedorov Urological Society to get the latest updates. My EAU membership status gives me the option to access a variety of materials published in European Urology. I participated in Annual EAU Congress in Madrid where I got in touch and shared ideas with European specialists also doing research in my field of interest. I wish I could present my paper at the annual EAU and RSU Congresses next year when it is ready.

Vladislav Yakovlev It is great to nurture partnership traditions with European profession, which has its origins back in the 18th Century, and this is reflected today through the en-bloc EAU-RSU membership initiative. Having access to opinion leaders’ reports, educational videos and reports, etc., significantly contribute to professional development. Another privilege of being a member of both associations is are the personal contacts made during the annual congress where I get

Students in Russia have also joined via the Junior en-bloc EAU agreement membership under the auspices of the St. Petersburg Fedorov Urological Society. The Junior en-bloc membership agreement between our scientific society, the second biggest affiliate of Russian Society of Urology (RSU), and the EAU was signed in 2013. EAU Membership Office

Junior EAU/RSU-St.Petersburg Fedorov urological society team together with their mentor - Prof. Tkachook (sitting)

Maria Potapova, first-year resident This is my first year after I have graduated from the Pavlov Medical University and joined the Department of Urology. Like other students interested in urology I attended and presented reports at elective seminars in urology and participated in clinical research programme together with the department faculty members. My senior colleagues use RSU and EAU databases (UROsource in particular) for updates in urology. This year I also joined these associations and I look forward to the EAU Congress in Munich. Yuri Kornienko, medical student I am a fifth-year medical student at the First Pavlov State Medical University in St. Petersburg. My father is a urologist and my goal is to become a urologist too. We had a 10-day urology course in our training programme and we visited a department of urology, examined patients and observed operations. I realised urology is much more comprehensive than what we have discussed in class. I joined the RSU and EAU in 2016 and want to learn more about urological care, establish contacts with students from other European medical schools, and be in the loop regarding scientific news and evidence-based data.

Apply for your EAU membership online! Featuring the Joint SIU-ICUD Consultation on Urologic Management of the Spinal Cord InjuredCongress Patient 36th the 36thofCongress of the and the 2nd SIU Nurses’ Educational Symposum Société Internationale d’Urologie

Société Internationale d’Urologie

Hilton Buenos Aires Hilton Buenos Aires

October 20–23, 2016

October 20–23, 2016 Why You Should Attend • SIU represents a close-knit community of international urologists, and the Congress features world experts presenting the latest and most relevant advancements in urology that YOU need to know about.

• Buenos Aires, known as the “Paris of Latin America”, is a vibrant, cosmoplitan, and stylish metropolis. • The condensed format of SIU Congresses gives you a one-of-a-kind opportunity for more high-quality interactions with leaders in urology.

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

Abstract Submission Deadline:

April 1, 2016

Becoming a member is now fast and easy!

www.siu-urology.org #siu16

SIU Academy reaches over 43,000 users. Are you ONE OF them?

Go to www.uroweb.org and click EAU membership to apply online. It will only take you a couple of minutes to submit your application, the rest is for you to enjoy! www.siu-urology.org

6018_SIU2016_EUT_Feb.indd 1

January/February 2016 Client: SIU 2016 Description:


European Association of Urology

15/01/2016 10:16 am

Docket number: 26-6018

File Size: Trim Size:

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European Urology Today



EUREP16 14th European Urology Residents Education Programme 2-7 September 2016, Prague, Czech Republic

www.eurep16.org Unique and exclusive training opportunity General information Participation and contribution This teaching programme has been developed and created exclusively for all European urological residents. The EUREP provides an almost complete update and overview of modern urological practice presented by a distinguished European faculty. The EUREP is an initiative of the European School of Urology in collaboration with the European Board of Urology. The written part of the FEBU exam (Fellow of the European Board of Urology) will take place at a later date in different cities throughout Europe. Further information will be available on www.ebu.org. Format The format is a full six-day course comprising five modules. Each day is made up of two sessions that last around seven hours. Morning sessions feature state-of-the-art lectures, while afternoon sessions offer interactive case discussions, video, and test-your-knowledge sessions. The hands-on-training sessions will take place around the modules. The training which is sponsored by Olympus helps the participants sharpen their skills and offers hands-on interaction with state-of-the-art equipment. Venue of the EUREP Meeting The EUREP will be organised in Prague, Czech Republic. The venue at the Clarion Congress Hotel provides excellent facilities and the four-star hotel has all the necessary facilities needed for both the scientific programme and social activities. Travel Arrival date: Thursday, 1 September 2016 Departure date: Wednesday, 7 September 2016 after the modules end.

Important information for applicants! European participants in EUREP no longer have their travel costs reimbursed. This means that all selected participants must pay for their travel to and from Prague. The EAU/ESU will continue to cover the cost of accommodation for European residents in a shared room as well as the cost of the course (incl. lunches, coffee breaks).

Preliminary programme 2016

Registration information

Module 1 Urological cancer

Important dates Online registration opens on 6 January 2016. The selection process will be made after the close of registration on 1 May 2016. A total of 360 participants will be selected. Participants will be notified by email if they have been selected. If selected, the deadline for cancellation is 1 August 2016 after this time a cancellation fee of €500 will be charged.

Testis & Penile cancer Treatment of localised and metastatic testicular cancer Treatment of localised and metastatic penile cancer Non-muscle invasive bladder cancer Diagnosis, staging and risk stratification Management of low, intermediate and high risk disease Upper urinary tract cancer

Selection criteria Registrations can only be submitted through the online registration system. The registration will only be considered complete if the registration is accompanied by: • A letter from the head of department indicating the date that the participants training will end • A copy of your passport

Muscle invasive bladder cancer Surgical and non-surgical treatment options Neoadjuvant and adjuvant chemotherapy

As an essential part of the European Urology Residents Education Programme (EUREP) in Prague, intensive hands-on training will be delivered. This year's programme consists of hands-on interaction with state-of-the-art equipment in laparoscopy, ureteroscopy (URS) and transurethral resection (TUR) -all of which sponsored by Olympus. The workshop provides the participants with a unique opportunity to train basic techniques with complex training models and under expert supervision. Thanks to the intense tutoring scheme -with a personal tutor per training station- a fast learning effect can be expected. The courses in laparoscopy are specifically designed for individuals with minimal or no prior experience in laparoscopic suturing. Tutors will, of course, gladly adapt tasks for more experienced individuals. Basic techniques will be trained in a dedicated step-by-step programme including Scientific secretariat ESU Office 16

European Urology Today

F. Liedberg (SE)

M. Roupret (FR)

Renal cancer Diagnosis and management Treatment of localised renal cancer Management of locally advanced and metastatic disease

Module 2 Prostate cancer and BPH Prostate cancer Screening, early detection and staging Treatment for localised disease Active surveillance, surgical treatment, radiation, focal therapy Locally advanced and metastatic prostate cancer Treatment of castration resistant prostate cancer and new agents

Additional criteria 1. EAU membership. Priority is given to those who are or become a member before the registration deadline 2. Year of training. Priority is given to residents in their final year of training (i.e. training should be finished before September of the following year based on the information received from the proof of status) 3. It is required to obtain CME credits by completing European Urology multiple choice questions (MCQ’s). For further information please check www.eurep16.org 4. First come – first served 5. English skills 6. Target per country 7. It is only allowed to attend the EUREP course once

M. Graefen (DE), A. Briganti (IT) Chair

A. De La Taille (FR) S. Joniau (BE)

BPH Medical treatment BPH BPH: surgical treatment

Module 3 Andrology, stones and upper tract endourology Andrology Physiopathology diagnosis and treatment of erectile dysfunction Penile curvature Priapism and metabolic syndrome Male infertility diagnosis and treatment Surgery for male infertility and vasectomy Male hypogonadism

For further detailed information regarding the registration rules for the 14th EUREP course we strongly recommend that you visit www.eurep16.org

Stones Aetiology, management and prophylaxis of urolithiasis ESWL treatment of urolithiasis Percutaneous and open surgery

Registration non-European residents If you are a non-European resident that is interested in taking part in the 14th EUREP course please go to www.eurep16.org for the rules and regulations regarding participation.

G. Dohle (NL), Chair

E. Liatsikos (GR)

I. Moncada (ES)

O. Traxer (FR)

Upper tract endourology Stents in the urinary tract Ureteroscopic stone manipulation Endourology in UPJ obstruction

Module 4 Functional urology Essential terminology Initial assessment Fundaments of urodynamics Stress urinary incontinence and pelvic organ prolapse Overactive bladder Reconstruction and diversion Assessing the neuropathic patient General management of the neuropathic patient Post-prostatectomy incontinence Complex issues; pain, fistula and mesh exposure

Hands-on-training workshops Sharpening Your Skills: TUR, URS, and Laparoscopy

O. Hakenberg (DE), M. Hora (CZ) Chair

intracorporeal suturing depending on individual skill level. The training curriculum for the ureteroscopy workshop is designed by Prof. Olivier Traxer of Tenon Hospital, Paris. Residents will learn about the proper use of flexible ureteroscopes using a variety of stone disposables in order to remove kidney stones. The course in transurethral resection of the prostate gives residents the great opportunity to learn more about the basics of high-frequency surgery, the instruments needed, as well as tips and tricks for daily surgery.

P. Radziszewski (PO), Chair

J. Heesakkers (NL) G. Kasyan (RU)

J. Khastgir (GB)

Module 5 Paediatric urology, trauma and infection Paediatric urology Essentials of obstructive uropathy Congenital malformations of the external genitalia Infections Urinary tract infections

C. Radmayr (AT), H. Abol-Enein Chair (EG)

G. Bogaert (BE)

F. Wagenlehner (DE)

Trauma Diagnosis and management of kidney, bladder and urethral trauma

Participants can only participate in 1 session Lap plus a TUR or URS. Places for URS and TUR are limited. More information about the different training modules can be found at www.eurep16.org The hands-on-training workshops are sponsored by an unrestricted educational grant from:

T +31 (0)26 389 0680 F +31 (0)26 389 0674

“If you meet the criteria we would encourage you to register for this opportunity, “ Prof. Palou, course director

eurep@uroweb.org January/February 2016

Masterclass on Female and functional reconstructive urology Participants gain insights from comprehensive, insightful masterclass Dr. Frank Martens Radboudumc Dept. of Urology Nijmegen (NL)

experts gathered during the session, it was apparent that solutions were not always easy to identify, but the discussion also showed that there are possible alternatives.

Since the pelvis is made up of several organs, especially in the female, a multidisciplinary approach is mandatory. Dr. Dieter Hahnloser (CH), an anal-rectal surgeon, showed the possibilities and Frank.Martens@ challenges in managing fecal incontinence and radboudumc.nl constipation. He emphasised the role of effective collaboration since many patients who consult The 8th ESU Masterclass on Female and Functional urologists also suffer from complaints that affect Reconstructive Urology was held in November last other structures in the pelvis (and vice versa) and year in collaboration with the EAU Section of Female treatments and their effects can be conflicting. But it and Functional Urology (ESFFU). Course directors was also demonstrated that treatment managements Dr. John Heesakkers (NL) and Prof. Dirk de Ridder (BE) don’t necessarily have to come into conflict, but can selected 35 participants out of almost twice as many also act synergistically when physicians are aware of applicants for this three-day course in Berlin, which the multi-organ origin and consequences for each was supported by a medical educational grant from structure or compartment in the pelvis. Pfizer. Several clinical experts presented diverse topics in this interactive masterclass where all participants were encouraged to discuss the presentations, videos and cases. The presented cases were not only complex and challenging, but also showed practical and clinical tips and tricks. Dr. Ajit Vaze (IN) opened the first session on female stress incontinence. After an overview of definitions, classifications and decision-making, Prof. Dirk de Ridder presented the conservative and surgical management of stress incontinence. The EAU Guidelines for these treatments were presented, particularly on how to implement these guidelines in daily practice. In another session on male incontinence, the pro’s and con’s, do’s and don’ts were discussed by the faculty members and participants. Dr. Vaze and Prof. David Castro Diaz (ES) also discussed managing complications. Despite the

treatments, including sub-topics such as the neurogenic patients, the elderly and refractory OAB. He emphasised the difficulties in developing definitions and that consensus is needed to come up with definitions. Since clear definitions where there is common agreement among experts and practitioners are still lacking the challenge remains and certainly the debate or discussion will continue.

participants which made the session truly interactive and very insightful with regards to practical implementation.

During a session on chronic pelvic pain, Fiona Burkhard (CH) examined the field of reconstructive urology, such as diversion surgery for functional reasons, urethral diverticula and fistula. Several faculty members also contributed to the discussion of these topics.

Also, one can become an ESFFU affiliate to become a part of a community of experts and young specialists. We can all benefit from this network to exchange knowledge and experience. If you are an active EAU Member and you would like to actively contribute to the work of the ESFFU, you can submit an associate member application.

Almost all faculty members were always present to share their experience during presentations of other faculty members. They also showed a great interest in the cases which were prepared and presented by the

To urologists with an interest in female urology, reconstructive urology and neuro-urology, I can recommend this very comprehensive and insightful masterclass.

For more information on Affiliate and Associate roles, contact Angela Terberg, EAU Section Office at a.terberg@uroweb.org or call +31 (0)26 3890680.

"...selected 35 participants out of almost twice as many applicants for this three-day course in Berlin..." Challenging debates Several sessions concerning the middle compartment of the pelvis, including female sexual function and pelvic organ prolapsed, were enthusiastically discussed with the participants by Prof. Elisabetta Costantini (IT), Dr. Vaze and Prof. De Ridder. They showed their own clinical experience using videos. Discussions on whether to use mesh or not and how to classify and manage frequent or compelling complications extended well after the session. Prof. John Heesakkers discussed the overactive bladder (OAB), clinical decision-making and

Faculty and participants of the Masterclass on Female and functional reconstructive urology November 2015

ESU Bladder cancer course Lively discussions on management in Greece bladder preservation strategies for muscle invasive bladder cancer. He presented the results of recent studies and highlighted the significant early and long-term morbidity associated with radical cystectomy. He also underscored the need for alternative treatment Prof. M. Babjuk options that might reduce morbidity while preserving oncological outcomes. He sountp@hotmail.com also pointed out the importance of identifying patients that are unfit for surgery and also A European School of Urology (ESU) Course, held last emphasised the benefit of neoadjuvant chemotherapy 7 November 2015, formed part of the 10th Congress of for a cohort of bladder cancer patients. It was clear the Urological Association of Northern Greece. With from his presentation that there are patients that will bladder cancer as topic the ESU faculty included benefit from a tri-modality treatment approach using Professors Maurizio Brausi, Marek Babjuk and local TUR with bladder biopsies or partial cystectomy faculty Dr. Kyriakos Moysidis. together with radiotherapy and chemotherapy regimens. Around 100 congress participants attended the course which went on for more than the allotted three hours Prof. Brausi presented an overview of the current due to the enthusiastic discussions. Prof. Babjuk indications and approaches to radical cystectomy and examined the current EAU Guidelines on non-muscle showed a very informative video clip of tips and tricks invasive bladder cancer (NMIBC) and highlighted in radical cystectomy. He underlined the importance recent developments in the diagnosis and of the “fast-tract” pathway in the management of management of NMIBC. patients after radical cystectomy with early mobilisation and diet to avoid complications. Prof. Brausi gave an update on the principles of TUR of bladder The course ended with Dr. tumours. He underlined the Moysidis presenting the case of a clinical significance and patient who had radical repercussions of a “lege artis” cystectomy and suffered serious initial TUR in the accurate staging, postoperative complications. The as well as in the recurrence rates case triggered a lively discussion of bladder tumours. He also between the audience and the Prof. M. Brausi pointed out that although TUR is Dr. K. Moysidis faculty that lasted even after the one of the earlier procedures taught to urology course. residents, they should be supervised by senior urologists while performing TURBTs since the Overall it was an exciting course with excellent, surgeon’s experience is of crucial importance in the focused presentations that were very well received procedure’s oncological efficacy. by all participants. It is a pleasure to host an ESU course, the first ever to take place during our Following the break, Prof. Babjuk analysed the congress, and we thank the ESU faculty for their current indications for and the therapeutic yield of time and effort. Dr. Petros Sountoulides Secretary General 10th Congress of the Urological Association of Northern Greece (GR)

January/February 2016


9th ESU Masterclass on Female and functional reconstructive urology In collaboration with the EAU Section of Female and Functional Urology (ESFFU)

17-18 November 2016, Berlin, Germany EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations

European Urology Today


Who’s Who in the Board of the European School of Urology Ben Van Cleynenbreugel: Future training will be multi-disciplinary By Joel Vega

training challenges that I encounter in my clinical work.

