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European Urology Today Official newsletter of the European Association of Urology

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Vol. 28 No.5 - October/December 2016

London calling

Urology Week in pictures

CEM/SEEM: Roundup reports

Sneak preview on what to expect at EAU17 in London

A glimpse of Europe-wide activities during Urology Week

Overview and highlights from the last editions of the Regional Meetings

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EAU pledges action to tackle prostate cancer Launch of White Paper on prostate cancer by EAU in January 2017 Prof. Hein Van Poppel Adjunct SecretaryGeneral Leuven (BE)

hendrik.vanpoppel@ uzleuven.be Prostate cancer (PCa) is the most commonly diagnosed cancer in men with more than 417,000 new cases and 92,000 deaths in Europe recorded each year. Currently, 1 in 7 men in Europe will develop detectable PCa before the age of 85. More than two million men in Europe are living with this disease and so it is a strategic priority for the EAU to raise awareness of the impact of PCa and to collaborate to promote more action at EU level. Although significant advances are being made in the fight against the disease, cancer remains a key public health concern and a tremendous burden on European societies. It is for this reason that a range of activities have taken place at EU level to help Member States in the fight against cancer. EU action on cancer The European Code Against Cancer is a European Commission initiative to inform people about actions they can take for themselves or their families to reduce their risk of cancer. The scientific evidence behind the code can be accessed here: http://cancer-code-europe.iarc.fr/index.php/en/ scientific-justification The current fourth edition consists of twelve recommendations that most people can follow without any special skills or advice. The more recommendations people follow, the lower their risk of cancer will be. It has been estimated that almost half of all deaths due to cancer in Europe could be avoided if everyone followed the recommendations. The fourth edition of the Code is published on the website, together with additional information about each recommendation and related aspects of cancer prevention.

more needs to be done to give PCa equal attention, given its impact on the health of European men. From 2009 to 2013, the European Commission (EC) ran the European Partnership for Action Against Cancer to help Member States and other stakeholders tackle cancer more efficiently. In 2014, the EC established the Expert Group on Cancer Control to help in the preparation of EU policy initiatives in this area. The Expert Group, chaired by the EC, brings together representatives from Member States national authorities as well as representatives from patient groups, scientific and medical associations specialised in cancer, organisations working on cancer prevention and industry. More information about the EC’s policy on cancer control, including the work of the Expert Group can be found here: http://ec.europa.eu/health/ major_chronic_diseases/diseases/cancer/index_en. htm#fragment1 Also in 2014, an EU Joint Action on Cancer Control (CANCON) was launched to develop an EU Guide on Quality Improvement in Comprehensive Cancer Control. This Joint Action will finish in 2017 with the final conference in Malta on 14 – 15 February. Please see http://www.cancercontrol.eu/ for more information on this initiative. More recently, the EC initiated a ground-breaking project to develop a European quality assurance scheme for breast cancer services underpinned by accreditation and referring to high quality, evidencebased guidelines. Alongside this, the EC, through its consecutive Research Programmes has supported a number of EU collaborative research projects in cancer, including projects specifically focused on PCa.

"The EAU will lead a campaign to promote the recommendations of the White Paper..."

EAU action on prostate cancer The EAU has a wealth of expertise, scientific resources and tools targeting both clinicians and patients on which the EU work on PCa could build and expand. The EAU has already delivered a range of activities to raise awareness of the importance of PCa and to compile the most comprehensive guidelines The first edition of the Code was published in 1987. worldwide based on the latest scientific evidence. The fourth edition was prepared in 2012–2013 In partnership with Europa Uomo, the EAU organised by cancer specialists, scientists and other experts from a European PCa Awareness Day (EPAD) in 2015, where across the European Union in a project coordinated by key policy makers, scientific experts, European the International Agency for Research on Cancer, urological associations and representatives of patient with financial support from the EU Health Programme. groups gathered at the European Parliament in In formulating the recommendations, the experts took Brussels to discuss the impact of PCa in Europe. into account the latest scientific evidence available. All the experts who contributed to the fourth edition According to recent research, cancer has now were requested to work independently and be guided overtaken cardiovascular disease as the main cause of only by their expert views, not by the position of any death in 12 European countries (Belgium, Denmark, France, Italy, Luxembourg, The Netherlands, Portugal, organisation or institution. Slovenia, Spain, UK, Norway and Israel). This In 2003, the EU Health Ministers unanimously adopted increases the importance of a European effort a Council Recommendation on cancer screening, towards prevention. The most common cancer sites setting out principles of best practice in are breast, colorectal, prostate and lung, and expert opinions agree on the addition of bladder and kidney the early detection of cancer. The Recommendation invited all Member States to take common action to cancer based on the most recent figures of their burden in Europe. implement national population-based screening programmes for breast, cervical and colorectal cancer, The European Multidisciplinary Meeting on Urological with appropriate quality assurance at all levels. PCa was not included in this list and the EAU considers that Cancers (EMUC) focusses on controversial diagnostic issues and treatment strategies during an annual three-day congress with the collaboration of the European Society for Medical Oncology (ESMO), the European Society for Radiotherapy & Oncology (ESTRO), the European Society for Radiology (ESR), the European Society for Pathology (ESP) and the EAU. During the 8th EMUC meeting from 24-27 November in Milan, Italy, Dr. Tit Albreht, coordinator of CANCON, will give an overview of the work of the EU Joint October/December 2016

Action and will explain how the forthcoming Guide on comprehensive cancer control could help to improve diagnosis and care for patients with urological cancers. PCa is the most frequent cancer and the third most common cause of death in men in Europe and has an important impact on healthcare systems. Therefore, I have been leading the production of an EAU White Paper on PCa in close collaboration with the European Prostate Cancer Coalition (EUomo), the European Cancer Patient Coalition (ECPC) and the Association of European Cancer Leagues (ECL). The paper aims to raise awareness of some of the key issues about PCa in Europe and to make the following recommendations for action at European level: • The EU needs to raise men’s awareness of PCa. This is a considerable healthcare problem that would benefit from a uniform EU-wide riskadapted early detection programme. The EU needs to increase funding to improve both the timely diagnosis and treatment of men with PCa. It needs to fund work to better understand the association between potential risk factors and lethal PCa. • European institutions and Member States need to ensure that PCa patients receive high quality, standardised, and integrated care with a focus on a patient-centred multidisciplinary approach. • The EU and its Member States should also ensure equitable access to novel technological tools that enable better diagnosis, treatment and research. The future is likely to encompass risk-adapted treatment programmes that require contemporary imaging and diagnostic tools.

• Fast and equitable access to innovative treatments and personalised medicines should be made for all PCa patients who can benefit from them. • Finally, the EU and its Member States should promote the implementation of cancer survivorship plans, including specific plans for PCa patients, to facilitate the return to a normal life for all European PCa patients. The EAU and other collaborating organisations will launch the White Paper on PCa at an expert meeting on PCa on 24 January 2017 in Brussels, organised by the International Centre for Parliamentary Studies (ICPS) in collaboration with the EAU. The EAU will then lead a campaign to promote the recommendations of the White Paper to all relevant stakeholders at European and national levels in the lead up to the next European Prostate Awareness Day (EPAD), which will take place in autumn 2017 in the European Parliament in Brussels. It remains a strategic priority for the EAU to offer its scientific expertise and to actively engage with the EU institutions and other stakeholders to create a better future for all of Europe’s PCa patients.

Wishing You a Joyful Holiday Season and a Happy New Year!

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Cutting-edge Science at Europe’s largest Urology Congress Register now for the early bird fee! Deadline: 16 January 2017

European Urology Today

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Role of metabolic evaluation in urolithiasis Lifestyle advice, medical therapy can reduce stone recurrence Prof. Kemal Sarica President EAU-EULIS Dr. Lutfi Kirdal Kartal Research and Training Hospital Istanbul (TR) saricakemal@ gmail.com

Dr. Noor Buchholz Sobeh’s Vascular and Medical Centre Dubai (UAE)

noor.buchholz@ gmail.com Co-authors: Enrique Cao Avellaneda (ES), Andreas Bourdoumis (UK) There is evidence that intervention in the form of lifestyle advice and some forms of medical therapy can reduce the rate of stone recurrence1. Metabolic investigation and prevention are important elements in the clinical management of renal stone disease.

European Urology Today Editor-in-Chief Prof. M. Wirth, Dresden (DE) Section Editors Dr. M.A. Behrendt, Amsterdam (NL) 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) Special Guest Editor Mr. J. Catto, Sheffield (GB) Founding Editor Prof. F. Debruyne, Nijmegen (NL) Editorial Team E. De Groot-Rivera, Arnhem (NL) 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 Disclaimer No part of European Urology Today (EUT) may be reproduced without written permission from the Communication Office of the European Association of Urology (EAU). The comments of the reviewers are their own and not necessarily endorsed by the EAU or the Editorial Board. The EAU does not accept liability for the consequences of inaccurate statements or data. Despite of utmost care the EAU and their Communication Office cannot accept responsibility for errors or omissions.

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Table 2: Characteristics of high-risk stone formers General factors Early onset or familial stone formation Solitary kidney (no increased risk but major ieffect of recurrence) Infection stone or Uric acid/Urate or Brushitecontaining Diseases associated with stone formation Hyperparathyroidism Metabolic syndrome Gastrointestinal diseases (intestinal resection, Crohn’s disease, malabsorptive conditions) Nephrocalcinosis Sarcoidosis Genetically-determined stone formation Cystinuria Primary hyperoxaluria Renal tubular acidosis 2,8-Dihydroxyadeninuria or Xanthinuria Lesch-Nyhan síndrome Cystic fibrosis Drug-associated stone formation (i.e. antiretrovirals, antibiotics) Anatomical abnormalities Medullary sponge kidney Ureteropelvic juntion obstruction or stricture or caliceal diverticulum/cyst Vesico-ureteral-renal reflux or ureterocele Horseshoe kidney

practice is to individualise according to incidence of recurrence and according to stone composition. For example, a newly-diagnosed patient with medullary nephrocalcinosis or cystinuria probably requires more intensive follow-up in the first few years than a patient with known primary hyperparathyroidism awaiting definitive treatment. Nevertheless, some evidence is available, at least for the initial period. For the initial specific metabolic work-up, the patient should stay on a self-determined diet under normal daily conditions and should ideally be stone-free for at least 20 days. Follow-up studies are necessary in patients taking medication for recurrence prevention. The first follow-up 24-hour urine measurement is suggested eight to 12 weeks after starting pharmacological prevention of stone recurrence. This enables drug dosage to be adjusted if urinary risk factors have not normalised, with further 24-hour urine measurements if necessary. Once urinary parameters have been normalised, it is sufficient to perform 24-hour urine evaluation every 12 months. There is limited published evidence on this issue and efforts to conduct more studies and review panels are well under way.

"Imaging should include ultrasound of the kidneys and ideally low dose CT KUB to investigate spontaneous passage or the presence of other calcifications."

Who to screen Identification of metabolic risk factors and correct interpretation of results from 24- hour urine collection and stone analysis are central to planning an effective Table 4: Basic evaluation of a stone former prevention strategy. Risk factors can be classified into Medical history and Stone history (prior events, hereditary and acquired, anatomic and metabolic. Metabolic evaluation of recurrent stone formers is The most important and recognised are lifestyle/ slowly but steadily coming to the forefront of physical examination family history) dietary and urinary metabolic risk factors, urolithiasis diagnosis and management. The Diagnostic imaging Ultrasound/ CT KUB summarised in Table 1. importance of risk stratification and screening is Blood analysis Creatinine established and directs management and prevention Calcium (ionised calcium Table 1: Lifestyle/dietary and urinary risk factors for of recurrent stone formation. or total calcium with nephrolithiasis With ongoing studies and research, we learn more albumin) about the complex interplay of promoting and Uric acid Urinary risk factors Lifestyle/Dietary risk inhibiting factors of crystallisation and the influence factors Urinalysis Urine dipstick test: of quantification in formulating individualised realistic Low urine volume Obesity-Diabetesleucocytes, erythrocytes, and evidence-based treatments for this group of Metabolic syndrome nitrite, protein, urine pH, patients. Persistent Acidic or Decreased water intake/ specific weight Alkaline urinary pH Dehydration References Urine culture Hypercalciuria Low fiber diet 1. Hosking DH, Erickson SB, Van den Berg CJ, et al.: The stone clinic effect in patients with idiopathic calcium Hyperoxaluria High protein diet urolithiasis. J Urol 1983;130:1115–1118. Hyperuricosuria High Sodium diet 2. Oguz U, Resorlu B, Unsal A. Metabolic evaluation of Advanced evaluation of a stone former Hypocitraturia High carbohydrate diet patients with urinary system stone disease: a research of In patients with risk factors, initial evaluation should Hypomagnesuria High oxalate diet pediatric and adult patients. Int Urol Nephrol. 2014 Feb; consist of the basic stone patient work-up and also High/Low calcium intake 46(2): 329-34. include thyroid and parathyroid function tests, urine 3. Hesse AT, Tiselius H-G, Siener R, Hoppe BB, Willi spot test for cystine) and 24-hour urine collection. Sedentary occupation/ HE,(editors).Urinary stones, diagnosis, treatment and The most common metabolic abnormalities in Stress prevention of recurrence. ed 3. Basel, Switzerland: adults are4: Karger AG; 2009. We must assess stone patients as to high or low-risk • hypercalciuria (>5 mmol/24h, 30-60%) 4. Worcester EM, Coe FL.New insights into the pathogenesis of recurrence based on the clinical, analytical results • hyperoxaluria (>0,5 mmol/24h, 26-67%) of idiopathic hypercalciuria.Semin Nephrol. 2008 and the composition of the stone (Table 2). • hyperuricosuria (>4 mmol/24h, 15-45%) Mar;28(2):120-32. • hypocitraturia (<1,7 mmol/24h in females and <1,9 What to do mmol/24h in males, 5-29%). Acknowledgement: This article is an abbreviated In a recent study on paediatric and adult patients with version of an article with the same title submitted at least one urinary stone event, an underlying reason Frequency of screening to a special edition of the Egyptian Journal of could be identified in up to 90% of cases. Urology on conservative stone treatment on behalf Consequently, metabolic evaluation was warranted to There is no consensus as to the ideal follow-up plan for recurrent stone formers. The most common of EAU-EULIS. complement the investigations and to prevent recurrences2. If a stone is available, it should be sent for analysis (Table 3). Table 3: Frequent stone types by composition and X-ray characteristics Basic evaluation of a stone former Stone type Chemical composition Mineral X-Ray The basic evaluation of any stone former includes a detailed general history, dietary habits and Calcium Calcium oxalate monohydrate Whewellite Radiopaque medications taken, a focused history on any Calcium oxalate dihydrate Weddellite Radiopaque previous episodes of renal colic or treatments Calcium carbonate Aragonite Radiopaque received, a family history for stones, in particular, Uric acid and urates Uric acid Uricite Radiolucent and a physical examination. Urinalysis by dipstick Uric acid dihydrate Uricite Radiolucent and urine culture, as well as basic blood serum testing is indicated. Imaging should include Ammonium urate Radiolucent ultrasound of the kidneys and ideally low dose CT Phosphates Magnesium ammonium phosphate Struvite Poorly radiopaque KUB to investigate spontaneous passage or the Basic calcium phosphate Apatite Poorly radiopaque presence of other calcifications3. Urine pH profile Calcium hydroxyl phosphate Carbonite apatite Radiopaque (measurement after each voiding at least four times/ Carbonate apatite phosphate Dahllite Radiopaque day) and microscopy of morning urine sediment Calcium hydrogen phosphate Brushite Radiopaque (for rare compositions) may also be performed if indicated by the initial assessment (Table 4). Genetics determinated Cystine Poorly radiopaque Xanthine, 2,8-Dihydroxyadenine Radiolucent Drug Stone Indinavir, Antibiotics (i.e Radiolucent EAU Section of Urolithiasis (EULIS) sulphonamides, clarithromycin) October/December 2016


Update from the Guidelines Office All 28 EU member states have now formally endorsed the EAU Guidelines Guidelines Office meetings update September was a busy time for all the Guideline Panels as they rushed to finalise their texts in advance of the October deadline. September saw meetings by the Male Infertility Panel in Vienna, Urinary Incontinence in Rome, NMIBC in Prague, Urological Infections in Basel, RCC in Lisbon and Renal Transplantation, Male LUTS and Chronic Pelvic Pain in Amsterdam. By the October deadline meetings will also have taken place for Urological Trauma, Prostate Cancer, MIBC and Neuro-Urology. The Guidelines Panel Chairs met with the Guidelines Office Board in October, in Lisbon. This highly productive meeting, chaired by Prof. Dr. James N’Dow, served as an opportunity to discuss Guidelines activities for the 2018 versions and proposals planned for the coming two to five years. Presentations were given by Prof. Dr. Anders Bjartell on the development and handling of a Conflict of Interest policy for the GO Panel members and Mr. Denis Horgan, executive director of the European Alliance for Personalised Medicine, on how the EAU Guidelines could engage with the European Union (EU) to drive the development of EU endorsed Urological Guidelines. As always, the meeting served as an opportunity for the Panel Chairs to ask questions of the Board and discuss plans for their Panels over the upcoming years. Endorsement of the EAU Guidelines We are pleased to announce that the Danish Urological Society (DUS) has formally endorsed the EAU Guidelines. This recognition from the DUS means that the EAU Guidelines have now received the endorsement of 55 national societies, including all 28 EU member states. The Guidelines Board has a policy, as part of its dissemination activities, of seeking formal endorsement of its guidelines from national societies and is therefore delighted by news of this latest endorsement from the DUS.

Associate training The Guidelines Office Methods Committee co-ordinated a two day Guidelines Associate training workshop in Amsterdam on the 16 and 17 September. The workshop looked into systematic review methodology, and featured presentations from the faculty in the morning and practical sessions in the afternoon. The training covered topics such as the development of a search strategy, abstract and full text screening, data abstraction, risk of bias assessment, data analysis and interpretation. New staff member We are pleased to welcome a new member of staff – Dr. Imran Omar – who officially started working with the Guidelines Office on 1 September. Imran will be based in Dr. Imran Omar Aberdeen and will be assisting the Guidelines Panels with their systematic reviews. We wish him every success in his new position. #eauguidelines - Dissemination of the Guidelines on Twitter The Guidelines Panels have been using Twitter to disseminate their Guidelines in < 140 character format using the #eauguidelines for almost 20 months now. In the nine months since January 2016, just from Guideline Panel tweets, the following statistics have been recorded by Uroweb: • • • •

Total number of impressions = 705,923 Sum of engagements = 15,994 Sum of retweets = 3,245 Number of participants/followers (as at 31 October 2016) = 11,629

The three most popular tweets based on impressions were as follows:

Report from EAU Guidelines Systematic Review Workshop in Guangzhou, China As part of a broader EAU-CUA consultation, a two-day EAU-CUA Guidelines Systematic Review Workshop took place in August in Guangzhou, China, to train Chinese urologists in systematic review methodology. The workshop was chaired by Prof. Dr. James N’Dow, Chair of the EAU Guidelines Office, and Prof.Dr. Huang Jian, President Elect of the CUA Guidelines Office. Over the course of the two-day workshop, delegates learnt that systematic reviews are a methodical, transparent and accountable process for bringing together the entire body of research answering a specific question (PICO) and which help the reader explore the differences between studies. The attendees also discovered how systematic reviews provide a reliable, unbiased and comprehensive picture of the available evidence, which can then be used to support decisions in health care, or to identify areas where future research may be required. A number of individual sessions were held throughout the course of the two-day workshop, including: understanding the fundamentals of evidence-based medicine, basic strategies for searching for evidence in the literature, how to critically appraise a study and any bias therein, the processes involved in undertaking a systematic review, and how to perform a meta-analysis. Throughout the workshop the EAU representatives keenly encouraged the involvement of the Chinese delegates. The workshop was part of a broader EAU Guidelines Office strategy to help achieve harmonization of urological care worldwide by ensuring the availability of high quality Clinical Practice Guidelines (CPGs), and to actively promote their implementation by clinicians and healthcare providers.

Alongside the DUS, the EAU Guidelines have also recently been endorsed by hhe Croatian Society of Urology, the Maltese Association of Urology, the Mexican Society of Urologists (SMU) and the Brazilian Urological Association (SBU).

28 member states of the European Union

project has made and have a number of plans for expanding the presence of the EAU Guidelines on social media, including the greater use and promotion of Twitter polls. The Committee are also in the process of developing a strategy to communicate and promote guideline related activities worldwide.

The workshop also included a presentation from Prof. Dr. Alberto Briganti, EAU Guidelines Board member and Chair of IMAGINE, who addressed all delegates about the EAU’s ambitious plans to assess the impact of the EAU Guidelines. Prof. Dr. Briganti explained the EAU’s belief that dissemination should be an active process, whereby tailor-made information is actively imparted to the appropriate audience and barriers to knowledge transfer are identified and overcome. The CUA agreed that the assessment of the impact of the guidelines was of the upmost importance.

The Dissemination Committee, led by Prof. Dr. Maria Ribal, are excited about the continuing progress this

The workshop was considered a great success and has strengthened the links between the CUA and the EAU Guidelines Office. Both parties are keen to explore future collaborations with one another and to build upon this highly positive experience.

EAU pledges action to tackle prostate cancer. . 1 EULIS: Role of metabolic evaluation in urolithiasis. . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Update from the Guidelines Office . . . . . . . . . 3 ESFFU: Bladder augmentation in SCI patients. . 6 Joint efforts ensure successful 3rd CEUEP. . . . 6 Clinical challenge. . . . . . . . . . . . . . . . . . . . . . 7 Key articles from international medical journals. . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11 In the Land of the Rising Sun. . . . . . . . . . . . 12 ESU section: ESU Course in Morocco. . . . . . . . . . . . . . . . . 13 ESU Course in Tunisia. . . . . . . . . . . . . . . . . . 15 Raising the bar of urological practice in Armenia. . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 16th Congress, Russian Society of Urology. . . 17 EUREP: A well-designed, responsive programme . . . . . . . . . . . . . . . . . . . . . . . . . 18 A unique learning experience in wonderful Prague. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Quality programme impresses Portuguese resident. . . . . . . . . . . . . . . . . . . 19 HOT helps young urologists hone surgical skills . . . . . . . . . . . . . . . . . . . . . . . . 19 EAU UROLOGY WEEK 2016 roundup . . . . 20-21 ESUT section: ESUT boosts presence in Southeast Asia. . . . 22 ESUT HOT Sessions at CEM16 . . . . . . . . . . . . 22 23rd ESUR Meeting in Parma, Italy. . . . . . . . 23 CEM16: Issues and trends in onco-urology. . . . . . . . . . . . . . . . . . . . . 24-25 The SEEM16 roundup. . . . . . . . . . . . . . . 25-26 ESGURS16: In-depth, critical look into reconstructive urology . . . . . . . . . . . . . . . . . 27 EBU section: The European Board of Urology and the UEMS. . . . . . . . . . . . . . . . . . . . . . . . 28 UMC Hamburg-Eppendorf gets EBU certification. . . . . . . . . . . . . . . . . . . . . . 28 Polish Urology: A tumultuous start of a successful field. . . . . . . . . . . . . . . . . . . . . . . 31 Russian urologists train skills in bladder surgery workshops. . . . . . . . . . . . . . . . . . . . 32 13th ERUS: Practical information for a dynamic field. . . . . . . . . . . . . . . . . . . . . . . 33 Obituary Luis Guillermo Martínez Bustamante . . . . . . . . . . . . . . . . . . . . . . . . . 34 YUO/YAU section: New course Leadership for Medical Professionals . . . . . . . . . . . . . . . . . . . . . . . . 25th Turkish National Urology Congress and ESRU Sessions. . . . . . . . . . . . . . . . . . . . HOT Course at 12th SEEM . . . . . . . . . . . . . . . Nordic Residents in Urology: Exciting plans for 2017 . . . . . . . . . . . . . . . . .

EAU-CUA group shot Guidelines Office

October/December 2016

EAUN section: 2nd ESUN Course on Neurogenic detrusor overactivity. . . . . . . . . . . . . . . . . . . . . . . . . . EAUN-CUAN ties enter new phase . . . . . . . . Patient empowerment in urology. . . . . . . . . Asia–Pacific Prostate Cancer Conference. . . . EAUN Fellowship. . . . . . . . . . . . . . . . . . . . . ERUS EAUN Robotic Nurse Meeting in Bruges, Belgium. . . . . . . . . . . . . . . . . . . .

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Cutting-edge Science at Europe’s largest Urology Congress

Revolutionising the Scientific Programme What has changed and what to expect

Prof. Dr. Arnulf Stenzl

Exciting, significant additions have been included in the comprehensive scientific programme of the upcoming 32nd Annual EAU Congress (EAU17). Chairman of the EAU’s Scientific Congress Committee (SCO), Prof. Dr. Arnulf Stenzl (DE), talks about these latest updates and more. Read on.

Additional goals of EAU17 Year after year, the always-anticipated Annual EAU Congress aspires to trigger new ideas and examine new prospects. For 2017, it will also add focus on personalised treatment for patients. “EAU17 will help delegates to distinguish when to follow the EAU Guidelines and when to judiciously individualise treatment – always considering whichever is the best for the patients”, states Stenzl. EAU17’s scientific programme will also rectify the common notion that urology is a medical specialty that only deals with older males. “There are several sessions with top speakers who will address female neurourologic problems. These informative sessions will include the simple forms of urinary incontinence to the more complicated neurological and inflammatory conditions”, said Stenzl. “Moreover, there will be various sessions devoted to paediatric urology as well.” Addressing the main issues The upcoming Congress will deliberate on the urgent and controversial issues that challenge the urological community. Stenzl discloses, “EAU17 will

tackle contemporary topics such as the recent results regarding prostate cancer screening in good prognosis prostate cancer (prospective randomized study - PROTECT), focal therapy in prostate cancer and immunotherapy in urologic cancer. The use of meshes in the treatment of urinary incontinence in women will also be analysed, and how to avoid legal issues in complex cases will be discussed, among many others.” More Plenary Sessions In contrast to the standard four Plenary Sessions in previous years, there will be seven at EAU17. Almost each Congress morning will be dedicated to two simultaneous Plenary Sessions. “By increasing the number of Plenary Sessions, we offer delegates additional essential clinical information on top of the academically-oriented sessions. For example, we have included a highly challenging session, which will be moderated by a lawyer. This way we will also learn about different insights regarding complex cases which were eventually resolved, but not without legal complications,” Stenzl explains. Room for improvement The SCO constantly searches for the most effective setups to enhance dissemination of knowledge and audience reciprocity. When an EAU Congress ends, attendees are asked about their overall experience. Feedback from them always brings added value of what needs to be retained and what needs to improve. Stenzl recalls, “Last year, we’ve received input asking for more semi-live videos wherein techniques and procedures are

comprehensively discussed. For EAU17 we’re aiming to integrate this idea into the programme.” Furthermore, there will be the ESUT session (EAU Section of Uro-Technology) live surgery, which will deliver the best practices by some of the world’s uro-surgical experts, and will deal with the challenges and practical issues faced by surgeons in actual practice. The live surgery will take place on Saturday, March 25 broadcasted from Guy’s and St Thomas’ NHS Foundation Trust Hospital. Pursuing excellence The Annual EAU Congress continually develops its unrivalled programme to pursue quality and excellence. Attendees can expect intensive ESU (European School of Urology) and Hands-On Training courses; and special programmes such as the Urology Beyond Europe sessions, which will convene urologists from all over the world. The first Congress day will begin with abstract sessions, then ends with the Opening Ceremony wherein the most prestigious EAU awards will be handed out. On the second Congress day, the special training-based YUORDay17, which is organised by the EAU Young Urologists Office & European Society of Residents in Urology will take place. The always-popular EAU Section Meetings will be part of the intensive programme and numerous industry sessions will round off each Congress day. “The upcoming EAU17 does not solely cater to the urological community; it is multidisciplinary. The

Important dates Congress dates 24-28 March 2017 Exhibition dates 25-27 March 2017 Early fee registration deadline 16 January 2017 Late fee registration deadline 13 February 2017 Abstracts available online for EAU Members 24 February 2017

Check out the programme ove

www.eau17.org

rview at

Congress has plenty to offer from the young resident to the experienced practitioner. It extends its reach beyond Europe to bring together the best of the best from around the world, and to share their expertise for the betterment of patient care and clinical practice,” concludes Stenzl.

w for the Join us at EAU17! Register no nuary 2017 early bird fee. Deadline: 16 Ja

The Awardee Experience Inspiration and perspectives from poster abstract session winners The European Association of Urology highlights and acknowledges pioneering achievements of urologists across and even beyond Europe. Every year, prestigious awards are granted to innovative urological research and poster presentations at the Annual EAU Congress. Previous poster abstract session winners Dr. Mathieu Roumiguié, first-prize winner for the Best Abstract (Oncology), and Dr. Ulla Nordström Joensen, first-prize winner for the Best Abstract (Non-Oncology), recall their experiences from research inception to post award. Their research Roumiguié is a Clinical and Research Fellow in the Department of Urology at the Centre Hospitalier Universitaire (CHU) Rangueil in Toulouse, France. His research for the paper “136 Periprostatic adipose tissue acts as a driving force for the local invasion of prostate cancer in obesity: Role of the CCR3/CCL7 axis” began when he and his team observed that there was a connection between peripostatic tissue and prostate cancer. “The prostate gland is surrounded by adipose tissue, an active endocrine organ able to secrete chemokines, referred to as adipokines. Compared to benign epithelium, cancer cells overexpress receptors for adipokines suggesting a crosstalk between PPAT and cancer. We hypothesised that this could be instrumental in the increased aggressiveness reported in obese cancer patients and in extracapsular disease,” Roumiguié said. “We concluded that the ability of peri-prostatic adipose tissue to attract cancer cells away from the prostate gland is dependent on an original CCR3/CCL7 axis.” 4

Joensen is a Resident in urology in the University Department of Growth and Reproduction and Department of Urology, University Hospital of Copenhagen, Rigshospitalet in Denmark. Her research for the abstract “176 Varicocele is negatively associated with semen quality and hormone levels: A study of 7067 men from six European countries” began when most knowledge on varicocele and testicular function was largely based on studies of subfertile and infertile men. “This makes it difficult to extrapolate the results to the general population,” said Joensen. “The main purpose of the paper was to describe the associations between testicular function (both semen quality and reproductive hormones) in healthy men from the general population, with and without varicoceles that were mostly incidentally diagnosed in this study. We came to the conclusion that any grade of varicocele is associated with impaired testicular function even in healthy young men from the general population.”