The European School of Urology (ESU) is running an interview series with its board members to share the insights of its board members on various issues such as the role of technology, future prospects in urology, training and education, among others.

Q: How do you see the future of education and urology? Van Cleynenbreugel: Professional training in urology will certainly involve the collaboration of many urological sub-specialities or disciplines. The ESU has anticipated or expects these collaborations to further develop or expand in the future, which means that as educators we have to look beyond our own specialities and beyond the traditional classroom training. We are already seeing the crucial role of digital-based learning programmes which offer distinct advantages in a region as far-reaching and diverse as Europe.

Board member Dr. Ben Van Cleynenbreugel has been serving the ESU Board for several years and shared his thoughts regarding challenges in education and training in urology. Below is a transcript of the Q&A interview with Dr. Van Cleynenbreugel: Question: Can you tell us a bit more about your background, specialty and experience? Van Cleynenbreugel: I completed my medical education and training in urology in 2000, and at the UZ Gasthuisberg I specialised in endoscopy, laparoscopy and robot-assisted surgical procedures, in particular procedures that involve the upper urinary tract. This includes a whole range of interventions such as TURP, TURP, (flex) URS, PCNL, pyeloplasties, partial nephrectomies and nephroureterectomies, among many others. My clinical work prompted me to further concentrate on learning surgical skills and how specialised training can help urologists avoid complications by going through certified surgical training courses. With my former mentor and the encouragement of the former director of the European School of Urology (ESU), Prof. Hein Van Poppel, I got the opportunity in 2006 to lead the laparoscopic hands-on training during the annual EUREP, one of the frontline teaching activities organised by the ESU. Four years

Dr. Ben Van Cleynenbreugel, ESU Board Member

later (until 2014 ) I coordinated the training. The initial six laparoscopic training stations were gradually expanded to 15, and seven more endoscopic training stations were eventually added, three for TUR, and four stations for URS. Q: What are your goals for the European School of Urology? Van Cleynenbreugel: With my work in the ESU’s minimally invasive training curriculum, we eventually developed the e-BLUS programme in collaboration with the EAU Section of Uro-Technology (ESUT). This programme was also the basis or constituted the core of the “training in urology group” developed in

Nijmegen, The Netherlands. The e-BLUS programme and exams, which systematically assess the laparoscopic skills of trainee surgeons, are now being offered and introduced in several countries.

New training systems need to be continually developed, updated or be made responsive to the technologies of today or in the future. This is a constant challenge for educators and mentors and in surgery, skills refinement and training certainly have a crucial role in reducing morbidity and complication rates. Q: In a high-pressure career as a specialised surgeon and educator, how do you find time for family and recreational activities?

Based on the success of this programme, we created the “ESU Training & Research Group” where I serve as Van Cleynenbreugel: One needs to set aside quality chairman. In collaboration with the EAU Section on time for family, not only out of responsibility but also Urolithiasis (EULIS) and ESUT we are developing a to find the necessary energy for one’s work. One training curriculum for endoscopy and laparoscopy. needs to re-charge every now and then after a week or days of constant work. Q: What is your role in the ESU board? Van Cleynenbreugel: Within the ESU Board I focus on hands-on training programmes, aside from the

I am happily married and the proud father of a six-year-old girl. In my free time I enjoy my motor bike and recreative shooting.

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 • A tool-kit for practising evidence based urology • 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 • Update renal, bladder and prostate Guidelines 2016, What is changed? • 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 • Basic laparoscopic training • Suturing and knotting (Anastomosis) Robot • Introduction to robotic surgery Diagnostics and follow-up • Urodynamics • Fluorescence imaging • MRI Fusion biopsy Functional urology • Women's health SUI • OnabotulinumtoxinA administration for OAB • Sacral neuromodulation Endoscopy Lower • TUR (b/p) • Enucleation techniques • Laser vaporisation • HoLEP Upper • URS semirigid and flexible ESU Social media training

January/February 2016

ESU to offer successful ICG course in Munich congress ICG course in Turkey examines intraoperative imaging with ICG Assoc. Prof. Cenk Acar Eryaman Hospital Dept. of Urology Ankara (TR)

drcenkacar@ gmail.com The European School of Urology (ESU) endorsed the first laparoscopic animal hands-on training course on Indocyanine Green (ICG) in urology, held in Istanbul last 10 September 2015. The training took place at the Acibadem University’s Center of Advanced Simulation Education (CASE) which is equipped with high-tech endoscopic and robotic surgery training laboratories. Based on the success of this course, a new ESU Hands-on training course on ICG will be offered in Munich during the 31st EAU Annual Congress. The 60-minute ESU course will train participants on the basics of the ICG procedure. Intraoperative fluorescence imaging and tissue interrogation during urologic surgery has become one of the most popular topics in recent years. Injecting the fluorescent material to circulation or a specific

The trainers and trainees in Istanbul

tissue seems to be the best method to visualise the relevant anatomy in near-infrared spectrum. Today, fluorescence imaging is mainly done in partial nephrectomy and prostate sentinel node dissection in urology. It is apparent that intraoperative fluorescence imaging facilitates the quality of minimal invasive surgeries (MIS). Therefore, it prompts surgeons to adapt these kinds of technologies and enable them to improve their surgical skills to achieve perfection.

Acibadem University CASE wet laboratory, Istanbul

Eight participants from the Middle East and Turkey attended the one-day training course in Istanbul. The main topics were partial nephrectomy, bowel interposition and perfusion and prostate sentinel lymph node dissection. The Minimally Invasive Urology Association and Turkish Uro-oncology Association members (Levent Turkeri, Cenk Bilen, Cag Cal and Cenk Acar), Emre Balik from Koc University’s Department of General Surgery, Henk Van Der Poel of the Netherlands Cancer Institute-AVL hospital and Nynke Van Der Berg from Leiden University gave lectures and shared their experience during the hands-on training on ICG. The course was meant for urologists who have intermediate, advance laparoscopic experience, and are interested to gain their first experience with ICG

Teaching activities 2016 European School of Urology February 2-5 13-16

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

March 11-15

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

April 22

May 20-21 28

ESU course on Bladder cancer at the national congress of the Ukrainian Urological Association, Kiev (UA)

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

September 2-7 14-16 23

Vascular network and perfusion of bowel with ICG

on animal models. Participants gained five hours of hands-on training, with the tutors supervising the ICG procedure and the various steps of urologic surgeries. In the morning, lectures on optical and chemical properties of ICG were summarised and the surgical steps of partial nephrectomy and ICG in partial nephrectomy were discussed.

establish the sentinel lymph node dissection training model, prostate dissection, ICG injection in prostate and visualisation of pelvic lymph nodes and lymphatic pathways were successfully performed on pigs.

"...animal models should be the first step in learning the proper skills for intraoperative imaging in urology."

Both trainees and trainers gave a lot of positive feedback. One of the trainees mentioned the course was very useful to refine one’s skills with technological innovations, especially for partial nephrectomy, which reduces the surgeon’s stress during resection and renography. These positive comments indicated that it was a successful course.

The trainees also used the ICG in laparoscopic partial nephrectomy with STORZ D light-P HD fluorescence system, supervised by their mentors. Selective arterial clamping and defining avascular parenchyma with different amounts of ICG injections were performed on pigs. In the theoretical session, tips and tricks of bowel segment interposition for urinary diversion during radical cystectomy were clearly explained from a general surgeon’s perspective.

Moreover, the course showed the importance of learning ICG-based fluorescence imaging using animal models. It also appears that the interest on intraoperative imaging of urology will increase in the future. Today, robotic systems with fluorescence technology are attracting urologists who are interested in using ICG. However, laparoscopic fluorescence imaging seems feasible only in some countries due to the high costs of robotic surgery. It should be noted that animal models should be the first step in learning the proper skills for intraoperative imaging in urology.

During the hands-on training, bowel vascular network evaluations with ICG and endostapler application in intestinal anastomosis were carried out on pigs. In the last session, laparoscopic lymphadenectomy, the concept of sentinel lymph node dissection and the emerging applications of ICG were discussed. To

To reiterate, the next hands-on training (HOT) course on ICG-guided surgery will be in Munich during the EAU Annual Congress from March 11 to 15. The 60-minute course aims to raise awareness regarding intra-operative fluorescence imaging. It will include presentations and training using a phantom set-up.


ESU - Weill Cornell Masterclass in General urology 26 June-2 July 2016, Salzburg, Austria

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

June/July 26 – 2

Different modes of Storz D light –P fluorescence system in partial nephrectomy on pig

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

Register Now!

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 national congress of the Armenian Urological Society, Yerevan (AM)

October 4-8 tbd

3rd Confederación Americana de Urologia Residents Education Programme (CAUREP), Panama City (PA) ESU course at the 23rd Panhellenic Urological Congress, Kyllini – Ileia (GR)

November 3-4 17-18 24-27

3rd ESU Masterclass on Lasers in urology, in collaboration with the EAU Section of Uro-Technology (ESUT), Barcelona (ES) 9th ESU Masterclass on Female and functional reconstructive urology, in collaboration with the EAU Section of Female and Functional Urology (ESFFU), Berlin (DE) ESU courses at the 8th European Multidisciplinary Meeting in Urological Cancers (EMUC), Milan (IT)

Contact: esu@uroweb.org

January/February 2016

European Urology Today



3rd ESU Masterclass on Lasers in urology


In collaboration with the EAU Section of Uro-Technology (ESUT)

3-4 November 2016, Barcelona, Spain EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations

A unique opportunity to train with international experts in laparoscopy The European training in basic laparoscopic urological skills (E-BLUS) is a first-rate programme offered to residents and urologists who want to improve their basic skills in laparoscopy. Because of the growing need for international standardisation in urological skills, the E-BLUS course can be attended during the Annual EAU congresses as well as several national and international society meetings in and beyond Europe. The E-BLUS courses are designed to cater to the specific needs of the participants and represent a unique opportunity to

train with international experts in laparoscopy. The E-BLUS programme includes: • Hands-on training (HOT) sessions of different levels carried out under the guidance of experienced tutors. • A set of training-box exercises developed and validated by the Dutch project Training in Urology (TiU) to train basic skills needed in urological laparoscopy. • E-BLUS examination and certification. • An online theoretical course.

Interested to participate in the E-BLUS course during the 31st Annual EAU Congress in Munich? Send an email to e-blus@uroweb.org Interested to offer the E-BLUS course during your national or international event? Send an email to e-blus@uroweb.org


European training in basic laparoscopic urological skills

No one succeeds alone. We are proud to be a part of a hard-working, dedicated community. We know and understand the importance of collaboration, of sharing and building on the ideas of others. That’s why we’re expanding into social media platforms so that we can increase interaction with and within the community.



European Urology Today

european urology Forward faster. Together.

european urology

January/February 2016

European Urology Forum 2016 Challenge the experts



13-16 February 2016, Davos, Switzerland Threat of urological infections at “Challenge the Experts” The growing incidence of urological infections has nowadays increasingly been at the forefront of research and the concern is justified considering not only the alarming rate of occurence but also the severity of infections and their impact on a patient’s quality of life. At the upcoming 25th European Urology Forum to be held in Davos, Switzerland from 13 to 16 February, the issue of urological infections will take centre stage during the “Challenge the Experts” sessions with Dr. Béla Köves (Budapest, HU) presenting a series of lectures on recurrent urinary tract infections (UTI), catheter-associated UTIs and multi-resistant infections due to prostate biopsies.

Koves also noted that regarding research, the increase of antibiotic resistance remains a very serious threat. “A better understanding of the pathogenesis and molecular genetic background of urinary tract infections is of utmost importance,” he said. In other areas he mentioned that nocturia is also a common problem with a very negative impact in the patient’s quality of life.

“In our era of antibiotic resistance urological infections represent one of the biggest threats to urological communities all around the world, so it is important to talk about this issues,” said Koves.

“The topic of nocturia, its correct diagnostics and management is also under-represented in urological lectures and discussions,” he said.

“The Challenge the Experts session is a very good opportunity to highlight this growing problem. The lectures about recurrent urinary tract infections, catheterassociated infections and the infections caused by prostate biopsies are all relevant topics covering the the most frequent problems encountered by any urologist,” he added.

Koves is one of five presenters invited by the European School of Urology (ESU) who will participate in the sessions which test the participants’ expertise on their chosen topics. The other participants are JeanNicolas Cornu (Rouen, FR), Marcel Fiedler (Heilbronn, DE), Miguel Ramirez-Backhaus (Valencia, ES) and Anna Katarzyna Czech (Krakow, PL). Topics selected by the presentors ranged from reconstructive surgery,

Registration is still possible! functional urology, uro-oncology to minimally invasive procedures, among others. Now on its 25th edition, the European Urology Forum is one the longest-running scientific and educational events organised by the ESU for mid-career urologists with special focus on discussing major and controversial issues in various urological specialities. Combining state-of-the-art sessions, case studies and the “Challenge the Experts,” the programme provides a a critical update not only on what’s new in urology but also the impact on current treatment procedures, management strategies and future prospects in both medical and surgical therapies.


1st ESU-ESUT Masterclass on Operative management of Benign Prostatic Obstruction 20-21 May 2016, Heilbronn, Germany

To meet the challenge of providing optimal surgical management of Benign Prostatic Obstruction, the European School of Urology (ESU) and the EAU Section of Uro-Technology (ESUT) will offer the 1st ESU-ESUT Masterclass on Operative Benign Prostatic Obstruction in Germany. This new two-day masterclass from 20 to 21 May will be held in Heilbronn and aims to provide a comprehensive theoretical and practical knowledge and skills training on the surgical management of BPO, particularly minimally invasive techniques recently introduced and incorporated in current guidelines. The programme will cover theory, tips and tricks on various types of TURP, enucleation techniques, pre- and intra-operative management, post-operative care and two modules on skills training using hands-on models and actual instrumentation. We name you 3 reasons not to miss this masterclass! Expert Insights and Practical Tips New minimally invasive procedures in Benign Prostatic Obstruction require expert insights on best practices.

January/February 2016

With both theoretical and practical sessions, participants gain a comprehensive knowledge on basic and advanced techniques. Individual Mentorship at Hands-on Training Two modules on instrument handling and hands-on training with dedicated stations enable our mentors to provide individual guidance and skills assessment. Learn basic skills or refine your techniques through tailored, step-by-step training procedures. Interactive Discussion and Live Surgeries The masterclass aims not only to provide training on the most essential minimally invasive techniques but also looks for ideas and feedback. Using experience from live surgeries and recordings of actual cases, discussions are geared to trigger critical assessment or stimulate new approaches Experts from across Europe and dedicated trainers and mentors will help participants practice and refine their skills.

Visit esubpo16.org and apply now!

European Urology Today


Young Urologists/Residents Corner ESRU strategy on social media Dr. Juan Gómez Rivas Internal Coordinator, ESRU Chairman of RAEU Madrid (ES)

juangomezr@ gmail.com Social Media (SoMe) includes a large spectrum of public platforms like Twitter, Youtube or Facebook that have changed the way how humans interact and communicate.

and links from web pages or videos. Twitter is growing at extraordinary levels in urology and the unquestionable advantages are: to follow publications, journals, renowned urologists, create discussion groups and forums on topics of interest in urology; and 4. Encourage NCOs to interact with ESRU SoMe.


Since this strategy was taken, ESRU’s presence in SoMe have increased considerably. Here are the numbers (as of this writing):

Figure 1: SoMe platforms

Facebook: a) Likes: More than 830. An increase in more than 200 likes since March 2015. b) Fans: ESRU have fans from all over the world from Africa to America (Figure 2) c) Reach: an average post reach between 200-300 people.
















• Openness and disclosure: Showing what is going Belgium 35 on in ESRU; • Access: Showing availability for fans to reach and Saudi Arabia 21 interact with ESRU; Russia 18 We are currently experiencing an explosion in the use • Networking: Showing shared interests with of SoMe in the areas of health and urology because followers and fans; SoMe offers clear advantages for communication, • Sharing of tasks: Collaboration with followers and Figure 2: Where do our Facebook fans come from? Figure 3. Where do our Facebook fans come from? information sharing, enhancing experience of Twitter @ESRUrology: fans to solve problems of mutual interest; meetings and conferences as well for networking. a) Followers: More than 900 in less than one year. • SoMe survey: in collaboration with GeSRU and Country % (Figure 1). Since March 2015, the European Society of Third account in followers of the EAU after the RAEU, ESRU designed a survey to assess the Residents in Urology (ESRU) has opted for a new EAU itself (@Uroweb) and ESRUS (@ influence of SoMe on urologic knowledge Spain 14 % SoMe strategy to have more visibility through their ERUSrobotics). acquisition among young urologists across members. This strategy includes: b) Tweets: More than 3,800. Second account in tweet Europe. The survey was completed with more United States 13 % activity after @Uroweb. than 315 responders and the results are United Kingdom 12 % 1. To have a SoMe manager: In our Board meeting c) Follower’s nationality: once again as shown in surprising. We expect to present them soon. in Madrid 2015 the new position of Internal Facebook, @ESRUrology is a an account followed France 6% Coordinator in ESRU was created who will be in world-wide. (Figure 3) ESRU has the commitment in 2016 to keep working charge of SoMe, resident´s database and d) Impressions: an average of 650 per day. with all EAU offices to increase their and our presence Italy 6% communications between the Executive e) Influencers: We were “Top influencers” in in SoMe and we also hope to get more than 1,000 Turkey 5% several EAU meeting during this year such as Committee and NCOs; likes / followers in Facebook and Twitter during the #SEEM15, #CEM15, #ESURSBUR15, #EMUC15, 2. Increase our presence in Facebook: Nowadays, Annual EAU Meeting in Munich. #EAU16. Germany 4% #ERUS15 and #EULIS15. Also, in during the four persons are in charge of ESRU´s Facebook Urology Week campaign (#urologyweek) and publications (all members of the Executive From the ESRU Executive Committee we thank the Netherlands 3% #Movember. Committee) and this has led to expand the EAU Young Urologist office (@eauyoungurology) contents in this platform; which encouraged us to get into Twitter and also the Canada 2% 3. Open a Twitter account: Twitter is a microblogging How to get better in SoMe? EAU (@Uroweb) for their support in SoMe, Belgium 2% The strategies presented during our board meeting in particularly in Twitter, and this support includes platform launched in 2006 with 560 millions of Prague 2015 for better @ESRUrology presence in users in 2015, where you can type a text of < 140 following us, retweeting, mentions and joining our Figure 3: Where do our followers on twitter come from? characters, which can be associated with images SoMe included: conversations. Figure 3. Where do our Twitter followers come from?

Preparing for the EBU exam Spanish Association of Urology’s senior residents participate in training course Leonardo Tortolero Scientific Activities Manager Spanish Residents and Young Urologist Workgroup Vigo (ES) leotor85@gmail.com

Marco Ciappara Spanish Residents Young Urologist Workgroup Board Member Madrid (ES)

Dr. Juan Gomez Rivas, chair of the residents and young urologists workgroup of the AEU (RAEU), introduced the course with a talk about the origins of the RAEU, the AEU’s services for residents and the RAEU’s major projects such as the urological urgencies on-line course, surgical atlas app, the programme for the Resident's Day in the next National Spanish Congress of Urology to be held in June 2016 in Toledo, the RAEU’s social media activities, and the development of training surveys, to name a few. The course for final-year residents included state-ofthe art lectures on major urology topics (oncology, lithiasis, functional urology, pediatric urology, transplantation, andrology and BPH) with emphasis on scientific evidence and the importance of a thorough knowledge of the EAU guidelines to achieve optimal management of patients in everyday clinical practice. Also noteworthy was the atmosphere during the meals and dinners organised during the course,

ciappara.marco@ gmail.com

Martes, 17 de noviembre Miércoles, 18 de noviembre 8:30 – 8:45

Inauguración Junta Directiva AEU

8:45 – 9:30

Cáncer de riñón J.M. Cózar

9:30 – 10:00

Caso clínico: Cáncer de riñón metastásico R. Llarena

8:30 – 9:15

HBP Tratamiento médico J. Carballido

9:00 – 9:30

HBP Tratamiento quirúrgico A. Rodríguez

9:30 – 10:00

10:00 – 10:15 Pausa café 10:15 – 11:00 Cáncer de próstata localizado B. Miñana 11:00 - 11:45 Cáncer de próstata localmente avanzado y metastásico M. Unda 11:45 – 12: 15 Caso Clínico: Cáncer de próstata resistente a la castración J.L. Álvarez Ossorio 12:15 – 12:30 Pausa café 12:30 – 13:00 Cáncer Testículo J. Burgos 13:00 – 13:30 Troncalidad en Urología L. Prieto Chaparro 13:30 - 16:00 Almuerzo 16:00 - 16:45 Cáncer de Vejiga no Músculo Infiltrante J.M. Fernández 16:45 – 17:30 Cáncer de Vejiga Músculo Infiltrante M.J. Ribal

Caso clínico HBP A. Gómez

10:00 – 10:15 Pausa café 10:15 – 11:15 Litiasis. Tratamiento médico C. Reina 11:15 –11:45

Litiasis. Tratamiento quirúrgico J.H. Amón

11:45 – 12:15 Caso clínico: Litiasis A. Serrano 12:15 – 12:30 Pausa café 12:30 – 13:30 Traumatismos genitourinarios L. Martínez Piñeiro 13:00 – 13:30 Caso clínico: Traumatismo uretral C. Llorente

Jueves, 19 de noviembre 8:30 – 9:15

Disfunción eréctil N. Cruz

9:00 – 9:30

Cirugía Peneo-escrotal J. Romero

9:30 – 10:00

Caso clínico: Disfunción eréctil V. Chantada

10:00 – 10:15 Pausa café 10:15 – 11:15 Trasplante. Guía de Práctica Clínica J. Passas 11:15 – 12:15 Urología Pediátrica J. Caffarati 11:45 – 12:15 Infecciones no específicas del tracto urinario J. Moreno 12:15 – 12:30 Pausa café 12:30 – 13:30 Ética de la Práctica Urológica Mª J. García Matres

13:30 – 16:00 Almuerzo 16:00 – 16:45 Incontinencia no quirúrgica M. Esteban 16:45 – 17:30 Incontinencia quirúrgica G. Escribano 17:30 – 18:00 Caso clínico: Incontinencia J.M. Adot

17:30 – 18:15 Derivación intestinal J. Castiñeiras 18:15 – 18:30 Pausa 17:30 – 18:30 Caso clínico: Cáncer vesical J. Palou

The 14th edition of the course for senior urology residents was held last 17 to 19 November at the offices of the Spanish Association of Urology (AEU) in Madrid with the participation of 75 Spanish residents. For the first time, residents from other countries also attended with five residents from Portugal. During this three-day course, senior residents had the opportunity to review and update their knowledge on major urology topics by participating in the various sessions. A selected group of Spanish experts from many urological subspecialties was responsible for organising the course which was presided by Prof. Jose M. Cózar, AEU president, Prof. Castiñeiras, former AEU president, Prof. María J. Ribal, head of the Uro-Oncology Unit at the Hospital Clinic of Barcelona, and Prof. Luis MartinezPiñeiro, former chairman of the Section Office of the EAU, among others, who all shared their knowledge and extensive experience. 22

European Urology Today

Figure 2: Course programme

which gave the residents the opportunity to share their views with the other participants and experts in a relaxed ambience. We deeply appreciate the AEU’s initiative to organise this course days before the EBU exam. After completing the course, an evaluation test was

conducted EBU-style. The number of correct answers and the ranking of each of the participants were sent by email. We also thank the AEU and the industry sponsors for providing this free course to all residents. For 2016, we look forward to another dynamic meeting that aims to benefit urology residents from Spain and neighbouring countries.

Any comments, suggestions or articles for the Young Urologist/Residents Corner are welcomed at: eut@uroweb.org S. Silay, Section editor Figure 1: Professors and residents during the course

January/February 2016

Young Urologists/Residents Corner Next level for the Young Academic Urologists Teamwork is a YAU hallmark and empowers its members to realise shared goals Dr. M. Selcuk Silay Chair YAU Assoc. Prof, Pediatric Urologist Chair, Pediatric Urology Division Bezmialem University Istanbul (TR) selcuksilay@gmail.com It is an honour and a great pleasure to write my first article as the new Chair of the Young Academic Urologists (YAU) of the EAU. During the YAU meeting in Barcelona on 15 November, our previous chair Francesco Sanguedolce, who significantly contributed to the first years of YAU, handed over this respectful duty. By taking this opportunity, I thank Francesco on behalf of all YAU members for his kind efforts. It has been four years since the YAU was created as part of the EAU Young Urologist Office (YUO). Since then many activities have been initiated with scientific production as one of the YAU’s main goals. Accordingly, an impressive number of articles (42) have been published in high-impact journals. This

collaborative work included the publication of book chapters, patient information booklets and paramedical articles in this newsletter. Moreover, reviewership was performed for some chapters of the EAU Guidelines and peer-reviewed journals such as the European Urology and Journal of Urology. This is a huge amount of work that we are really proud of. Many other publications and projects are either submitted or are being prepared by our hardworking members and I would like to congratulate every single member of the YAU for these extraordinary efforts. Beyond the scientific production, most of our members are also involved in the EAU sections and in the Guideline Office’s panels, which clearly demonstrates our member’s high profile and their potential as future experts and opinion leaders in their respective fields. However, we believe that we have just started and we set the sky as the limit, as they say! The YAU’s next move will not only be in publications but also nurturing the future key opinion leaders of urology, Matula award winners and finally academic urologists who deserve to become AAEU members. Those objectives can only be achieved with consistent, diligent teamwork and an effective strategic plan. Thus, the YAU Board is currently working on new regulations and projects.

Under my term we have two main objectivesmaintaining the achivements and increasing productivity. At this stage we will increase the transparency of the YAU structure and projects and we aim to improve our ongoing collaborations with the EAU Sections. Some of our groups (robotics, pediatrics) already initiated scientific collaboration with their affiliated sections and many other projects are underway. With regards productivity, Most of our members are also involved in the EAU sections and in the Guideline Office’s panels we certainly need your support. If you are under 40 years of age and have an academic profile, you are What can YAU do for its members? YAU provides its members a scientific platform at an more than welcome to join us. Even if you fail to comply with the criteria to be a YAU member, you can international level where you can excel. It is a market full of talented academic urologists which can lead to still send your project to the relevant group for evaluation and if accepted, you can start conducting a or open up to many other academic platforms and EAU affiliates or opportunities such as the Section collaborative study without becoming a panel Office, or as reviewer for journals, guideline panel member. members etc. In the end, our ultimate goal is to develop and expand the community of key opinion What can you contribute as a YAU member? leaders in urology. And if you have the enthusiasm, Currently, YAU has eight main groups and 74 leadership skills and energy, YAU can definitely help members. We come together twice a year to design the projects and brainstorm. But we are not limited to you reach your goals, enabling you to be a key opinion leader in the field of your interest. any numbers and groups. We now have a new Twitter address: When you apply and become a panel member of the ‘@EAUYAUrology’. Please follow us on Twitter for the YAU working groups, you have the opportunity to demonstrate your project’s viability at an international latest news about YAU, new announcements and level! And note that you can always conduct scientific opportunities. We look forward to your applications. Official Twitter Account of Young Academic Urologists: Teamwork is the key to our success. Hence, we are not work in your home institution on your own. only a team because we work together, we are a team because trust, respect and care for each other! However, when 10 different Official institutions from different Twitter Account of YoungweAcademic Urologists: Come and join our team… countries and 10 academic urologists who are in the same level come together, you can definitely improve the quality of your project and increase the chance of it being accepted by a high-impact journal. Moreover, you will have the chance to enhance your project and career profile.



The YAU Board at the meeting in Barcelona on 15 November 2015

Standardisation in surgical training New practical certifications following success of E-BLUS Dr. Domenico Veneziano Member, Working Party on Endourology & Urolithiasis Young Academic Urologist (YAU) Reggio Calabria (IT) info@domenicoveneziano.it

Just like urology with all its sub-specialties, the world of hands-on training is vast. It does not only involve teaching laparoscopic skills, but also training in various manoeuvres ranging from robotics to ultrasound-guided punctures. Additionally, education concerning endoscopic stone treatment skills is rapidly gaining interest.

only the European School of Urology (ESU), but also experts from the EAU Section of Urolithiasis (EULIS), the EAU Section of Uro-Technology (ESUT) and the Young Academic Urologist Working Party (YAUWP). The YAUWP “Endourology and Urolithiasis group” had a critical role in the very first steps of the development process, taking care of the “procedural task analysis” (PTA). The PTA is based on literature review and is aimed to define different aspects of the surgical procedure, according to published papers and guidelines.

The development of a training curriculum, along with its learning assessment, is a very complex and resource-demanding process. As suggested by the “full life-cycle curriculum development process” by Satava and Gallagher1, the outcomes measures/metrics drives the whole process, along with the didactic material for the psychomotor skills (non-technical).

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to laparoscopic skills training, where the E-BLUS is considered as the “basic” of the steps. In accordance with the data collected, the basic step of the endoscopic stone treatment curriculum has been focused on scope navigation (rigid and flexible) and the use of operative channels. Lithotripsy techniques and basketing have been considered as intermediate skills, while full procedure accomplishment and problem solving have been selected as advanced skills.

The analysis of the PSS allowed a division of the whole procedure in three training steps: basic, intermediate and advanced. This structure has already been applied

Afterwards, a preliminary set of basic tasks has been defined and tested during EUREP 2015, to identify any major issue related to the required training time and participant satisfaction. A Training Needs Analysis (TNA) showed the technical and non-technical skills, which are strictly related to the basic training step. In November 2015, based on the TNA and the PTA, a final exercise list has been defined, along with training and assessment requirements. To date, several steps still have to come before completing the development process, which will require a close collaboration among the experts and a full support of the sections. In case validity studies will confirm the reliability of the whole procedure, this could be the first move to the establishment of a new set of certifications in endourology- another step for the EAU with its aim to standardise surgical training.

In relation to the field of stone treatment, the research of these aspects started in mid-2014, thanks to the collaboration of multiple entities inside EAU. The project, under the coordination of the ESU/ ESUT training research group, today involves not

Working on this phase, YAUWP allowed the whole curriculum development to be based on objective data, instead of personal experiences. The PTA enabled the structuring of a solid cognitive part, comprising all the non-technical skills necessary to support the hands-on training part. At the same time, a “procedural steps study” (PSS) has been initiated, starting from the PTA, in order to list every single step of the endoscopic stone treatment procedure.