An application has been made to the EACCME® for CME accreditation of this event

European Urology Today

After the awards Roumiguié said “This award has brought the team more confidence on the relevance and quality of our work. Granting of awards like these also encourages others to further develop projects regarding this topic.” Joensen said “I was grateful to accept this award because it’s a wonderful acknowledgement of the huge amount of work we’ve put into acquiring the unique data in our research. It means a great deal that the EAU commends and rewards the collaboration between several European countries which was needed to make the results generalizable for many European men, and not only for a single country. Ideas and

points from other participants at the Congress helped in the presentation of our study. Its publication in EAU’s high-ranking journal reached a larger audience.” Updates for EAU17’s poster sessions There are new changes with regard to the poster sessions at the upcoming EAU17 Congress such as poster sessions will also take place on Friday, 24 March 2017. The Scientific Congress Office is constantly looking into new innovatory setups to give the presenters the best podium to present their work. Know more about the highly-anticipated EAU17 Congress in London by visiting the official website at www.eau17.org.

October/December 2016


#EAU17 Cutting-edge Science at Europe’s largest Urology Congress

Keep calm and travel to London! Why you should use social media during EAU17 Nicknamed “The Square Mile”, the vibrant city of London is headquarters to 165 of the Global Fortune 500 companies, and boasts of a number of worldrenowned medical facilities and clinical trial centres.

Follow, Like and Share! In the last few years, news flies at the speed of Twitter. You receive the news as it happens with a click on a hashtag. And to see a day’s recap in photos, there is Facebook and Instagram. Go on, share your thoughts to the urological community. Get it out there through social media!

Over 300 languages are spoken in the British capital, making it one of the most diverse cities in the world and one of the most interesting. British novelist and historian, Sir Walter Besant, once said, “I’ve been walking about London for the last 30 years, and I find something fresh in it every day.”

FOLLOW us on Twitter @uroweb and #EAU17 Use the hashtag #EAU17 to share your insights, follow experts and/or ask your questions. Feel free to retweet what’s new as well! And remember to follow the official EAU account @uroweb for more info.

To stay true to London’s uniqueness, here are some fascinating facts about the city: Rich history Every corner tells a story. At Trident Studios in London’s Soho district is where The Beatles recorded part of the “White Album” and where David Bowie recorded “The Rise and Fall of Ziggy Stardust”. Ronnie Scott’s Jazz Club on Frith Street was the site of Jimi Hendrix’s last public performance in 1970. In Graces Alley stands Wilton’s Music Hall, the world’s oldest surviving music hall built in 1743. London has more than 800 bookshops and over 380 public libraries including the British Library, which holds the Magna Carta. Originally issued by King John of England, the Magna Carta established the principle that everybody, including the king, was subject to the law. The children’s hospital, Great Ormond Street Hospital, was gifted the copyright of “Peter Pan” by its author, Sir James Matthew Barrie. London was founded by the Romans who named it “Londinium”. The city has had five names in the last 20 centuries and was once the capital city of six countries at the same time! The city was called “home” by hundreds of historical figures such as Karl Marx, Mahatma Gandhi, Voltaire, Charles Darwin, Sigmund Freud, Wolfgang Amadeus Mozart, Sylvia Plath, Vincent van Gogh, Charles Dickens, Florence Nightingale, and Edgar Allan Poe. Some info about the landmarks London has four UNESCO world heritage sites: Tower

of London, Maritime Greenwich, Westminster Palace and Kew’s Royal Botanic Gardens. A bear actually lived in the Tower of London in 1252! The bear, believed to be a polar bear, was a gift to King Henry III from King Haakon of Norway. It was given a long leash so it could swim in the river Thames and catch fish. Big Ben is not the name of the clock but actually the name of the bell. The tower it is housed in is simply referred to as the Clock Tower. In 1949, a flock of starlings perched on the minute hand and slowed the clock by four and a half minutes!

LIKE us on Facebook For additional photos and photo albums, like the official EAU page at www.facebook.com/EAUpage/ and feel free to share posts and tag people you know! SHARE your pictures on Instagram Take photos and share them at EAUPage with or without cool filters. Tag people you know and people you just met on your photos!

Expand your world via social media. Network and keep the conversation going even after the Congress!

The London Eye is 135 meters high with 32 “cabinets” for passengers representing the 32 suburbs of London. Each cabinet weighs about 10 tons and can accommodate 25 people. The Shard is the tallest building in Europe and one of London’s newest landmarks. 95% of the construction materials are from recycled sources. The O2 Arena in Greenwich is the largest structure of its kind in the world. The Statue of Liberty or the Great Pyramid of Giza can easily fit inside.

web at @uro ers know th w Did you as 11,500 follo r yh numbe e th currentl d ter an on Twit ues to grow? contin

EAU16 doubled the tweets per day in comparison to EAU15. With the highest activity on Sunday with almost 5,000 tweets.

Did you know that you can get specific updates of EAU events via our Facebook page?

This is just a peek of what London is and what it has to offer. Discover this magnificent city, keep calm and explore! Getting to the EAU17 Congress To be a London black cab driver, one is expected to know the points of interest mentioned above (around 50,000 in total) and 25,000 roads, and must pass the test called “The Knowledge”. He/she also knows that London has five international airports. Although London Heathrow may be the largest, London City airport puts you on the doorstep of the ExCeL conference centre, which is the venue of the EAU17 Congress. Know more on how to travel to the venue and to get around London via www.eau17.org/venue

Highest abstract submission ever! The number of abstract submissions for EAU17 reached around 5,000 submissions worldwide based on the initial tally. This number surpassed the abstracts submitted to Munich (EAU16) which totalled 4,414 and the 3,975 abstracts submitted for the 2015 congress held in Madrid. Submissions came from 84 countries across the globe with a higher number of submitted abstracts originating from Asian countries. In Munich, abstracts came from 77 countries compared to 71 countries recorded for Madrid. There were significant increases in the number of abstracts submitted per topic such as in prostate and renal cancers. The abstracts are currently being reviewed anonymously by 271 experts in the different fields. 19 December 2016: Abstracts outcome available online through the abstract submission website

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24 February 2017:

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October/December 2016

European Urology Today

5


Bladder augmentation in SCI patients Surgery as the most efficient way to lower bladder pressure The following options can be considered: urinary Table 1: Early and late complications of diversion (ileal conduit), continent urinary diversion augmentation cystoplasty for neurogenic bladder associated with bladder augmentation, or augmentation cystoplasty. The choice between these Early complications options has to be made after a complete evaluation and discussion with the patient. Ileal conduit is usually Metabolic complications 2-15% The initial assessment of the SCI patient is conducted proposed in case of complicated situations with already Abdominal wall 2-9% after the end of the spinal shock phase and of course renal impairment, and the best indications for continent Infections 1-9% includes urodynamic study, but must evaluate all the urinary diversion are failure of conservative Urinary Fistula 0-6.3% jeannicolas.cornu@ other issues that can impact the treatment: bladder management when CISC is not possible. In the latter, Bowel obstruction 2-12% gmail.com dysfunction as a whole (usually included retrograde prosthetic or surgical sphincterotomy can be attempted. Diarrhea 0-12% opacification, cystoscopy, renal function, imaging), Mortality 0-3.2% Spinal cord injury (SCI) is usually induced by spinal neurological condition (disease type, evolution), and The gold standard indication for bladder trauma (mainly following accidents). Other etiologies patient characteristics (sex, age, life expectancy, augmentation is, thus, failure of conservative include complicated spine surgery, ischemia, co-morbidities, morphology, associated disease, management when CISC is possible and the urinary infection, inflammation, or tumors. The current tract and renal function are maintained. Several types abilities). Late complications estimated incidence of SCI in USA is around 4/100,000 of bladder augmentation have been proposed: per year1. One of the most important issues following The basic non-invasive tools for SCI management detubularised ileal segment, colon augmentation and Lithiasis 2-10.5% SCI is the management of neurogenic bladder include conservative measures, like Crédé manoeuver, gastric augmentation. Each option has it pros and Pyelonephritis 9-20% dysfunction, which happens almost constantly during scheduled voiding, clean intermittent selfcons but ileal segment augmentation is seen as the Pain-hematuria 2-18% evolution. catheterisation (when possible), and medications. best way to lower bladder pressure reservoir, with Infections 1-9% Urinary catheter is sometimes proposed but cannot be weaker contractions than after augmentation with a Urinary Fistula 0-2% The origin of bladder dysfunction in SCI patients is the recommended in the long-term because of the risk of colonic segment2. Bowel obstruction 2-25% interruption of neurogenic pathways. Immediately infections, renal impairment and bladder stones and Diarrhea 10-47% after SCI, during the so-called spinal shock phase, the increased risk of bladder cancer. Mini-invasive options The technique is well established with dissection of Mortality 0-2% bladder is usually atonic, with complete urinary are mainly represented by intradetrusor botulinum the bladder, usually a supratrigonal partial cystectomy retention due to an interruption of the micturition toxin injections, which have been licensed for without reimplantation of the ureters (bladder reflex. After this initial phase, which can last up to neurogenic bladder management for several years. pressure being the main issue for vesico-ureteral three months, the “neurogenic bladder” profile of the reflux), detubularisation of a rather long portion of patient will appear. Surgical option intestine (around 30-40 centimeters), and a While the main goal of bladder augmentation is Surgery is considered as a last resort in SCI patients circumferential anastomis between the ileal part and usually practiced to improve storage and lower For suprasacral lesions, the dysfunction usually seen when other options have failed. As there are no the bladder neck. The procedure is conducted open, bladder pressure, it may require secondary is a combination of detrusor overactivity (DO) and consensual criteria of failure, the opportunity to laparoscopically or robotically-assisted. Short-term interventions for urinary incontinence. Further detrusor sphincter dyssynergia (DSD). In very low propose surgical management is evaluated during complications are well-known (See Table 1). re-interventions also include fistula management, levels injuries, the profile can be different, with follow-up in case of complications (repeated infections, Long-term results of ileal bladder augmentation have secondary over-activity symptoms, or surgery for chronic retention due to underactive bladder and stones, etc.). Failure to lower bladder pressure on been shown to be satisfactory, main complications bladder cancer. Follow-up is thus recommended in hypertonic urinary sphincter. These cases can be repeated urodynamics, or persistent subjective being urinary tract infections, need for CISC, those patients with regular control of bladder and however complicated with detrusor overactivity symptoms are also reasons to propose surgery. incontinence, diarrhea, and stones (Table 1)3,4. renal imaging, renal function assessment, endoscopy during evolution. if needed. Dr. Jean-Nicolas Cornu Dept. of Urology Charles Nicolle University Hospital University of Rouen Rouen (FR)

threatening. The management of SCI patient has thus one main objective (maintaining a low pressure in the bladder) for multiple goals (preventing complications, improving quality of life and relieving urinary symptoms).

References

In the most frequent case of suprasacral SCI patients, the main issue is a chronic abnormally high bladder pressure. The latter is due to the combination of disturbed bladder emptying (often incomplete), and repeated, inhibited contractions of the detrusor (DO). This condition explains the risk of subsequent renal impairment, vesico-ureteral reflux, bladders stones, and infections, as well as the symptoms of incontinence and discomfort. Acute and chronic retention is also a main cause of autonomous hyperreflexia, a dreadful condition that can be life

EAU Section of Female and Functional Urology

1. Manack A, Motsko SP, Haag-Molkenteller C, et al. Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database. Neurourol Urodyn. 2011;30(3):395–401 2. Taweel WA, Seyam R Neurogenic bladder in spinal cord injury patients. Res Rep Urol. 2015 Jun 10;7:85-99 3. Gurung PM, Attar KH, Abdul-Rahman A, Morris T, Hamid R, Shah PJ Long-term outcomes of augmentation ileocystoplasty in patients with spinal cord injury: a minimum of 10 years of follow-up. BJU Int. 2012 Apr; 109(8):1236-42 4. Game X, Karsenty G, Chartier-Kastler E, Ruffion A. Treatment of neurogenic detrusor hyperactivity: enterocystoplasty. Prog Urol. 2007 May;17(3):584-96

Figure 1: Assessment items in complicated neurogenic bladder

Joint efforts ensure successful 3rd CEUEP Stronger partnership among Chinese and European urologists By Astrid Venhorst

Both societies also noted the continued collaboration among its key opinion leaders. The EAU, for instance, has granted in 2012 Honorary Membership to former CUA President Prof. Yan-Qun Na and this year, current CUA President Prof. Ying-Hao Sun received the same honour.

Beijing and Guangzhou hosted from 2 to 3 November 2016 the 3rd Chinese European Urology Education Programme (CEUEP). CEUEP was co-organised by the International Communication & Training Department of the Wu Jieping Medical Foundation, the European Association of Urology (EAU) and the European School of Urology (ESU). Considered as the Chinese edition of the EAU’s well-known European Urology Residents Education Programme (EUREP) annually held in Prague, CEUEP reflects the long-standing cooperation between the EAU and Chinese urology. Under the flag of the CUA, the programme has been organised since 2008 to be continued by the Wu Jieping Medical Foundation later. The EAU also works closely with CUA on other joint projects, such as the EAU World Chinese Urology joint session in the Urology Beyond Europe programme during the annual EAU congress, which will run its fourth year in London during EAU17.

Souvenir group photo in Beijing and Guangzhou venues

Since 2008 CUA has granted International Honorary Memberships to former EAU Secretary Generals Professors Per-Anders Abrahamsson and Frans Debruyne, current EAU Secretary General Prof. Chris Chapple, former EAU Adjunct Secretary General Prof. Walter Artibani, former Chairman of the International Relations & Strategy Planning Office Prof. Didier Jacqmin, and Chair of the EAU Guidelines Office Prof. James N’Dow. CUA is currently involved in a joint guidelines project with the EAU Guidelines Office.

In recognition of the EAU’s support and cooperation and the EAU's contribution to urology in China, the CUA honoured the EAU with the CUA Best Strategic Partner Award. The ceremony took place during the Welcome Reception Dinner of the 23rd CUA Annual Meeting in Tianjin where former EAU Adjunct Secretary General Prof. Walter Artibani received the award on behalf of the EAU. International Relations Office

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European Urology Today

Souvenir group photo in Guangzhou

Opening ceremony includes a symbolic ringing of bells

October/December 2016


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

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

Oliver.Hakenberg@ med.uni-rostock.de

Case study No. 48

Physical examination is largely normal including the external genitalia and DRE. Examination of the penis, after asking the patient to walk for a few minutes, A 55 year-old high school teacher with a history of revealed a rigid erection of both corpora cavernosa, ischemic heart disease since 2004, presented with the corpus spongiosus and the glans. Complete a complaint of spontaneous erections whenever he detumescence occurs one minute after lying down. walks or stands for five to 10 minutes. These Neurological examination revealed sensory loss in the erections are not accompanied by sexual desire but L5 dermatomes in both lower limbs without any loss induced by standing or walking. There is no pain or in motor function. discomfort except for a sensation of urinary urgency. The erection subside within one to two All laboratory investigations were normal including minutes after sitting or lying down but reappears urinalysis, blood sugar, renal function tests, complete with standing or walking. The patient has no other blood count, ESR and sickle cell tests as well as serum lower urinary tract symptoms and has an testosterone, LH, FSH, and prolactin. An MRI of the otherwise normal sexual function. There is a spinal cord revealed a central herniation of several history of backache radiating to the posterior thigh lumbar intervertebral discs at multiple levels causing since 2005. During the last three years he spinal stenosis in addition to bilateral root developed paresthesia in the legs which also compression at L 5. increases in magnitude when he stands or walks.

The patient was advised to undergo surgery for his spinal cord problem, but he refused since his cardiologist had informed him that it would be too risky due to his ischemic cardiac disease. Medical treatment was started using oral baclofen titrated up to 15 mg daily and later flutamide 250 mg every eight hours. Baclofen had no effect at all, flutamide resulted in an initial response for two weeks but none thereafter. Discussion points: • Is this a case of stuttering priapism or not? • Is there any medical treatment that may prevent these erections? • Is spinal surgery likely to solve the problem? Case provided by Dr. Nihad P. Sh. Al-Ibraheem, Urology Specialist, Department of Urology, Rizgary Teaching Hospital, Erbil , Iraq; nihadpauls@yahoo.com

Biopsy before any decisions Comments by Dr. Matthias Trottmann Munich (DE)

Is this a case of stuttering priapism or not? The characteristics of stuttering priapism are repetitive, self-limited painful episodes of prolonged erections – analogous to repeated periods of low flow (or ischaemic) priapism, with an intervening time of detumescence1,2. Generally, the duration of these episodes are variable, shorter than in ischaemic priapism, and can progress into a major episode3. The reported symptoms of this case presented here do not fit this definition of stuttering priapism because there is a clear triggering factor, the change of the patient´s position. Undesired erections occur when the patient is standing up or walking around and are in this case invariably reversed when he is lying or sitting down. This is atypical for stuttering priapism. Furthermore, sickle cell anaemia, the most common cause for stuttering priapism4, was excluded by laboratory investigations. As referred to in several case reports, this condition can rarely be caused by an (incomplete) cauda equina compression and consecutive mechanical irritation of the sacral

roots5,7. Corresponding to this aetiology are the MRI findings described and the other neurological symptoms such as paraesthesia in the legs which increases in magnitude when the patient stands or walks. Is there any medical treatment that may prevent these erections? Treatment options need to be discussed. Since this patient has a high perioperative risk due to ischaemic cardiac disease, the option of spinal surgery was excluded so that only conservative options remain. In some patients, depending on the underlying cause, analgesics, anti-inflammatory drugs and steroids can be effective for the treatment of lumbar disc prolapse, together with physio and ergo therapy8. Additionally, there is one similar case report in the literature which showed excellent results after local pharmacological infiltration of the compromised spinal roots9. Is spinal surgery likely to solve the problem? According to the existing case reports, spinal surgery for decompression can lead to complete resolution of the symptoms, including the disappearance of unwanted erections7. Although it has to be understood that the longer the cauda equina nerve compression has been present, the poorer the extent of recovery that can be expected will be10. References 1 Salonia A, Eardley I, Giuliano F, et al. Guidelines on

priapism. European Association of Urology 2015. 2 Morrison BF, Burnett AL. Stuttering priapism: insights into pathogenesis and management. Curr Urol Rep 2012; 13(4): 268-76. 3 Montague DK, Jarow J, Broderick GA, et al. American Urological Association guideline on the management of priapism. J Urol 2003; 170(4 Pt 1): 1318-24. 4 Fowler JE Jr, Koshy M, Strub M, et al. Priapism associated with the sickle cell hemoglobinopathies: prevalence, natural history and sequelae. J Urol 1991; 145(1): 65-8. 5 Brish A, Lerner MA, Braham J. Intermittent claudication from compression of cauda equina by a narrowed spinal canal. J Neurosurg. 1964; 21: 207-11. 6 Ravindran M. Cauda equina compression presenting as spontaneous priapism. J. Neurol Neurosurg Psychiatry 1979; 42(3): 280-2. 7 Cansever T, Civelek E, Sencer A, et al. Intermittent priapism in degenerative lumbar spinal stenosis: case report. Turk Neurosurg 2007; 17(4): 260-3. 8 Corniola MV, Tessitore E, Schaller K, et al. Lumbar disc herniation--diagnosis and treatment. Rev Med Suisse 2014; 10(454): 2376-82. 9 Fernandez Aparicio T, Minana Lopez B, Rodriguez Antolin A. Priapism caused by cauda equina compression. Report of a case and review of the literature. Actas Urol Esp 1992; 16(8): 661-5. 10 Todd NV. Neurological deterioration in cauda equina syndrome is probably progressive and continuous. Implications for clinical management. Br J Neurosurg 2015; 29(5): 630-4.

Case study No. 49 An 86-year-old woman presents with acute urinary clot retention. This is evacuated transurethrally and on endoscopy bleeding from the left ureteric orifice is seen. Retrograde ureteropyelography indicates a mass in the renal pelvis which is confirmed by ultrasound (Fig.1) and CT scan (Fig.2). Ureteroscopy also confirmed the presence of a papillary tumour of about 3 cm in the renal pelvis originating from the lateral (parenchymal) area. Biopsy verified low-grade transitional cell carcinoma. Two years previously, this lady had undergone right nephroureterectomy for transitional cell carcinoma. Since then she had developed a mild degree of renal insufficiency with a stable serum creatinine of 120 µmol/l. When discussing the current diagnosis and options, she categorically stated that under no circumstances would she want to be dependent on dialysis at her age.

Fig. 1: Ultrasound of the left kidney

Fig. 2: Abdominal CT scan

Discussion point: • What treatment options - if any - can be offered? Case provided by Oliver Hakenberg, Department of Urology, Rostock University. E-mail: oliver.hakenberg@med.uni-rostock.de

Continued from page 06

Hands-on training impressions

October/December 2016

Impressions of the lectures on a range of major urology topics

Full rooms in Beijing and Guangzhou

European Urology Today

7


Key articles from international medical journals Dr. Francesco Sanguedolce Section editor London (UK)

retropubic prostatectomy group versus six (4%) in the robot-assisted laparoscopic prostatectomy group had postoperative complications (p = 0.052). Twelve (8%) men receiving radical retropubic prostatectomy and three (2%) men receiving robot-assisted laparoscopic prostatectomy experienced intraoperative adverse events.

fsangue@ hotmail.com

As expected patients in the radical retropubic prostatectomy group had about three times greater estimated total blood loss (p < 0.0001), and a longer average time spent in hospital after surgery (p < 0.0001) than with those in the RALRP group. In addition although pain scores were lower in men who underwent RALRP at 24 hours and one week after surgery and physical quality of life scores higher at six weeks, this did not translate into an earlier return to work.

Robot versus open prostatectomy Since the first reported robot-assisted laparoscopic prostatectomy (RALRP) by Binder and Kramer in 2001 rapid adoption of the technology has led to this becoming the dominant surgical approach in many countries. However, paucity of high-quality evidence that the additional costs are associated with improvement in either quality of life or oncological outcomes makes payers question the necessity of this development. This study aimed to assess clinical and quality of life outcomes in men undergoing radical prostatectomy for clinically-localised prostate cancer randomised between and open or robot-assisted approach. Men from the Royal Brisbane and Women’s Hospital with newly diagnosed clinically localised prostate cancer were randomly assigned (1:1) to receive either RALRP or radical retropubic prostatectomy. Two surgeons performed all cases. The robot-assisted laparoscopic prostatectomy surgeon had completed a two-year robotic fellowship, followed by 200 robotic prostatectomies post-fellowship at the commencement of the trial and the radical retropubic prostatectomy surgeon had 15 years post-fellowship experience and had done 1500 procedures at the commencement of the trial. Randomisation was computer generated and occurred in blocks of ten. This was an open trial; however, study investigators involved in data analysis were masked to each patient’s condition. Further, a masked central pathologist reviewed the biopsy and radical prostatectomy specimens. Primary outcomes were urinary function (urinary domain of EPIC) and sexual function (sexual domain of EPIC and IIEF) at six weeks, 12 weeks, and 24 months and oncological outcome (positive surgical margin status and biochemical and imaging evidence of progression at 24 months). The trial was powered to assess health-related and domain-specific quality of life outcomes over 24 months.

In such a hotly contested area it is unsurprising that this study has been criticised in part as a single institution study and because of the disparity in experience between the operating surgeons at the start of the study. However, this group has achieved something that appeared unattainable for bigger centers. They have also shown that at least in the short-term results between open and RALRP are equivalent. Urinary and sexual function are expected to continue to improve with time and, as such, significant differences in functional outcome between these surgical approaches might not become apparent until longer follow-up and those results are awaited; but although RALRP is much easier for the surgeon it is not yet clear that it improves patient outcomes.

Source: Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Yaxley JW, Coughlin GD, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L, Dunglison N, Carter R, Williams S, Payton DJ, Perry-Keene J, Lavin MF, Gardiner RA. Lancet 2016; 388: 1057-66.

New therapeutic mechanisms to exploit in mRCC

Equivalence testing on the difference between the proportion of positive surgical margins between the two groups (15 [10%] in the radical retropubic prostatectomy group vs. 23 [15%] in the RALRP group) showed that equality between the two techniques could not be established based on a 90% CI with a Δ of 10%. However, a superiority test showed that the two proportions were not significantly different (p = 0.21). Fourteen patients (9%) in the radical Key articles

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combine sunitinib and pazopanib with nivolumab; it is possible that sonepcizumab may be a better immunomodulator with which to pair with these VEGF-directed therapies

Patients were required to have clear cell mRCC and to have received treatment with at least one prior VEGF-directed agent. Prior treatment with immunotherapeutic agents and no more than one mTOR inhibitors was permitted. It was an open-label, single arm study with a primary endpoint of progression-free survival. Patients were treated with sonepcizumab 15 mg/kg iv weekly initially. However, following data from a concurrent phase 1 study the dose was increased to 24 mg/kg iv weekly. Additional endpoints included response rate, safety, and overall survival (OS) were performed post hoc.

Mr. Philip Cornford Section editor Liverpool (GB)

philip.cornford@ rlbuht.nhs.uk from Medicare inpatient, outpatient, and home health agency records. The use of androgen deprivation therapy (ADT) from three months to one year and two years after primary radiotherapy was also recorded. Health care expenditures were derived from the Medicare records and costs were adjusted to 2012 US dollars.

The discordance between PFS and OS in this study Patients undergoing SBRT require mirrors what was observed in the randomised phase 3 study of nivolumab, which demonstrated no far fewer therapy sessions, which difference in PFS compared with everolimus. A similar makes treatment cheaper. However, discordance was also noted with the use of novel immunotherapeutic agents across tumor types, with it was associated with more PD-1 and programmed death-ligand 1 (PD-L1) urinary incontinence and erectile inhibitors demonstrating modest response rates and PFS but substantial improvements in OS in patients dysfunction at two years... with lung and bladder cancer. Latent immune responses that follow evidence of radiographic A total of 17,889 patients undergoing SBRT (237 disease progression are believed to explain this individuals), brachytherapy (4,136 individuals), IMRT phenomenon and this was a particular risk in this study, which had a CT scan at four weeks as protocol. (10,715 individuals), proton beam therapy (363 individuals), and combination therapy (2,438 The immunostimulatory properties and the favorable individuals) were analysed for one-year outcomes. adverse event profile of sonepcizumab, combinatorial Analysis of two-year outcomes was performed in a subgroup of patients with sufficient follow-up. There approaches with checkpoint inhibitors can be was an increase in SBRT use from < 0.4% to 2.7% of envisioned. Hepatotoxicity and colitis have limited the radiotherapy used. Similarly, they demonstrated previous attempts to combine sunitinib and an increase in the use of IMRT and proton beam pazopanib with nivolumab; it is possible that therapy and a decrease in the use of brachytherapy sonepcizumab may be a better immunomodulator over time (p < .001,). A higher percentage of patients with which to pair with these VEGF-directed treated with SBRT and brachytherapy had low-grade therapies. Furthermore, given non-overlapping cancer (Gleason score 6 vs. 7) compared with mechanisms of action, sonepcizumab could possibly individuals treated with IMRT and proton beam complement currently available PD-1 and PD-L1 therapy (54.0% and 64.2% vs. 35.2% and 49.6%, inhibitors and certainly is worthy of further respectively; p < .001). investigation.

Source: A phase 2 study of the sphingosine-1phosphate antibody Sonepcizumab in patients Over the past decade targeted therapies for metastatic with metastatic renal cell carcinoma. Pal SK, renal cell carcinoma (mRCC) via either inhibition of Drabkin HA, Reeves JA, Hainsworth JD, Hazel SE, the VEGF receptor or mTOR have improved Paggiarino DA, Wojciak J, Woodnutt G, Bhatt RS.

progression-free survival but the vast majority of patients remain incurable. Recently for patients treated with VEGF directed therapy new compounds have been approved including cabozantinib and the Between August 23, 2010, and November 25, 2014, 326 men were enrolled, of whom 163 were randomly PD-1 inhibitor nivolumab and the multikinase inhibitor lenvatinib giving between 4.5 and 7.5 months assigned to radical retropubic prostatectomy and 163 of progression-free survival but no cures. to RALRP. Eighteen withdrew (12 assigned to radical retropubic prostatectomy and six assigned to RALRP); Consequently, people have investigated mechanisms thus, 151 in the radical retropubic prostatectomy group of resistance to VEGF-directed treatment including the bioactive lipid sphingosine-1-phosphate (S1P). proceeded to surgery and 157 in the RALRP group. Sonepcizumab is a fully humanised monoclonal A total of 121 patients assigned to radical retropubic antibody against S1P and this paper reports the prostatectomy completed the 12-week questionnaire versus 131 assigned to RALRP. Urinary function scores results from a phase 2 study characterising the preliminary safety and efficacy in patients with did not differ significantly between the groups at previously treated mRCC. either six weeks or 12 weeks post-surgery. Sexual function scores also did not differ significantly between the radical retropubic prostatectomy group Hepatotoxicity and colitis have and robot-assisted laparoscopic prostatectomy group at six weeks post-surgery (30.70 vs. 32.70; p = 0.45) or limited previous attempts to 12 weeks post-surgery (35.00 vs. 38.90; p = 0.18).

In such a hotly contested area it is unsurprising that this study has been criticised in part as a single institution study and because of the disparity in experience between the operating surgeons at the start of the study

Forty patients with a median age of 66 years were enrolled across five institutions. They had previously received a median of three prior therapies (range 1-5). Although the current study did not achieve its primary endpoint based on the two-month progression-free survival, a median OS of 21.7 months was observed. Four patients (10%) demonstrated a partial response, with a median duration of response of 5.9 months. No grade 3/4 treatment-related adverse events were observed in > 5% of patients the most frequent grade 1/2 treatment-related adverse events were fatigue (30%), weight gain (18%), constipation (15%), and nausea (15%). Biomarker studies demonstrated an increase in S1P concentrations with therapy although there was no correlation with response to therapy. Comprehensive genomic profiling of three patients with a clinical benefit of > 24 months indicated von Hippel–Lindau (VHL) and polybromo-1 (PBRM1) alteration

Cancer 2016. doi: 10.1002/cncr.30393

Stereotactic body radiotherapy more toxic than IMRT Stereotactic body radiotherapy (SBRT) is a form of radiosurgery that comprises the delivery of highly conformal hypofractionated radiation to a welldefined target. SBRT is considered to offer advantages over traditional radiotherapy insofar as it enables the delivery of high radiation doses over fewer fractionations, thereby curtailing the overall duration of treatment when compared with traditional external beam approaches such as intensity-modulated radiotherapy (IMRT). In addition, radiobiologic evidence has suggested that a hypofractionated approach presents the potential for therapeutic equipoise without additional normal tissue toxicity. The combination of promising data and aggressive marketing of SBRT with technologies such as CyberKnife has resulted in the use of SBRT for the treatment of prostate cancer in both the localised and metastatic settings. This paper presents data from the SEER program linked with Medicare follow-up data. . They identified men aged 65 years or older who underwent SBRT or traditional radiotherapy (IMRT, brachytherapy, proton beam therapy or combination therapy) as primary treatment of localised prostate cancer from 2004 to 2011. All patients were followed for at least one year after the initiation of radiotherapy, with December 2012 established as the end of the study. Trends in the use of primary radiotherapies were characterised along with complications including urinary incontinence, non-incontinence genitourinary morbidity, erectile dysfunction, gastrointestinal morbidity, and hip fracture, which were identified

SBRT compared with brachytherapy and IMRT was associated with equivalent gastrointestinal toxicity but more erectile dysfunction at two-year follow-up (p < .001). SBRT was associated with more urinary incontinence compared with IMRT and proton beam therapy but less compared with brachytherapy (p < .001, respectively). The median cost of SBRT was $27,145 compared with $17,183 for brachytherapy, $37,090 for IMRT, and $54,706 for proton beam therapy (p < .001). Patients undergoing SBRT require far fewer therapy sessions, which makes treatment cheaper. However, it was associated with more urinary incontinence and erectile dysfunction at two years and that will be of concern to men with localised prostate cancer considering their treatment options.

Source: Use, complications and costs of stereotactic body radiotherapy for localised prostate cancer. Halpern JA, Sedrakyan A, Hsu W-C, Mao J, Daskivich TJ, Nguyen PL, Golden EB, Kang J, Hu JC. Cancer 2016; 122: 2496-504.

Pre-operative assessment of AB and UTI incidence The preoperative presence of asymptomatic bacteriuria (AB) is not associated with a higher incidence of postoperative symptomatic urinary tract infection (UTI) in patients who are receiving antimicrobial prophylaxis in accordance with European Association of Urology (EAU) Guidelines. The objective of this study was to evaluate whether it is always necessary to test for the presence of AB in patients undergoing urological surgical procedures and if present, to treat AB with antimicrobial prophylaxis. All patients who underwent urological surgical procedures from December 2008 to October 2013 in a tertiary referral urological centre were considered for this study. All patients received antimicrobial

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Prof. Oliver Hakenberg Section Editor Rostock (DE)

Oliver.Hakenberg@ med.uni-rostock.de prophylaxis in line with EAU Guidelines on urological infections. AB was diagnosed if ≥ 10(5) colonyforming units/ml were cultured. The population was sub-divided into two groups: Group A, patients with preoperative AB, and Group B, patients without AB. Data on post-operative symptomatic urinary tract infections (UTI) were compared for the two groups.

No difference in terms of overall rate of post-operative symptomatic UTI was found between the two groups… Two thousands and 201 patients were considered eligible for this study and were analysed. Six hundred and sixty-eight (30.4%) patients were found to harbour AB (Group A), and 1,533 (69.6%) did not (Group B). Microbiologically verified symptomatic post-operative UTIs occurred in 198 patients (8.9%). No difference in terms of overall rate of post-operative symptomatic UTI was found between the two groups [Group A 70 (10.4%) and Group B 128 (8.3%); OR: 1.28 95%CI 0.94 -1.74; p = 0.12], as well as in terms of urosepsis [Group A 2 (0.30%) and Group B 4 (0.26%); p = 1.0]. The authors concluded that in patients undergoing urological surgical procedures who are receiving antimicrobial prophylaxis in accordance with EAU guidelines, the preoperative presence of AB in this study was not associated with a higher incidence of postoperative symptomatic UTI.

comparison site, urine cultures ordered did not change significantly across all three periods. There was a significant difference in the number of urine cultures ordered per month over time when comparing the two sites using longitudinal linear regression (p < .001). Overtreatment of ASB at the intervention site fell significantly during the intervention period (from 1.6 to 0.6 per 1,000 bed-days; IRR, 0.35; 95% CI, 0.22-0.55), and these reductions persisted during the maintenance period (to 0.4 per 1,000 bed-days; IRR, 0.24; 95% CI, 0.13-0.42) (p < .001 for both). Overtreatment of ASB at the comparison site was similar across all periods (odds ratio, 1.32; 95% CI, 0.69-2.52). When analysed by type of ward, the decrease in ASB overtreatment was significant in long-term care.

…intervention targeting health care professionals who diagnose and treat patients with urinary catheters reduced overtreatment of ASB compared with standard quality improvement methods The authors concluded that their intervention targeting health care professionals who diagnose and treat patients with urinary catheters reduced overtreatment of ASB compared with standard quality improvement methods. These improvements persisted during a low-intensity maintenance period. The impact was more pronounced in long-term care, an emerging domain for antimicrobial stewardship. The take home message is that overtreatment of asymptomatic bacteriuria (ASB) in patients with urinary catheters remains high. Health care professionals have difficulty differentiating cases of ASB from catheter-associated urinary tract infections.

Source: Effectiveness of an antimicrobial stewardship approach for urinary catheterassociated asymptomatic bacteriuria. Trautner BW, Grigoryan L, Petersen NJ, Hysong S, Cadena J, Patterson JE, Naik AD. JAMA Intern Med. 2015 Jul;175(7):1120-7. doi: 10.1001/

jamainternmed.2015.1878. Source: Is Pre-Operative Assessment and Treatment of Asymptomatic Bacteriuria Necessary for Reducing the Risk of PostOperative Symptomatic Urinary Tract Infections Pooled analysis demonstrated after Urological Surgical Procedures? Cai T, high clinical cure rates with Verze P, Palmieri A, Gacci M, Lanzafame P, Malossini G, Nesi G, Bonkat G, Wagenlehner FM, ceftolozane/tazobactam Mirone V, Bartoletti R, Bjerklund Johansen TE. Urology DOI: 10.1016/j.urology.2016.10.016

Overtreatment of asymptomatic bacteriuria (ASB) in patients with urinary catheters can be lowered by means of guidelines implementation The objective of this study was to evaluate the effectiveness and sustainability of an intervention to reduce urine culture ordering and antimicrobial prescribing for catheter-associated ASB compared with standard quality improvement methods. Investigators made a pre-intervention and postintervention comparison with a contemporaneous control group from July 2010 to June 2013 at two Veterans Affairs health care systems. Study populations were patients with urinary catheters on acute medicine wards and long-term care units and health care professionals who order urine cultures and prescribe antimicrobials. The study approach was a multifaceted guidelines implementation intervention. The primary outcomes were urine cultures ordered per 1,000 bed-days and cases of ASB receiving antibiotics (overtreatment) during intervention and maintenance periods compared with baseline at both sites. Patient-level analysis of inappropriate antimicrobial use adjusted for individual covariates.

treatment of complicated Intrabdomial Infections and cUTI caused by ESBLproducing Enterobacteriaceae

The increase in infections caused by drug-resistant ESBL-producing Enterobacteriaceae (ESBL-ENT) is a global concern. The characteristics and outcomes of patients infected with ESBL-ENT were examined in a pooled analysis of Phase 3 clinical trials of ceftolozane/tazobactam in patients with complicated urinary tract infections (ASPECT-cUTI) and complicated intra-abdominal infections (ASPECT-cIAI). All trials were randomised and double blind. The ASPECT-cUTI regimen was seven days of either intravenous ceftolozane/tazobactam (1.5 g) every 8 h or levofloxacin (750 mg) once daily. The ASPECT-cIAI regimen was 4-14 days of either intravenous ceftolozane/tazobactam (1.5 g) plus metronidazole (500 mg) or meropenem (1 g) every 8 h. Baseline cultures were obtained in both indications. Enterobacteriaceae were selected for ESBL characterisation based on predefined criteria and were verified genotypically. Outcomes were assessed at the test-of-cure visit 5-9 days post-therapy in ASPECT-cUTI and 24-32 days post-randomisation in ASPECT-cIAI among microbiologically evaluable (ME) patients.

…randomised trial data demonstrated high clinical cure rates with ceftolozane/tazobactam treatment of cIAI and cUTI caused by ESBL-ENT

Study surveillance included 289,754 total bed-days. The overall rate of urine culture ordering decreased significantly during the intervention period (from 41.2 to 23.3 per 1,000 bed-days; incidence rate ration [IRR], Investigators found that out of 2,076 patients 0.57; 95% CI, 0.53-0.61) and further during the maintenance period (to 12.0 per 1,000 bed-days; IRR, randomised, 1,346 could be included in the pooled ME population and 150 of 1,346 (11.1%) had ESBL-ENT 0.29; 95% CI, 0.26-0.32) (p < .001 for both). At the Key articles

October/December 2016

at baseline. At US FDA/EUCAST breakpoints of ≤ 2/≤ 1 mg/L, 81.8%/72.3% of ESBL-ENT (ESBL-Escherichia coli, 95%/88.1%; ESBL-Klebsiella pneumoniae, 56.7%/36.7%) were susceptible to ceftolozane/ tazobactam versus 25.3%/24.1% susceptible to levofloxacin and 98.3%/98.3% susceptible to meropenem at CLSI/EUCAST breakpoints. Clinical cure rates for ME patients with ESBL-ENT were 97.4% (76/78) for ceftolozane/tazobactam [ESBL-E. coli, 98.0% (49 of 50); ESBL-K. pneumoniae, 94.4% (17 of 18)], 82.6% (38 of 46) for levofloxacin and 88.5% (23 of 26) for meropenem. It was concluded that randomised trial data demonstrated high clinical cure rates with ceftolozane/tazobactam treatment of cIAI and cUTI caused by ESBL-ENT.

Source: Efficacy of ceftolozane/tazobactam against urinary tract and intra-abdominal infections caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae: a pooled analysis of Phase 3 clinical trials. Popejoy MW, Paterson DL, Cloutier D, Huntington JA, Miller B, Bliss CA, Steenbergen JN, Hershberger E, Umeh O, Kaye KS. J Antimicrob Chemother. 2016 Oct 5 DOI: 10.1093/jac/ dkw374

A new robot-assisted surgical option for focal therapy in prostate cancer? Focal therapy is not currently recommended as standard treatment in prostate cancer management; however multiple series using different ablative techniques have shown safety and interesting mid-term outcomes, mainly for cancer foci located at the peripheral zone of the gland. Whereas various energies such as high-intensity focused ultrasound, cryotherapy, or electroporation have been developed for focal treatment, “old” surgery stays tied to the dock. In the present study, the authors explored the feasibility of robotic partial prostatectomy in case of biopsy- and imaging-proven pure anterior prostate cancer.

Prof. Oliver Reich Section editor Munich (DE)

oliver.reich@ klinikum-muenchen.de No intraoperative complication was reported and no difficulty for dissecting the posterolateral aspect of the prostate was highlighted by the authors. Nevertheless, one patient had Clavien-Dindo grade 3b peritonitis due to sigmoid diverticulum perforation and two cases had a posterolateral surgical margin. In terms of functional outcomes after partial prostatectomy, 83% of patients remained potent after surgery. All patients were continent. This exploratory surgical study shows that in highly selected consenting patients, a robotic anterior partial prostatectomy is feasible with interesting functional results in terms of potency and continence. However, oncologic outcomes need further assessment with longer follow-up given the relative high rate of PSA failure and the small sample size. The use of template transperineal biopsies in pre-treatment case selection might also be useful to improve the disease characterization given that targeting biopsies in the very anterior part of the prostate remains often imprecise using the transrectal route.

Source: Partial prostatectomy for anterior cancer: Short-term oncologic and functional outcomes. Villers A, Puech P, Flamand V et al. Eur Urol 2016 doi :10.1016/j.eururo.2016.0;8.057

MRI before radical prostatectomy: Please also look at the urethra!

Continence recovery after radical prostatectomy depends on various factor including patient age, surgical technique (apical reconstruction) and Over an eight-year period, 17 patients with isolated experience. Among the patient-related factor, the anterior prostate cancer were enrolled in an IDEAL length of the membranous urethral (MUL) has been phase 2a trial and underwent a robotic anterior suggested to be a potential preoperative prognostic partial prostatectomy. The patients should respond to factor for early continence recovery. The membranous the following inclusion criteria: a pre-urethral, low- to urethra contains smooth muscle fibers and is also intermediate risk prostate cancer confirmed by MRI surrounded by the rhabdosphincter. This length is and by targeted biopsies. Median follow-up was 30 easily measurable on pre-operative T2-weighted MRI months. images, and could be used for patient counseling before surgery planning. Robotic surgery consisted of en bloc excision of the anterior part of the gland, along with the urethra, The aim of this systematic review and meta-analysis including the transition zone, the anterior was to summarize all available literature reporting fibromuscular stroma, and the anterior part of the the prognostic value of MUL for the recovery of peripheral zone. The posterior part of the prostate continence after radical prostatectomy (open including the distal sub-montanal apex and the retropubic, pure laparoscopic, or robot-assisted neurovascular bundles was preserved. Urethroprocedures). Overall, 13 studies were included in the vesical anastomosis was performed between the evidence synthesis . Only one was a randomized bladder and the distal urethra with the remaining controlled trial, 12 were cohort studies based on a gland (peripheral zone and seminal vesicle) located prospective design in three studies. The scores calculated using the Downs and Black evaluation tool behind the posterior bladder wall. Surgery was feasible in all cases without intraoperative were high in the vast majority of studies. complications or open conversion. Median PSA nadir was 0.4 ng/ml representing a PSA decrease of 8.7 ng/ The results also emphasized the ml compared with preoperative PSA.

This exploratory surgical study shows that in highly selected consenting patients, a robotic anterior partial prostatectomy is feasible with interesting functional results in terms of potency and continence In the first seven patients, a control biopsy was performed at six months. Because all biopsies were negative in case of normal MRI, only for-cause biopsies were performed for the subsequent patients. A rising PSA suspicious for persistent occurred in 24% of cases: 17% in Gleason score 6 patients, 30% in Gleason score 3+4 patients. The cancer recurrence-free survival at three years was 67%. MRI was suspicious in these patients and MRI-targeted biopsies were positive at the anterior margin. Salvage robot-assisted radical prostatectomy resulted in undetectable PSA in 75% of these patients.

role of apical preservation and reconstruction during radical prostatectomy aiming at preserving all anatomical structures directly linked to continence function

The mean MUL measurements ranged from 10.4 mm to 14.5 mm with individual extreme values varying from 5 mm to 34.3 mm. The MUL was measured by urologists, radiologists, or both specialties via consensus. Examiners were blinded to the patient’s clinical data? There was no evidence of a difference in effect between sagittal and coronal MRI methods for MUL measurement. Definition of continence was based on direct patient questioning and/or selfreported questionnaires in 12 out of 13 series. Only one study defined continence with a strict definition using a 24-hour pad test. Most of the studies showed a significant positive effect of greater MUL on the odds of continence recovery at six and 12 months after surgery. Few studies have assessed the effect of MUL on early

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

tebj@medisin.uio.no continence at one (one study) and three (six studies) months after radical prostatectomy. No significant effect was found at one month, whereas a greater MUL seemed significantly associated with a faster return of continence since month 3. The multivariate meta-regression showed that for every extra millimeter of MUL the estimated odds of return to continence were increased by 5%-15%. This conclusion confirmed that the membranous urethra plays an important role in continence, contributing to maintaining urethral closure pressures. Various clinical and surgical factors have to be taken into account; however the measurement of MUL before surgery may help the clinician to improve patient counseling and to anticipate potential delays to continence recovery. Attention should not be focused only on prostate and disease characteristics. The results also emphasized the role of apical preservation and reconstruction during radical prostatectomy aiming at preserving all anatomical structures directly linked to continence function.

Source: Preoperative membranous urethral length measurement and continence recovery following radical prostatectomy: A systematic review and meta-analysis. Mungovan SF, Sandhu JS, Akin O et al. Eur Urol 2016 doi :10.1016/j.euruo.2016.06.023

LUTS and incident falls in community dwelling older men The authors sought to determine which lower urinary tract symptoms (LUTS) are associated with incident falls in community dwelling older men. The Concord Health and Ageing in Men Project involves a representative sample of community dwelling men 70 years old or older in a defined geographic region in Sydney, New South Wales, Australia. Included in analysis were 1,090 men without neurological diseases, poor mobility or dementia at baseline. Lower urinary tract symptoms were assessed using I-PSS (International Prostate Symptom Score) and incontinence was assessed using ICIQ (International Consultation on Incontinence Questionnaire) at baseline. I-PSS sub-scores were calculated for storage and voiding symptoms. Incident falls in one year were determined by telephone follow up every four months.

Lower urinary tract storage and voiding symptoms were associated with falls in community dwelling older men. Of the symptoms of overactive bladder urgency incontinence carried a high risk of falls I-PSS storage and voiding sub-scores were associated with falls. Urgency incontinence was associated with falls (adjusted incidence rate ratio 2.57, 95% CI 1.54-4.30). In addition, intermediate to high I-PSS storage sub-scores without urgency incontinence were associated with falls (adjusted incidence rate ratio 1.72, 95% CI 1.24-2.38). Other types of incontinence and urgency alone without urgency incontinence were not associated with falls. Lower urinary tract storage and voiding symptoms were associated with falls in community dwelling older men. Of the symptoms of overactive bladder urgency incontinence carried a high risk of falls. Storage symptoms also contributed to the fall risk independently of urgency incontinence. Circumstances of falls among men with lower urinary tract symptoms should be explored to understand how lower urinary tract symptoms Key articles

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increase the fall risk and generate hypotheses regarding potential interventions. Furthermore, the authors propose, that trials to treat lower urinary tract symptoms in older men should include falls as an end point.

Source: Lower urinary tract symptoms and incident falls in community dwelling older men: The concord health and ageing in men project. Noguchi N, Chan L, Cumming RG, Blyth FM, Handelsman DJ, Seibel MJ, Waite LM, Le Couteur DG, Naganathan V. J Urol. 2016 pii: S0022-5347(16)30746-7. doi: 10.1016/j. juro.2016.06.085. [Epub ahead of print]

Radical prostatectomy after solid organ transplantation The risk of de novo cancers after solid organ transplantation is not negligible due to prolonged immunosuppression and the increased of transplant recipients. The oncology treatment may also be challenging given the co-morbidity burden, the previous surgery, and the supposed higher risk of tumor progression in immunosuppressed patients. A previous renal transplantation may complicate the management of a newly diagnosed prostate cancer. Pelvic radiotherapy induced the risk of harm of the graft and of radiation-induced ureteral stenosis. Surgery is mainly the preferred therapeutic option; nevertheless previous pelvic surgery and immunosuppression may interfere with postoperative recovery and lead to unusual intraoperative complication as compared with the not-transplant patients setting. However, little data has been published. In the present study, Beyer et al. assessed the oncologic and functional outcomes of 30 patients undergoing radical prostatectomy after organ solid transplantation. Among these patients, 20 renal transplant recipients were included. The study was retrospective and single-center, reviewing cases during a 20-year period. In all but one patient, an open retropubic radical prostatectomy was performed. Median operating time was 180 minutes. Postoperative complications occurred in one third of cases, including 10% of Clavien grade 3 or more major complications (including one ureter injury).

…radical prostatectomy in the posttransplantation setting is at higher risk of complications. Functional outcomes are also altered with an increased risk of persistent urinary incontinence Overall, 73% of patients were continent at month 12 after surgery. This rate was defined by the use of 0-1 pad daily. Information regarding potency in preoperatively potent patients was insufficient to draw relevant conclusions regarding that endpoint. Median follow-up was 45 months. Overall, the PSA recurrence rate was 20% after surgery and the four-year PSA-recurrence survival rate was 69%. No cancerspecific death was reported. To conclude, radical prostatectomy in the post-transplantation setting is at higher risk of complications. Functional outcomes are also altered with an increased risk of persistent urinary incontinence. Oncologic outcomes and cure rates appeared comparable with those published in the overall population of prostate cancer patients. Nevertheless, a direct comparison using a matched pair analysis would be appreciable to confirm such similar results. A prospective assessment of both oncologic and functional outcomes is also needed. Although the open retropubic approach was systematically used in renal transplant recipients, the feasibility of a robot-assisted procedure should be also evaluated given the advantage of limiting the risk of ureteral injuries by a Retzius-sparing approach.

Source: Oncological, functional and perioperative outcomes in transplant patients after radical prostatectomy. Beyer B, Mandel P, Michl U, et al. World J Urol 2016 ; 34 :1101-1105.

Morbidity and mortality after surgery for lower urinary tract symptoms Little real-world data is available on the comparison of different methods in surgery for lower urinary tract symptoms due to benign prostatic obstruction in terms of complications. The objective of the paper was to evaluate the proportions of TURP, open prostatectomy (OP) and laser-based surgical approaches over time and to analyse the effect of approach on complication rates. Using data of the German local healthcare funds (Allgemeine Ortskrankenkassen (AOK)), the investigators identified 95,577 cases with a primary diagnosis of hyperplasia of prostate who received TURP, laser vaporisation (LVP), laser enucleation (LEP) of the prostate or OP between 2008 and 2013. Univariable logistic regression was used to analyse proportions of surgical approach over time, and the effect of surgical method on outcomes was analysed by means of multivariable logistic regression.

OP has the greatest risks of complication despite a low reintervention rate. LVP demonstrated favourable results for transfusion and bleeding, but increased longterm re-interventions compared with TURP... The proportion of TURP in Germany decreased from 83.4% in 2008 to 78.7% in 2013 (p < 0.001). Relative to TURP and adjusting for age, co-morbidities, AOK hospital volume, year of surgery and antithrombotic medication, OP had increased mortality (odds ratio (OR) 1.47, p < 0.05), transfusions (OR 5.20, p < 0.001) and adverse events (OR 2.17, p < 0.001), and lower re-interventions for bleeding (OR 0.75, p < 0.001) and long-term re-interventions (OR 0.55, p < 0.001). LVP carried a lower risk of transfusions (OR 0.57, p < 0.001) and re-interventions for bleeding (OR 0.76, p < 0.001), but a higher risk of long-term reinterventions (OR 1.43, p < 0.001). LEP had increased re-interventions for bleeding (OR 1.35, p < 0.01). Complications were also dependent on age and co-morbidity. Limitations include the lack of clinical information and functional results. OP has the greatest risks of complication despite a low re-intervention rate. LVP demonstrated favourable results for transfusion and bleeding, but increased long-term re-interventions compared with TURP, while LEP showed increased re-interventions for bleeding. The authors stated that these findings support a careful indication and choice of method for surgery for LUTS, taking into account age and co-morbidities.

Dr. Guillaume Ploussard Section editor Toulouse (FR)

g.ploussard@ gmail.com in those without erectile dysfunction (median 2.9 vs. 1.6 ng/l; p < 0.001). Men with erectile dysfunction (i.e., IIEF-5 sum score < 22) were also significantly older; had a higher systolic blood pressure, lower estimated glomerular filtration rate, higher augmentation index and N-terminal pro-B-type natriuretic peptide; and had a higher prevalence of hypertension, diabetes mellitus, and previous coronary artery disease than subjects without erectile dysfunction. These covariates were adjusted for in a multivariate linear regression model, yet the IIEF-5 sum score remained significantly negatively associated with the hs-cTnI concentration (standardized β -0.206; p < 0.001). The investigators concluded that the presence and severity of erectile dysfunction is associated with circulating concentrations of hs-cTnI, indicating subclinical myocardial injury independently of cardiovascular risk factors, endothelial dysfunction and heart failure biomarkers.

Source: Relation of erectile dysfunction to subclinical myocardial injury; Omland T, Randby A, Hrubos-Strøm H, Røsjø H, Einvik G. Am J Cardiol. 2016 Sep 13. pii: S0002-9149(16)31477-1. doi: 10.1016/j.amjcard.2016.08.070. [Epub ahead of print]

New bio-adhesive technology to increase stone-free rate during retrograde intrarenal surgery for kidney stones Stone-free rate (SFR) during retrograde intrarenal surgery (RIRS) is the primary surgical end-point when treating kidney stones. This outcome can be affected by those stone residual fragments (RF) that intentionally or unfeasibly are not removed during RIRS. Regardless advances in technique and technology, RFs are present after surgery in more than 50% of the cases; according to the size and site, some of the RFs are expected to be flushed away with the urine in the weeks following the procedure, but in a > 10% of the cases significant RFs may persist. Natural history of significant RFs may include need for ancillary procedures, acute event (renal colic), or even increase of risk for new stone formation.