Preliminary curriculum testing in Prague during EUREP 2015

1. Satava RM, Gallagher AG. Next generation of procedural skills curriculum development: Proficiency based progression. 2015 J of Health Spec. DOI: 10.4103/1658600X.166497

European Urology Today


Advances in laparoscopy for urological indications – Part 3 Instruments and surgical platforms situation during laparoscopy might be influenced by a surgical platform such as an operating chair. There are only two ergonomic platforms described in the current literature.8-10

Prof. Jens Rassweiler Dept. of Urology SLK Kliniken Heilbronn (DE)

jens.rassweiler@ slk-kliniken.de

Fig. 3: Kymerax (Terumo, Japan): Motorized 6-DOF-instrument with specifically designed handle for deflection and rotation of tip of instrument. Removed from market after early clinical experience.

Dr. Jan-Thorsten Klein Dept. of Urology & Pediatric Urology University of Ulm Ulm (DE)

jan-thorsten.klein@ uniklinik-ulm.de Co-Authors: Dogu Teber, Medical School of Medicine, University of Heidelberg; Thomas Frede, University of Heidelberg, Department of Urology Helios Kliniken Müllheim; Ali Serdar Gözen, SLK Kliniken Heilbronn (DE). Since the end of the 20th century, there has been a tremendous development replacing open surgery by minimally invasive or even non-invasive surgery accomplished by continuous improvement of video-endoscopic technology, implementation of physical principles and even the introduction of robot-assisted surgery.1 In a series of articles, we summarize upcoming technology and also speculate on the future of laparoscopy in urology. Basically, this concerns development in (i) video-endoscopy, (ii) endoscopic armamentarium, (iii) surgical platforms, and (iv) single-port surgery in comparison to robot-assisted surgery. Instruments with 6 degrees of freedom (DOF) A significant handicap of laparoscopic surgery represents reduction of range of motion because of fixed trocar position determining the angle of

Fig. 1: Radius System (Tuebingen Scientific, Tuebingen, Germany): 10 mm prototype, use of two instruments during vesicourethral anastomosis together with 3D-helmet. 5mm, disposable device with better use of the instrument in combination with ETHOS-chair providing arm-rest.

Fig. 4: Robot Dex (Dextérité Surgical, Annecy, France): Motorized system with ergonomic handle compared to classical suturing. Clinical experience with laparoscopic radical prostatectomy and partial nephrectomy.

instrument to the working field: The incision point acts like a spherical joint reducing the degrees of freedom (DOF) of any instrument from six to only four: jaw, pitch, rotation, insertion plus the actuation of instrument.1 During dissection, this drawback can be overcome by the use of angulated instrument tips (ie right-angle dissector) and adequate trocar arrangement.2 However, such ergonomic disadvantages become critical during reconstructive the part of an operation such as the urethro-vesical anastomosis. Evidently, the Endowrist-technology as applied in robot-assisted laparoscopic surgery with all daVinci-systems again represents the optimal solution.1,3 However, there are several solutions of laparoscopic instruments providing 6 DOF.4-7 Radius Surgical System® Already in 2007, the Radius Surgical System® (Tuebingen Scientific) has been introduced clinically. This device enables 6 DOF-motions via 10 mm trocars based on movements of the wrist and a wheel for rotation of the instrument (i.e. for suturing). Initially, only two effectors (endo-dissect, needle holder) were available.4 Bi-manual use of the instrument use was relatively difficult. The next step represented the introduction of a single-use 5 mm device. However, the stability of the device (ie. Radius-scissors) was suboptimal as well as the grip of the needle holder. On the other hand, the combination of ETHOSplatform with its armrests significantly improved the handling of the instrument (Fig. 1). Actually, a EUSP-sponsored project examines the efficacy and ergonomics of this setting compared with the gold standard of the Da Vinci-system.5

Expert views


European Urology Today

ETHOS-chair offers a conceptual solution to the problem: The surgeon sits/rides over the patient`s head during pelvic surgery instead of standing or even sitting laterally thereby avoiding the Toreroposition during suturing. Moreover, it creates a quasi-in-line position of the surgeon to the working field with the monitor between the legs of the patient. The surgeon has access to all trocars to help and correct assistants (Fig. 5). The surgeon has two adjustable arm- and footrests with integrated foot-switches including electrically motorized movements of the chair. This proved to be very helpful during dissection (ie. no need to search the footpedal, ergonomic position of the foot for activation; stabilisation of instrument moves during surgery)9. In a recent study comparing the ergonomics of standard laparosopy versus laparoscopy using ETHOS-chair, and da Vinci-system, the use of ETHOS improved ergonomics significantly (i.e. Surgeon`s muscle pain score: 32 vs 16 vs 4).10 The device can also be used for laparoscopic or retroperitoneoscopic surgery particularly during the reconstructive part (ie. partial nephrectomy, pyeloplasty). The sitting position and armrests reduce significantly the fulcrum effect of laparoscopy. Manually manipulated robot-like device The MIM-system developed by Jaspers et al. at the University of Utrecht, represents an interesting modification of bedside-device providing 6 DOFs. Based on a parallelogram-design, the device allows movements of the instrumens almost similar to the da Vinci device.11 However, the mechanical realization is still relatively clumsy and has been only tested experimentally (Fig. 6). Robotic and manually manipulated camera-arms Robotic camera holders Principally, there are two basic approaches for the mechanism of camera holder design: (i) SCARA-type (Selective Compliance Assembly Robot Arm) consisting of three motorised joints in combination with one passive (ball)joint. The three DOFs are indirect translated to the three different DOFs and (ii) parallelogram-type, consisting of three motorised

Cambrigde-Endo® This instrument applies flexion of the handle to perform 5 and 6 DOF-movements. Mainly scissors and dissectors are used to accomplish LESS-surgery.6 However the distance from the point of flexion to the end-effector is relatively long compared to other alternatives (Fig. 2). Kymerax-System® The Kymerax-System® (Terumo, Japan) was carefully designed as a motorized instrument to accomplish 6 DOF-movements. Based on an ergonomic handle the system allowed flexion and rotation of the instruments by pressing a button (Fig. 3). Our group and others tested Kymerax in vitro and in-vivo. Again simultaneous use of two instruments proved to be relatively hard to accomplish, whereas clinically the rotation mechanism proved to be helpful. Sterilization of motorized instruments affords special attention, particularly concerning cleaning of tissue remnants in the end-effectors. In 2014, Terumo unfortunately took the device out of the market.

Fig. 2: Cambridge Endo (Cambridge, United Kingdom) using wrist-angulation to bend the tip of instrument. Mainly used for LESS. For laparoscopy the tip length seems to be too long (i.e. during vesico-urethral anastomosis)

Recently, a specially designed ergonomic body support consisting of a platform with foot pedal, a semi-standing support, a remote control, and a chest support was presented. EMG results showed a reduction of 44% of erector spinae, 20% for semitendinosus and 74% for gastrocnemious muscle, when using the chest support. The muscle reduction using the semi-standing support was 5%, 12%, and 50% respectively.8

Fig. 8: Endo-assist / Freehand (Prosurgics, United Kingdom): Camera holder controlled by head movements of the surgeon.

joints that directly activates the three DOFs of the scope.12 A varitey of robotic camera holders are available: Most clinical experience exists with the automated endoscopic system for optimal positioning (AESOP, Intuitive Surgical, Sunnyvale, USA), which enables the surgeon to move the telescope by voice-control (Fig. 7). Every surgeon had his own voice-disk that allows him to use any AESOP worldwide.13 The device alone enabled solo surgery (i.e. radical nephrectomy, pyeloplasty) or in case of radical prostatectomy the operation can be performed by two surgeons.14 AESOP was the first robotic device that was used for transatlantic telementoring.15 Unfortunately, due to the takeover of Computer Motion by Intuitive Surgical, AESOP is no longer manufactured. EndoAssist/FreeHand (Prosurgics, UK; ORProductivity, UK), which uses the head movements of the surgeon to activate the camera arm (Fig. 8), and the LapMan (Medsys, Gembloux, Belgium), which uses control buttons in the surgeon`s hand and recently connectable to the handle of an endoscopic instrument (LapStick). The use of headmovements proved to be not ergonomically efficient in our hands. In clinical trials no specific advantages of the arm could be detected compared to human assistance.16-18 The Viky-System (Endocontrol, France) uses both a foot paddle and wireless speech recognition to control the motors moving the camera (Fig. 9). According to the procedures the company offers three models (i.e. a large ring for LESS, a small ring for radical prostatectomy). Recently, the Viky-System was also use to robotically move a TRUS-probe during robot-assisted laparoscopic radical prostatectomy.19

Fig. 5: ETHOS-platform (ETHOS-Surgical, Portland, USA) to improve ergonomics during laparoscopic surgery. Surgeons sits over the patient`s head during laparoscopic pelvic surgery. The armrest significantly improves ergonomics during suturing.

Recently, Soloassist (Actormed, Barbing, Germany) has been developed at the Technical University of Munich. The surgeon uses a small joystick to operate a robotic arm, determining their own field of vision and thus avoiding such issues. The camera is also held in place mechanically, reducing vibration and stabilizing the field of vision. This is particularly important with 3D cameras. Soloassist was compared to conventional laparoscopic cholecystectomy: Hospital stay and operation-related complications were not enhanced in the Soloassist group. The differences in core operation time significantly favoured the human assistant. In 4.8 % of the cases, the operation could not be performed completely with the camera-holding device.20 We were able to use the device in combination with the ETHOS-chair (Fig. 20), however, the use of the joy-stick was not as efficient as using voice-control.

Fig. 6: MIM-system (Minimally invasive manipulator). Movements are mechanically controlled by use of parallelogram technology. Animation of prototype only used in in-vitro experiments.

The basic idea behind these active holders is that the surgeon does not to have to interrupt the surgical process and that it becomes unnecessary to release an instrument for reposition of the camera.

Dexterité-System® This system also uses the combination of ergonomic handle and motorized instruments (Fig. 4) similar to Kymerax-system®. Early clinical experiences are promising for using the system for laparoscopic partial nephrectomy and radical prostatectomy.7 Platforms for laparoscopy Ergonomic chair Some of the factors contributing to a non-ergonomic

Fig. 7: AESOP (Intuitive Surgical, USA): Voice-controlled camera-arm requiring no hand for change of position. No more produced.

January/February 2016

Interestingly with increasing experience, the control of the camera holder without any hand (i.e. by voice) becomes less important. However, at least the arm should be movable with a single hand.

Fig. 9: Viky-system (Endocontrol, Grenoble, France) uses both a foot peddle and wireless speech recognition to move the motors controlling the endoscope (here in porcine model).

Passive holders for camera and instruments Additionally, mechanical camera-arms powered by high-pressure air (i.e. Unitrack, Aesculap, Tuttlingen, Germany; Endoboy, Endobloc, France; Styrker Scope holder) have been introduced as a cost-effective alternative. Other mechanical holders consisting of a number of bars connected with joints have been initially designed for open surgery (i.e. Martin-arm), and modified for laparoscopy (Karl Storz, Tuttlingen, Germany). These holders can be attached at the operating table and their tips contain a clamp that holds the endoscope or an additional instrument. Recently, the University of Utrecht introduced the Movix a manual controlled camera holder featuring an intuitive one-button control.21 Such devices do not provide any robotic features, such as preprogrammed positioning, voice-controlled movements, telementoring. Based on their design they require one or two hands for manipulation.

In summary, camera arms may play a role, particularly in combination with 3D-videotechnology (i.e. to facilitate stable image with heavy-weight telescopes) or to perform solo surgery. The use of head-sets proved to be not ergonomically efficient, the use of voice-control relatively complicated, the use of foot pedals or joy-sticks is also not convenient for Fig. 10: Solo-assist (Actormed, Barbing, Germany): The surgeon the surgeon. So finally a motor-controlled movement uses a small joy-stick to move the camera-arm. Here combine by the hand of the surgeon or assistant seems to be use with ETHOS-chair during laparoscopic radical the most simple and ergonomically most efficient prostatectomy. solution.

References 1. Rassweiler, J., Binder, J., Frede, T. Robotic and telesurgery: will they change our future. Curr. Opinion in Urology 11, 309-320 (2001) 2. Frede, T. et al. Geometry of laparoscopic suturing and knotting techniques. J. Endourol. 13, 191-198 (1999) 3. Rassweiler, J., Frede, T. Robotics, telesurgery and telementoring – their position in modern urological laparoscopy. Arch. Esp. Urol. 55, 610-628 (2002) 4. Frede, T., et al. The Radius Surgical System - a new device for complex minimally invasive procedures in urology? Eur. Urol. 51, 1015-1022 (2007) 5. Tokas, T., Gözen, A.S., Tschada, A., Rassweiler, J. A laparoscopic combination with comparable ergonomic results to robotic surgery, tested in an experimental laparoscopic radical prostatectomy setting. J. Urol. 193, e390 (abstract PD18-11), (2015) 6. White, W.M., et al. Single-port laparoscopic abdominal sacral colpopexy: initial experience and comparative outcomes. Urology 74, 1008-1012 (2009) 7. Janetschek, G. Robotics: Will they give a kick to single-site surgery. Eur Urol 66, 1044-1045 (2014) 8. Albayrak, A., et al. A newly designed ergonomic body support for surgeons. Surg Endosc. 21, 1835-1840 (2007) 9. Rassweiler JJ, Goezen AS, Jalal AA, Schulze M, Pansadoro V, Pini G, Kim F, Turner C (2011): A new platform improving the ergonomics of laparoscopic surgery: Initial clinical evaluation of the prototype. Eur Urol 2012; 61:226-229 10. Gözen, A.S., et al. Comparison of operating positions and ETHOS surgical platform for laparoscopic pelvic surgery simulation. J Endourol 29, 95-99 (2015) 11. Jaspers, J.E.N., Bentala, M., Herder, J.L., De Mol, B.A., Grimbergen, C.A. Mechanical manipulator for intuitive control of endoscopic instruments with seven degrees of freedom. Min Invas Ther and Allied Technol 13,

191-198 (2004) 12. Buess, G.F., et al. A new remote-controlled endoscope positioning system for endoscopic solo surgery. Surg Endosc 14, 417-418 (2000) 13. Kavoussi, L.R., Moore, R.G., Adams, J.B., Partin, A.W. Comparison of robotic versus human laparoscopic camera control. J. Urol. 154, 2134-2136 (1995) 14. Rassweiler, J., Gözen, A.S., Scheitlin, W., Teber, D., Frede, T. Robotic-assisted surgery: Low-cost-options. In: Kumar, S., Marescaux, J. (eds.) Telesurgery, Springer, Heidelberg, pp. 67-89 (2008) 15. Janetschek, G., Bartsch, G., Kavoussi, L.R. Transcontinental interactive laparoscopic telesurgery between the United States and Europe. J Urol 160, 1413-1415 (1998) 16. Boer den, K.T., et al. Tima-action analysis of instrument positioners in laparoscopic cholecystectomy; a multicenter prospective randomized trial. Surg Endosc 16, 142-147 (2002) 17. Wagner, A.A., Varkarakis, M., Link, R.E., Sullivan, W., Su, L.-M. Comparison of surgical performance during laparoscopic radical prostatectomy of two robotic camera holders; EndoAssist and AESOP: A pilot study. Urology 68, 70-74 (2006) 18. Polet, R., Donnez, J. Gynecologic laparoscopic surgery with a palm-controlled laparoscopic holder. J Am Gynecol Laparosc 11, 73-78 (2004) 19. Hung, A.J., et al. Robotic transrectal ultrasonography during robot-assisted radical prostatectomy. Eur Urol 62, 341-348 (2012) 20. Gillen, S., et al. Solo-surgical laparoscopic cholecystectomy with a joystick-guided camera device: a case-control study. Surg Endosc 28, 164-170 (2014) 21. Jaspers, J.E.N., Den Boer, K.T., Sjoerdsma, W., Bruijn, M.: Design and feasibility of PASSIST, a passive instrument positioner. J Laparoendosc Surg 10, 331-335 (2000)

YUO Board Meeting in Amsterdam Boosting YUO’s network through closer partnerships Dr. Selcuk Sarikaya Past Chairman of ESRU Turkey Chair Elect of ESRU Kecioren Research and Training Hospital Ankara (TR)

congresses, questionaire-based studies, and collaborations with the other sections of European Association of Urology. Meanwhile, the ESRU is planning new activities, several projects and sessions to be organised in national and international congresses. Another item on the agenda were the Young Academic Urologists

drselcuksarikaya@ hotmail.com Projects and the long-term planning strategy of the Young Urologists Office (YUO) were discussed during the YUO board meeting in Amsterdam last 19 November. Prof. Michiel Sedelaar and other board members who have attended the meeting noted that in recent months the ESRU has completed several projects, with Dr. Giulio Patruno reporting on the latest accomplishments such as endorsed courses and symposiums, online webinar, sessions held during

(YAU). Dr.Selcuk Silay has been elected as new YAU chairman and there was a very informative presentation about the YAU’s plans. The nonacademic group led by Dr.Guillermo Martinez has also gave an overview of the TEC Project. Following Martinez’s presentation, the preliminary programme of the YUORDay 2016 during the upcoming Annual EAU Congress was discussed. The programme of YUORDay is very well designed and contains several topics and sessions.