Source: Morbidity and mortality after surgery for lower urinary tract symptoms: A study of 95,577 cases from a nationwide German health In order to maximise effects of lasertripsy and stone insurance database; Gilfrich C, Leicht H, clearance during RIRS, a novel bioadhesive system has Fahlenbrach C, Jeschke E, Popken G, Stolzenburg been successfully tested on ex-vivo porcine models. JU, Weißbach L, Zastrow C, Günster C. Prostate Cancer Prostatic Dis. 2016 Aug 9. doi: 10.1038/ pcan.2016.33. [Epub ahead of print]

Relation of erectile dysfunction to subclinical myocardial injury The circulating concentration of cardiac troponin I (cTnI) is an index of subclinical myocardial injury in several patient populations and in the general population. Erectile dysfunction is associated with greater risk for cardiovascular events, but the association with subclinical myocardial injury is not known.

This system consists of two biocompatible, polysaccharide-based components that, after injection in the calyceal cavities through a 3 Fr catheter inserted in the working channel of a flexible ureteroscope (fURS), are able to embed the fragments for retrieval with a basket.

As highlighted by authors, some improvements are still needed especially to increase elasticity of the jelly lump for an even easier retrieval with basket

The authors aimed to test the hypothesis that the presence and severity of erectile dysfunction is associated with greater concentrations of cTnI in the general population.

The jelly lump is blue-dyed for easy identification; also, after eventual breakage when passing through the edge of a ureteral access sheath (UAS), the residual lump can be grasped again for further removal.

The presence and severity of erectile dysfunction was assessed by administering the International Index of Erectile Function 5 (IIEF-5) questionnaire to 260 men aged 30 to 65 years recruited from a population-based study. Concentrations of cTnI were determined by a high-sensitivity (hs) assay. Hs-cTnI levels were significantly higher in subjects with than

A study was designed to compare results of 15 RIRS done with the bio-adhesive system and 15 according to standard technique; human stone fragments of ≤ 1 mm were inserted with a small incision through the renal cortex in the lower pole of female porcine kidneys. In all the cases the basket used was the NGage and the UAS was a 14-16 Fr.

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European Urology Today

October/December 2016


SFR was evaluated by the same surgeon endoscopically and macroscopically via organ autopsy; it was 100% for the group in observation (group 1) and 60% for the standard group (group 2), p = 0.017. Even though the NGage is not a device designed to retrieve such small fragments, this results somehow confirms efficacy of the novel system. Retrieval time was also in favour of group 1 vs. group 2 (10.3 mins vs. 36 mins respectively, p = 0.001) as well as number of retrieval (8.46 vs. 27.13 respectively, p = 0.001). As highlighted by authors, some improvements are still needed especially to increase elasticity of the jelly lump for an even easier retrieval with basket. Finally, the device needs to be validated in human patients, where size of UAS will be smaller (usually between 11 and 14 Fr in outer sheath diameter), small fragments (≤ 1) could be mixed with larger ones (1-3 mm) and the type of basket may vary. Also another aspect to consider is biocompatibility and natural history in the long-term of residual parts of the jelly lumps which might be left in the renal cavities.

Source: Novel Biocompatible Adhesive for Intrarenal Embedding and Endoscopic Removal of Small Residual Fragments after Minimally Invasive Stone Treatment in an Ex Vivo Porcine Kidney Model: Initial Evaluation of a Prototype. Hein S, Schoenthaler M, Wilhelm K, et al. J Urol. 2016 May 30. pii: S0022-5347(16)30543-2. doi: 10.1016/j.juro.2016.05.094. [Epub ahead of print]

Robotic assisted partial nephrectomy in highcomplexity renal masses (PADUA score ≥ 10) Partial nephrectomy (PN) is considered the gold standard for the treatment of small renal mass (T1a or ≤4 cm); EAU Guidelines in Renal Cancer also recommend, whenever feasibility and expertise are available, to also attempt PN for the treatment of larger tumours (T1b). However, size of tumours is not the only factor that can have an impact on the surgical, oncological and functional outcomes of the PNs; nearness to renal sinus, endophytic lesion, laterality may be other anatomical variables that can condition the outcomes. Nephrometry scores like RENAL and PADUA have been introduced to better stratify tumours considering the most prominent anatomical characteristics of tumours. The higher the scores, the higher the likelihood of not achieving successful outcomes. In order to simplify outcomes reporting, another concept has been introduced: the “Trifecta”. Even though definitions may vary, Trifecta involves results about positive surgical margin (PSM), warm ischaemia time (WIT) and complications. A recent study has investigated the effect of highcomplexity scored renal tumours according to PADUA score (≥ 10) on the “Trifecta” rates (1). In their series, authors used the definition of Trifecta as by Khalifeh et al. which includes the combination of negative surgical margins, WIT of < 25 min, and no intraoperative and postoperative complications of grade >3 according to the Clavien–Dindo classification system (2).

Although the study presents several limitations, it provides evidence in support of the use of PN in more challenging cases, even though a high degree of expertise is required Their cohort of robotic-assisted partial nephrectomy (RAPN) included 72 (24.4%) patients with low PADUA score (6-7), 102 (34.6%) with intermediate complexity score (PADUA 8-9) and 121 (41%) with highcomplexity PADUA score.

Accordingly, Trifecta achievement rates were lower in high-complexity score group, being 37.5% respect to 56.9% and 65.3% recorded for the intermediate and low-complexity groups (p ≤ 0.001). Aside from the higher percentage of intra-operative rate of complications, reasons of Trifecta failure were higher rate of PSM (9.9% vs. 5.8% vs. 4.1%, p < 0.001), WIT > 25 mins (42.5% vs. 28.5% vs. 29.3%, p = 0.12) and higher rate of complications (38% vs. 36.2% vs. 22.2%, p = 0.62). At multivariate analysis, factors significantly associated with Trifecta achievement were tumour size, operative time and ASA grade. Interestingly, post-operative complication rates were similar across the three groups and no differences were observed with respect to oncological (overall survival and cancer-specific survival) and functional outcomes (eGFR changes) at the follow-up. Although the study presents several limitations, it provides evidence in support of the use of PN in more challenging cases, even though a high degree of expertise is required.

Sources: 1) Outcomes of high-complexity renal tumours with a Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score of ≥10 after robot-assisted partial nephrectomy with a median 46.5-month follow-up: a tertiary centre experience. Abdel Raheem A, Alatawi A, Kim DK, et al. BJU Int. 2016 Nov;118(5):770-778. doi: 10.1111/bju.13501. Epub 2016 May 26.

Post-operative PSA nadir was 0.4 ng/ml; biochemical relapse was observed in 23.5% (n = 4) of the cases, 3 with pT3a stage at RPP; all of them underwent subsequently a successful salvage robot-assisted radical prostatectomy. Mean blood loss was 300 ml. Peri-operative included

…concerns may be raised with respect to the high rate of PSM, pT3a disease (why not spotted at mpMRI?) and biochemical relapse, for a technique that might be indicated to patients suitable for active surveillance.. Four grade 2 Clavien-Dindo complications occurred peri-operatively, including urinary tract infection (n = 2), leakage (n = 1) and dynamic ileus (n = 1). All the patients were continent at one year and potency was maintained in 83% (n = 10) of the patients fully potent at baseline. Overall, lessons learned from the authors included that 1) the most challenging part of the procedure is the development of the postero-lateral plane between the TZ/AFMS and the peripheral zone, were PSM were prevalent; 2) intermediate risk lesions may not be suitable for an aRPP because of the high risk of PSM and biochemical relapse; 3) the technique is more successful in the case of larger prostate (> 40 gr) where the anatomical plane is better identifiable.

2) Comparative outcomes and assessment of trifecta in 500 robotic and laparoscopic partial nephrectomy cases: a single surgeon experience. Khalifeh A, Autorino R, Hillyer SP et al. However, concerns may be raised with respect to the J Urol 2013; 189: 1236–42

Robotic partial prostatectomy: Is there a new frontier of focal treatment for low-risk prostate cancer? The advent of multiparametric Magnetic Resonance Imaging (mpMRI) has increased the ability of imaging to identify prostatic lesions with high accuracy. This factor led to a twofold consequence: better risk stratification of prostate cancers and diffusion of focal therapies modalities. High-intensity focal ultrasound (HIFU), cryotherapy, or laser ablation focusing on specific location seen at mpMRI have been thermal energy-based ablative treatments tested in some tertiary referral centres, but their indication and efficacy is still to be determined and validated. Another novel approach for focal treatment of prostate cancer has been proposed by a French team performing an anterior robotic partial prostatectomy (aRPP) in a small cohort of patients with anterior only prostatic lesions. In the span of eight years (2008-2015) they recruited 17 highly selected low (Gs 3+3, n = 8) and intermediated (Gs 3+4 or 4+3, n = 9) risk prostate cancer patients with a single lesion detected on mpMRI involving the anterior portion of the prostate. The technique consisted in the en-bloc excision of the anterior part of the prostate including the anterior fibromuscular stroma (AFMS), bladder neck (BN), prostate adenoma (transition zone and median lobe) along with the proximal prostate urethra, peripheral zone apical anterior horns, anterior aspect of the distal (sub-montanal) urethra, and anterior BN. Urethro-bladder anastomosis was required only to re-establish continuity of anterior bladder mucosa (2 to 10 o’clock) with the urethral sphincter. The technique was also designed to minimise any injury to erectile nerves. The authors made sure that lesions detected were at sufficient distance from margins of resection according to pre-defined criteria, in order to minimise the risk of positive surgical margins (PSM).

Pre-operative clinical features included mean age of 61 yrs, median PSA of 9.8 ng/ml, Gleason score 6 or 7 and median cancer volume of 3.7 cm3. Median As expected, patients with high-complexity scores had follow-up time was 30 months. Histology of aRPP a significant longer WIT and length of stay (LOS), revealed a pT3a disease in 47% (n = 8) of the cases; higher blood loss (EBL) and intra-operative PSM was detected in 53% (n = 9) of the patients, complications rates; the latter was conditioned by a 29% (n = 5) involving the anterior aspect and 35% higher number of cases converted to radical (n = 6) the posterior/lateral aspects of the nephrectomy (overall, 7 out of 8). specimens.

high rate of PSM, pT3a disease (why not spotted at mpMRI?) and biochemical relapse, for a technique that might be indicated to patients suitable for active surveillance.

Source: Partial Prostatectomy for Anterior Cancer: Short-term Oncologic and Functional Outcomes. Villers A, Puech P, Flamand V, et al. Eur Urol. 2016 Sep 6. pii: S0302-2838(16)30530-9. doi:10.1016/j.eururo.2016.08.057. [Epub ahead of print]

Ratio between renal volume and recipient weight is a strong predictor of posttransplant function in livedonor transplantation The relationship between renal size and outcome in cadaver kidney transplantation has been well studied but not in live donor renal transplantation. This study looked at anatomic asymmetry and post-transplant recipient function in renal transplantation which has not been extensively studied before.

(< 5%, 5–10%, > 10%) were not different (p = 0.190). On multivariate models, only Vol/Wgt was significantly associated with higher odds of having eGFR > 60 ml/min/1.73 m2 (OR=8.94, 95% CI 2.47–32.25, p = 0.001) and had a strong discriminatory power in predicting the risk of eGFR< 60 ml/min/1.73 m2 at one-year (ROC curve = 0.78, 95% CI 0.68–0.89). The authors concluded that in the presence of donor renal anatomic asymmetry, Vol/Wgt appears to be a major determinant of recipient renal function at one-year post-transplantation. Renography can be replaced with CT volume calculation in estimating split renal function.

Source: Live Donor Renal Anatomic Asymmetry and Post-Transplant Renal Function. B. Tanriover, S. Fernandez, E.S. Campenot, J. Newhouse, I. Oyfe, P. Mohan, B. Sandikci, J. Radhakrishnan, J.J. Wexler, M.A. Carroll, S. Sharif, D.J. Cohen, L.E. Ratner, M.A. Hardy. Transplantation. 2015; 99(8): e66–e74.

Are there increased risks of cardiovascular morbidity in donors after live donor nephrectomy? There is an ongoing discussion about potential adverse effects of live renal donation to the donors. There are some data that suggest that living kidney donation may be associated with increased cardiovascular mortality although the mechanisms are unclear. Also, there is a robust inverse graded association between glomerular filtration rate (GFR) and cardiovascular risk, but proof of causality is lacking. The authors of this study hypothesized that the reduction in GFR in living kidney donors is associated with increased left ventricular mass, impaired left ventricular function and increased aortic stiffness. To examine this hypothesis, the authors conducted this multicentre, parallel group, blinded end-point study of living kidney donors and healthy controls (n = 124), conducted from March 2011 to August 2014. The primary outcome was a change in left ventricular mass assessed by magnetic resonance imaging (baseline to 12 months).

…reduced GFR should be regarded as an independent causative cardiovascular risk factor and that this may be of consequence in live renal donors

The authors analysed 96 live-kidney donors, who had anatomical asymmetry (>10% renal length and/or volume difference calculated from CT angiograms) and their matching recipients. Split function differences (SFD) were quantified with 99mTc-DMSA renography. Implantation biopsies at time-zero were semi-quantitatively scored.

At 12 months, the decrease in isotopic GFR in donors was -30±12 mL/min/1.73m2. In donors compared with controls, there were significant increases in left ventricular mass (+7±10 versus -3±8 g; p < 0.001) and mass:volume ratio (+0.06±0.12 versus -0.01±0.09 g/ mL; p < 0.01), whereas aortic distensibility (-0.29±1.38 versus +0.28±0.79×10-3 mm Hg-1; p = 0.03) and global circumferential strain decreased (-1.1±3.8 versus +0.4±2.4%; p = 0.04).

A comprehensive model utilizing donor renal volume adjusted to recipient weight (Vol/Wgt), SFD, and biopsy score was used to predict recipient estimated glomerular filtration rate (eGFR) at one-year. The primary analysis consisted of a logistic regression model of outcome (odds of developing eGFR > 60 ml/ min/1.73 m2 at one-year), a linear regression model of outcome (predicting recipient eGFR at one-year, using the CKD-EPI formula), and a Monte Carlo simulation based on the linear regression model (n = 10,000 iterations).

Donors had greater risks of developing detectable highly sensitive troponin T (odds ratio, 16.2 [95% confidence interval, 2.6-100.1]; p < 0.01) and microalbuminuria (odds ratio, 3.8 [95% confidence interval, 1.1-12.8]; p = 0.04). Serum uric acid, parathyroid hormone, fibroblast growth factor-23, and high-sensitivity C-reactive protein all increased significantly. There were no changes in ambulatory blood pressure. Change in GFR was independently associated with change in left ventricular mass (R2 = 0.28; p = 0.01).

…in the presence of donor renal anatomic asymmetry, Vol/Wgt appears to be a major determinant of recipient renal function at oneyear post-transplantation

The authors concluded that reduced GFR should be regarded as an independent causative cardiovascular risk factor and that this may be of consequence in live renal donors.

In the study cohort, the mean Vol/Wgt and eGFR at one-year were 2.04 ml/kg and 60.4 ml/min/1.73 m2, respectively. Volume and split ratios between two donor kidneys were strongly correlated (r = 0.79, p < 0.001). The biopsy scores among SFD categories

Clinical trial registration NCT01028703.

Source: Cardiovascular Effects of Unilateral Nephrectomy in Living Kidney Donors; Moody WE, Ferro CJ, Edwards NC, Chue CD, Lin EL, Taylor RJ, Cockwell P, Steeds RP, Townend JN; CRIB-Donor Study Investigators. Hypertension. 2016 Feb;67(2):368-77.

Key articles

October/December 2016

European Urology Today

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In the Land of the Rising Sun EAU-JUA Exchange Programme: Insights into the Japanese work ethic Dr. Otakar Capoun General University Hospital Dept. of Urology Prague (CZ)

agreed prices of goods and appointment schedules. The daily work at hospitals is precisely planned and everyone is expected to strictly conform. In case of a delay or the need for more extra hours on a task, doctors simply stay longer in the hospital to accomplish their tasks.

Organizational skills The Japanese frown on surprise and unpreparedness during every day routine, a trait which is also related to their punctuality. Even an accommodation is better arranged by phone a few hours before on the same “A man with a sour face should not open a shop.“ day rather than going straight to a hotel unannounced Japanese proverb for a room. Organization of our trip was therefore very efficient, including the schedule for the Exchange In April 2016 me and Dr. Géraldine Pignot of the Programme, train departures and arrivals, approximate Onco-urology Centre in Marseille participated in a prices of tickets, names and locations of hotels and two-week fellowship at three Japanese universities. also pick-ups from the airport and train stations. The This visit was a part of the Exchange Programme schedule of every single visit at departments was sponsored by the European Association of Urology always carefully prepared. We even received a leaflet (EAU) and the Japanese Urological Association (JUA). with names, photographs and information about all As my colleague has already written about some doctors. At another hospital, we got badges with our aspects of our exchange programme, in this article photos and names written also in Japanese characters Kyomizu-dera Temple Kyoto I would describe some of the typical characteristics of and our names also printed on lockers. the Japanese society, their lifestyle and the work ethic in hospitals in Japan. Respect for rules filing into a patient's record of uroflowmetry curves The Japanese as a people have absolute respect for and cystoscopy images. Most departments can use a Politeness the common and general rules. One of the first wide range of surgical methods including laser or The Japanese are one of the most polite people I have surprising moments a foreigner may experience in robotic procedures. They digitize even histological Japan is a simple crossing of a street. Everyone waits slides and at one department we took part in a ever met on my journeys. Everything starts with a for the green light even when there is not a single smile and the traditional bow. For us Europeans this special pre-operative meeting where particular vehicle on the street. Japanese society is unfamiliar style of greeting is considered much more polite than histological samples were presented by an urologist our handshake. A handshake is also common, usually with vandalism and graffiti. Vending machines on the who specialised in pathology. streets, for instance, bear no signs of damage. There when the Japanese meet foreigners. A half-hearted is also no trace of vandalism in subways or other hand shake from the Japanese is thus more likely out Workload of shyness or cautiousness rather than disrespect. This public transportation. Although you can hardly find The Japanese are among the most hard-working litter bins, the streets are clean and everyone takes politeness was also reflected in how they people. Normal working hours in hospitals is from accommodated our itinerary despite the full agendas of professors and doctors. All of the professors gave us a generous amount of time enabling us to exchange insights regarding the differences between European and East Asian society, culture and health care. otakar.capoun@ seznam.cz

professionals, top doctors and professors also have the biggest workload. The advantage of this system is that you can complete almost any task or you can spend a long time, for example, with foreign visitors (which we ourselves realized), because time during working days is “irrelevant.” Weekends are exclusively reserved for the family. The Japanese only have a two-week vacation and it is practically impossible to take it at one time. Working hard has its rewards considering the output of the Japanese economy level but also its trade-offs which

The doctors we visited were friendly and showed us their in- and outpatient departments and operating theatres. After their working hours, they even showed us tourist sights and brought us to fine restaurants. Politeness can be also seen in the attitude of the hospital staff towards a guest, so that we have never felt that we have interrupted their routines. We have not only seen their actual daily clinical work but our questions and requests were all accepted with gratitude. Punctuality The most iconic example of Japanese precision is the Shinkansen bullet train. These trains depart from the platform every three minutes and the average estimated delay, including a delay due to natural disasters, is around 54 seconds recorded in 2014. Regular or precise timetables in other forms of public transportation, however, are a bit more difficult due to the overall traffic congestion as can be expected in big cities not only in Japan but also elsewhere in the world. Punctuality is also important in business and trade and one can fully rely on compliance with the

Chion-in Temple Kyoto

rubbish to their homes or hotel rooms. At hospitals, adherence to general rules is seen when working in operation theatres and in-patient departments. The respect shown by students and younger physicians to their professors and senior colleagues also exemplifies this culture of respect. Professors also determine the main course of a team and assign individual tasks. Patients also come to planned visits with all the results and are expected to keep appointments for further examination. Caring for medical students The relationship between professors and medical students is also remarkable. Besides the respect for authorities, we were, for example, invited with other medical students by a professor to lunch where we discussed aspects of pre-graduate education. We also participated in an evening lecture where doctors from a urological department including a professor presented urology as a medical discipline. They also highlighted the benefits of working at their department.

A-Bomb Dome Hiroshima

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European Urology Today

Technological progress Technologically, Japan is undoubtedly a very advanced country. Technological advances are not limited to the transportation, electronics and automobile industries; Japan is among the top countries that lead in drug research and development of novel medical devices. We even witnessed the development of a new microscopic instrument for percutaneous nephroscopy and lithotripsy. In a department we saw a complete digitization of patient cards including the electronic

Tocho-ji Temple Fukuoka

around 8 am to 6 pm. However, it is almost unacceptable that the employee would leave a workplace on time. Moreover, those engaged in scientific or post-graduate studies work on their projects mostly after working hours. It should also be mentioned that young female physicians spend more time at work than their male counterparts. Among

would be hardly acceptable in European society. This overview of Japanese society is by far final not a full or detailed report. But I hope that this article provides some inspiration to those who have not yet visited this extremely interesting and unusual country, whether as tourists or during professional meetings, fellowships and educational exchanges.

European Urological Scholarship Programme (EUSP) Do not forget to submit your online applications for Short Visit, Clinical Visit, Clinical and Lab Scholarship, and Visiting Professor Programme, before the next deadline of 1 January 2017! For more information and application, please contact the EUSP Office – eusp@uroweb.org or check our website http://www.uroweb.org/education/scholarship/

October/December 2016


ESU Course in Morocco Dealing with the challenge of infection in urology Prof. Magnus Grabe Chair ESU course Malmö (SE)

magnus.grabe@ med.lu.se

Ass. Prof. Gernot Bonkat Alta Uro AG Basel (CH)

bonkat@ alta-uro.com At the congress of the Moroccan Urological Association, the European School of Urology (ESU), as part of the European Association of Urology (EAU), conducted a course on the challenge of infection in urology. The present report summarised the key issues that were discussed during the three-hour session. A list of ‘Key Points to Consider’ is given at the end. This report, reproduced with editorial consent from the Journal of the Association Marocaine d’Urologie (AMU) with minor amendments, provides highlights of the course which was organised in collaboration with the ESU and AMU. Urological infections The course, which provided an update of key issues in urological infections, was conducted as an interactive course including cases discussions presented by two younger urologists. Urological infections are part of the daily challenges encountered by urologists. In recent years, the world-wide increase of bacterial resistance to available antimicrobial agents, the lack of development of new antibiotics, the increased awareness of infectious complications and the complexity of the problems have prompted the urological community to better understand the underlying causes and mechanisms of uro-genital infections. The course focused on the rational use of antimicrobial agents for treating infections and for prophylaxis, including peri-operative prophylaxis in urological surgery. The background documents were the EAU guidelines on Urological Infections versions 2015 and 2016 (www.uroweb.org/guidelines). To better understand the balanced use of antibiotics, it is necessary to consider two principles of classifications: 1. The classification of urinary tract infections (UTI) from asymptomatic bacteriuria to life-threatening sepsis, considering the anatomic localisation, the severity, the general and individual risk factors and the pathogen (-s) involved. A comprehensive chart-figure is given in the guidelines (Figure 1, v 2015, p 10) and was discussed 2. The present working classification of urological procedures in relation to the level of contamination (Tables 22-24, v 2015, p 56-57)

risk factors, in patients with anatomical or functional risk factors (complicated UTI), and in a number of men with inflammatory/infected prostate disease. Take-home messages from this course section: 1. Asymptomatic bacteriuria (ASB), whatever the underlying cause, is usually not a threat to the patient’s kidney functions. ASB, in most situations, should not be treated; 2. Bacteriuria must be controlled prior to urological surgical procedure by treatment for 1-3-5 days based on sensitivity profile, the type of surgery and the patient’s general condition (poorly defined regimen in the literature); 3. Pre-menopausal women with symptomatic rUTI will usually not require extensive investigations. Self-treatment by various means can be considered in cooperative patients; 4. Post-menopausal women with rUTI should be assessed for risk factors; 5. Evaluation is also indicated in cases of gross haematuria, obstructive symptoms, neurogenic bladder, recent uro-genital surgery, bacterial persistence after sensitive-based therapy, diabetes or other immuno-compromised condition (atypical cases); 6. Prevention of rUTI should as far as possible be attempted by non-antibiotic methods (e.g. high fluid intake, voiding education, vaginal oestrogens (post-menopausal women), immuno-active prophylaxis, probiotics); and 7. Low-dose daily antibiotics are effective, but the last option, and must be re-evaluated regularly in view of the patient’s own safety and the risk of resistance development. Male accessory glands infections: What is new? In a recent study from Germany, it has been shown that the traditional view of causative pathogens for epididymitis should be modified. Chlamydia trachomatis and other sexually transmitted pathogens were detected in all age groups up to 57 years of age, although it dominates in the age groups 15-37, while enteric pathogens were also seen in all age groups, however with a clear increase in percentage with age. This observation, that would need confirmation from other studies in different countries, led the panel to change the EAU recommendations (v 2016, Ch. 5) for treatment of acute infective epididymitis (LE:3 but LE upgraded to A): • Initially prescribe a single antibiotic or a combination of two antibiotics against Chlamydia trachomatis and Enterobacteriaceae in young sexually active men; in older men without sexual risk factors only Enterobacteriaceae have to be considered • If Gonorrhoeal infection is likely give single dose ceftriaxone 500 mg i.m. in addition to a course of an antibiotic active against Chlamydia trachomatis • Adjust antibiotic agent when pathogen has been identified and adjust duration according to clinical response Transrectal prostate biopsy Prevention of infectious complication after ultra-soundguided transrectal prostate biopsy was discussed after the presentation of a severe complicated case. The risk of an uro-genital infectious complication with or

Table 1: Summary of preventive measures in conjunction with transrectal prostate biopsy Non-antibiotic prevention Is biopsy really necessary? Is the patient well informed, aware of and accepts the risks? Careful patient assessment for risk factors Route of biopsy trans-perineal versus trans-rectal (considered) Enema before biopsy is controversial (no proven benefit) Rectal preparation with povidone-iodine seams to lower the risk of infectious complications (LE:1a;LR:B) (EAU recommendation v 2016, Ch. 6) Local anaesthesia: no proven risk of increasing infectious complication

Antibiotic prevention (LE: 1b; LR: A) Key risk factors: • Previous uro-genital infection • Bacteriuria present • Diabetes and immuno-compromised patient • Risk of colonisation with ESBL or other resistant multiresistant microbes (take a rectal swab if suspected) General – all patients Low risk: single dose shown sufficient Individualised regimen when risk factors? • Targeted based on history, urine culture, rectal swab • Addition of one antibiotic

without sepsis is reported in most studies between 1 to 5 per cent, even under antimicrobial coverage. The prevalence of prostate cancer is fortunately much lower in Morocco as compared to Europe (WHO/IARC – Globoscan 2012), limiting the number of such complications in the North African population. The procedure is considered as a contaminated procedure. Prevention is a combination of non-antibiotic and antibiotic measures and each patient has to be assessed individually (Table 1). Principles of peri-operative antimicrobial prophylaxis in urology The use of antimicrobial agents in conjunction with urological interventions is not controversial nowadays, but still insufficiently documented for most interventions. There is strong evidence for only a few procedures such as prostate biopsy and TUR-P and moderate evidence for common endoscopic stone procedures (PCNL, RIRS, URS). Evidence is weak, controversial or not demonstrated for many common interventions such as cystoscopy, different ESWL modalities, TUR-BT, and total prostatectomy. As antibiotics have to be used in a responsible manner within the frame of an antibiotic stewardship programme and not freely at the discretion of each prescriber, a model is needed. The EAU guidelines panel on Urological Infections presented a model a few years ago based on the above-mentioned classification and according to the level of contamination of the urinary, male genital and intestinal tracts (Table 2). Peri-operative antimicrobial prophylaxis is by principle a single dose given shortly prior to surgery (30-90 minutes depending on route of administration and pharmacodynamics) and aimed at protecting the patient from an infectious complication directly related to the procedure. The drug is on the site of surgery timely. If several doses are given, therapy has started. The preoperative assessment of the patient and the expected circumstances of surgery are essential. Patient risk factor assessment is a combination of: • General risk factors (e.g. advanced age, nutritional and immunological status, co-morbidity and life style such as obesity and smoking), and • Individual factors (v 2015, Table 1: ORENUC, p 10). Bacteriuria and a history of febrile uro-genital infection markedly increase the risk of infectious complications. There are presently a few studies showing that adherence to the guidelines reduces the number of

doses of antimicrobial agents and costs without changing the outcome for the patient in terms of infectious complications. Take-home messages for this section: • Peri-operative antimicrobial prophylaxis is effective in some defined procedures; • A working model based on the level of surgical contamination facilitates the decision- making on the use of antimicrobials in conjunction with interventions; • Risk factor determination is essential for the patients’ safety at surgery; • Preoperative bacteriuria and a history of febrile uro-genital infection are high-risk factors; and • Further studies are necessary to better enlighten the urological community on a rational use of antibiotics and safe outcome for the patients, also using the classification of UTI and infectious complications for standardised reporting. Key points to remember · Standardised classifications of UTI and of urological procedure are valuable tools for a responsible use of antimicrobials and for conducting clinical studies · The laboratory urine culture with sensitivity profile is the best method for detecting bacteriuria for treatment and prophylaxis and should be available prior to surgery · Recurrent UTI is a clinical problem. Recurrent ASB must be distinguished from recurrent symptomatic UTI. Antibiotic treatment of ASB should be avoided, except prior to surgical procedures · A recent study on male accessory gland infections (MAGI) has shown that the traditional view of causative agents in sexually transmitted infections has changed. The recommendations have been modified accordingly (see above) · The risk of infectious complication related to trans-rectal prostate biopsy is well known. Prevention consist of both non-antibiotic measures and the prescription of antimicrobials (Table 1) · The model of classification of urological procedures based on the surgical site contamination level facilitate the decision making of peri-operative antimicrobial prophylaxis (Table 2) References The main references are the European Association of Urology Guidelines Urological Infections Versions 2015 and 2016 (www.uroweb.org/guidelines) and related references. The version 2015 can be found in the archives of the website.

Table 2: Surgical field contamination level in urology (working model). The table presents a few examples of common procedures. These two modes of classifying UTI and surgical For details, consult original tables (EAU guidelines 2015, Ch. 3N, p 50-58) procedures provide a practical model to build the use of Surgical contamination Description Bacteriuria UT* Some examples of daily surgery antimicrobial agents in different situations and, thus, offer a tool for antimicrobial stewardship in urology. Clean Urinary or genital tracts not entered. No Vasectomy Uninfected, no inflammation. No break in Planned scrotal surgery Detection of bacteriuria prior to urological procedures technique Cystoscopy** In a systematic review of the literature reported in the ESWL (no obstruction) EAU guidelines (v 2016, Ch. 4), it is shown that the Clean-contaminated Urinary or genital tracts entered. Uninfected, No TUR-BT, TUR-P (simple) alternative methods of detection of bacteria in the urine (Urinary or genital tracts no inflammation. No break in technique; no or Trans-perineal prostate biopsy – dipstick test, dipstick culture, automated microscopy only) controlled spillage PCNL, RIRS, URS and flow cytometry – are all inferior to laboratory urine Total prostatectomy culture. The urological infection panel therefore states Clean contaminated Urinary and intestinal tracts entered. No Urine deviation surgery that: Laboratory urine culture is the recommended (Urinary and intestinal Uninfected, no inflammation. No break in (no identified complicating factors) method to determine the presence or absence of tracts) technique; no or controlled spillage clinically significant bacteriuria in patients prior to Contaminated Urinary or genital (and intestinal when Yes Trans-rectal prostate biopsy undergoing urological interventions. (LE:3; LR:B). required) entered. TUR-P (catheter) Inflammation, spillage, major break in TURB (large, necrotic) Recurrent urinary tract infection technique ESWL with drainage Recurrent UTI (rUTI) is a common clinical issue. It is Open, fresh accidental wound PCNL, RIRS, URS complex - drainage essential to first differentiate between recurring Infected/dirty Pre-existing infection, viscera perforation Yes Emergency surgery. Emergency asymptomatic bacteriuria (ASB) and recurring Old wound TUR-P, TUR-BT symptomatic infection. rUTI can be observed in both pre- and post-menopausal women without any other * Urinary tract. Bacteriuria detected prior to intervention. ** Urethra and bladder entered but atraumatic short procedure October/December 2016

Principle of antibiotic policy No general

General Single dose

General Single dose Therapy if several doses Preoperative control of bacteriuria + cover surgery

Treatment

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2nd ESU-ESUT Masterclass on Operative management of Benign Prostatic Obstruction

ESU - Weill Cornell Masterclass in General urology

19-20 May 2017, Heilbronn, Germany

9-15 July 2017, Salzburg, Austria An application has been made to the EACCME速 for CME accreditation of this event

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1st ESU-ESUT Masterclass on Urolithiasis

New EAU Education Online course:

16-17 June 2017, Patras, Greece An application has been made to the EACCME速 for CME accreditation of this event

Metastatic Prostate Cancer Get a complete view on clinical aspects, diagnosis and treatments of Metastatic Prostate Cancer (mPCa)

The development of this course has been supported by JANSSEN and IPSEN with a concession of an educational grant

An application has been made to the EACCME速 for CME accreditation of E-Learning Material (ELM)

uroweb.org/education 14

European Urology Today

October/December 2016


ESU Course in Tunisia Tunisian urologists get updates on managing pelvic floor dysfunction on the surgical treatment of stress urinary incontinence (SUI).

by the number of cases the surgeon has performed. Sievert emphasized key issues such as excellent anatomical and physiological knowledge of the pelvic Meanwhile, lecturer Dr. Hashim discussed these floor in his state-of-the-art presentation. Whereas the important guidelines within the context of daily muscles play a key role in the physiological functioning clinical practice and the different degrees of SUI and of a healthy pelvis in the surgical approach, key aspects pelvic organ prolapse (POP). Using a management for the best functional reconstruction are the bone approach from the UK, Hashim highlighted crucial structures (e.g. ischial spine, ischial tuberosity, coccyx, points, such as offering the patient a conservative sacral promontory) and ligaments (sacrospinous karl.sievert@ treatment approach for at least three months. This ligament, sacrotuberous ligament, obturator pmu.ac.at first-line treatment option includes behavioural membrane) which are crucial in reconstructing the changes related to diet and physiotherapy such as pelvis and achieving the best functional outcomes. pelvic floor exercise. If this fails or the patient is not The European School of Urology (ESU) organised the The development of surgical approaches offers satisfied with the outcome, the case has to be course “Pelvic Floor Dysfunction- Patient Selection reconstructive surgical techniques in open, discussed along with a complete diagnostic and Surgery” as a pre-congress event for the 16th laparoscopic and robot-assisted surgery. The outcomes, Congress venue in Hammamet, Tunisia investigation by a multi-disciplinary team of pelvic Tunisian Urological Society Meeting recently held in as Dr. Hashim mentioned in his overview, seem to be floor reconstructive specialists (including gynaecology, equivalent but depend on surgical expertise. Hammamet, Tunisia urology, coloproctology, physiotherapy, etc.). The co-morbidities. These various treatment options team should provide the patient with the best The congress gathered more than 125 participants should be carefully planned and performed either Complications information to enable the patient to make a sound from Northern African countries such as Tunisia, using an early or delayed approach. If the outcome might involve complications, it is decision regarding the most appropriate treatment. Libya, and Morocco and others. recommended that they be classified using the As mentioned earlier the FDA has noted safety issues prosthesis/graft complication classification code The field of reconstructive urology for the female has However, the best clinical outcome is dependent on the (www.ics.org/complication). These complications are regarding mesh implants. gained significant importance in recent years, but knowledge and experience of the surgeon as reflected often related to the co-morbidities of the patient Although new mesh materials are in the market like although there is a wide range of urological treatment Poly Vinylidene Fluoride (PVDF), many of the known (e.g. previous surgery, options this has primarily focused on mid-urethral products have been withdrawn from the market. diabetes mellitus) and slings. The use of meshes and slings appeared to Thus, the challenge remains to teach the most can be avoided, such as simplify the surgical approach, but the incidence of effective, safest treatment options that are available. performing a separate erosion, pain (dyspareunia), infection, bleeding, etc., With the increased awareness and updated hysterectomy which is also alerted the Food and Drug Administration (FDA) anatomical and surgical knowledge, the best product mentioned in the to the side-effects. Formal warnings were issued for the patient can be correctly identified, providing guidelines. related to meshes and slings, which prompted the patient with better treatment to ensure a quality patients to ask or seek alternative treatment options. outcome and reduce complications risk. Complications can occur in relation to POP or sling The close relationship between the EAU, as The challenging cases presented by Dr. Kh. Atallah surgeries but do not represented by the ESU, and the Tunisian necessarily reflect failure. (Tunis) and Dr. M. Bouassida (Tunis) on pelvic organ Urological Society, paved the way for organising prolapse provided the opportunity to use the Sievert provided the the course which allows open discussions among participants with different theoretical knowledge and led to an enthusiastic and experts and participants. Following the opening open discussion. Overall, the course achieved its aim scenarios and the remarks by Congress President Dr. Amin Bouker, to offer a platform where issues and dilemmas in this suggested treatment Prof. K-D. Sievert presented the EAU guidelines Organisers of the ESU course options to manage those field can be carefully examined. Prof. Dr. Karl-Dietrich Sievert Paracelsus Private Medical University of Salzburg Salzburg (AT)

Raising the bar of urological practice in Armenia 18th Congress of the Armenian Association of Urology Dr. Ruben Hovhannisyan Chairman, 18th Annual AAU Meeting Head, International Relations Office Armenian Association of Urology ruben_hovhannisyan@ yahoo.com The Armenian Association of Urology (AAU) held its 18th Annual Meeting, a unique event in the country which attracted both local and international participants. The AAU’s annual meetings mean a lot to Armenian urologists as they have served several generations of Armenian urologists by providing unified standards and approaches in urology. The annual event also fills the gap that exist between the generations and help in disseminating skills and knowledge, thus raising the general bar of urological practice in the country. On alternate years, our annual meeting includes a European School of Urology (ESU) course with the participation of three expert lecturers. This makes our

ESU course participants pose for a 'fun' souvenir photo

October/December 2016

meeting a European event with appropriate level, content and aims, and with the EAU’s participation and input. On September 23, 2016 the 7th ESU Course was held in Yerevan, Armenia followed by the second day of the Congress.

I consider this latest AAU meeting, with the participation of the EAU, AUA and RSU, as a remarkable event which might not happen again. This collaboration gave us a special feeling, which will always be remembered. A meeting that presented new standards would certainly affect our This year the annual meeting has become a truly priorities. And joint efforts such as these international unique event to stay forever in our memories, leaving collaborations will inspire us as we navigate the hard an indelible mark. Notably, a four-member delegation times of developing our own professional from the American Urological Association (AUA), environment, based on the standards of evidenceheaded by AUA President Professor Richard Babayan based medicine. from Boston, participated in our congress. Our American colleagues also gave a series of lectures, But even the presence and support of the most skilled and the AUA president spoke in detail about the speakers and congress organisers are not enough to organizational and educational role the AUA plays in cover the vast area of and manifold challenges and the United States. Albeit unofficially, but with pride, controversial issues in onco-urology. Despite that the we can say that both AUA and ESU courses have taken participants from the AUA, EAU and RSU have place simultaneously. For two days, Armenia has demonstrated that concern, consideration and frank become the place where the EAU and the AUA met; opinions can compensate for the limitations, inspiring we have grown into the platform that has showcased the organizers and congress participants. the educational aims of the world’s two largest and most influential urological associations. I also would like to note some highlights such as the very high attendance and active participation of the Both the ESU Course chairman and the AUA president audience. The ESU course was interactive thanks to the informed the audience how their organizations seek efforts of session chairman, Prof. Van Moorselaar, and to assist our association in raising the general level of the support of the faculty members, Prof. urology and the commitment to international Yossepowitch and Dr. Klatte. The organization of the outreach. For some time Armenia has served as a course was very efficient and this was due to the destination for educational assistance from international associations, demonstrating their resolution to help us integrate with international urology. These partnerships assisted us in our own goals and highlighted the need for integration. In addition, a delegation from the Russian Society of Urologists (RSU) composed of four urological surgeons, and headed by the Urologist-in-Chief of the Russian Federation Prof. Dmitry Pushkar, has also participated in the congress. The Russian group gave some lectures that complemented those presented Faculty members of the ESU Course by the EAU and AUA.

AAU participants give a thumbs-up for a successful meeting

dedicated efforts and enthusiasm of the EAU’s Ms. Karina van Lenthe. We also note the very comprehensive range of the annual meeting’s scientific programme and the ESU course that reflected the event’s remarkable scientific reach and depth. Finally, we thank the leadership of the EAU, AUA and RSU for this wonderful professional event, and to all those who have contributed to making our meeting plans a reality. We hope the investment made by the above-mentioned organizations, their representatives and local staff, will further boost our international and professional links and help us improve healthcare. European Urology Today

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www.baltic17.org

www.esudavos17.org

BALTIC17

European Urology Forum 2017

4th Baltic Meeting in conjunction with the EAU

Challenge the experts

26-27 May 2017, Vilnius, Lithuania An application has been made to the EACCME® for CME accreditation of this event

4-7 February 2017, Davos, Switzerland EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations

Call for Abstracts Deadline: 1 April 2017

Preliminary ESU programme in London 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 and imaging urodynamics

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European Urology Today

#EAU17

ESU Hands-on Training Courses

Paediatric urology • Paediatric urology for the adult urologist 1 and 2

Trauma • Urinary tract and genital trauma

Penis/testis • Testicular cancer • Penile diseases

Unclassified and miscellaneous topics • Evaluation of risk in comorbidity in onco-urology • How to proceed with a haematuria • Surgical anatomy • Ultrasound in urology • Laparoscopy for beginners • Update renal, bladder and prostate cancer guidelines 2017. What is changed? • Basic surgical and endo urological skills

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

Urethral strictures • Advanced course on urethral stricture surgery Urothelial tumours • Practical management of non-muscle invasive bladder cancer • 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

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

www.eau17.org

Robotic surgery • ESU/ERUS HOT in Robotic surgery intro course • ESU/ERUS HOT in Robotic surgery advanced virtual robotic procedural training Laparoscopy • ESU/ESUT HOT in Basic laparoscopic skills (E-BLUS training) • E-BLUS exam Diagnostics and follow-up • ESU/ESFFU HOT in Urodynamics • ESU/ESUT HOT in Fluorescence guided laparoscopic surgery • ESU/ESUT/ESUI HOT in MRI fusion biopsy Functional urology • ESU/ESFFU HOT in OnabotulinumtoxinA administration for OAB • ESU/ESFFU HOT in Sacral neuromodulation procedure standardisation Endoscopy • ESU/ESUT HOT in Transurethral therapy of LUTS - bipolar TURP • ESU/ESUT HOT in HoLEP • ESU/ESUT HOT with Thulium laser for vaporesection of prostate • ESU/ESUT/EULIS HOT in Ureterorenoscopy

October/December 2016


16th Congress, Russian Society of Urology EAU and RSU nurture closer ties with collaborative activities Prof. Igor Korneyev Saint Petersburg State Pavlov Medical University Dept. of Urology St. Petersburg (RU) iakorneyev@ yandex.ru The Russian Society of Urology (RSU) held from October 20 to 22 its 16th Congress. The RSU programme included a European School of Urology (ESU) course in urolithiasis as part of the collaborative activities agreed upon by EAU Secretary General Prof. Chris Chapple and RSU Chairman Prof. Alyayev.

EAU-RSU Co-Chairmen

According to RSU’s Executive Director Prof. Gazimiev, more than 1,500 doctors, residents, and medical students from all over the country registered for the congress held in Ufa, capital city of the Bashkortostan Republic in Russia. Around 223 presentations in Russian and English were made in 12 plenary and section meetings during the three-day meeting.

given. Prof. Grigoryev led a session which included case reports from real clinical practice. This session led to a spirited discussion with the audience, reflecting the high interest of Russian urologists on the EAU guidelines and its practical implementation in the local healthcare system. The 2016 EAU The first day plenary session started with keynote guidelines update review was presented at the end of lectures presented by Professors Alyayev, Glybochko, this session, followed by concluding remarks from the Medvedev and Pavlov. These reports provided updates, organisers and the closing ceremony. advances and innovations in urology in 2016. The lectures were followed by a plenary session on major Congress participants certainly benefited from the urological issues co-chaired by Prof. Wirth. There were high-quality presentations and updates on the most three section meetings chaired by Russian and recent developments in urology. The congress also European key-opinion leaders in endourology and provided another opportunity for knowledge urolithiasis, onco-urology, reconstructive urology and exchange and strengthens the links among many neurourology. Experienced and young doctors from urologists of diverse background. It is clear the EAU various regions in Russia presented the results of their and RSU are establishing closer ties and the congress scientific research in basic and clinical urology. has become another important step forward to build a reliable and collaborative platform. The end of the Day 1 was highlighted by a session meeting covering three major office urology topics: postoperative rehabilitation of patients after endoscopic surgery, male infertility and premature ejaculation moderated by Professors Martov, Korneyev and Ahvlediani, respectively.

Prof. Manfred Wirth presented the EAU lecture regarding current opinion in managing high-risk prostate cancer, a key topic not only in Russia but also worldwide due to the fast-changing developments in evidence-based decision-making.

Day 2 started early with the “Breakfast with Experts” sessions with a discussion on topics such as nerve-sparing techniques in radical prostatectomy, incidental prostate cancer, technical aspects of urethral surgery in men and testosterone replacement therapy in hypogonadism. The plenary session consisted of three state-of-the-art lectures with updates in prostatic diseases given by Prof. Petrov, updates in urethral diseases presented by

October/December 2016

Teaching activities 2017 European School of Urology February 4-7 12-14

It was the first RSU Congress to have a two-day live surgery course organised by Congress Co-Chairman Prof. Pavlov, Rector and Chairman of the Urological Department at Bashkir State Medical University. Video translation was provided from several operating rooms simultaneously and moderated by a panel which had discussions with congress Live surgeries were transmitted to the Congress Hall participants. International surgical teams worked Dr. Butnary and Prof. Barbagli and current trends in together and presented their skills in open and penile cancer treatment presented by Prof. Matveev. laparoscopic radical cystectomies, prostatectomy, The second day section meetings included surgical adrenalectomy, open female urethra transposition, urethra-vaginal fistula repair, and laser treatment for andrology and male reproduction, pediatric urology, inflammatory diseases of urinary tract and benign stone disease. More than 1,100 visitors from Russia and abroad were registered on-line for these sessions diseases of the prostate. There were10-minute reports followed by enthusiastic discussions. which demonstrated surgical techniques.

Maria Potapova from St. Petersburg presents her first report at the RSU Congress

At the Congress venue

The highlight on Day 3 was the European Urology School course in urolithiasis led by Dr. med. M. Straub and Dr. S. Proietti. The course attracted more than 250 participants. The EAU guidelines on urolithiasis, technical aspects of ESWL and laser in stone treatment, as well as tips and tricks on percutaneous lithotripsy were presented. Recommendations for stone analysis to indicate personalised diet and drug treatment were

European Urology Forum 2017 – Challenge the experts, Davos (CH) ESU course at the national congress of the Iraqi Urological Association, Tehran (IQ)

March 24-28

ESU Courses, Hands-on Training Courses, Innovation in Education at the time of the 32nd Annual EAU Congress, London (GB)

April 22

ESU course on Recent developments in diagnosis and surgical treatment of urolithiasis at the national congress of the Serbian Association of Urology, Novi Sad (RS)

May 19-20 26-27

2nd ESU-ESUT Masterclass on Operative management of Benign Prostatic Obstruction, Heilbronn (DE) ESU course at the EAU Baltic Meeting, Vilnius (LT)

June 16 16 16-17 20

ESU course at the national congress of the Romanian Association of Urology, Bucharest (RO) ESU course on Urolithiasis at the national congress of the Ukrainian Urological Association, Kiev (UA) 1st ESU-ESUT Masterclass on Urolithiasis, Patras (GR) ESU course at the national congress of the Polish Urological Association, Katowice (PL)

July 9-15

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

September 1-6 25

15th European Urology Residents Education Programme (EUREP), Prague (CZ) ESU-ERUS courses at the 15th Meeting of the EAU Robotic Urology Section (ERUS), Bruges (BE)

October 12 17-21

ESU Masterclass at the European Lower Urinary Tract Symptoms meeting (ELUTS17), Berlin (DE) 4th Confederación Americana de Urologia Residents Education Programme (CAUREP), Santa Cruz (BO)

November 6 16-19

ESU course at the national congress of the Scientific Society of Urologists of Uzbekistan, Tashkent (UZ) ESU courses at the 9th European Multidisciplinary Meeting in Urological Cancers (EMUC), Barcelona (ES)

December 8

ESU course on Bladder cancer and endoscopic stone management: 2017 update, at the national congress of the Algerian Association of Urology, Algiers (DZ)

Contact: esu@uroweb.org

European Urology Today

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

EUREP: A well-designed, responsive programme Compact curriculum gets thumbs up of final-term faculty member Now on its 14th year, the annual European Urology Residents Education Programme (EUREP) has now earned a reliable reputation as the front-line training programme not only among young doctors and urology residents in Europe but also among specialists who are impressed with its compact but comprehensive curriculum. “The EUREP programme is well-designed and supported by enthusiastic urologists, super-specialised in a part of urology. In one week the residents get a full update of clinical urology, which could help them, for example, pass the FEBU exam,” said Prof. Gert Dohle, faculty member of the European School of Urology (ESU) and final-term EUREP faculty member. Dohle served this year for the last time as EUREP lecturer in andrology, a field that he also represents as member of the EAU Working Group on Male Infertility. “The atmosphere is always friendly and interactive, giving the residents plenty of opportunities to improve

Prof. Gert Dohle

their knowledge and skills. Prague is also a wonderful place for social activities in the evenings, including the barbeque and karaoke on Sunday. I have always found EUREP one of the EAU’s best educational activities,” added Dohle.

For a speciality like andrology which needs more recruits among the ranks of residents and young urologists, Dohle said it is important to provide a stimulating or inspiring introduction. “As a urologist specialised in andrology, my preference would be to stimulate andrology within urology. Apart from the training during the residency period, fellowships in andrology should be offered, both clinical and scientific fellowships,” Dohle explained when asked how to attract young residents to a specific speciality such as andrology.

andrology and has the skills to handle andrological problems,” he said. Asked what areas EUREP could further improve on or highlight in the future, Dohle said EUREP has sufficiently matured over the years and only needs to refine some details. “The EUREP does not need much improvement since it already meets the expectations of a great course. A short training with questions or a pre-test could be added in the beginning to test the knowledge of the residents. It would be interesting to see if there are many differences in knowledge between the residents

from the different European countries. Some modules could also have more case discussions,” he said as he underscored that practical insights are well appreciated by the participants as it helps them manage patients with specific complaints. Offered and held annually in Prague, Czech Republic, EUREP has five required modules which are presented during the six-day course on a rotating basis, with mornings reserved for state-of-the-art lectures and discussions, videos and test-yourknowledge sessions scheduled in the afternoon. Next year’s EUREP will take place from 1 to 6 September 2017.

To enhance the “promotional” work among young doctors, Dohle said the EAU Section of Andrological Urology (ESAU) where he serves as board member is already collaborating with its partner, the European Academy of Andrology, to organise courses and training in certified andrology centres throughout Europe.

Prof. P. Radziszewski, Chair of the Functional urology module, discussing overactive bladder

“Currently, we are working on an EU/UEMS-status for board-certified andrologists. Andrology should become a sub-speciality not only for urologists but also for endocrinologist. The advantage is that patients would know which doctor is well-trained in

One of this year’s tutor groups, part of the 360 residents from 41 countries, with the faculty in front

A unique learning experience in wonderful Prague Committed, expert faculty inspires Argentinian participant Dr. Diego Santillán Hospital Italiano de Buenos Aires Dept. of Urology Buenos Aires (AR)

diego.santillan@ hospitalitaliano.org.ar Every year the Confederacion Americana de Urologica (CAU) and the European Association of Urology (EAU) provide two full grants for final-year Latin American residents to attend the best urology course organised for residents worldwide. Since 2002, the European Urology Residents Education Programme (EUREP) is held in September every year in Czech Republic’s capital city, Prague. To qualify for this scholarship one must be an active member of both organisations with the application supported by curriculum vitae (CV). A good level of English is a must. Answering multiple choice questions about different articles that are published monthly online in the European Urology journal will

18

European Urology Today

give you CME credits and thus more chances to be accepted. I was one of the lucky South American residents who got the grant and I feel proud of being the only Argentinian representative in this year’s course. Anxiety overtook me when I received the confirmation email. I had participated in CAUREP in December 2014 in Uruguay so I knew about the excellent quality of the course. Fortunately, everything went as expected and even better than I thought. The EUREP organisers were very professional, worked with great commitment and paid attention to every single detail. A warm welcome, the personal badge and the course booklets with the lecturers’ PowerPoint presentations were provided upon registration. The four-star Clarion Congress Hotel was ideally located and its cosy bedrooms were a comfort after nine hours of sessions. Continental breakfasts, a wide variety of menus for lunch and re-energising coffee breaks were provided with no extra charge during the event. Despite the fact that it is difficult to summarise all the urology subspecialties in only five days, the worldrenowned faculty members gave state-of-the-art

lectures with excellent content. We also had close interaction with the faculty in a very cordial atmosphere. The lectures were fast-paced and mainly based on the EAU guidelines as they are the main resource for the European Board of Urology (EBU) exam. However, with every subspecialist also giving his personal opinion, lively debates took place every now and then and these enthusiastic exchanges I consider as the most enriching part. The one-hour hands-on training (HOT) sessions were also offered, thanks to the invaluable support of Olympus. These training sessions, I consider as the “not-to-be-missed” part of the EUREP. The sessions included laparoscopic, ureteroscopy (URS) and transurethral resection (TUR) training. More than 15 laparoscopic towers, 5 ureterorenoscopic stations and 4 TUR stations were available in a fullyequipped room. Expert tutors evaluated our abilities and then coached us based on our personal needs in a one-to-one manner allowing us to focus on important steps and learn tips and tricks useful for daily practice or even as preparatory training for the EBLUS exam. Moreover, EUREP is not only a compact refresher course on basic urology concepts and discussing

current controversies with the faculty but also about making new friends and getting acquainted with international colleagues. The Sunday karaoke with its amasing barbeque and cold beer gave a great opportunity to have fun with newfound friends. The Spanish group led by Professors Joan Palou and Ignacio Moncada invited me to join them for a delicious typical Czech dinner on the last day. I highly recommend residents to apply for the EUREP which I consider as my best academic experience ever. You will never forget Prague and its beautiful towers and castles. Neither will you regret trying a refreshing Pilsner Urquell or a hot trdelník while walking the city’s narrow and winding streets. I am sure you will improve your urological knowledge, learn useful surgical tips, widen your professional networking and, equally important, make new friends. I would like to thank not only the CAU and EAU for giving this unique and unforgettable experience but also all the faculty members. I really appreciate that they set aside six days away from their families, without earning as much money as they would have if they had stayed at their hospitals, to teach and train us.

October/December 2016


Quality programme impresses Portuguese resident EUREP experience: Comprehensive updates and networking Dr. Nuno Miguel Pereira Azevedo Centro Hospitalar do Porto Dept. of Urology Porto (PT) nuno@pereiraazevedo.com I recently attended the 14th European Urology Residents Education Programme (EUREP) as a final-year resident on the advice of several colleagues who had enjoyed and benefitted from the programme in previous years. After five intensive days, I can confirm that this programme is a must for urology residents-in-training, and my high expectations were more than fulfilled!

In my opinion, EUREP offers a lot to participants. My highlights were: the well-organised updates on current urological practice, in many cases given by same the experts who write the EAU Guidelines, and provided glimpses of future updates; the hands-on training (HOT) sessions, which allowed individual training and tailored tips and tricks from highly skilled mentors; and the social interactions, which provided a casual atmosphere throughout the event and allowed me to foster new professional contacts and make new friends. I found that the selection criteria based on EU-ACME credits (earned by answering questions based on European Urology articles) was a clever way to further promote professional and scientific development. Moreover, online access to previous presentations even before EUREP begun enabled me to prepare

for the sessions. It is well worth making the effort to access these in advance to make the most from each module. The discussion of structured clinical cases with renowned specialists was another highlight that gave me – and, based on my conversations with fellow colleagues – other participants diverse perspectives on everyday practice from different centres and countries. These discussions also allowed us all to discuss views and experiences from our distinctive training programmes and backgrounds. The coffee breaks provided an excellent opportunity to talk about the state-of-the-art procedures in urology. This year, the Olympus laparoscopy competition also provided the opportunity for us to exchange practical tricks – it was a great honour for me to win the first prize (and, if I may say, beat the EUREP all-time record)!