There was a presentation about the leadership programme and Prof. Sedelaar spoke about its goals, which, aside from being an excellent programme for young urologist, also aims to support the organisational structure of the EAU. As section editor, the author also discussed issues regarding this newsletter such as the planning for new articles in upcoming issues. The last topic examined web site and social media activities. Young urologists are very active in social media The YUO board discussing projects and the long-term planning and each sections have their own page with strategy while EAU staff member Angela Terberg is taking notes hundreds of followers.

The YUO Board at the meeting in Amsterdam last November

Finally, the substitutions were discussed and the board made plans for the next meeting. The YUO is one of the EAU’s very active groups and in the coming months the group aims to boost its reach with the support and active involvement of residents and young urologists. YUO welcomes new ideas and contributions and we hope to see you all in our forthcoming activities!

YUORday16 (EAU Young Urologists Office & ESRU) Saturday, 12 March 10.00 - 17.00 Location: Room Madrid (Hall B2, level 0) Chairs: G. Patruno, Rome (IT) J.P.M. Sedelaar, Nijmegen (NL) Aims and objectives of this presentation This session is intended for residents, a training-based session in which residents are protagonists. Although main topics have been selected specifically for younger urologists and residents, we believe that they can also be useful for more experienced colleagues. Moreover, this year is ESRU’s 25th anniversary. 10.00 - 10.15 Introduction G. Patruno, Rome (IT) J.P.M. Sedelaar, Nijmegen (NL) 10.15 - 11.00 What residents need to know about the EAU organisation Moderators: To be confirmed S. Sarikaya, Ankara (TR) 10.15 - 10.25 European School of Urology J. Palou, Barcelona (ES)

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10.25 - 10.35 EAU Regional Office To be confirmed 10.35 - 10.45 European Research Foundation To be confirmed 10.45 - 11.00 EAU Patient Information project T. Bach, Hamburg (DE) 11.00 - 12.30 EUSP Session Moderators: To be confirmed J.P.M. Sedelaar, Nijmegen (NL) 11.00 - 11.15 A great research opportunity for young urologists M.J. Ribal, Barcelona (ES) 11.15 - 11.30 How to write a successful EUSP application J.A. Schalken, Nijmegen (NL) 11.30 - 11.45 Partnership between EBU & EUSP S.C. Müller, Bonn (DE) 12.00 - 12.15 Experience of an EUSP Scholar M.A. Behrendt, Basel (CH) 12.15 - 12.30 Best Scholar Award winner I. Lucca, Vienna (AT)

12.30 - 13.00 Campbell Team Challenge Quiz Quizmasters: Á.C. Rosecker, Budapest (HU) M. Schmid, Göttingen (DE) M.J. Ribal, Barcelona (ES) 13.00 - 14.40 Surgery: Tips and tricks Moderators: P. Uvin, Leuven (BE) J.L. Vasquez, Copenhagen (DK) 13.00 - 13.25 Minimal invasive urinary incontinence surgery E. Finazzi Agrò, Rome (IT) 13.25 - 13.50 TURP B. Miñana López, Molina De Segura (ES) 13.50 - 14.15 TRUS and MR guided prostate biopsy To be confirmed

14.55 - 15.30 Treatment of benign large prostates Panel: F.M.J. Debruyne, Arnhem (NL) P. Schatteman, Dilbeek (BE) 15.30 - 16.00 Radical cystectomy Panel: J. Bjerggaard Jensen, Århus N (DK) J. Palou, Barcelona (ES) 16.00 - 16.45 We are not supermen: "Scrubs" session Moderators: To be confirmed A. Urkmez, Istanbul (TR) 16.00 - 16.15 Delivering bad news N.W. Clarke, Manchester (GB) 16.15 - 16.30 Novel therapies in mCRPC To be confirmed

14.15 - 14.40 Penile emergencies: fractures and priapism A. Kadioglu, Istanbul (TR)

16.30 - 16.45 Practise, practise, practise: Latest developments in simulation training D. Veneziano, Reggio Calabria (RC) (IT)

14.40 - 14.55 Celebrating 25 years of ESRU C.R. Chapple, Sheffield (GB)

16.45 - 17.00 Prizes and awards Moderator: G. Patruno, Rome (IT)

14.55 - 16.00 Old school versus new school, which is the best? Moderators: D. Duijvesz, Rotterdam (NL) J. Gómez Rivas, Madrid (ES)

17.00 - 17.00 Residents group picture

European Urology Today



ESUI16 5th Meeting of the EAU Section of Urological Imaging In conjunction with the 8th European Multidisciplinary Meeting on Urological Cancers

24 November 2016, Milan, Italy 24-27 November 2016, Milan, Italy

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

Imaging and shifting paradigms in urology

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)


Early fee registration deadline: 8 April 2016 Abstract submission deadline: 1 May 2016

ESUT16 5th Meeting of the EAU Section of Uro-Technology (ESUT) 8-10 July 2016, Athens, Greece The EAU Section of Uro-Technology is gearing up for its fifth meeting, its first since becoming an EAU Section. From July 8-10, Athens will welcome surgeons and other delegates from across the world to ESUT16. ESUT Chairman-elect and local organiser for the meeting, Prof. Evangelos Liatsikos (Patras, GR) gave us an insight into the preparations of the meeting. “Registration is already open, and we’ve received a lot of interest from abroad. It’s promising to be a very interesting meeting.” The last standalone ESUT meeting took place in 2003, when what was then still the European Society for Uro-Technology met in Paris. One of the reasons for holding the ESUT meeting in 2016 is the change in chairmanship which is scheduled for the 31st Annual EAU Congress in March. Prof. Liatsikos will be taking over from Prof. Rassweiler, the current ESUT Chairman. “We thought this would be a good occasion, as a farewell to Jens,” said Liatsikos. “It won’t be easy to take over from him, as he did a great job over the years. We’ll certainly do our best!” Hot topics in Uro-Technology Being the Section of Uro-Technology, the ESUT is committed to offering the delegates all the latest in technical developments and tools for the urologist. Liatsikos: “The meeting will showcase everything that’s new in the fields of benign or cancerous prostate surgery, stone surgery, laparoscopy, and laser treatment. All the biggest companies will showcase their latest products.” More important still than having and using the right tools is technique. Many of the debates that will be held at ESUT16 revolve around different approaches that surgeons may wish to take when operating on

patients. Debates are scheduled on the merits of miniaturised instruments for use in PCNL, as well as “the big fight” on prone or supine position. Live surgery ESUT16 features six different live surgery sessions, covering a range of topics. Prof. Liatsikos: “At the moment, there are three different approaches to live surgery. Local, from a hospital in the same city as the presentation; long-distance, from across the world; and finally pre-recorded, ‘as live’ cases. At ESUT16, we will be featuring all three.” Local procedures will be conducted in Athens, and local patients will be matched with surgeons, with most of them coming from abroad. Prof. Alex Mottrie, Chairman of the EAU Robotic Urology Section will be operating from Aalst. The prerecorded procedures will be screened in between the live surgery, making sure the sessions are filled with cases. Hands-on Training For delegates hoping to hone their skills, or perhaps

Prof. E. Liatsikos Chairman-elect

ask specific questions of the expert tutors, two different hands-on training courses will be available at ESUT16: endo-urology and laparoscopy. More details will be available on the meeting website as the meeting nears. “Opportunities for hands-on training always attract young urologists,” Liatsikos explains. “We hope to stimulate their interest in endo-urology.” Delegates can also look forward to taking part in the E-BLUS Examination. The European training in Basic Laparoscopic Urological Skills (E-BLUS) is a programme offered to residents and urologists who want to improve the basic skills in laparoscopy. It is a unique opportunity to train with international experts in laparoscopy and includes an online theoretical course, intensive hands-on training, finished off with an examination and certification. “We hope this meeting will take place regularly, perhaps in cooperation with other EAU Sections. Basically, anything to do with new technology is our concern. The faculty is almost ready and will be announced soon,” Liatsikos concludes. “We look forward to welcoming everyone to Athens next July!” Registration for ESUT16 is now open! The early fee registration deadline is April 8th. Please visit the meeting website for more details on registration and the different fees.

For registration information and programme overview, visit the meeting website at: www.esut16.org


European Urology Today

January/February 2016




Genitourinary Cancers Symposium

23rd Meeting of the EAU Section of Urological Research 20-22 October 2016, Parma, Italy EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations

February 16-18, 2017 Rosen Shingle Creek Orlando, Florida gucasym.org

2017 TARG E T I NG

Robotic Live Surgery





13th Meeting of the EAU Robotic Urology Section 14-16 September 2016, Milan, Italy

Inviting all robotically-minded urologists to Milan In 2016, the 13th meeting of the EAU Robotic Urology Section (ERUS) will take place from September 14-16 in Milan, Italy. In an era of incessant technological improvements, the ERUS meeting represents one of the best opportunities to get up to date with the latest advances in the field of robotic surgery and to directly interact with top experts coming from all around the world. This meeting is specifically aimed at educating on the latest evolutions in terms of robotic surgery, with the ultimate goal of raising the level of patient care.

1 March – Registration open 1 March – Abstract submission open 1 June – Abstract submission deadline

The upcoming ERUS meeting will include more than ten robot-assisted live surgeries performed by wellrecognized experts in the field. In particular, these sessions will focus on the most common urologic procedures, as well as on special indications and rare pathologies. ERUS16 will also benefit from the introduction of semi-live surgical sessions, where experienced surgeons will have the opportunity to describe their surgical technique and their tips and tricks in detail, in a step-by-step fashion using edited videos. Another novel element is the introduction of sessions that will focus on how to perform non-urological procedures robotically. This will include typical scenarios of everyday

surgical practice that might occur during urologic minimally invasive surgery. Participants will also be able to get in touch with novel robotic systems that will be introduced in the clinical practice in the near future. The educational aspect of the congress will benefit from courses held by the European School of Urology and from the possibility to participate to several hands-ontraining sessions. The ERUS meeting will also describe and analyze the latest findings in terms of diagnostic and therapeutic advances in the management of patients with urologic diseases. Finally, there will be the opportunity to submit abstracts and videos, where the best ones will be selected for discussion during the plenary session of the meeting. Abstract submission will open on 1 March 2016 (deadline 1 June 2016). We can’t wait to welcome you in Milan from September 14-16 at the ERUS annual meeting! On behalf of the ERUS Board Prof. A Mottrie On behalf of Local Organising Committee Prof. A. Montorsi

For more information and the preliminary scientific programme, please visit erus16.org! January/February 2016

European Urology Today






EAU 12th South Eastern European Meeting

EAU 16th Central European Meeting

23-24 September 2016, Sarajevo, Bosnia

7-8 October 2016, Vienna, Austria 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

BALTIC16 3rd EAU Baltic Meeting 27-28 May 2016, Tallinn, Estonia


Abstract submission deadline: 1 April 2016

Welcome to Tallinn for the 3rd EAU Baltic Meeting Tallinn will host the 3rd EAU Baltic Meeting from 27-28 May 2016. Drawing on the talents and expertise from the region, the EAU Baltic Meeting provides a platform that showcases the scientific and research gains of the Baltic countries. Expert urologists from across Europe join their colleagues in this annual meeting which aims to support the clinical and research careers of young and mid-career urologists. Aside from boosting professional exchanges, current and controversial topics in both regional and international urology are discussed and assessed. Prospects in treatment strategies and multidisciplinary approaches are examined in various activities such as hands-on training in laparoscopy, panel discussions, debates, state-of-the-art lectures and abstract sessions. Tallinn extends a warm welcome to everyone with its charming ambience and colourful cultural life. For a comprehensive urological update and to link up with your colleagues, donâ&#x20AC;&#x2122;t miss the opportunity to join us in Tallinn for the 3rd EAU Baltic Meeting!

For registration or more info: www.baltic16.org


European Urology Today

January/February 2016

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6th International Congress on the

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

“We’re taking urological history beyond books!”

Most urologists will delve into history briefly when they write an article and need to give a brief review of earlier developments.”

The EAU History Office is organising the 6th International Congress on the History of Urology in conjunction with EAU16. Attendance is free for everyone attending the 31st Annual EAU Congress in Munich. The congress promises to deliver a diverse and interesting scientific programme and many big-name speakers from urology’s past.

“We’re expecting to attract older, still practicing urologists who are coming to EAU16 in any case. But I’m also pleased to see that younger urologists have been regular contributors to our poster sessions and publications over the years.”

We spoke to Dr. Johan Mattelaer (Kortrijk, BE), former EAU History Office Chairman, full-time urological historian and attendee of every History Congress thus far. Previous History Congresses “The very first International Congress on the History of Urology took place in Fiuggi, Italy on October 8-11, 1992. The driving force behind this Congress was very much one man’s vision: Prof. Paolo Marandola from Pavia. He was already known as a historically-minded urologist, publishing several works with Prof. Sergio Musitelli (who still works with the EAU History Office). Sponsoring was a lot more commonplace back then, and he was able to organise a three-day scientific programme with speakers from all across the world.” “The second Congress was on the Greek Island of Kos, known of course for its connection to Hippocrates; the third in Vienna; the fourth in Baltimore in collaboration with the AUA’s History Office; and most recently (2011) in Budapest.” Uniqueness of the Congress “We felt that it would be a good time, and indeed location to host another Congress. Munich is in the centre of Europe, and by combining the Congress with EAU16, we hope to welcome a lot of interested urologists.” “Not every urologist is interested in finding out more about the roots of his or her field. However, we do see that the books that the History Office

in conjunction with

January/February 2016

publishes every year are well-received. A congress like this goes beyond a book: by bringing people together, in some cases people who are “living history” themselves, you do create a more immediate and involving situation for learning.” “This congress is unique. It is the only one devoted exclusively to the history and culture of urology. Secondly, we have some extraordinary speakers who you might never hear speak again.” Big names in urology “We really made an effort to live up to the “international congress” name by inviting speakers from far and wide. They join us from both North and South America, from Asia, Africa and of course Europe.” “One of the sessions is devoted to pioneers of the field. Claude Schulman will present a biography of Willy Gregoir, one of the founders of the EAU and urological innovator in his own right. Christian Chaussy will detail the first experiments with ESWL. Practically every speaker at the congress is a “big name”, with a formidable career and something to offer the delegates. Two participants are former EAU Secretary Generals: Frans Debruyne and Per-Anders Abrahamsson.” The value of history “Should practicing urologists show an interest in the history of their field? I think so, you can compare it to genealogy and knowing your ancestors.