I was honoured to receive the Olympus award from Vivian Besser and Hannah Wiemer (Olympus)

In summary, EUREP was a great opportunity and I encourage fellow urology residents to take part in this experience next year to benefit from this unique scientific, technical and social programme.

HOT helps young urologists hone surgical skills EUREP HOT programme: A reliable skills training module Dr. Domenico Veneziano EUREP HOT Course Coordinator Reggio Calabria (IT)

(Endoscopic Stone Treatment step 1) assessment curriculum. The new protocol, a result of the efficient collaboration between the ESU, ESUT and the European Section of Urolithiasis (EULIS), promises to become the second exam to be delivered by the EAU after E-BLUS. 127 participants were enrolled in Prague.

info@ domenicoveneziano.it

Not only were the participants asked to fill-out questionnaires, but each session was video-recorded for inter-rater reliability check. The study involved residents as well as members of the faculty and the HOT team. Results will be soon made available and will shed understanding as to whether or not the two-year development process that was adapted has led to a reliable assessment tool.

The European Urology Residents Education Programme (EUREP) is one of the most anticipated and successful urological courses in Europe. Its hands-on training programme, offering more than 500 training seats, was fully-booked this year, demonstrating the huge interest on practical education. The fine level of organisation of the 2015 edition created a solid base, which was replicated this year, making EUREP’s HOT programme an effective skills development laboratory. Indeed, the training sessions not only aimed to educate based on set guidelines, but were also used to carry on multiple data collection studies. Olympus Europe, the sole sponsor of the programme, provided this year 24 working stations: 15 for basic and intermediate laparoscopic training, four for bipolar TURP and five for endoscopic stone treatment. After the development of a comprehensive E-BLUS teaching guide in 2015, which is available for printing and distribution, two studies were run during the five days of EUREP16. These studies were under the supervision of the European School of Urology/EAU Section of Uro-Technology (ESU/ESUT) training research group. The first study, coordinated by Dr. Bhaskar Somani, aimed to collect validation data for the novel EST s1

A secondary project has been run on the intermediate Tutors and residents posing in the HOT training room stations under the coordination of Dr. Ben Van Cleynenbreugel. This project focused on the evaluation of a prototype for intermediate skills training. Despite the high workload, the HOT team was involved this year not only in teaching, but also in several meetings aimed to further advance the state-of-the-art in practical training. The most discussed topic has been “training the trainer,” which involved the planning of courses that will allow EUREP training standards to be promoted and adapted beyond the confines of EUREP. We believe that even the flagship programme of the ESU has still some room for improvements and this is the reason why more than 450 filled-out feedback questionnaires have been collected from the participants. While the EUREP hands-on training is gaining a reliable reputation as a training platform held in just five days, the team of mentor-tutors and the ESU are making efforts to further improve the teaching of surgical skills and prepare young urologists to meet the challenges ahead.

Liked what you’ve read? Interested in EUREP 2017? If you are interested in applying for EUREP 2017 (1 to 6 September 2017), we have some handy tips and dates to remember. EUREP is only for residents in their last year of training and candidates undergo a strict selection procedure. The following are required from potential participants or are considered during the selection: • • • • • • • •

Last-year resident; EAU junior member; Accrue CME credits by completing MCQ’s in European Urology; Applications considered on a first come-first served basis; Proficient English language skills; Selection by geographic spread; Participation is only granted once; and Limited slots for non-Europeans.

Dates to remember: December 2016 – EUREP website will open 9 January 2017 – Registration opens. All registrations should be accompanied by a copy of your passport and proof of status. 1 May 2017- Registration closes On or around 15 June 2017, applicants will be informed if they have been selected or not. For details and other questions, email us at eurep@uroweb.org Dr. Arnolds (tutor, NL) explains the procedure

October/December 2016

A participant in action, Dr. Eret (tutor, CZ) watches closely

European Urology Today

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EAU UROLOGY WEEK 2016 roundup Working together towards Quality of Life and urological health Urology Week is a yearly initiative of the European Association of Urology (EAU) which engages multitudes of participants within and beyond Europe. The massive success of Urology Week 2016 is the result of a worldwide group effort from supporters just like you. Thank you for helping us raise awareness on the importance of urological health and its link to the Quality of Life (QoL).

Events in Europe Whether you’re a medical practitioner, a politician, member of the media, or a student who participated during Urology Week, your efforts have made an impact and continue to do so. However large or small, every effort counts! Here are some notable and creative examples of events planned for and during Urology Week. UroRun 2016 UroRun 2016 was an exhilarating five-kilometre run organised by Klinika Urologii i Onkologii Urologicznej PUM which took place in the heart of Szczecin, Poland on 25 September. The event was definitely an exciting prelude to Urology Week! Demonstrations using robots Visitors of the shopping malls in Germany and Slovenia experienced what it was like to

operate using robotic surgical systems. Aside from learning by doing, they were also informed by urologists and surgeons about the significance of urological health. Open Days Several hospitals and clinics have organised “Open Days” where healthcare providers offered free consultations and educated the public on several urological conditions. Festiwal KultURO Festiwal KultURO of the Polish Urological Association and the Department of Urology of Jagiellonian University aimed to break the taboo on talking about urological diseases. The event created an inviting environment for in-depth discussions about disease prevention and early detection through art and music.

www.urology week.org showed 33 registered events across Europe

Stories The heart of Urology Week is people. Whether they are healthcare providers or patients themselves, their stories on the urology week website inspired others to talk more openly about urology. For those who shared their experiences with urological conditions, they made others who are in the same situation feel that they are not alone such as Barbara (34) from Berne, Switzerland and Niels (33) from Zeist, The Netherlands. Stories from urologists and nurses, too, helped others see urology in a different light. To read the stories go to www.urologyweek.org/stories

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No time for British reserve Why it’s time to shed the fear and report bowel cancer symptoms early P4

Urology Week in the media Radio interviews with BBC and more Urology Week hit the airwaves with a total listener reach of 50,694,000! EAU’s Dr. Tim O’Brien (GB) went on 13 live and studio interviews and 12 pre-recorded interviews to discuss the importance of urological care and its relation to patients’ QoL.

Bladder and Bowel campaign Secretary General of the EAU, Prof. Chris Chapple, was interviewed for the Bladder and Bowel campaign. His article “Good patient awareness improves urological care” spoke of providing the best quality care for patients and the importance of being well-informed. The article was published in an independent supplement with a circulation of 164,163 and distributed with the newspaper The Guardian.

Interview with Prof. Chapple in the Guardian

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What’s new in IBS treatment? Dr Anton Emmanual outlines recent developments P6

Global Congress on Bladder Cancer 27 - 28 October, Brussels. Discussions on the dilemmas of clinical decision making - read more on bladdr.org

Good patient awareness improves urological care Urology is a very varied branch of medicine covering urinary and male reproductive disorders from overactive bladder to cancer. We can help ourselves by getting informed

U

rology Week runs from September 26th to the 30th, with events across Europe to raise awareness. “We share experiences, look at new developments and help people understand there is help for their symptoms,” says says consultant urological surgeon Professor Chris Chapple. “We want the best quality care for patients, and people can help by being well informed,” he says, adding that you must do online research at validated NHS or hospital sites. “Beware of internet Follow us

scaremongering and don’t rely on advice over the garden fence. Early diagnosis is very important as it will lead to better treatment and care.” He urges immediate action if you have blood in your urine. “See your GP, even if it goes away after a few days. I see lots of people who think, Professor Christopher Chapple oh it’s gone away, but in six months’ time it’s come back Consultant urological and by then the tumour surgeon at Sheffield Teaching Hospitals NHS causing the problem may have grown.” He stressed Foundation Trust, Secretary General at the European however that most people when investigated do Association of Urology (EAU) not have a tumour but it is essential to exclude one.

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People can help themselves with lifestyle changes like losing weight – being overweight is a cause of urinary incontinence. “There’s physiotherapy for patients with stress incontinence, which women are more vulnerable to because they have a shorter urethral tube than men, and childbirth can weaken that muscle or the pelvic floor. Patients can also see advisors for early stage management while waiting for treatment.” On the medical side, the new beta3 agonist drug therapy for overactive @MediaplanetUK

bladder is NICE approved, and shown to have fewer side effects than traditional anticholinergics. The UK has seen increasing use of robots in surgery over the past 2-3 years, though Chapple stresses that robots are a very useful tool but must be used appropriately by an experienced surgeon. “There’s a lot of work underway in innovative healing methods, and quality of life. Ultimately, we’d all prefer not to have surgery, so the emphasis is on early stage intervention.” Please recycle

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October/December 2016


‘I Support’ social media campaign

Twitter, Facebook and Instagram #UROLOGYWEEK Social media was an amazing tool in disseminating Urology Week’s message. Participants from around the globe connected through Twitter, Facebook and Instagram. Photos and videos about Urology Week streamed in Facebook and Instagram.

Thunderclap campaign A Thunderclap is a tool Urology Week used to disseminate its main message as one massive, simultaneous wave of posts via Facebook, Twitter and Tumblr. Urology Week’s Thunderclap campaign even surpassed the minimum amount of participants and had an impressive social reach of 177,275! These ranged from coverage of open days, selfies, interesting articles, to photos of a rock band whose members are urologists. And the tweets about Urology Week alone have made over two million impressions! The #urologyweek Influencers

Quality of life photo campaign

Conclusion In the end, Urology Week 2016 became a worldwide initiative, not just EAU’s. Working together raised awareness on the importance of urological health and how it affects QoL.

A picture is worth a thousand words, especially with the hashtag #urologyweek in the captions.

Participants created a ripple effect; we can all stay aware of the urological topics not just within a week, but for the whole year round!

Many have shared their photos with the “I Support Urology Week” sign via social media. And through another photo campaign called “Quality of Life”, many have also shared who/what they value the most e.g. spending time with family, love for fishing, watching football or going out for a run.

Join us in 2017!

October/December 2016

Stay tuned for more info, which will be shared beginning of next year!

European Urology Today #urologyweek

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ESUT boosts presence in Southeast Asia Philippine Urological Association harnesses ESUT expertise Prof. Ali Serdar Gözen Chair, ESUT Training Group Heilbronn (DE)

The course opened with welcome remarks from Dr. Jaime C. Balingit, chairman of the Department of Urology of East Avenue Medical Center. Gözen, head of the ESUT’s Training Section, gave an introduction on ESUT structure and activities and the European school of Urology (ESU)/ESUT European Basic Laparoscopic Urological Skills (EBLUS) Programme. He also presented a follow-up lecture on Small Access Retroperitoneoscopic Technique (SMART).

asgozen@yahoo.com

Following the first European Association of Urology Section of Uro-Technology (ESUT) training courses held in Jakarta and Manado, Indonesia in 2013 and 2014, EAU training standards have been successfully introduced in Southeast Asia. The initial activities were followed in the last two years with training courses organized with the Russian Endourology and New Urotechnology Society in Vladivostok and with the Thailand Urological Society in Chiang Mai during the 2016 Videourology Congress. This year, the ESUT cooperated with national associations such as the Philippine Urological Association (PUA) when it joined the PUA on October 6 to 8 in Metro Manila. Professors Jens Rassweiler and Ali Serdar Gözen represented the ESUT in what is considered as the largest urology post-graduate course in the Philippines which has the theme “Retroperitoneoscopy & Extraperitoneoscopy, Paths Less Travelled.”

"Profs. Jens Rassweiler and Ali Serdar Gözen represented the ESUT in what is considered as the largest urology post-graduate course in the Philippines..." The local retroperitoneoscopic specialists present in the meeting included Dr. Jun Dy, Dr. Samuel Vincent Yrastorza, Dr. Karl Marvin Tan, Dr. James Claveria and Dr. Juvido Agatep. They shared their experiences and expertise on the topics assigned to them. Aside from the comprehensive lectures and interactive open forums, Day 1 of the programme also gave participants the chance to have an ESU/ ESUT basic laparoscopy Hands-on Training Course (E-BLUS). Everyone was eager to try out the different modules that were provided. In pairs, the participants patiently lined-up to finish the course, which turned out to be a friendly competition. The enthusiasm at the end of Day 1 was evident with several participants staying longer at the venue to further work on the laparoscopy training models.

PUA President Dr. Pedro Lantin and Heilbronn fellows Dr. Samuel Vincent Yrastorza and Dr. Juvido Agatep, as well as PUA members, welcomed the ESUT representatives in Metro Manila, one of Southeast Asia’s biggest metropolitan cities. The course was held at the East Avenue Medical Center, one of the biggest public hospitals in the Philippines. The high attendance by urologists was remarkable, considering that almost one-third of the country’s urological community took part in the event.

EAU Section of Uro-Technology (ESUT)

The participants were eager to avail of the hands-on training opportunities in Manila

The gathered PUA members posing together with Prof. Jens Rassweiler (middle front)

Live surgeries Prof. Rassweiler, Chairman of the EAU Section Office and former ESUT chair, gave three lectures on retroperitoneoscopic laparoscopic surgery and performed with Prof. Gözen two live laparoscopic retroperitoneal surgeries which were simultaneously transmitted to the plenary hall and posted on the internet. A laparoscopic retroperitoneoscopic adrenalectomy and retroperitoneoscopic partial nephrectomy cases were completed successfully. Both cases were discussed interactively with the moderator and the audience. The operations were fast and each segment of the surgery were fully explained and discussed with the attendees in the main hall. The surgeries were the first cases to be performed in the newly opened surgery suites of the East Avenue Medical Center which has a dedicated Minimally Invasive Operating Room. Day 2 of the course ended with a fellowship night to foster camaraderie among members of the society and distinguished guests. A sumptuous dinner was shared by everyone with musical performances to keep everyone entertained. It was also a chance for Prof. Rassweiler to showcase his talent by performing classic rock and blues songs. Day 3 took place at the Center for Advanced Skills, Simulation and Training Innovation, (CASSTI) at The Medical City in Pasig City. A lecture on retroperitoneoscopic surgery on a porcine model was conducted followed by a live demonstration. The ESUT animal training programme was used during the session. This also marked the first successful retroperitoneoscopic training programme in a porcine model done in the Philippines. Five stations were prepared with 11 porcine models for the hands-on training.

Live surgery was performed in the the East Avenue Medical Center, Manila

As the course came to a close, the participants expressed thanks not only for the new knowledge and skills they gained but also for the friendships forged. As of this date, plans are underway for a possible follow-up of the programme. In fact, discussions are ongoing to include the resident group as EAU Junior Members to facilitate contacts and further cooperation with the EAU in future training programmes. With this programme, everyone looks forward to an innovative and dynamic practice of urology in the Philippines.

ESUT HOT Sessions at CEM16 Honing surgical skills in newly-formatted laparoscopic training Dr. Jan-Thorsten Klein Universitätsklinikum Ulm Dept. of Urology & Paediatric Urology Ulm (DE)

The course used three fully-equipped dry-lab work stations, and to guarantee an ideal training environment each workstation was supervised by an experienced tutor. The trainees had the opportunity to work on different models, including suturing tasks and simulation of laparoscopic kidney surgery using perfused kidney models which provided a very interesting training protocol for each participant.

jtk171272@gmx.net

New training formats After a short introduction demonstrating the different steps of the surgical techniques and videoclips of the tasks, the participants were divided into small subgroups of three to four participants per workstation where they performed real hands-on training.

As part of the EAU Section of Uro-Technology‘s (ESUT) aims to boost the surgical skills of young urologists, the ESUT organised a Hands-on Training Session during the16th Central European Meeting (CEM16) held in Vienna, Austria last October 7 and 8. The two full-day sessions included laparoscopic surgery on Day 1 and retrograde intrarenal stone surgery (RIRS) on Day 2. With the high interest among the young doctors, all courses were fully booked.

"...two sessions ... were fully booked which reflected the high interest particularly on techniques of flexible ureterorenoscopy." EAU Section of Uro-Technology (ESUT)

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Two sessions (each lasting for two hours) were offered and all participants showed rapid progress in their training performance. After the laparsocopy training, a session provided a new training format which included case discussions. Clinical cases were presented and critically discussed. The cases tackled main complications often encountered during laparoscopic surgery such as bleeding and trocar injuries and two so-called ‘nightmare‘ scenarios. Meanwhile, Day 2 was dedicated to retrogarde intrarenal surgery. The sessions were structured like in Day 1, starting with a theoretical introduction on the indication, pre-operative management, surgical technique and postoperative management of semirigid and flexible ureterorenoscopy. The participants then used the workstations to practice all possible stone-manipulating techniques (e.g. laser desintegration, stone-dusting and stone fragment extraction using Dormia baskets or graspers), under the supervision of expert endourology-trainers.

The participants were divided into small subgroups of three to four participants per workstation to perform real hands-on training

Two sessions (two hours each) were fully booked which reflected the high

Sixty-four participants benefitted from a in-depth look into modern minimally invasive surgery

interest particularly on techniques of flexible ureterorenoscopy. Following the two URS hands-on sessions, case discussions were held to prompt insights on surgical procedures and best practices. Various nightmare scenarios and typical complications of URS (e.g. what to do in case of perforation, bleeding, etc.) were shown and discussed. The ESUT exert efforts to implement its goals of providing quality training and these two hands-on training days met the expectations of 64 satisfied participants who benefited from this in-depth look into modern minimally invasive urological surgery. October/December 2016


23rd ESUR Meeting in Parma, Italy ESUR pursues goal to forge new collaborative links Prof. Kerstin Junker Chair, ESUR Homburg (DE)

Kerstin.Junker@ uniklinikumsaarland.de The 23rd Meeting of the EAU Section of Urological Research (ESUR) held last October in Parma, Italy, with Prof. Saverrio Bettuzzi as host, gathered an estimated 150 urologists and scientists from various fields in urological research. The first session focused on checkpoint inhibitors as new therapeutic agents in advanced urological carcinomas. Elfriede Nössner (Munich, DE) discussed the complex mechanism of this new targeted therapy and the prerequisites of effectiveness. To learn from progresses in other tumour fields, Nicholas McGranaham (London, UK) presented data on possible predictive markers and the importance of tumour heterogeneity for immune therapy. George Thalmann (Berne, CH), board member of the EAU Section of Oncological Urology (ESOU), gave an overview on clinical trials which examined checkpoint inhibitors in metastatic urological tumours.

Tumour heterogeneity is a topic of special interest in prostate cancer. As shown by Michael Haffner (Baltimore, USA), Gleason 3 tumour lesions can also lead to distant metastases. Michael Stöckle (Homburg, DE) discussed the importance of these findings for therapy decision, including active surveillance in low-risk prostate cancer. Molecular characterisation of disseminated tumour cells in prostate cancer and the role in metastases as well as a source of biomarker development was highlighted by Miodrag Guzvic (Regensburg, DE). In recent years, knowledge regarding cancer as a disease of metabolic reprogramming has expanded. Ferdinando Chiaradonna (Milan, IT) gave a general overview about the major metabolic changes that occur during tumour development and their hallmarks. Matthias Schwab (Stuttgart, DE) presented data on renal cell carcinoma as a metabolic disease, and discussed the importance of investigating metabolic changes to develop new biomarkers and implement novel therapeutic strategies. The role of

In the second plenary session Francois Radvanyi (Paris, FR) discussed what can be learned from breast cancer research concerning molecular diversity of bladder cancer. He showed that there are many similarities which are important for prognostic evaluation in bladder cancer, including basal/luminal differentiation. Jonathan Rosenberg (New York, USA) presented data on possible targets for an individualised therapy in advanced bladder cancer. EAU Section of Urological Research

abstracts have been accepted for the meeting, including 10 whose presenters received travel awards from sponsor Movember Foundation. Furthermore, Dr. Domenico Albino, received the ARTP Award for the best presentation in prostate cancer research entitled ‘ESE3/EHF controls the Lin28/let-7 microRNA axis to restrain cell transformation and cancer stem-like compartment in prostate cancer’.

Intra-tumoral heterogeneity and its impact on clinical decision are discussed in many tumour types. In the first session on Friday, Samra Turajlic (London, GB) showed that renal cell carcinomas are characterised by clonal genetic heterogeneity and discussed its impact on the development of metastatic tumours and novel targeted therapy. These issues were further addressed by Alessandro Volpe (Novara, IT) who focussed on the clinical relevance and the role of tumour biopsies. Dr. Domenico Albino, Bellinzona, IT receives the ARTP award for the best presentation

polyamines metabolism in prostate cancer and how this can be translated to novel biomarkers was critically evaluated by Frederica Rizzi (Parma, IT). The morning session on Saturday focused on two very important topics: viruses and tumour diseases. Sigrun Smola (Homburg, DE) gave an overview on virusinduced carcinogenesis in cervix carcinoma and head and neck tumours, where the role of HPV is better known than in penile cancer. Rosa Djajadiningrat (Amsterdam, NL) discussed the first data on HPV in penile cancer biology and therapy. Virus-based tumour therapy is a fast-developing field in cancer therapy. Jean Rommelaere (Heidelberg, DE) gave a general overview on this issue, and described current clinical trials, while Elena Martens-Uzunova (Rotterdam, NL) presented on the complex network of non-coding RNAs.

A lauded tradition in the ESUR programme, the most outstanding researcher in experimental and/or translational urological research was honoured with the Dominique Chopin Award, with Zoran Culig (Innsbruck, AT) as this year’s recipient for his work in prostate cancer. Culig is not only active in European urological research for many years, but has also served as board member and ESUR chairman. In his award lecture, Zoran Culig described the long and tedious process or so-called ‘bench-to-bedside’ cycle in prostate cancer research. As in previous years, the ESUR meeting has once again facilitated a dynamic scientific exchange among researchers and urologists and helped its members forged new contacts and established collaborative links among many research groups in European urology. The next edition of ESUR will take place on 12-14 October 2017 in Paris.

The last thematic session addressed chemoprevention in tumour diseases. Following a state-of-the-art lecture by Andrea DeCensi (Milan, IT), the role of metformin to reduce cancer risk and mortality was summarised by Sara Gandini (Milan, IT). Yukihiko Hara (Tokyo, JP) gave an overview on the physiological functions and cancer prevention properties exhibited by green tea catechins.

Delegates enjoyed the networking dinner in a rustic Italian restaurant

Besides the lectures, recent results from experimental and clinical researches were presented in 24 short talks and during the poster sessions. Altogether, 80

Prof. Zoran Culig (left) was honoured with the Dominique Chopin Award 2016

www.esur17.org

ESUR17 24th Meeting of the EAU Section of Urological Research 12-14 October 2017, Paris, France In collaboration with the EAU Section of Uropathology

Research Fellowship The California Urology Foundation, in association with the Société Internationale d’Urologie, announces the availability of a Urologic 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 must include a proposed urology research project, a detailed CV, and a minimum of 3 letters of professional references. References must be received for a candidate to be considered. An application missing any of the items listed above will be considered incomplete. The deadline for the July-June 2018 Fellowship will be February 28, 2017. Application forms are available on the SIU website www.siuurology.org under Scholarships and Training→Fellowships. Applications should be submitted exclusively online. Any questions or concerns should be directed to the 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

October/December 2016

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SIU 2017 UCSF EUT

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2016-11-10 2:03 PM

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CEM16: Issues and trends in onco-urology More than 200 participants gather in Vienna for last CEM By Joel Vega With a nod to the gains in urological development in Central Europe and an acknowledgment of current and future challenges, around 200 participants gathered in Vienna, Austria, for the last and EAU 16th Central European Meeting (CEM16). After nearly two decades of knowledge-sharing among urologists based in the region, CEM16, which took place from October 7 to 8, was the last edition in its current format and Vienna offered a fitting venue for the longest-running frontline meeting of the erstwhile EAU Regional Office. Meeting challenges head-on and preparing for future hurdles in urology set the tone for the two-day event. “We can be organ specialists or we can be surgical specialists. We have a choice to make if we are to strengthen our specialty and be willing to expand the boundaries of urology,” said EAU Treasurer and Executive Board member Prof. Manfred Wirth (DE) in his opening remarks. Wirth said the EAU is currently looking at new meeting formats to replace the so-called regional meetings. And despite the fact that the CEM has been one of the most attractive forums for urologists based in Central Europe, current trends in continuing education and training demand new approaches in education and professional skills training. He noted that with new formats he expects future meetings to further help boost the quality and dynamism of urological work in the region. Wirth was joined by former Regional Office chairman Prof. Bob Djavan (AT) and CEM organiser Prof. Michael Rauchenwald (AT) in welcoming the participants to Vienna, the first time the meeting was organised in the Austrian capital. With three plenary sessions in onco-urology and one on functional urology, the Scientific Programme highlighted current issues and topics in prostate, bladder, renal and testis cancers. “The CEM has always pursued the goal to provide a venue to young urologists and I believe we have achieved this if we look at the quality of research and clinical work being done today by our colleagues here,” said Djavan. For his part, Rauchenwald highlighted the importance of reaching out to colleagues across borders and reiterated that progress in medical science is a communal effort that often finds its inspiration when like-minded professional gather together to share their insights. In his opening lecture on onco-urological highlights, Wirth discussed medical strategies in prostate cancer such as hormone therapy, immunotherapy, use of bisphosphonates, support care and, in special cases, intravesical therapy. He noted that focal treatment has also expanded with high-intensity focused ultrasound (HIFU), laser ablation and cryotherapy in prostate cancer (PCa) and radio frequency ablation (RFA), cryotherapy and HIFU for kidney cancer. Wirth examined the wider use of multiparametric (mpMRI) that reduces the frequency of biopsy, active surveillance and early chemotherapy in hormone-

naïve metastatic PCA patients. In bladder cancer, he noted comparative studies on open and robot-assisted radical cystectomy, complications, impact of adjuvant chemotherapy and immunotherapy, among other issues. “There is benefit of nephron-sparing surgery in sicker patients with co-morbidities, and we also need to consider the value of MRI in differentiating malignant from benign kidney lesions,” said Wirth with regards renal cancer. Dr. Michiel Sedelaar (NL), chairman of the EAU Young Urologist Office (YUO), spoke on the goals and current projects of the YUO and emphasised the crucial role of young urologists in the organisation. “Our ambition is to have the involvement of young urologists in at least 50% of EAU activities,” said Sedelaar and added that to fulfil this aim leadership and skills training programme are being offered to promising urologists. Developments in uro-oncology The first session focused on uro-oncology with Wolfgang Horninger (AT) discussing the role of MRI in PCa. Horninger said MRI is already used in active surveillance (AS) since nobody would wait for so long and besides MRI offers precise targeting of suspicious lesions. “mpMRI is a promising technique and can avoid unnecessary biopsies without impairing the detection of clinically significant PCa,” he said. Gero Kramer (AT) spoke on primary chemohormonetherapy for advanced treatment-naive PCa, considering it as a new standard. “Early combination of therapies with non-overlapping mechanisms of resistance may prevent the emergence of drug resistance,” said Kramer, as he noted that there is a strong rationale for combining ADT with taxanes. Docetaxel improves survival for hormone-naïve mPCa and that it should be considered for routine practice in suitable men with newly diagnosed metastatic disease, according to Kramer. H. Christoph Klingler (AT) tackled issues on small renal masses and examined the question of watchful waiting vis-à-vis surgical excision. “Is surveillance justified? Yes, but only with benign tumours (biopsy confirmed) and multi-morbid patients with poor life expectancy,” he said. Christopher Springer (AT) looked into the clinical implications of genetic research and prostate cancer. “There are over one million TRUS biopsies and most of them are unnecessary. Most men do not benefit from aggressive treatment. We should identify the high-risk (for treatment) and avoid the detection of low-grade (disease),” he pointed out. Shahrokh Shariat (AT) prefaced his lecture by saying that surgery in PCa has evolved and that radical prostatectomy (RP) should be rarely used for low-risk, organ-confined disease. “With the advent of more effective systemic therapy (such as anti-androgens, immunotherapy, chemotherapy), RP is being explored for locally advanced and oligometastatic cancer as part of a multimodality approach,” said Shariat.

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“Bladder cancer remains a challenging disease. We do hope, however, that immunotherapy may lead to promising treatment options in the future,” said Babjuk He noted that in Europe alone there is a rising number of bladder cancer cases and healthcare costs in 2012 reached around €490 billion, making this malignancy one of the most fatal and challenging in urology. “Radical cystectomy plus systemic chemotherapy is recommended for locally advanced disease,” said Babjuk and added that radical cystectomy has a high failure rate- around up to 50% of cases. Complications are also high, making the procedure a risky option for many patients. “If we need to reduce the burden of bladder cancer, we also need to focus on preventive approaches such as reducing smoking which may help lower bladder cancer incidence,” said Babjuk. Madersbacher discussed management strategies for invasive bladder tumours in elderly patients. Among the criteria that doctors should look into before considering cystectomy in elderly patients is tumour size and focality, bladder function, hydronephrosis, surgical risk, cerebral capacities and the wishes or expectations of the patients, among others.

Nauman Nabi, Urologist from Limerick, Ireland attended three editions of CEM

Janetschek said it is misleading to think that robotics is the end-phase of an evolution. “We are at the beginning of this evolution not at the end,” he said while citing recent developments such those happening in Ireland and South Korea, with the former reporting about the MIRO Surge-robot, and the Koreans showing the potential of the REVO-I robotic surgical system in a porcine model (robot-assisted fallopian tube transection and anastomosis). Testicular cancer Managing testicular cancer was taken up by Sedelaar, while Dejan Bratus (SL) discussed the role of lymphadenectomy or Lymph Node dissection (LND) in advanced testis cancer. “Testicular cancer is associated with a very good up-front prognosis for cure. Even in metastasized patients chemotherapybased treatment can cure up to 80%, and overall 95% of testis cancer patients can be cured,” said Sedelaar. He, however, noted there is a downside to chemotherapy since long-term toxicities are considerable.

“Age per se is not a contraindication for radical cystectomy in the elderly, but in the end this is an individualized decision,” Madersbacher said as he underscored that surgical experience is crucial in managing elderly BCa patients. More research should also be conducted in this area and doctors must examine alternative forms of urinary diversion. Prospects in laparoscopic and robotic surgeries Gunter Janetschek (AT) delivered a thought-provoking overview on robot-assisted laparoscopy versus robotic surgery, saying that the former has a better chance to outpace the currently popular robotic procedure such as daVinci.

Managing bladder cancer Bladder cancer issues were taken up by Marek Babjuk Janetschek: “The future is robot-assisted (CZ), Stephan Madersbacher (AT) and J. Schrami (CZ). laparoscopy…and I think and hope that it will not be technologies such as daVinci…We must also look for better alternatives to daVinci with systems that provide features such as motorized three-arm device, autostereoscopic monitor and active force feedback.”

“Attending CEM is like a homecoming” “I have attended three CEM meetings and it’s like a community to me where one feels at home. It is unfortunate if this is the last meeting as these events offer young urologists good opportunities to present their work, learn from veteran urologists and simply catch up with the latest developments. I hope there will be similar meetings in the future.”

From left: Prof. M. Wirth, Prof. B. Djavan, Prof. H. C. Klingler and Prof. M. Rauchenwald at the opening day of CEM16 in Vienna

Presenting results from studies and research articles in recent years and recalling his experience, Janetschek outlined the conclusions by other researchers that in head-to-head comparisons, robotic technology and standard laparoscopic both offer comparable results. “Oncologic and functional results are comparable between standard laparoscopy and daVinci. Between daVinci radical prostatectomy (RP) and open RP the continence rates are comparable, while oncologic results are as good in both,” he said. He expects the costs of daVinci to decrease in the future as the technology faces competition and its accessibility expands. With wider access, daVinci faces a natural devolution with regards adaption, similar to what occurred in ESWL for stone treatment. Using the data from a study by N. Fossati which recently appeared in European Urology, Janetschek said surgical experience is key in robotic technology. “Robotic technology compensates for lack of experience, but morbidity is not evaluated,” he said.

Participants test their laparoscopy skills during the HOT sessions

Regarding Retroperitoneal Lymph Node Dissection (RPLND), Bratus said RPLND is still an “important part of multi-modal treatment of testis cancer,” emphasising that decision regarding surgery should be made for each patient individually and with the patient’s informed consent. He also stressed that RPLND should be done in referral centres of expertise. Otakar Capoun (CZ) looked into the issue of circulating tumour cells in onco-urology, examining the status of research studies being done on the subject. “There is almost nothing done in penile and testicular cancer,“ he said. Young Urologists Competition Day 2 plenary sessions included the much-awaited Young Urologists Competition, a well- attended session where young urologists from across the region present their research insights to an 11-member jury. October/December 2016


Best Abstract Winners Karl Storz Awards for Clinical Research First Prize: Bogdan Geavlete (RO) - Robotic (Avicenna) flexible ureteroscopy in renal stones Second Prize: Filip Kowalski (PL) - Are we ready for watchful waiting and focal therapy in treatment of prostate cancer? Analysis of histological material after radical prostatectomy Third Prize: Christian Mirvald (RO) - Risk of malignancy in complex cystic renal masses (Bosniak category III-IV) Berlin-Chemie Awards First Prize: Bogdan Cheorpeaca (RO) - Genomic aspects regarding prostate cancer aggressiveness Second Prize: Katarina Otavová (CZ) - Cell surface phenotype of the bladder tumors using ultrasensitive flow cytometry - a feasibility study

Third Prize: Jana Jurecekova (SK) - Genome-wide association study of prostate cancer in population of Slovak men Best Video Dario Garcia Roja (ES) - Laparoscopic repair of ileal conduit parastomal hernia using the modified Sugarbaker technique Young Urologists Competition First Prize: Artur Leminski (PL) - The treatment of muscle invasive bladder cancer in Poland: Is Central-Eastern Europe facing the same? Second Prize: András Horváth (HU) - HSV guided viral gene therapy in the treatment of bladder cancer Third Prize: Viktor Kovacik (SL) - Complex endoscopic treatment of upper urinary tract stones

Antonin Brisuda (CZ) spoke on the use of urine immunocytochemistry as a way to improve cytology. Andras Horvath (HU) examined Herpes Simplex Virus (HSV)-guided viral gene therapy in treating BCa. Horvath, who used an animal model in the study, said initial results showed that viral gene therapy can be a promising and future alternative BCa treatment. “Our results proved the efficacy of OncoVex (GALV/CD) virus in vitro, in vivo and in combination with mitomycin in treating bladder cancer.” M. Knezevic (HR) examined the potentials of 3D printing in urology, while Viktor Kovacik (SK) discussed the complex endoscopic treatment of upper urinary tract stones. Artur Leminski (PL) looked into the treatment of muscle invasive bladder cancer in Poland in relation to current treatment practices in Central Europe. Miha Pukl (SL) studied the long-term outcome of favourable prognosis prostate cancer after radical prostatectomy, while R. Stoica (RO) discussed bladder pain syndrome. Leminski eventually took the first prize, a unanimous decision by the judges who cited his well-argued insights and conclusions regarding high-risk

Berlin-Chemie 1st Prize Award Winner B. Cheorpeaca (2nd from left) receives his prize from Prof. B. Djavan (L), Prof. Rauchenwald and Prof. Sedelaar

Seven contestants from across Central Europe pitted their research conclusions not only against each other but also with the jury composed of opinion leaders and experts who challenged the participants with probing questions. “There are certainly very useful insights, and we have not only seen quality

non-muscle invasive bladder cancer (NMIBC) treatment. Prize-winning abstracts and video CEM16 accepted 118 abstracts which were presented in six poster sessions that covered key topics such as prostate cancer, renal tumours and transplants, sexual dysfunction, uro-genital reconstruction, infections, stones and urothelial tumours. A video session showed five accepted submissions from Spain and Czech Republic which covered procedures in percutaneous cystotomy, robot-assisted radical prostatectomy and laparoscopic re-pyeloplasty, among others. Entries from Romania made a solid showing by taking half of the six prizes including two poster presentations that bagged the first prize awards given by Karl Storz and Berlin Chemie (See Box for List of Winners). Bogdan Geavlete (RO) won with his presentation titled “Robotic (Avicenna) flexible ureteroscopy in renal stones,” while his compatriot Bogdan Cheorpeaca, also from Bucharest, took the Berlin Chemie first prize for his study on “Genomic aspects regarding prostate cancer aggressiveness.”

Prof. B. Djavan (from left) hands over the First Prize to Artur Leminski, winner of the Young Urologists Competition, with Prof. Sedelaar and Prof. Rauchenwald

presentations but also the studies that were presented,” said Sedelaar who co-chaired the session with Djavan and Rauchenwald. “Every year we have seen the quality improving and I am proud of the excellent work being done here in the region,” said Djavan.

CEM16 tackles a wide range of issues and dilemmas in onco-urology

The SEEM16 roundup 250 Participants gather in Sarajevo for successful SEEM By Erika De Groot The recently concluded EAU 12th South Eastern European Meeting (SEEM16) convened 250 participants to address the urological challenges, concerns, and controversial issues in the region. SEEM16 has attracted delegates from 20 different countries, majority of which came from Turkey, Croatia, and Bosnia and Herzegovina. This highlyinformative meeting took place from 23 to 24 September in historic Sarajevo, capital city of Bosnia and Herzegovina. Friday recap Chairs Prof. M. Hiroš (BA), Prof. B. Djavan (AT) and Prof. F. Montorsi (IT) kick-started the event with an enthusiastic welcome, and mentioned in their remarks the wide range of topics that will be covered in the Scientific Programme. The first day focused on oncological topics such as prostate, kidney and bladder cancers. The comprehensive programme also

included Hands-on Training (HOT) courses in laparoscopy, case studies and poster sessions. PCa sessions In his lecture, Dr. S. Bajramovic (BA) explained that testosterone therapy may be a viable option for selected men with prostate cancer suffering from testosterone deficiency, as it does not increase the risk and the severity of prostate cancer (PCa). Multiparametric MRI (mpMRI) can help prevent over-diagnosis of low-risk cancer; improve the sensitivity detection of moderate to high-risk cancer; and reduce the number of biopsies performed. These and other mpMRI benefits were discussed by Prof. L. Türkeri (TR). Prof. Montorsi expounded on salvage lymph node dissection (sLND), which provides a complete PSA response in roughly 50% of patients. Although only 20% of patients do not have recurrent PCa after sLND, clinical progression is delayed for two to three years.

Deliberation during Dr. A. Koni’s presentation

Based on the increasing number of robotic radical prostatectomy cases per year and da Vinci surgical systems installed, robotic prostatectomy is a viable option in Eastern Europe, particularly in Turkey, according to Assoc. Prof. A. Erdem Canda (TR). Video sessions on laparoscopic radical prostatectomy involving dorsal venous complex dissection, nerve sparing techniques, seminal vesicles, and urethrovesical anastomosis were shown.

Judges for the Young Urologists Competition look on

October/December 2016

Kidney cancer sessions Prof. Sanguedolce explained why renal biopsy is the preferred diagnostic tool when characterisation of renal masses is uncertain in cases wherein active surveillance is considered necessary. In his follow-up lecture, he disclosed that patients who mostly benefit from partial nephrectomy are those with baseline CKD-M (Chronic Kidney Disease due to medical causes) and/or with other significant comorbidities. Moreover, new techniques (e.g. clamp-off, super-

selective clamping) may provide lower post-operative loss of renal function.

"Prof. Liatsikos’ lecture was followed by a riveting debate between Prof. B. Önal (TR) and Prof. M.S. Silay (TR) on the use of safety wire during stone disease treatment." The video sessions that followed covered laparoscopic partial nephrectomy including procedures such as renal ischemia, renal artery clamping, tumour excision and parenchyma suturing.

Continued on page 26

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Prof. Silay argued that using safety wire increases ureteral trauma, can obscure vision during lithotripsy, and can inhibit stone extraction with baskets. He stated that the risks in using it for the ureter (including the instruments) should be investigated.

Continued from page 25

Young Urologists Competition Seven contestants from across the region presented their research to 13 critical jury members during the Young Urologists Competition. The contestants showcased their skills and know-how on a diverse range of contemporary topics, ranging from minimally invasive partial nephrectomy to new trends in flexible ureteroscopy. The top three winners were named at the end of the day. HOT courses and poster sessions In the three HOT courses on basic ureterorenoscopy, participants gained insights through case discussions, tips and tricks and the expertise shared by the tutors. After the video demonstration of different steps and tasks of procedures, the participants were grouped in small teams and received instruction based on their level of experience. Two poster sessions on miscellaneous research and female urology, neurourology, infections and adrenals, including a video session were also part of Saturday’s comprehensive schedule.

A pensive Prof. Önal

Bladder cancer In his lecture, Assoc. Prof. N. Bojanic discussed new imaging technology as an opportunity to fine-tune detection and staging because it improves the accuracy of decision-making for personalised treatment. In addition, he stated that hexylaminolevulinate (HAL) photodynamic diagnosis (PDD) is currently the only imaging diagnostic technique for bladder cancer approved in Europe and in the United States. According to Prof. A. Vuksanovic (RS), en bloc resection of a bladder tumour has advantages that include easily controlled depth of resection, vertical radicality, better haemostasis and better vision. He explained that there is a reduction in recurrence rate and time, and that progression rate is lower although not significant. Thereafter, oncology cases were presented by Prof. Djavan (prostate cancer), Prof. M. Ayati (IR) (carcinoma in-situ bladder) and Prof. S. Tyritzis (GR) (locally advanced prostate cancer). HOT courses and poster sessions Since the number of centres with laparoscopic expertise is still limited in Europe, laparoscopic training programmes have become increasingly important. Three courses were offered on SEEM16’s first day:

“Basic laparoscopy course (E-BLUS)”, “Intermediate laparoscopy course & suturing exercises”, and “Basic & intermediate laparoscopy course”. Four poster sessions were scheduled to focus on topics regarding stones, prostate cancer, renal diseases and trauma, and uro-genital reconstruction and the penis/testis. Saturday overview SEEM16’s final day commenced with a lecture by Prof. E. Liatsikos (GR) comparing extracorporeal shock wave lithotripsy (ESWL) and retrograde intra-renal surgery (RIRS). He concluded that ESWL is the gold standard treatment option for pelvic stones smaller than 1cm, while RIRS is a treatment choice offering high chances of stone-free outcomes in small stone load with acceptable morbidity. Pros & Cons session Prof. Liatsikos’ lecture was followed by a riveting debate between Prof. B. Önal (TR) and Prof. M.S. Silay (TR) on the use of safety wire during stone disease treatment. Prof. Önal cited multiple sources that stated that placing safety wires is standard practice and is used in many endoscopic procedures. He also explained the relevance of using safety wires within the legal context such as in cases of malpractice.

Final lectures Prof. R. Inman (GB) shared his tried and tested tips on how to deliver effective lectures. These included the importance of rehearsal and enjoying one’s own presentation. He disclosed that he intentionally asked the organisers to schedule his presentation after the lunchbreak to hold the audience's attention. He proved his point successfully.

"In his follow-up lecture, Dr. Sanguedolce disclosed that patients who mostly benefit from partial nephrectomy are those with baseline CKD-M (Chronic Kidney Disease due to medical causes) and/or with other significant comorbidities." The Berlin-Chemie/Menarini sponsored session that followed presented case discussions on the conservative treatment of Lower Urinary Tract Syndrome/Benign Prostatic Hyperplasia (LUTS/BPH).

Prof. Montorsi deliberates during the Q&A

These included long-term and combined treatments of LUTS/BPH symptoms, and the improvement of the quality of life in patients with conservative treatment. According to Dr. C. Kouriefs (CY), the best chance for the ultimate success of vesicovaginal fistula repair is achieved not only with the first repair, but also the type of approach most familiar to the surgeon. Additionally, the basic principles of adequate dissection, water-tight tension-free closure and good post-operative urine drainage when properly applied are also crucial in successful repairs. The most challenging urethral surgery is posterior urethroplasty, according to Prof. Inman. He explained that suprapubic catheterisation is a safe initial management; that repair of pelvic fracture urethral injury requires experience and expertise; and that redo surgery is less successful. Awards Before SEEM16’s final day came to a close, awards were given to the lucky few (See Box for List of Winners). The top three Young Urologist Competition winners were named. Three Karl Storz awardees and three Berlin Chemie Award winners were chosen from the 121 selected abstracts. Relevant topics in the region were addressed, new knowledge was shared, and the names to watch out for in the future were announced. The 12th SEEM edition ended with success.

SEEM16’s YUC awardees and Best Poster Presentation winners Nine promising awardees were given recognition at the EAU 12th South Eastern European Meeting (SEEM16) held in Sarajevo, Bosnia and Herzegovina. The awards were handed out by chairs Prof. M. Hiroš (BA), Prof. B. Djavan (AT) and Prof. F. Sanguedolce (GB).

From the 121 abstracts in six poster sessions, the jury awarded six prizes which were sponsored by Berlin Chemie and Karl Storz. The winners are as follows:

The three winners of the Young Urologists Competition:

First prize: “A simple, non-biological model for percutaneous renal access training” by Dr. Sedat Öner (TR)

First prize: Dr. Panagiotis Kallidonis (GR) for his presentation “Minimally invasive partial nephrectomy: Tumour enucleation and clampless technique” Second prize: Dr. Emina Habibovic (BA) for her presentation “Laparoscopic donor nephrectomy eliminates the need for open surgery”

The three Karl Storz Best Poster Presentations awardees:

Second prize: “Resurfacing and reconstruction of the glans penis after partial penile amputation – initial experience and cosmetic results” by Dr. Ognen Ivanovski (MK)

The three Berlin Chemie Best Poster Presentations awardees: First prize: “Detrusor After-Contraction (DAC): Urodynamic and clinical characteristics and associations” by Dr. Konstantinos Mytilekas (GR) Second prize: “Does a standardized algorithm for managing patients post-robotic-assisted radical prostatectomy improve recovery? Experience with the Optimized Surgical Journey” by Dr. Said Yaiesh (KW)

Third prize: “Complications of en-block resection of bladder tumors with bipolar hook cutting electrode” by Asst. Prof. Simon Hawlina (SI)

Third prize: “Histopathologic and molecular comparative analyses of intravesical aurora kinase A inhibitor with bacillus Calmette-Guerin in precursor lesions of non-muscle invasive bladder cancer in vivo model: Preliminary results” by Dr. Kerem Teke (TR)

Asst. Prof. Hawlina (SI), third-prize winner of the Karl Storz award

Dr. Mytilekas (GR), first-prize winner of the Berlin Chemie award

Third prize: Dr. Artan Koni (AL) for his presentation “Retrograde intrarenal surgery: The first cases in our center”

Dr. Kallidonis (GR) first-prize winner of the Young Urologists Competition

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ESGURS16: In-depth, critical look into reconstructive urology International participants laud insightful, expert-led programme By Erika De Groot The recently concluded 8th Meeting of the EAU Section of Genito-Urinary Reconstructive Surgeons (ESGURS16) held last October 7 and 8 in Madrid, Spain was a successful gathering of experts and novices who aimed to look into the latest updates in genito-urinary reconstructive surgery. This year the meeting, which presented lectures, roundtable case discussions and energetic debates, was organised in conjunction with the Spanish Genito-Urinary Reconstructive Surgery Group (CRU-AEU) meeting. “The feedback we’ve received has been amazing! This pushes us to keep going. We’ve definitely enjoyed a high-quality meeting with a comprehensive programme. Even the coffee breaks were contributory; it was a great time to speak with other colleagues. Overall, the meeting was a good opportunity for beginners to gain experience, and for seasoned surgeons to guide them,” said Dr. Javier Romero-Otero of the Hospital Universitario 12 de Octubre (Madrid, Spain), ESGURS local organiser. “ESGURS was an outstanding meeting of stimulating discussions with distinguished surgeons,” said Prof. Dr. Paulo Egydio (BR) of Clínica Dr. Paulo Egydio (São Paulo, Brazil). “It was highly informative and truly focused on improving our clinical practice.”

"The second day of the scientific programme featured “semi-live” full-length video case discussions. These challenging cases covered every single detail of a procedure with the advantage of being able to ‘pause’ the operation.” Live and semi-live surgery sessions The meeting extensively featured live surgery sessions and presented complex cases in an informal yet conducive setting. Dr. Ahmad Shamsodini Takhtei (QA), Head of Urology at the Alwakra Hospital (Alwakra, Qatar) commented: “ESGURS had a pleasant and easy-going ambience. Despite having to discuss and examine highly complex cases during the two-day meeting, the friendly and receptive atmosphere made it easy to present to the audience. The cases were discussed in creative and engaging ways.” The meeting also impressed Egydio and Shamsodini Takhtei, especially when some of the field’s best surgeons addressed key issues and demonstrated a variety of procedures which included various procedures in urethral reconstruction. These procedures included Peyronie’s disease correction, penile prosthesis implantation, hypospadias repair in

adults, male incontinence treatment, retzius-sparing (trans-Douglas) RRP with simultaneous penile implant and much more. “My expectations of the meeting were met as current key issues and controversies concerning reconstructive surgery were challenged. For me, a couple of lectures stood out. These covered topics such as Peyronie's reconstruction of complex cases and live surgery on tunica reconstruction with or without graft, and dorsal or ventral graft on urethral reconstruction,” according to Egydio. Shamsodini added: “What I expected to take home with me were new tips and tricks in the field of reconstructive surgery, development of new surgical skills, and shared experiences with others. And these expectations were definitely met at ESGURS.” The second day of the scientific programme featured “semi-live” full-length video case discussions. These challenging cases covered every single detail of a procedure with the advantage of being able to ‘pause’ the operation. Shamsodini Takhtei: “One of the most memorable and educational for me at ESGURS was the video with the sliding technique for Peyronie’s disease.” Challenges As the field of genito-urinary reconstructive surgery progresses, so does the challenge. “In my opinion, the procedures that deal with penile length and girth reconstruction without graft are very complex. These are one of the main challenges in the field,” said Egydio. Awards for the best Case Report presenters, handed out by Dr. Djinovic and Dr. Martínez Salamanca

Shamsodini Takhtei added: “One of the major challenges is the consultation with patients. It is important that they understand what’s going to happen. From the beginning of the consultations, give them realistic expectations. Let them know the challenges that will be involved; challenges that you as a surgeon will face, the potential complications of the procedures and the results. It is essential to build trust between you and the patient. I believe that there’s no hero surgeon, there’s only a hero patient.” What the future holds Despite the challenges they mentioned, Egydio and Shamsodini Takhtei expected breakthroughs in the next five to 10 years. “In the near future, the best time for penile reconstruction for length and girth restoration will be at the time of penile prosthesis indication,” Egydio said. “I expect further development of the procedures and techniques for reconstructive surgery. I also expect more efficient equipment with fewer components,” noted Shamsodini Takhtei. With such a high number of the world’s best genito-reconstructive surgeons assembled during the meeting, ESGURS16 offered a platform for critical discussion and insightful debates. The meeting has provided lecturers and participants the ideal podium

EAU Section of Genito-Urinary Reconstructive Surgeons (ESGURS)

Easy-going ambience with the ESGURS16 faculty and delegates

to brainstorm ideas, link up with colleagues from around the globe, and present innovative solutions. Audience participation was actively encouraged and gave attendees the chance to ask the experts in a constructive manner and cordial setting. Overall impressions “It was absolutely a great honour to present in front of colleagues from all over Europe and colleagues from other countries. Presenting at ESGURS was a great opportunity to show the international audience how we diagnose and treat patients in my country. It was a wonderful opportunity for me to be able to bring home additional know-how in terms of patient care,” said Shamsodini Takhtei.

Presenters of the best Video Abstracts. Awards handed out by Dr. Sansalone and Prof. Bettocchi

October/December 2016

At ESGURS’ final day, awards were given to the winners of the best case report presentations and video presentations. Romero-Otero concluded the day that ESGURS is a ‘must-attend’ meeting for genitourinary reconstructive surgery and added that he looks forward to the next meeting. “Reconstructive surgery is one of biggest challenges for a surgeon and it’s necessary to have a dedicated meeting. ESGURS is that definitive meeting and should be the referral meeting. The next ESGURS will follow the success of this year’s. This meeting works and we know it,” said Romero-Otero. European Urology Today

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The European Board of Urology and the UEMS Pursuing goals in quality education and training Mr. Jan Nawrocki President European Board of Urology (EBU) Brighton (GB)

president@ebu.com The European Board of Urology (EBU) is a section of the Union of European Medical Specialists (UEMS). Its aims are to improve the care of patients with urological disease by ensuring the highest standards of training and education. These aims are achieved by a number of means. Each member country nominates two representatives from their national associations who work collaboratively with the members of other countries and their associations to achieve shared objectives. These activities include an educational curriculum which articulates minimum requirements for urological training. In addition, educational standards for training institutions are set and monitored, whilst rules for accreditation of educational activities are provided. The UEMS, like the EBU, has a long history. In 1958, the representatives delegated by the professional organisations representing medical specialists in the six member countries of the very new European Community (EEC) convened in Brussels and created the Union of European Medical Specialists (UEMS). In due course the founders of the UEMS established contacts with the concerned authorities of the other

European countries beyond the European Union and defined the basic principles in the field of medical specialist training in Europe. Amongst other matters, the UEMS wished to tackle the issue of quality. A vision of the future resulted in the elaboration of common general criteria, applicable to all specialists which would ensure the highest quality in all states. To realise this ambitious objective, the UEMS created in 1962 Specialist Sections for each of the main disciplines practiced in the member states. The EBU is one of those sections. These groups of specialists, made up of representatives of the national associations of the specialties concerned, carry out a considerable workload with the idea of coordinating and harmonising specialist training and criteria for the recognition of medical specialists. The first European Directives concerning medical doctors, published only in 1975, were quite largely inspired by the proposals and the surveys presented by UEMS and realised through its Specialist Sections. Currently, there are 37 member countries representing over 40 specialties. Activities and programmes The EBU has been working on its objectives and aims in respect of the standards of education and training for over 20 years and these aims are being realised today. EBU activities and programmes are wellestablished and are increasingly recognised internationally as marks of excellence. EBU certification of training programmes and centres is used in many countries and allows those from elsewhere to identify educational programmes and centres of value. The EBU provides a means of endorsing Continuing Medical Education (CME) and Continuing Professional Development (CPD) activities and amongst the most well-known activities are the EBU examinations.

The EBU In-Service Assessment (ISA) is a formative assessment that assists learning in all stages of a urologist’s career. In contrast, the Fellowship of the European Board of Urology (FEBU) exam is a summative test which provides a means of testing the level of achievement in urological training. It is open to final-year residents and trained urologists who meet the eligibility criteria. A number of countries require success in this examination as part of their resident training programmes and the number of FEBUs awarded has this year passed 4,500. Although the main set of aims remains unchanged, there is an on-going need for continued work and improvement in the objectives and activities. In the

last couple of years, the EBU has helped in the development of on-line log books to assist learning and CPD and there will be further new ways of supporting learning and quality of training. The EBU benefits from the opinions and advice of the national associations through the work and representation of its national delegates. However, the EBU values the contribution of all urologists both trained specialists and those who are still in training. Therefore, anyone wishing to make a contribution is encouraged to contact the EBU directly or through their national representatives. For more information visit our website at www.ebu.com.

EBU Executive Committee May 2016 President Mr. Jan Nawrocki (UK)

Past-President Prof. Dr. Stefan Müller (DE)

Chairman EBU Examination Committee Dr. Artur Antoniewicz (PL)

Secretary Prof. Hans-Peter Schmid (CH)

Treasurer Prof. Olivier Haillot (FR)

Chairman EBU Certification Committee Mr. Michael Aitchison (UK)

Incoming President Prof. Dr. Arnaldo Figueiredo (PT)

Incoming Secretary Dr. Michael Rauchenwald (AT)

Chairman EBU Accreditation Committee Dr. Karl German (MT)

UMC Hamburg-Eppendorf gets EBU certification External validation confirms high standards of urology training Prof. Dr. Margit Fisch Chair, Dept. of Urology University Medical Centre HamburgEppendorf Hamburg (DE) m.fisch@uke.de

Ass. Prof. Atiqullah Aziz Dept. of Urology University Medical Centre HamburgEppendorf Hamburg (DE)

centres. We think that a standardized basic urological education is necessary for each resident to have a sufficient knowledge before initiating a further training in sub-specialities - independent of continuing a career in hospital or in an outpatient department. Based on our opinion, the requirements for the EBU certification fulfil the criteria, which we think is adequate for a basic urological training. With the bar set high for the certification, we feel mostly honoured to be granted the EBU certification which confirmed that our standard in resident training is high. An external evaluation of the own department with feedback from distinguished colleagues always brings new insights in a field where continuous improvement is warranted.