“As the History Office, we’re very happy that the EAU and its Executive also see the value of historical research in the field. After all, there’s very little sponsoring interest in the past! So to publish or to organise meetings like this, we need the support of a larger society like the EAU. Most great books on medical history that I’ve seen have been supported by companies or by trusts. In our case, we’re supported by the European Association of Urology!” For a complete list of speakers and more information on the 6th International Congress on the History of Urology, visit www.eau16.org/history-congress

Forbidden Fruit: Sex, Eroticism, Art A new book by Johan Mattelaer, available in Munich Former EAU History Office Chairman Dr. Johan Mattelaer delves into the cultural aspects of urology and sexology once again in this new, attractively illustrated volume. Over the course of thirteen chapters Forbidden Fruit explores the depiction of the human body and eroticism in worldwide art. Pick up your copy at the EAU Booth, while stocks last.

www.eau16.org/history-congress European Urology Today


The 11th Jacob Lester Eshleman Urology Workshop Pursuing urological training goals in East Africa Prof. Magnus Grabe University of Lund Lund (SE)

magnus.grabe@ med.lu.se The 11th Jacob Lester Eshleman Urology Workshop took place from 23 to 27 November last year at the Institute of Urology, Kilimanjaro Christian Medical Centre (KCMC), in Moshi, Tanzania with Dr Frank Bright, head of the KCMC’s Institute of Urology, as lead organiser together with Drs. Jasper Mbwambo, Jacques Bogdanowicz and Nicolaus Ngowy. The programme was sponsored by the ANANSE Foundation, The Netherlands (financial, managerial and faculty contributions), BAUS/Urolink, UK (faculty), the Global Philanthropic Committee (SIU, EAU, AUA), and The OAK Foundation, Geneva, Switzerland (financial). Olympus Surgical Technologies Europe provided a donation of full video equipment for cystoscopy and the transurethral resection (monoand bipolar TUR) and a simulator for hands-on TUR training. Objectives The primary objective of the workshop was to strengthen the capacity of the Institute of Urology to perform transurethral resection (TUR) of the prostate and diagnosis and treatment of urinary bladder cancer, both increasing diagnosis, by supervised TURP and TUR-BT to be carried out by residents in training. Around eight to 10 procedures were scheduled initially including an introduction of bi-polar resection technique. Another goal was to perform reconstructive surgery as required on children with congenital abnormalities and disorders of sex development (paediatric urologists). The third objective was to perform reconstructive surgery on adult patients with urethral strictures or diseases of the penis, as required. Half a dozen patients had been selected. Faculty and participants The faculty was composed of Dr. F. Bright, chair of the workshop, co-chair Dr. J Bogdanowicz, known for his long-term support to KCMC, the staff of the KCMC/East Africa Tanzania (S. Yongolo, C. Mkony, K. Mtete,

J. Mbwambo, N. Ngowy), faculty with links to the EAU/GPC (M. Grabe, R. Nijman, A. de Vylder) and representatives of the BAUS/UROLINK (S. Venn, P. Thomas, D. Dickersen, H. Steinbrecher). The faculty was further strengthened by six independent senior consultants in urology from the UK. Participants included around 12 senior consultants in urology from the East African countries Kenya, Tanzania and Uganda and as many residents-intraining of the KCMC from Kenya, Uganda, Rwanda, Malawi and Tanzania. Moreover, around 25 medical students from KCMC who were on a four-week training in urology participated at the lectures, selected surgical interventions and group discussion.

Jacques Bogdanowicz (NL) supervised TURP performed by senior residents on a few patients. Rien Nijman (NL), Henrik Steinbrecher (UK) and Ann de de Vylder (NL), together with the residents-intraining operated on several paediatric cases, such as (i) cystectomy and urine deviation with Mainz pouch in a three-year-old girl with bladder extrophy; (ii) a reconstructive procedure in a young boy with buried penis; (iii) reconstruction of epispadias; (iv) two cases of partially amputated penis after circumcision and (v) several cases of hypospadias of which many were part of the DSD. Phil Thomas, Susi Venn and other faculty members from BAUS/Urolink, proceeded with different cases of reconstructive surgery in adults, such as urethra stricture and penile diseases and a few paediatric patients). All surgery carried out by members of the faculty took place in close cooperation with residents-in- training and/or senior staff members. Lectures More than a dozen lectures were given during the workshop, on the following topics: Paediatric urology: Introduction to Disorders of sex development (DSD) (R. Nijman); Surgical options & management of DSD (H. Steinbrecher); Hypospadias repair (H. Steinbrecher); Management of bladder extrophy, epispadias and Sigma pouch (R. Nijman);

With regards to the dramatic development of bacterial resistance on a worldwide basis, principles of Antimicrobial Stewardship for treatment and prevention of infections were presented (M. Grabe). Residents in training brought up individual cases for discussion including partially amputated penis after circumcision, micro-penis options for reconstruction and vaginal pain syndrome. Finally a lecture on Urological diseases in a global perspective was given in a hospital conference lecture hall (M. Grabe). Education of medical students Several sessions were held in smaller groups with the participating medical students. Different urological topics were brought up by members of the faculty. One session was dedicated to the principles of antimicrobial stewardship and the importance of responsible, controlled, reasonable and evidencebased use of antibiotics to limit the risk of microbial resistance development.

Dr Jacques Bogdanowicz supervises a resident of the Institute of Urology, KCMC, in a TUR prostate resection


European Urology Today

Peter Serwadda, resident in urology, presents cases for surgery while live surgery is progressing and projected on a separate screen

Rien Nijman, paediatric urologist from the Netherlands, lectures on Disorders of Sexual Development and congenital abnormalities of the children

Suzie Venn, urologist from the United Kingdom, in a case discussion with the participants

administrative and technical matters, all new equipment could not be set up in due time. The initial tests were however conclusive that the equipment would eventually be well and safely functioning in responsible hands and would be a great tool for forthcoming TUR training sessions.

• Lectures on the various aspects of the themes with more time for discussion, in smaller groups; and • Participants actively presenting theme-related cases for discussion.

Live surgery The cases to be operated upon were presented in plenary by one of the senior residents (Peter Serwadda) with a history and patient background, supported by imaging of various quality. Selected interventions were projected directly to the auditorium ensuring demonstration to and interactive discussion with the workshop participants.

Transurethral resection (TUR): Introduction to bi-polar resection (P. Comford); An overview of TUR for bladder cancer (M. Grabe); Management of NMIBC the European Guidelines (M. Grabe); Adult urology: Penile reconstruction in adults (R. Donat); How to analyse and treat upper urinary tract dilatation (J. Gellister); Erectile dysfunction (Aasem Chaudrey) and Stress incontinence (S. Venn).

Dr Frank Bright opens the workshop with the director of the KCMC and members of the hospital leading managerial board

Magnus Grabe in a group session with medical students focused on antimicrobial stewardship and the rational use of antibiotics for treatment and prevention

Comments on the programme The primary objective of the workshop was to focus on transurethral resection of bladder tumour and prostate surgery (TUR) in conjunction with the introduction of the generous donation by Olympus of a full set of TUR and cystoscopy equipment and instruments. Regrettably, due to logistical,

Thanks to a flexibility in the organising committee and of the faculty members an intensive surgical and theoretical week could be completed with also a large number of patients, chosen from the 38 pre-selected patients, relieved from burdensome, often invalidating conditions. Urological training Training urology in Sub-Saharan Africa is a major challenge. Workshops as this one are of great importance to consolidate cooperation, strengthen surgical technics and discuss epidemiology of diseases and priorities. The lack of surgical services in general and urology in particular is enormous with several billions of peoples worldwide without access to basic surgical treatment (The Lancet Commission on Global Surgery, 2015, Nb 9993, Aug 8). The African population’s improvement in health conditions, demographic changes (e.g. aging) and changes in health priorities are remarkable as is a raising economical perspective. Provision of all health care including surgical care must follow this development. A well-schooled ambitious young generation is ready to take part in this challenge and should be enthusiastically supported.

High quality of video projection and communication between the OR and the auditorium can ensure successful training sessions. Also good cooperation with the diagnostic imaging is recommended. For substantial impact of training and reach the objective of sustainability, workshop activities should be followed by funded continuous training by faculty remaining on-site for a few weeks or more and regularly returning. This wish has for the case of KCMC been expressed by both the former head of the Institute Prof. Kien Mteta and the present head Dr. Frank Bright. A big advantage of the KCMC Institute is the bridging of training beyond Tanzania to reach several other countries of East Africa, e.g. Kenya, Uganda, Malawi, Rwanda. The very low number of urologists on the Sub-Saharan African continent (Table 1) working under high pressure, underscores the need for such training activities. The situation is similar in most Sub-Saharan African countries. Another important aspect of education for the future is assistance with the training of residents in epidemiology of diseases and clinical research to increase their understanding of the priorities in urological care. The training of to-day is the training for the surgical priorities in five to 10 years ahead.

Workshops in general reach high quality with: • A concentrated and focused programme - one main theme; • Surgical training of residents and fellows, e.g. TUR with a limited number of supervisors experienced with the local environment/site; • Interaction between junior and senior consultants from local African institutes/hospitals and foreign faculty; • Fewer operations, with more time given to discuss in smaller groups the different steps of the procedure, the difficult moments, the risks, the potential complications (conducted by the operating resident and supervisor); Table 1: Approximate number of urologists (+ residents in training) in some East African countries (personal communications from country representatives). For comparision, in Europe: one urologist for 15 000 to 30 000 inhabitants. Country


Malawi Rwanda Tanzania Uganda Kenya

16.000.000 13.000.000 50.000.000 38.000.000 45.000.000

Approximate number of urologist (+ in training) 1 (+1) 3 (+2) 15 (+X)* 9 (+2) 32 (+X)*

Approx urologist per million inhabitants 1/16 m 1/4 m 1/3 m 1/4 m 1/1.4 m (?)

* Uncertain figures January/February 2016

Towards a Urogenital European Reference Network Share, Care and Cure approach to manage rare urogenital diseases Michelle Battye EAU EU Policy Coordinator Sheffield (UK)

michelle.battye@ uroweb.org Imagine if the best specialists from across Europe could join their efforts to tackle complex or rare medical conditions that require highly specialised healthcare and a concentration of knowledge and resources. That's the purpose of the European Reference Networks and it's becoming a reality fast.

Health systems in the European Union (EU) seek to provide high-quality, cost-effective care. This is particularly difficult in the case of conditions requiring a concentration of resources or expertise, and even more so with rare or low-prevalence complex diseases or conditions. With a new initiative called European Reference Networks (ERNs) a formal platform at the EU level will be established to construct partnerships on healthcare to take advantage of potential synergies and economies of scale.

The European Commission will launch a call for proposals for ERNs with different specialties in the first two weeks of March 2016. In the field of rare and complex urogenital diseases and conditions, the EAU has been leading in bringing together centres of expertise across Europe to create an ERN. This network will cover rare paediatric urogenital diseases, highly specialised functional urogenital surgery and the latest state-of-the art treatment for patients with rare urogenital cancers.

ERNs aim to support Europe-wide cooperation on highly specialised healthcare between providers and centres of expertise for patients with rare conditions no matter where they are in Europe. By bringing together highly specialised healthcare providers in different Member States patients will have access to the best possible expertise and care available in the EU in a more equitable way.

Innovation as driving force Research and innovation – with full engagement of our patient organisations - will be one of the driving forces of our ERN. We will bring together the knowledge and expertise of various clinicians and centres in a new and ambitious way, focussing on a life-long multi-disciplinary approach treatment for our patients. By working together, we

will exploit new technologies, innovate and translate new devices and ideas to market more quickly and thereby maximise economic impact and, most importantly, create more effective outcomes for our patients. Should you feel that your centre is qualified to be a leading provider of urogenital specialised services and will meet the strict criteria for becoming one of the centres of excellence, please contact Michelle Battye, EAU EU Policy Coordinator: michelle.battye@uroweb.org By utilising the already existing experience, knowledge and networks of the EAU to the greatest extent, we will be able to develop new innovative sharing, caring and, if possible, curing approaches for rare urogenital diseases to improve patient care throughout all Member States.

Preparing for the FEBU exams UK urology resident shares tips on exam preparation Dr. Kampantais Spyridon, FEBU Dept of Urology University Hospital of South Manchester Manchester (GB) kabspir@ hotmail.com In the first year of my urological specialty training in 2011, I attended the Annual European Association of Urology Congress in Vienna, and during the residents session the former European Urology Editor-in-Chief,

Prof. Francesco Montorsi, gave a lecture regarding urological education.

information and advancements in urology, improving my education and boosting my knowledge base.

During this talk he was asked by residents for his opinion on the best way to study urology. Montorsi replied that due to the rapidly changing nature of modern urology, studying from classical textbooks would be time consuming and may lead to the medical student not being fully updated with the latest advances.

However, during the last year of my training and just prior to the FEBU exams, I began to test myself using past papers from previous years and in-services tests. I found that my performance was around 65 to 75 % - enough to pass the MCQ section but leaving little margin for error. From the nature of the questions, I realized that I had to make a more systematic and comprehensive study of urology. The book that I selected was the full EAU guidelines, a text recommended by the European Board of Urology (EBU).

He suggested regularly reading recognized journals, such as the European Urology, as one of the ways to prepare. Since then I read European Urology on a regular basis and I am grateful for Prof. Montorsi’s advice. I managed to stay abreast with the latest

of questions were covered in the full edition of EAU guidelines but some areas which were not included were mainly associated with urinary diversion and the subsequent metabolic complications.

For potential candidates, my tip on preparing for FEBU exams would be to study the full version of European guidelines, combined with a reading of chapters from a urology textbook on embryology, disorders of adrenal glands, urinary diversion and metabolic complications. This should be sufficient to achieve a result of over 80% in the written part of the examinations, an achievement that aside from having the title of Fellow of the EBU, bestows personal satisfaction and confidence, which are vital for a I passed the MCQ part of the exams and achieved a score of 80% with an overall grade of 9/9. The majority challenging career in urology.

Special Session: EAU Research Foundation Meeting Saturday, 12 March 2016 14.45-17.00 hrs, Room 3

Join the EAU Research Foundation Meeting on EAU16 in Munich!

A first: EAU Research Foundation Special Session

interest for active urologists, not just researchers. We encourage them to reflect on their daily practice. On the other hand, it’s a case of showcasing how basic research can be performed and coordinated by the EAU RF.”

For the first time at the Annual EAU Congress, the EAU’s Research Foundation (EAU RF) has its own special session, a two-hour block on Saturday afternoon. The EAU RF will take the opportunity to not only present an update on its currently running projects, but also to emphasise these projects’ relevance for daily practice for urologists and patients alike.

Career Track update In recent years, the EAU Research Foundation has taken an interest in supporting the career development of young researchers. One of its initiatives in this regard is the EAU RF Career Development Programme. Through this programme, the Foundation aims to support excellent young researchers to develop an independent research career and in doing so strengthen the urology research environment.

EAU RF Chairman Prof. Peter Mulders (Nijmegen, NL) spoke to European Urology Today on how the EAU RF’s long-running clinical trials and research projects are designed to improve urologists’ decision-making. “This marks the first time that our activities are showcased in this way. We hope it stimulates discussion and participation, and that urologists see a side of the EAU RF that they might not have been aware of.” Research Projects In the past, the EAU RF has been represented at the Congress by a booth at the Exhibition, as well as contributing speakers to other sessions on its behalf. “We have so many different projects and initiatives that it became difficult to effectively get this across to our target audience,” Mulders explained.

Mulders: “The project examines the value of MRI for patients with PCa, including how MRI and biopsy can complement each other. The database is maintained in the management system at the EAU’s Central Office in the Netherlands.” Prof. Mark Emberton (London, GB) is set to introduce the project and encourage cooperation from people interested in participating. The EAU RF’s NIMBUS trial is independently-initiated and, uniquely, also independently funded. Led by Prof. Marc-Oliver Grimm (Jena, DE), NIMBUS examines the efficacy of a reduced number of intravesical BCG instillations (9 instead of 15 annually) for patients with non-muscle-invasive bladder cancer. This trial has the potential to recommend a procedure that spares patients from unnecessary treatment, side-effects and higher costs.

“Our main aim with presenting all of our upcoming and currently running trials and projects in a single session is to invite participation. We want to explain why the EAU RF supports or organises these specific projects, what their scientific value is, and ultimately how the patient may benefit from them.”

Another relatively new EAU RF project is EASE. Dr. Alessandro Volpe (Turin, IT) initiated the research project and continues to coordinate it. Mulders: “This registry takes place in multiple countries and tracks older patients with small kidney tumours and whether or not this leads to progression. At EAU16, we will explain the scientific basis of the trial and invite urologists from other countries to register their patients as well.”

One of the new research projects is ‘PRostate Evaluation for Clinically Important disease: Sampling using Image-guidance Or Not?’ or PRECISION for short. It is a randomised controlled trial of MRI-targeted biopsy, as compared to standard trans-rectal ultrasound guided biopsy for the diagnosis of prostate cancer in men without prior biopsy. PRECISION is an investigator-initiated project.

Longer-term registries already underway at the EAU RF include GPIU/ SERPENS, which tracks the antibiotic resistance in urinary tract infections in patients across Europe. Prof. Truls Erik Bjerklund Johansen (Oslo, NO) leads the project, and he will present the latest results, asking if antibiotic resistance is a current or a future issue for the practicing urologist. Mulders: “These projects deliver practical results, so they should be of

The EAU RF Career Development Programme gives the researcher the opportunity to transition from a senior postdoctoral research position to an independent principal investigator with three years of independent funding under the mentorship of an experienced principal investigator. The primary focus of selection is “excellence” and the secondary focus is “translational research” building the bridge between basic science and clinical research. The programme considers applications which would establish intrainstitutional collaborations and maximize the potential of the European research community. “Our session highlights all the possibilities of the EAU RF, like encouraging and supporting research in urology,” Prof. Mulders explained. Dr. Jens Ceder (Malmö, SE), the first researcher to be supported through the Career Track Programme, will present preliminary findings from his team’s research on cancer stem cells and their role in resistance to conventional therapies in PCa. A new research track will commence this year, under Dr. Alvaro Aytes Meneses (Barcelona, ES). It will be focussed on prostate cancer and treatment options. Online registration deadline: 22 February 2016

To find out more about the EAU Research Foundation and all of its ongoing projects, please visit www.uroweb.org/research January/February 2016

European Urology Today


New to the European Urology Family

Editor-in-Chief: J. Catto Co-Editors: A. Briganti and S.F. Shariat Associate Editors: G. Giannarini and T. Klatte

europeanurology.com 32

European Urology Today

January/February 2016

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

were described, such as combined treatments, and various forthcoming drugs were also considered, although not yet available.

paul.meria@ sls.aphp.fr

Three chapters were dedicated to minimally invasive interventional treatments and focused on sacral neuromodulation, posterior tibial nerve stimulation and intra-detrusor injections of botulinum toxin. The way of action of each treatment was described such as the technical aspects and the clinical results. Special considerations were addressed in the last chapters which covered the problems of elderly and bladder outlet obstruction. A practical synthesis was included in the concluding chapter.

Overactive Bladder: Practical Management

The catchphrase for this new book is “Don’t tell me, show me.” Fabrizio Dal Moro focused on “Orthotopic Urinary Diversion” in this atlas and described all the techniques currently available for this operation. The author aimed to assemble pictures, without any corresponding text, considering that the drawings were explicit and self-explanatory.

The introductory chapters summarised various aspects of terminology and physiopathology while the succeeding sections covered the evaluation of OAB, including clinical and urodynamic assessment. Recent developments and future techniques of evaluation were also addressed. The first-line management of OAB was described, focusing on lifestyle changes and physical therapy. A patient guide was included in this section.

Book reviews

He used his own drawings and based the book on original drawing boards. Some short notes completed each drawing. Fifty-five years of developments were covered nearly chronologically, since the oldest technique was described in 1960.

This accessible textbook represents undoubtedly an excellent tool for all practitioners involved in the management of OAB, and many readers will find substantial practical and useful information.

Want to be involved in the leading scientific platform within your urological subspecialty? Become Affiliate or Associate of an EAU Section! Each of the twelve EAU Sections brings attention to the development of a specific urological subspecialty. They provide an excellent opportunity to engage with a specialised platform, exchange experiences with like-minded experts, become involved in educational activities, and participate and organise Section meetings. Stay updated Are you an EAU Member? Become an Affiliate of an EAU Section today and receive the latest information on the work of the Section of your interest. Contribute Are you an Affiliate, already involved and published within the subspecialty, and have 10+ articles on PubMed? Apply as an Associate*, and shape the work of your Section.

: J. Corcos, S. MacDiarmid, J. Heesakkers : 978-1-118-64061-6 : available : Wiley-Blackwell : May 2015 : First : Hardcover : 101.30 euro : 264 : www.wiley.com

Atlas of Urologic Surgery: Volume I, Orthotopic Urinary Diversion

Overactive bladder (OAB) affects about 15% of adult population and impacts the quality of life of most patients. Despite the recent therapeutic advances, the management of OAB remains frequently challenging. Editors J. Corcos, S. McDiarmid and J. Heesakkers, with the help of nearly 30 worldwide experts contributed to this textbook an exhaustive and up-to-date practical information intended for practitioners, particularly urologists and gynaecologists.

The second-line treatment of OAB was addressed in the succeeding part which outlined the currently available drugs. Oral and transdermal medications

Authors ISBN E-book Publisher Publication Edition Binding Price Pages Website

After a figure which showed the vascular anatomy of ileum and colon, the author described the different techniques of reconstruction using ileum, colon or both. Step by step the author demonstrated which intestinal segment should be used and the technical aspects of bladder reconstruction. More than 30 techniques were assembled, each of them described on a single drawing board which goes direct to the point.

This original book is surprising, educative and “artistic” and will be useful for most urologists aiming to remember all available techniques of bladder reconstruction. Author & illustrator : F. Dal Moro ISBN : 978-15-172-8611-8 Publisher : CreateSpace Independent Publishing Platform e-Book : available Publication : Sept. 2015 Edition : 1st Binding : Paperback cover Price : 16.76 euro Pages : 72 Illustrations : 65 Website : www.amazon.it

EAU Education Online proudly presents:

The First EAU Guidelines E-Course:

Prostate Cancer How well do you know the EAU Guidelines? Educate and test yourself with this first in a series of EAU Guidelines E-courses. The online course features questions formulated by experts in the field, reviewed by the EAU Guidelines Office and the Young Urologists Office.

Prostate Cancer Learning Objectives • Review the most updated EAU guidelines on Prostate Cancer • Learn how to make informed decisions in treatment of Prostate Cancer Patients • Test your knowledge on the latest developments in Prostate Cancer according to the EAU Guidelines

If you would like to know more about the different EAU Sections and their activities visit



For more information on Affiliate and Associate role, contact Angela Terberg, EAU Section Office Coordinator at a.terberg@uroweb.org


* All applications are reviewed by the board of the subspecialty Section

More info: educationonline@uroweb.org

January/February 2016


3 CME points

European Urology Today


Delivery of survivorship Assessing the needs of cancer survivors Paula Allchorne, MBA, Dip, RGN (UK) Guy’s Hospital Dept. of Urology London (GB)

and problems, professionals can provide tailored support, education and intervention for their patients. If patients are physically and psychologically supported, educated and learn to cope and manage the after effects of their treatment and disease they will feel more empowered to self-manage and will want to live a more healthy and active life.

p.allchorne@ eaun.org

Recovery package Three key areas of the recovery package we have focused on in our hospital are the following:

Health services are continuously being put under pressure to deliver five-star service; with patient demand increasing and the lack of financial support and resources, this proves more and more difficult. The only way to meet such demands is by radically changing how we currently practise, and revisit our patient treatment pathways to make them more efficient and effective for both patient and hospitals. We know more people are surviving cancer because of early diagnosis and improved treatments. However, from patient satisfaction surveys and National Patient Reported Outcome Measures (PROMs) many cancer survivors are living with moderate to severe unmet needs (Macmillan, 2014). Marsh (2014), states “We have achieved most as surgeons when our patients recover completely and forget us completely.” The question we need to ask ourselves is this: If patients are experiencing unmet needs how can they move on with their lives and put their cancer care behind them? The UK has implemented the ‘Recovery Package’ as a national recommendation from The National Cancer Survivorship Initiative (2007). The aim is to implement key interventions to identify the unmet needs of patients in specific tumour sites. By gaining this knowledge and understanding of patients’ concerns European Association of Urology Nurses

Holistic Needs Assessments A Holistic Needs Assessment (HNA) is a questionnaire that is completed by patients affected with cancer, and identifies the patient’s physical, emotional, spiritual, practical and social needs and concerns. The aim is to address these unmet needs within an acceptable timeframe by sharing these unmet needs amongst the multidisciplinary team to improve patient’s management and care. In the UK, HNAs are recommended to be completed at the following points of the patients pathway; start of treatment, during treatment, end of treatment, diagnosis of recurrence and transition to palliative care.

"The seminar sessions have also been more efficient and effective for the healthcare professionals. Conducting one to two-hour group sessions has reduced the waiting list in the outpatients clinic because the nurses can now see up to twentyfive patients at once." Health and Well-Being Events Health and well-being events are events aimed at supporting patients through their treatment by

Fellowship Programme European Association of Urology Nurses

European Urology Today

Treatment Summaries A treatment summary is a letter sent to the commissione medica locale or primary care doctors. The aim is to provide information on what treatment the patient has had in hospital and to give instructions on any interventions, for example, on-going medication or clinical observations. The treatment summaries also help the patient to understand what to expect in the future including; late side-effects and possible treatment toxicities, future management plan and the contact details for health professional to answer any future concerns. These key elements of the recovery package aim to support and encourage self management. Survivorship pathway for prostate cancer patients In a busy urology unit in the UK, in 2014/15 we treated 1,500 prostate cancer patients. The only way to deliver these three elements of the recovery package we needed to devise a new survivorship pathway for prostate cancer patients. We ran several focus groups; for patients, specific ethnic groups and health professionals to establish what patients wanted from us. Also establishing what was feasible from the multidisciplinary team regarding time and commitment as there is currently no extra finances or resources associated with the recovery package. The following pathway was blueprinted:

Seminar 2 Post Treatment Erectile Dysfunction (ED) and Continence Seminar The erectile dysfunction and continence seminar is compulsory for all patients who have had robotic surgery. They attend this seminar four weeks after their catheter is removed to be educated on pelvic floor exercises, ED and a demonstration for using the vacuum erection device (VED). The HNAs highlighted that ED and continence were among the biggest concerns and unmet

• 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


involving different members of the multidisciplinary team to actively provide education, support or signposting people to the appropriate resources or support services. The events are tailored to your patient’s cliental and tumour specific needs and concerns. Patients’ biggest concerns or unmet needs are identified from the HNA questionnaires, which devised the content of what should be included in the health and well-being events.

Seminar 1 Pre Treatment Seminar This seminar is compulsory for all patients that are going to have prostate cancer treatment at our hospital. The pre-treatment seminar session physically and psychologically prepares patients for their pending treatment and enhances self management, educating them on their disease, side effects or complications they may experience during or after their treatment. There is also a key focus on healthy eating and physical exercise to promote life style changes. Each seminar session is tailored to the different treatments.

Application deadline: 31 August 2016

T +31 (0)26 389 0680 F +31 (0)26 389 0674 eaun@uroweb.org www.eaun.uroweb.org

Designed and Implemented by Paula Allchorne

Four seminar sessions have been embedded in to the prostate cancer survivorship pathway.

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

For Fellowship application forms, rules and regulations and information on which specialities the hosting hospitals can offer please visit the EAUN website.

Figure 1: Prostate Cancer Survivorship Pathway:

needs for our patients which is why this seminar was implemented. Seminar 3 Post-Treatment Well-being Event This is the only seminar we have not made compulsory based on the feedback from patients. Patients felt seminars 1 and 2 informed and taught them self management and coping techniques for their side effects and signposted them to other resources if they required any further interventions. However, we do still run a post-treatment wellbeing event for patients that have expressed any concerns that need more support physically or psychologically. Seminar 4 Discharge Seminar The discharge seminar is also compulsory for all patients that are being discharged back to their commissione medica locale or primary care doctors for follow-up. This seminar is aimed to encourage and empower patients to take back responsibility for their own health and future follow-up appointments. The seminar is designed to show patients what resources are in the community, help provide peer support and ensure they understand their future follow-up regime with their commissione medica locale or primary care doctors. Evaluation The new pathway has been successful not only for patients but also more cost efficient and effective for healthcare professionals. Delivering interactive group seminars has opened communication channels between patients, healthcare professionals and community services. All patients who have attended a seminar have completed a feedback questionnaire, and the majority of the patients found the seminar beneficial. A total of 97% of patients who attended the seminars felt they benefited and gained more knowledge and coping strategies and 100% of patients were satisfied with the seminars. One of the biggest impacts to the group seminars was peer support; patients found it comfort in knowing other people were in the same situation and there were resources that could help them cope. The seminar sessions encouraged patients to ask questions about personal problems and also helped patients who were too embarrassed to ask personal questions as the group discussions were reported back as having a relaxed atmosphere and put people at ease. One patient said: “All the questions I wanted to ask but was too embarrassed to were either addressed by the nurses or another patient asked the question.” The seminar sessions have also been more efficient and effective for the healthcare professionals. Conducting one to two-hour group sessions has reduced the waiting list in the outpatients clinic because the nurses can now see up to twenty-five patients at once. This new survivorship pathway has also reduced the number of outpatient’s appointments for patients, and has allowed healthcare professionals more time to provide efficient service to their patients.

Munich, Germany 12-14 March 2016

European Association of Urology Nurses

EAU16 app: Your smart congress companion Download the EAU16 app (EAUN16 Meeting included) via iTunes or Google Play • One, two and three-day registration fees • For all enquiries on registration, the Nurses’ dinner, Hospital visits and Urowalk please contact registrations@congressconsultants.com www.eaun16.org

in conjunction with

January/February 2016

Insights from the Prostate Cancer World Conference Urology nurse gains practical insights on caring for PCa patients Judy Kelly, Rn Grace Hospital Urology Dept. Tauranga (NZ)

india3@xtra.co.nz I am a New Zealand urology nurse specialist with a special interest in prostate cancer. Fifteen years ago I established a small company which gave me the opportunity to develop a nursing service intended to identify and meet the needs of patients undergoing urology surgery. I practice in Tauranga, a stunning seaside city in the aptly named region ‘Bay of Plenty.’ We have a large public hospital and a smaller more intimate private hospital called “Grace” which strives to be a centre of excellence in urology. The surgical treatments offered for men with prostate cancer are robotic-assisted laparoscopic prostatectomy, radical prostatectomy, brachytherapy and cryotherapy. We also have a brand new state-of-the-art Radiation Oncology Unit. In August 2015, with the support of the (PCFNZ) Prostate Cancer Foundation of NZ, Abbvie and the New Zealand Urology Nurses Society (NZUNS) I attended the Prostate Cancer World Conference in the sunny North Queensland city of Cairns. It was my third conference which is usually convened in Melbourne, Australia. This year the organisers broke with tradition and the balmy Cairns temperatures really did provide welcome respite to those of us enduring a long, cold southern hemisphere winter! European Association of Urology Nurses

The conference started extremely well with the official welcome being hosted on Green Island, Great Barrier Reef. Networking began in earnest on the boat trip out to the reef with a great turn out of delegates who spent the afternoon snorkelling and diving in the Gin clear water with its stunning variety of sea life and coral readily accessible. The conference ‘proper’ began the following day at the Cairns convention centre with the programme offering three streams: Clinical Urology, Translational science, Nursing & Allied Health. The event brought together approximately 650 delegates (from 26 countries) with world leaders in prostate cancer presenting their expertise and current research across all facets of care. Comprehensive programme I found the programme of tremendous interest and very relevant to nurses. In this article I would like to focus on lectures of interest to me and share some of “the pearls of wisdom” gleaned. On Day 1, Prof. Suzanne Chambers, clinical psychologist and author of “Facing the Tiger: Advice for Men and the People Who Love Them” spoke on the latest advances in psychological care for men with localised prostate cancer. Suzanne is a wonderful speaker who opened my eyes further to the prevalence of high levels of distress, depression and increased risk of suicide among men diagnosed with prostate cancer. I was surprised to learn that eight years after diagnosis, 30-40% of men had ongoing health-related distress, worry, low mood and insomnia. Almost half (47%) also reported at least some unmet sexuality support need. Prof. Chamber’s talk galvanised me into action and I returned home to establish a database of counsellors and psychologists with a special interest in caring for prostate cancer patients. Recognising that high levels of early distress predict later ongoing distress, I now ask all men to complete a “Distress Thermometer” (DT) as part of their rehabilitation assessment. The DT is a

prostate cancer treatment pathway. Treatment often starts, but does not end solely with a skilled surgeon!

validated tool designed to predict cancer distress (the prostate cancer version of the DT and associated validation data is available from Prostate Cancer Foundation of Australia). Another Day 1 highlight was a workshop which offered the audience many tips on networking in a conference environment. The speaker urged the audience to avoid looking at how contacts can benefit them, instead recommending they be the person that connects other people together. We were encouraged to practise asking questions (but not ‘closed’ ones), not fill awkward silences (you end up oversharing) connect people to one another, and ask “How can I help you?” rather than look to how people can help me. This workshop achieved its desired outcome with everyone conversing freely by the end of the session. Strangers were prepared to approach others and start a conversation based on commonalities. There was wonderful interaction and this set the tone for getting people together for the rest of the conference. On Day 2 I particularly enjoyed the lively and informative panel on “Challenging prostate cancer cases.” The multidisciplinary panel included a urologist, radiotherapist, medical oncologist, psychologist, nurse specialist, exercise physiologist, general practitioner and the president of Prostate Cancer Foundation of Australia. This panel discussion highlighted the importance of a team approach in caring for men with prostate cancer, with each panellist lending their perspective on the best approach for care. It takes a skilled team to provide holistic support to men on a

Role of physiotherapy A highlight from Day 3 was the presentation by Continence physiotherapist Dr. Irmina Nahon titled “Prehab physiotherapy – the best practice.” Her presentation highlighted the benefits of preprostatectomy assessment and a change in thinking in the way we teach men pelvic floor exercises. She described a new hypothesis: that training the urethral sphincter will improve continence outcomes for men having radical prostatectomy. She stated that health professionals need to move away from giving ‘anal cues’ when delivering pelvic floor muscle training, instead focussing on instructions which selectively recruit the urethra. In summary the correct verbal cues for teaching men are to perform pelvic floor contractions that will shorten the penis, lift the testicles and stop the flow of urine. A subject close to my heart, Dr. Favil Singh presented a wonderful talk titled “Pre-Surgical exercise programming to improve outcomes for men undergoing prostatectomy.” He said that if we could squeeze all the benefits of exercise into one pill, it would be the most prescribed pill in the world. Exercise has been shown to counteract the negative side effects of treatment, shorten recovery times and improve quality of life. Preliminary investigations by Dr. Singh and his team at Edith Cowan University show that targeted pre-surgical exercise intervention is well tolerated by prostate cancer patients and results in considerable improvements in neuromuscular strength and cardiovascular fitness. Despite the numerous adverse effects of prostate cancer treatment, exercise has the potential to provide a buffering effect in preserving functional capacity. The 2016 Asia Pacific Prostate cancer conference will return to the Melbourne Convention Centre, Victoria, Australia from 1 to 3 September. Make sure you save the date.

EAUN fellowship report Expert insights at nurse-led clinic in the UK Emanuel Vella, BSc (Hons) Nursing Theatres Mater Dei Hospital Msida (MT)

emanuel.a.vella@ gov.mt My fascination with all that is related to the nursing profession goes back beyond 2004, the year of my registration as a first-level Nurse. Soon after qualifying, I was given the opportunity to join the Operating Theatres Scrub Team at St. Luke’s Hospital, a few years before our migration to the new Mater Dei Hospital.

My primary objective was to witness first-hand the way experienced urology nurses perform and deliver. Unfortunately, such nurse-led clinics are still in their infancy in Malta and this fellowship helped me realised the potentials if we have the same experience and standard in Malta in the future. This is now more relevant than ever, especially with the upcoming Maltese Nurse Specialist Register that will be activated soon. Host institution Homerton University Hospital provides general hospital services and full range urology services. It is well known that this hospital supports the development of nursing. The hospital works closely with four other hospitals and includes top nurse-led clinics like Prostate Biopsy, PSA surveillance, haematuria and Intravesical therapy, among others. The support that the aforementioned clinics get from their healthcare institution is second to none.

courage and assistance were always on the nurses’ agenda, with care plans presented to patients in a friendly and understandable way. The unit nurses were helpful and went out of their way in explaining and sharing their knowledge on how to run such clinics in an efficient and costeffective way. Treatment was always given in a friendly manner and with a smile despite the hectic workload. Although I had set out for myself a somewhat loaded and optimistic schedule plan, I was able to observe and participate in many of the clinics in my list, which helped me gain an overview of nurse-led clinical services.

The nursing staff communication skills were commendable and definitely contributed to the effective and speedy manner in which they perform their tasks. As a team they helped each other when problems arise. They back up each other well and I initially trained in General Surgery followed by efficiently such as when a team member is The team I worked with was made up of a Nurse Urological and Neuro Surgery. Excluding Theatre unavailable, enabling them to attend to all patients Consultant Urology and Uro-oncology, a Clinical Nurse and avoid delays in delivering proper care. Nurse Specialists, all the rest, are obliged to be proficient in three specializations, not just for Specialist Uro-oncology, a Clinical Nurse Specialist flexibility’s sake, but also in case of a national disaster. Urology and a Urology Staff Nurse. The schedule was as follows: My main specialisation, however, is urological surgery The unit has a welcoming environment with a highly and I am working my way to become the second Monday 21st TWOC and Prostate Biopsy Clinic competent and friendly staff and made me feel part of Urology Theatre Nurse Specialist here in Malta. Our Tuesday 22nd MDT meeting and Prostate urology unit is a specialised dynamic environment, a competent team. On my arrival, I was greeted by the cancer follow up where innovative techniques are the norm with the urology staff nurse with whom I had corresponded. Wednesday 23rd Prostate Assessment and patient as the ultimate beneficiary. He showed me around the clinics and their respective Haematuria Clinics setup. Though small, the clinics were well equipped Thursday 24th Intravesical Therapy EAUN Fellowship with the necessary facilities. All medical equipment Friday 25th Urology telephone clinics My interest for the EAUN fellowship was fuelled by my was well placed and ergonomically efficient. The pursuit of knowledge on how other prestigious competent staff was very knowledgeable in using the urological facilities are being conducted and managed equipment and made difficult tasks look easy. I believe that I have not only reached my objectives by competent nurses. Such first-hand experience will but also surpassed some of them. From this surely boost my understanding, helping me in my My fluency in English helped me follow the experience I witnessed first-hand the way my main goal to reach a competence level to that of a procedures done by the multi-disciplinary teams and European colleagues deliver exceptional service to urological nurse specialist. I can say now that the their interaction with their respective patients. My urology patients. These experiences also helped me to knowledge I gained from this fellowship also mentors were highly qualified and experienced, and fine tune and hone my mentoring skills. Sharing exceeded my expectations and I am convinced that were motivated and very professional. Patients in professional experience with colleagues and students there is always room for improvement. Homerton are treated in a holistic approach, including is of paramount importance in our demanding the relatives in their care. The staff helped patients to profession. My goal was to return to my practice turn from passive spectators into active role players in better-informed in providing a cost effective and European Association of Urology Nurses their healthcare plan and delivery. Reassurance, efficient service to patients. This objective was January/February 2016

reached and the experience gained helped me improve my performance as a team player and motivator at our multi-disciplinary urological surgery team at Mater Dei Hospital in Malta. Recommendations for future EAUN fellowship beneficiaries It is an absolute must to plan well ahead for this fellowship, irrespective of one’s choice of venue and with clear goals and expectations. One should research well beforehand the costs of accommodation and flights when submitting one’s application. Applicants must also have a realistic comprehension of the costs when booking since London is no exception to high commuting costs. Taking part in this EAUN fellowship truly boosted my nursing career. The experienced gained will help me provide a high level of nursing care in Malta while still striving to improve my skills, knowledge and commitment. I thank Bruce Turner, Sasha Ali, Clare Smart and Clifford Astwood for their patience in mentoring me. I felt at home from Day 1 and will not hesitate to have this experience again with such a great team. Finally, my special thanks to the EAUN Board for their commitment to this fellowship programme. European Urology Today


2nd ESUN Course takes place in Rome, Italy Neurogenic detrusor overactivity & overactive bladder Stefano Terzoni, Rn EAUN Chair Elect Milan (IT)

s.terzoni@eaun.org The European School of Urological Nursing (ESUN) is proud to announce a brand-new course on neurogenic detrusor overactivity and the overactive bladder syndrome complex. The course will take place in Rome, Italy, on 4 and 5 November, 2016, and will provide the participants an overview of the pathophysiology of lower urinary tract dysfunction in idiopathic overactive bladder (OAB) and neurogenic detrusor overactivity, relating to neurophysiological mechanisms. In addition, the current evidence base for management will be discussed. Upon completion of this course, the participants will be able to describe the anatomy, physiology and pathophysiology of overactive bladder. They will also be able to describe and discuss the methods used for diagnosing and treat neurogenic and nonneurogenic overactive bladder. In addition they will European Association of Urology Nurses

be able to deliver the course in their clinical areas as part of a developmental training and educational commitment. The course is open to 25 nurses from all across Europe, who will arrive on Friday, 4 November in the morning and attend the first half of the course in the afternoon. On 5 November, the second part will take place in the morning. Thanks to a grant from Astellas, the participation fee is just €100; hotel rooms and the dinner for Friday 4th will be booked by the EAUN, so the delegates will only need to book their flight ticket, which will be covered by the grant as well. This ESUN course has been created and organised by the EAUN, with logistic support from AIURO, the Italian Association of Urology Nurses. The scientific programme includes the aetiology of bladder control and neurophysiology of the lower urinary tract, pathophysiology and management of OAB and neurogenic detrusor overactivity with similarities and differences, and evidence-based nursing. The course will be interactive: the participants will discuss clinical cases and focus on decision-making, with help from a faculty of experts. The final goal is to give nurses a clear understanding of how to manage these patients with a multidisciplinary team. We are committed to offering a high-level international course, with a practical approach based on clinical reasoning and the best available evidence. The course will be entirely held in English, so the participants are requested to be proficient in

Neurogenic detrusor overactivity and Overactive bladder 2nd Course of the European School of Urology Nursing 4-5 November 2016, Rome, Italy

understanding and speaking, in order to ensure the highest level of interaction. Don’t miss the opportunity to attend an important course in such a wonderful city; for all details regarding the course and registration, please contact Susan Brenninkmeijer, s.brenninckmeijer@congressconsultants.com

EAUN Board 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)


See you in Rome!

Call for Papers The International Journal of Urological Nursing - The Official Journal of the BAUN The International Journal of Urological Nursing is clinically focused and evidence-based and welcomes contributions in the following clinical and nonclinical areas: • General urology • Clinical audit • Continence care • Clinical governance • Oncology • Nurse-led services • Andrology • Reflective analysis • Stoma care • Education • Paediatric urology • Management • Men’s health • Research There are many benefits to publishing in IJUN, including: • Broad readership of papers—all published papers will be available in print and online to institutional subscribers and all members of the British Association of Urological Nurses • Fast and convenient online submission— articles can be submitted online at http://mc.manuscriptcentral.com/ijun

• Fast turnaround—papers will be reviewed and published quickly and efficiently by the editorial team • Quality feedback from Reviewers and Editors—double-blind peer review process with detailed feedback • Citation tracking—authors can request an alert whenever their article is cited • Listed by the Science Citation Index Expanded™ (Thomson ISI)

For further information and a free sample copy go to: www.wileyonlinelibrary.com/journal/ijun

Register for the Urowalk and the Nurses’ dinner during online registration or send an email to registrations@congressconsultants.org Online registration deadline: 22 February 2016

12-14 March 2016, Munich, Germany

The 17th International EAUN Meeting: Join us in Munich! The 17th EAUN Meeting will take place in Munich, Germany, from March 12 to 14, in conjunction with the 31st Annual EAU Congress. The brand-new nursing programme includes many interesting thematic sessions such as Urology issues during transition to adulthood (with Winnie Nugent, UK and Hanny Cobussen, NL), Sexuality and cancer (chaired by Paula Allchorne, UK), Tobacco and cancer (Susanne Vahr and Thordis Thomsen, DK), Painful bladder syndrome, Self-care in urostomy patients, Perspectives in prostate cancer care (with Franziska Geese, CH), Marie Anne Van Stam, NL, and Michael Kirby, UK), Primary challenges in urology (Jerome Marley, IE, Ian Banks, IE, Michel Kirby, GB) and many more. State-of-the-art lectures on Probiotics (Lidy Van Driel-Rooks, NL) and Genital mutilation, two 2-hour EAUN-ESU courses, one on Sunday on Instillations for non-muscle invasive bladder cancer (Bas Van Rhijn and Willem De Blok, NL) and another one on Monday Discussing cutting-edge management of Urinary stones (Oliver Traxer, FR, Bhaskar Somani, GB, Hendrik Oussoren, NL) and hot-topic sessions will provide comprehensive overviews of fundamental topics, like Nurse-led cystoscopy and urodynamics (with Peter Rosier, NL), Neoadjuvant treatments for bladder cancer (with Paula Allchorne, GB, Bas Van Rhijn, NL, Jonathan Borwell, GB). Ethical issues in urology will be discussed in a dedicated lecture by Marinane Rabe, DE, with interesting cases and inputs for debate.

that in a small group you can truly interact with the speaker, which is always well-appreciated by the participants, and it has therefore over the years become a milestone of our congress. The theme this year will be the Preparations for major urological surgery.

A session of videos submitted by the delegates will be held on Sunday, as well as a Marketplace session, which has the advance

The debate about the direction of urological nursing, started in Madrid last year, will go in-depth in the plenary session, as new

in conjunction with


European Urology Today

This year we received a lot of high quality abstracts from the delegates, with the top numbers coming from the UK, Italy and Japan; two poster sessions will be held on Saturday and Sunday, in which selected speakers will present their own work and run for a valuable prize. The delegates will also be involved in the popular difficult cases session, in which unusual nursing cases submitted by delegates will be presented and discussed e.g. on Complications after cystectomy, autonomic dysreflexia and encrustation uropathy. The EAU is launching patient information for patients with bladder cancer, which will be presented on Monday, while a special session on Saturday will introduce the new evidence-based EAUN guideline developed by a nursing panel on Male External Catheters. Our association is always committed to producing and updating high level guidelines, which will be available at no cost in the printed version at the EAUN booth (Room 2) (as well as in PDF format on the EAUN website: http://nurses.uroweb.org/nurses/guidelines/).

Lawrence Drudge-Coates, Chairman EAUN

Stefano Terzoni, Chairman SCO

developments are going on across Europe. Finally, important announcements about upcoming educational initiatives of the EAUN will be made during the General Assembly, held on Monday, at 12.15 h. Also non-members are welcome to attend. The programme for Munich is rich and has something for everyone, with many updates and sessions involving the delegates directly; don’t miss the opportunity of taking part in this important educational event! See you in Munich! Stefano Terzoni

For details on registration and the Scientific Programme, visit the EAUN’s meeting website at: www.eaun16.org

www.eaun16.org January/February 2016

Profile for European Association of Urology (EAU)

European Urology Today (EUT) Jan/Feb 2016  

EUT is the official newsletter of the EAU.

European Urology Today (EUT) Jan/Feb 2016  

EUT is the official newsletter of the EAU.

Profile for uroweb