Residency Training Programme Cooperation has been established over the years that allow the resident-in-training to gain a broad overview in the field of urology and oncology. During residency, annual rotations are held with two hospitals (Elbe-Klinikum Stade and Klinikum a.aziz@uke.de Buchholz) in the vicinity of Hamburg with focus on endourology. A six-month rotational fellowship in the The University Medical Centre Hamburg-Eppendorf Martini-Klinik offers the resident the whole spectrum (UKE) was founded in 1889 at a time when the city not of treatment in prostate cancer. In-house cooperation only underwent a rapid rise in population but also in with the department of oncology (Chair: Professor C. response to health issues due to urbanisation and the Bokemeyer) and andrology (Professor F. Sommer) expanded activities of the international harbour. allow the board-certified urologist to gain the additional training in “medical tumour therapy” and Today, the UKE comprises 13 centres including 80 andrology, respectively. Furthermore, the possibility to departments and institutes with more than 10,000 achieve the European board-certification in paediatric employees. A total of 3,600 medical students are urology (F.E.A.P.U.) is offered within the collaboration enrolled in the medical school. The urological with the department of paediatric surgery in the department comprises 51-60 beds with personnel of Altonaer Kinder Krankenhaus, which is chaired by 31 physicians, including 12 urologists and 19 residents. Professor Fisch. Roughly 1,500 surgical procedures are performed with over 3,300 admissions and 800 day-care procedures The regular rotation in different sub-specialities annually. The entire spectrum of urology, except renal represents a cornerstone of the education. Every transplants, with emphasis on reconstructive urology, year, an individually structured training plan for uro-oncology and pediatric urology is covered. With residents is developed by the chair to rotate in the the Martini-Klinik being on the same area, sub-specialities neurourology/incontinence with approximately 2,000 radical prostatectomies are urodynamics, reconstructive urology, paediatric performed annually in cooperation with the UKE. urology, minimally-invasive urology, andrology and uro-oncology based on the resident’s preferences. EBU Certification Oncologic consultations by residents supervised by a The aim of our centre was to externally validate our member of the faculty in the outpatient department education in line with other prestigious academic are offered for patients with urothelial carcinoma, advanced renal cell carcinoma and testicular carcinoma interdisciplinary in cooperation with the EBU Certified Centres department of oncology. 28

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Our department has a national accreditation for clinical training of five years which is the course of residency in Germany for board-certification. During this period, the resident is educated to independently provide comprehensive and expert care to patients suffering from urological diseases with a well-known spectrum of basic urological surgical skills. Every resident has five days per year besides the regular holidays to participate in further training. In addition, residents are individually assigned an experienced mentor of the faculty. Yearly documented performance reviews are held between mentor and mentee to improve their clinical skills. Regularly meetings of the chair of the department and staff members reevaluate the clinical progress of each resident. During residency, trainees are obliged to attend interdisciplinary conferences on a regularly basis together with staff members. Research Besides the clinical work, research and teaching medical students represent the other two cornerstones in academic urology. A total of two

residents are offered a granted research year in which they are exempted from the daily clinical practice in order to focus on their scientific research. The department has fully-equipped laboratory facilities of its own. An employed biologist specialised in tissue engineering coordinates the laboratory projects supervised by a member of the faculty. Further basic research projects in uro-oncology are ongoing within in-house cooperation with the Institute of Tumour Biology (Professor K. Pantel) and anatomy (Professor U. Schuhmacher), respectively. Residents interested in clinical research are offered a one-year fellowship in Boston under the supervision of Professor Q.D. Trinh of Harvard University. Furthermore, residents are supported financially to attend annually national and international congresses to present their work. Participation in FEBU Examinations Although not mandatory for German boardcertification, we strongly support participation in the FEBU exams to compete within the high European standards. Thus, final-year residents are exempted from work during that time.

Certification Residency Training Programme in Urology As part of efforts to standardise urological training in Europe, the EBU Certification Committee certifies basic training programmes in urology. After this initiative was first introduced in 1994, the title “EBU Certified Centre” has now become a distinctive measure of quality control. About 80 centres in Europe are EBU-certified. The EBU conducts an objective evaluation of the Residency Training Programme in Urology (RTPU). This process brings many benefits to the training programme: It enables the centres to gain insight into how consistent their standards are throughout the years and which areas need further improvement. The certification is based on the application, and on the site visit of the department during which the residents and teaching staff are interviewed. How do centres and residents benefit

• Residents trained at an EBU-certified training centre can benefit from the quality control procedure since it reflects the high standards maintained by a centre. • Participating centres are part of a growing number of institutions across Europe that aim to implement best practices in healthcare in a consistent and transparent manner. • Certified centres attract (inter)national residents interested in high-quality training.

October/December 2016


EBU Certified Residency Training Programmes in Urology Austria Krankenhaus der Barmhezigen Brüder Vienna Landeskrankenhaus Leoben Landeskrankenhaus Wiener Neustadt Medical University of Graz Medical University of Vienna, Comprehensive Cancer Center SMZ Ost - Donauspital Vienna SMZ Süd - Kaiser-Franz-Josef-Spital Vienna University Hospital Salzburg Belgium Ghent University Hospital Onze-Lieve-Vrouw Ziekenhuis Aalst University Hospitals Leuven

Czech Rep Charles University Faculty of Medicine in Pilsen Charles University Hospital Motol General University Hospital and Charles University 1st Faculty of Medicine Prague Estonia Tartu University Hospital North-Estonian Medical Centre FoundationAffiliated to Tartu University Hospital Finland Oulu University Hospital Germany Asklepios Klinik Barmbek Hamburg Ev.-Luth. Diakonissenanstalt zu Flensburg Helios Marien Klinik Duisburg Julius-Maximilians University Medical Center Würzburg Justus Liebig-University Giessen Klinik für Urologie und Kinderurologie Klinikum Bamberg Klinik für Urologie, Klinikum Ludwigsburg Klinik für Urologie, Universitätsmedizin Mannheim Klinikum Braunschweig Klinikum Garmisch-Partenkirchen Klinikum Kassel GmbH SLK Kliniken Heilbronn St. Antonius-Hospital Gronau GmbH Technische Universität München Klinikum rechts der Isar Uniklinik der RWTH Aachen Universitätsklinikum Essen Universitätsklinikum Halle (Saale) Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Urologie Universitätsklinikum Schleswig-Holstein, Campus Kiel University Hospital Carl Gustav Carus, TU Dresden University Hospital Schleswig-Holstein, Campus Lübeck University of Bonn University of Regensburg - Caritas St. Josef Medical Centre Urologische Klinik der Universität Düsseldorf Urologische Klinik und Poliklinik des Universitätsklinikums Jena Urologische Klinik, Klinikum der Stadt Ludwigshafen GmbH Greece Sismanoglio Hospital Athens University of Crete

Institute Sub-Specialty

Hungary Semmelweis University Budapest Italy General Hospital of Bolzano Malta Mater Dei Hospital Msida Netherlands VU University Medical Centre Amsterdam Onze Lieve Vrouwe Gasthuis – locaties West & Oost – Affiliated to VU University Amsterdam

Croatia University Hospital “Sestre milosrdnice” Zagreb

EBU Certified Sub-Speciality Centres

Norway Sørlandet Sykehus HF Kristiansand Sørlandet Sykehus HF Arendal Affiliated to Sørlandet Sykehus HF Kristiansand Vestfold Hospital Trust Tønsberg

Belgium University Hospital Leuven University Hospital Leuven

Oncology (Prostate, Kidney, Bladder) Female & Reconstructive Urology

Germany St. Antonius-Hospital Gronau GmbH

Prostate Cancer

The Netherlands Academisch Medisch Centrum Amsterdam

Stones Treatment & BPH

United Kingdom Leeds Teaching Hospitals NHS Trust

Renal Cancer

Certified EBU-EAU Host Centres Institute Specialty

Poland European Health Centre Otwock Holy Cross Cancer Centre Kielce Interdisciplinary Hospital Miedzylesie Warsaw Medical University of Warsaw Pomeranian Medical University Szczecin Specjalistyczny Szpital Miejski im. M. Kopernika Torun University Hospital in Kraków Portugal Coimbra University Hospital Spain Cliníca Universidad de Navarra in Pamplona Fundació Puigvert Barcelona Hospital Clínic de Barcelona Hospital del Mar (Parc de Salut Mar) Barcelona Hospital Universitario la Paz in Madrid Vall D'Hebron University Hospital Barcelona Sweden Urologiska kliniken Universitetssjukhuset Örebro

Belgium Onze-Lieve-Vrouwziekenhuis Aalst Onze-Lieve-Vrouwziekenhuis Aalst Onze-Lieve-Vrouwziekenhuis Aalst Onze-Lieve-Vrouwziekenhuis Aalst Onze-Lieve-Vrouwziekenhuis Aalst University Hospitals KU Leuven University Hospitals KU Leuven University Hospitals KU Leuven Germany Heinrich-Heine University, Medical Faculty, Düsseldorf Heinrich-Heine University, Medical Faculty, Düsseldorf Heinrich-Heine University, Medical Faculty, Düsseldorf Heinrich-Heine University, Medical Faculty, Düsseldorf University Hospital Carl Gustav Carus Dresden University Hospital Leipzig The Netherlands Canisius-Wilhelmina Hospital Nijmegen Radboud University Medical Center Nijmegen Radboud University Medical Center Nijmegen

Switzerland Kantonsspital St. Gallen Kantonsspital Winterthur University Hospital Zürich University of Berne Turkey Ankara University Medical Faculty Istanbul University, Istanbul Faculty of Medicine Uludag University in Bursa

United Kingdom North Bristol NHS Trust North Bristol NHS Trust

Female Urology & Incontinence BPH Prostate Cancer Renal Cancer Urothelial Cancer Prostate Cancer Neuro-urology Female Urology & Incontinence

Urothelial Cancer Prostate Cancer Renal Cancer Testicular Cancer Prostate Cancer Prostate Cancer

Prostate Cancer Prostate Cancer Paediatric Urology

Female Urology & Incontinence Stone disease

EBU ORAL EXAMINATION

EBU IN-SERVICE ASSESSMENT

Date: Saturday 3 June 2017 Venue: Brussels (BE)

Dates: Format: Duration: Time:

The EBU Oral Examination is the second part of the European Board Examinations in Urology. It is a one-day examination with the objective to test the candidate’s ability to evaluate and manage common cases in every day practice. The candidates are examined by a team of two urologists and will be given three clinical cases. Participation is subject to eligibility. Aside from the fact that the candidate must have passed the EBU (Online) Written Examination between in 2012 and 2016, one of the following criteria are met. A final-year resident who is trained as part of an official national urology training programme in a UEMS/EBU member country. The training must be completed before 31 October 2017. A certified urologist who is fully qualified as a urologist by the recognised national authority from a UEMS/EBU member country. UEMS/EBU Member Countries: Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta,

October/December 2016

Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, United Kingdom. The FEBU Diploma is issued to urologists who have passed the European Board Examinations in Urology. The FEBU Diploma is considered as a mark of excellence, it is not a license to practice urology. Worldwide 4,545 urologists carry this title. For more information and registration visit our website www.ebu.com. Registration available 5 December 2016-31 January 2017.

9 and 10 March 2017 Online test 2 hours Both days between 00.00 and 23.59 Greenwich Mean Time (GMT)

Every resident and trainee wants to succeed. Medicine, as a whole, and surgery, in particular, are competitive fields. So, no matter how able an individual, some anxiety is always felt by everyone when they are studying. Have I learnt enough? Have I learnt the right things? How am I doing compared to others? The EBU ISA (In-Service Assessment) provides a perfect way to help.

The assessment is conducted once a year. This is not an “exam” in the sense that there is a pass/ fail mark. It is meant to help you in your studies. Both individual and group registration is available. Candidates who are registered as part of a group get their results through their Programme Director. Many Programme Directors use the ISA as a method of understanding how their residents are progressing. For more information go to www.ebu.com. Online registration available 5 December 2016-31 January 2017.

The ISA is a test anyone can take. Residents, aspiring residents and trained urologists too choose to take the test each year to assess their knowledge. Trainees who want to enter residency programmes use the test to learn more about the field they want to enter and to demonstrate their commitment. Residents on training programmes have a means of comparing themselves against other residents not just in their own country, but across the world and in the same year of training. Trained specialists have a method of demonstrating their continuing medical education to their own local authorities as well as themselves.

European Urology Today

29


www.eurep17.org

www.erus17.org

EUREP17

ERUS17

15th European Urology Residents Education Programme

14th Meeting of the EAU Robotic Urology Section

1-6 September 2017 Prague, Czech Republic

26-27 September 2017, Bruges, Belgium

Robotic Live Surgery

An application has been made to the EACCME® for CME accreditation of this event

Additional events on 25 September: • Junior ERUS-YAU Meeting • ERUS-EAUN Robotic Urology Nursing Meeting • European School of Urology (ESU) Courses • EAU Young Academic Urologists (YAU) Meeting

Call for

ELUTS17 European Lower Urinary Tract Symptoms meeting

12-14 October 2017 Berlin, Germany

www.eluts17.org

ESUI Vision Award 2017 The EAU Section of Urological Imaging (ESUI) is calling for abstracts for the ESUI Vision Award 2017, which will be given to the first author of the most innovative imaging study published in urology during the last year. How to apply? Send a PDF copy of the published study or of the published/accepted abstract together with a CV and publication list to esui@uroweb.org

Deadline: 31 January 2017, 23.59CET. The award will be handed out at the 32nd Annual EAU Congress in London during the ESUI section meeting, on Saturday 25 March 2017 from 10.15 - 14.00 in Room London. The award is supported by an educational grant of € 1,500 by INVIVO CORPORATION

30

European Urology Today

October/December 2016


Polish Urology: A tumultuous start of a successful field History Office holds Fall Meeting in Krakow and joins Symposium on origins of Polish Urology By Loek Keizer On 18 and 19 November, the EAU History Office had its annual Fall Meeting in Krakow, Poland. It was hosted by one of its members, Dr. Roman Sosnowski (Warsaw, PL) with the help of the Polish Urological Association and the History of Medicine Department of Jagiellonian University in Krakow. The purpose of the Fall Meeting is to bring the History Office’s members together and to discuss its activities, while also preparing for the coming Annual EAU Congress. Important topics were the three-hour Historical Thematic Session that will be held in London at EAU17, the Historical Exhibition and also the The EAU History Office and its invited guests at the Jagiellonian University Museum. multiple publications that will be made available to The Collegium Maius in which the museum is based dates from the 14th century and is the EAU Members. Also on the table was a major expansion of the European Museum of Urology (history.uroweb.org), which will increasingly bring together the History Office’s output. It will become the platform for interviews and smaller articles in addition to its digital collection of instruments. This was the first meeting chaired by Prof. Philip Van Kerrebroeck (Maastricht, NL). He succeeded the long-serving Prof. Dirk Schultheiss (Giessen, DE) as EAU History Office Chairman at EAU16 in Munich. Prof. Schultheiss remains on the board. The History Office was joined in Krakow by Mr. Jonathan Goddard (Leicester, GB) on behalf of BAUS. His expertise and connections will be essential for a successful scientific programme and exhibition in London in March 2017. Needless to say, EAU17 delegates can look forward to prominent speakers from the history of British Urology, and some unique artefacts will be on loan from across the UK to give visitors a look at the tools that made history. EAU History office

Dr. Sosnowski welcomes the audience of the Symposium of Polish urological history. In addition to the EAU History Office, several Polish urologists and medical students attended.

oldest university building in Poland. Nicolaus Copernicus is its most famous graduate and some of his instruments are still on display.

Urology in Krakow For its two-day board meeting, the History Office was hosted by Prof. Ryszard Gryglewski (Krakow, PL), chair of the Department of Medical History at Jagiellonian University. Office members were also shown around the department, including its unique collections of medical history items.

to ensure its survival as a nation. Urologists often had military roles as well, volunteering to serve at the front and developing their skills in military hospitals.

The university’s Department of Anatomy was the setting of the 2nd International Symposium on the Polish Contribution in the Development of European Urology. Several prominent (retired) Polish urologists joined Prof. Gryglewski and Dr. Johan Mattelaer (Kortrijk, BE) to present the development of urology in Krakow, in Poland and within a European context.

In the past 25 years, the Polish Urological Association has since become a firmly Europe-oriented association.

What becomes clear throughout the talks is the extremely volatile history of Polish medicine and the country itself. While urology first developed as a standalone surgical specialty in the course of the 19th and first half of the 20th century, Poland was occupied by several foreign powers and involved in many wars

In recent years the EAU Dr. Sosnowski and Prof. Schultheiss took the opportunity to represent the Polish Urological History Office has Association and the EAU at the "Cardio Run", organised as part of the "Preventive Cardiology included a symposium 2016" Conference which took was also taking place in Krakow. as part of its fall meeting, taking the opportunity to add a broader scientific dimension place in Istanbul (2015), Helsinki (2014) and to its board meeting. Previous symposia took Antwerp (2013).

Provide sustainable patency.

37th

Congress of the Société Internationale d’Urologie Centro de Congressos de Lisboa

www.siu-urology.org #SIU17

OCTOBER 19–22, 2017

Featuring the SIU-ICUD Joint Consultation on Bladder Cancer and the 3rd SIU Nurses’ Educational Symposium ABSTRACT SUBMISSION DEADLINE: APRIL 3, 2017

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October/December 2016 Client: Description:

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2016-11-10 2:10 PM

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European Urology Today

31


Russian urologists train skills in bladder surgery workshops Laparoscopic workshops held to mark Urology Week Dr. Sergey Reva N.N. Petrov Research Institute of Oncology Saint-Petersburg (RU)

sgreva79@mail.ru

Dr. Alexander Nosov N.N. Petrov Research Institute of Oncology Saint-Petersburg (RU)

formation of orthotopic urine disposal and 10% - of a heterotopic bladder). This week, we have decided to demonstrate all our experience with these interventions by using the laparoscopic method. From October 26 to October 29, four surgeries were performed including two surgeries which were later posted online. From the surgeries which were posted online, one was performed with intracorporal ileal conduit formation, two with orthotopic bladder formation and another procedure involved a heterotopic bladder with formation of an output mechanism by Mitrofanoff. At the time of writing this article or 30 days after the last surgery, all patients were successfully discharged as out-patients for follow-up with no readmission, a result we expect with our goal to adhere to fast-track principles. Oncourology Department of the N.N. Petrov Research Institute of Oncology

nakuro@yandex.ru It has become a tradition at the N.N. Petrov Research Institute of Oncology in Saint-Petersburg, Russia, to hold regular week-long thematic online workshops demonstrating a series of laparoscopic interventions for various onco-urological pathologies.

Patient profile The patients were aged 53 to 75 years. Two patients had a clinically-determined locally spread processes (c3b-T4a), and one had a massive metastatic lesion of regional lymph nodes. The surgery lasted for 200 to 280 minutes, and the minimum duration was recorded for a patient with intracorporal orthotopic bladder formation.

In all cases, morphologic examination confirmed the presence of urothelial bladder cancer; two cases indicated locally spread processes, and one case showed metastatic lesion of lymph nodes. The video transmissions from the operating room were commented on in the website (daily online reviews involved approximately 20 to 30 persons) and in social media, including specialists from Western Europe. Many questions prompted lively debates.

A week of laparoscopic cystectomies is conducted every year; however, this year’s workshop was special. This year, our agenda of minimally invasive cystectomies was conducted as part of Urology Week, annually organised by the European Association of Urology. Urology Week has been observed in many European countries and the EAU invests a lot of attention to this event in its website and social media channels. Over the last year we performed more than 30 radical cystectomies for bladder cancer. During the last three years, 95% of surgeries have been performed in a totally laparoscopic way (including about 30% - with

Ureteral stents were removed on the seventh to tenth day. We have been adhering to this target period over the last months, and since the first few interventions, we have seen a reduction by almost a week with no changes in the number of early and late complications.

In the operation theatre

From our experience, we noted the following: minimally invasive surgery, even with such complicated intervention as radical cystectomy, gives confidence and calm. And despite a week of intensive work which involved a high number of patients who

underwent complex procdeures, all team members attended the annual congress of the Russian Association of Oncourology, where we shared our experience. On behalf of the personnel of the Oncourology Department of the N.N. Petrov Research Institute of Oncology, we express our gratitude to all workshop participants, particularly the staff of the surgery team of the Oncourology Department who have shown professional commitment in providing excellent patient care. For details on our work, check the following link: https://www.youtube.com/user/ Niioncologii

I support

Apply for your EAU membership online! Special session during EAU17 Date: Friday, 24 March 2017 Time: 12.15 - 13.30 hrs

mation Patient Information Patient Information Patient Inient Information Patient Information Patient Information EAU Patient Information Setting standards in cooperationPatient and care Information Patient Inmation Patient Information • From the perspective of national societies, residents, you like to receive all the benefits of EAU ient Information Patient Information PatientWould Information doctors, nurses and patients membership, but have no time for tedious paperwork? • The future of EAU Patient Information in daily practice mation Patient Information Patient Information Patient InSpeakers: a member is ient Information Patient Information PatientBecoming Information • Prof. Christopher Chapple, EAU Secretary General (GB) now fast and easy! • Prof. Dr. Thorsten Bach, EAU Patient Information Chairman (DE) mation Patient Information Patient Information Patient In• Prof. Carlos Llorente, Hospital Universitario Fundación Alcorcón, (ES) • Dr. Giulio Patruno, EAU Patient Information Board member (IT) Go to www.uroweb.org and click EAU • Mr. Andrew Winterbottom, Co-founder Fight Bladder Cancer (GB) Patientmembership ient Information Patient Information Information to apply online. It will only take • Ms. Corinne Tillier, EAUN Board Member (NL) you a couple of minutes to submit your mation Patient Information Patient Information Patient Inapplication, the rest is for you to enjoy! Come join us in London!Information Patient Information ient Information Patient 32

European Urology Today

European Association of Urology

October/December 2016


13th ERUS: Practical information for a dynamic field Three-day meeting highlights potential and versatility of robotic surgery By Loek Keizer As robotic surgery is maturing as a field and becoming more widespread in Europe, urologists are constantly pushing the envelope of technical innovation. The EAU Robotic Urology Section (ERUS) is dedicated to exploring advancements in the field, while also pushing for standardised training and patient safety. ERUS held its 2016 meeting in Milan on 14-16 September. As one of the larger section meetings, ERUS16 had a broad scientific programme with a multitude of live surgery sessions, hands-on training, ESU Courses, a technical exhibition and even a special programme for young urologists. The meeting attracted close to 700 participants from 47 countries. It featured six live surgery sessions and –a first at an ERUS meeting– four semi-live sessions In Milan, Prof. Montorsi (Milan, IT), Chairman of the Local Organising Committee, reflected on the meeting and the field of robotic urology in general: “We can look back on a very successful meeting. As a scientific meeting, everything comes down to the topics presented, and in that the programme was wellorganised and the speakers were of a very high quality.” “It’s very obvious that robotic surgery is here to stay. In the near future, perhaps already within ten years, robotic surgery will be the only way certain procedures will be performed.” Broadening horizons In an effort to underscore the maturing of robotic surgery, not just in urology but across the field of medicine, ERUS16 held a session on non-urological robotic surgery. Several presentations at ERUS16 showed that urologists were no longer the primary users of medical robots, finding themselves in second or even third place behind surgeons like gynaecologists. Prof. Giorgio Guazzoni (Milan, IT) co-chaired the session and explained its relevance: “It’s important for urologists to be informed. During our own surgery we can encounter problems like hernia repair, bowel resection or some gynaecological issues. These can be unexpected repairs following complications, but in some cases are part of the urological procedure or are simply performed together with the prostatectomy, like some hernia repairs.”

Dr. De Naeyer presents on the latest imaging techniques during the joint Junior ERUS – Young Academic Urologists’ meeting

Live surgery in the main auditorium. Six sessions allowed for twelve procedures to be simulcasted, with moderators alternating between the surgeons at work

the relevant information to help them in their careers. For the first time in its six years, the Junior ERUS – Young Academic Urologists’ Meeting included a segment of live surgery. The eighty delegates were treated to a robot-assisted radical prostatectomy with dual console, as performed by Dr. Nicolas Doumerc (Toulouse, FR), and assisted by Ass. Prof. Bernardo Rocco (Milan, IT).

(spaceflight!) and the troubles of long-distance lag, Pini turned to its current medical applications and potential. Telementoring is a subset of telemedicine and involves calling on the long-distance assistance of a surgeon for advice, but also as part of a wider training programme and CME systems. This in theory allows for more specialised surgeons a wider field to share their expertise.

"In the near future, perhaps already within ten years, robotic surgery will be the only way certain procedures will be performed.”

The next step is telesurgery, the long-distance control of a surgical robot. Requiring dedicated and reliable (optical) networking, well-known surgeons could theoretically offer their services on demand from their own institutions. The first demonstration of this principle already happened in 2001 (as surgeons in New York operated on a patient in Strasbourg), proving that the concept has its merits. Adoption of this practice does however have serious repercussions when it comes to liability, legality (multiple medical licenses are required) and ethics.

Dr. Nicolomaria Buffi (Milan, IT), Chairman of the Young Academic Urologists and also chairing the joint meeting, explained the choice of procedure for this relatively young audience: “This is a very common procedure. Every urologist starts out by working on the prostate before moving on to the kidneys and other more specific procedures. At the same time, this is a demonstration of the dual console, a very useful tool for tutoring and reducing mistakes.” As a meeting for urologists at the beginning of their careers, the first half was spent giving an overview of technology that will only be maturing in the coming decades, some still very futuristic in nature.

Other topics included the emergence of new surgical robots, training, accreditation and learning curves in robotic urology surgery, and presentations on surgical outcomes and the best papers in the past year. Prizes were awarded to the best posters and video abstracts for the Junior ERUS – YAU Meeting.

by the audience, with similar attendance figures to regular live surgery sessions. Every year, the quality of the live transmissions improves.” Surgery in Motion School Prof. Mottrie was also particularly proud of the launch at ERUS16 of the Surgery in Motion School (http://surgeryinmotion-school.org/). This online platform hosts highly detailed instructional surgical videos that show procedures step by step. The multifunctional platform is designed to complement surgeons’ skills and know-how. Mottrie stressed the involvement of several EAU Sections, the European School of Urology and European Urology, as well as many surgeons’ personal involvement. The video platform boasts around 40 different procedures, divided over five organs (adrenal glands, bladder, kidney, prostate and the genital organs), each divided into individual steps (over 500). The procedures are performed by a choice of surgeons, over 120 of which contributed their videos to this platform. EAU members have free access after logging on with their EAU credentials. The platform also allows for comments to be added to each video, encouraging the sharing of knowledge. Each procedure had links to

Semi-live Surgery Sessions For the first time at an Dr. Geert De Naeyer (Aalst, BE) gave an overview of ERUS meeting, the current imaging techniques, including patient-specific, scientific programme “I like to learn with other specialists, like general included four semi-live surgeons. They open our minds and change attitudes. iPad-based 3D reconstruction, as based on CT scans. Augmented reality –the projection of pre-operative surgery sessions. These One can get used to just seeing other urologists at sessions allow the case work, and by seeing other fields and their approaches imaging on the “real life” image of the procedure- is currently being worked on. Difficulties remain in presenters to bring their and techniques, you can learn a lot. This includes keeping the projection exactly in line with the relevant own pre-recorded case things like techniques, how to perform certain organs as the tissue is manipulated by the surgeon. and narrate it to the repairs, use of the stapler, and so on.” Currently, and engineer has to manually keep the audience. One advantage over live surgery is the The presentations during the session mentioned many projection in place relative to the patient’s tissue. ability to present more of the same benefits of robot use that urologists have 3D-printing is gaining new interest and has potential, rare cases and to already experienced, like enabling less invasive surgery, a a logical development of the digital 3D reconstruction. know the outcome. shorter hospital stay and ergonomic benefits for the The afternoon of the first day of ERUS16 featured a choice of four ESU Courses. Here Prof. This makes for a more surgeon. The other side of the coin is the relative cost For $300-400, some companies can print patientspecific kidney models, including the patient’s Montorsi presents during the course on RARP while co-chair Prof. Artibani (Verona, IT) looks on educational experience, of the procedure, a constant in all disciplines. tumour(s). This can help in preoperative planning, it though lacking the can support informed consent, and some models can interactive component of “It’s difficult to draw conclusions,” Guazzoni said. relevant entries in the EAU Guidelines and articles in “true” live surgery. “Cost is important, but placed against the safety of the even be resected as a pre-operative trial run for the surgeon. Hospitals have started purchasing their own European Urology, ensuring that visitors always have procedure, the shorter hospital stay and lower rates the most highly-rated references at their fingertips. ERUS Chairman Prof. Alexandre Mottrie (Aalst, BE) of complications, I think you can’t put a price on these 3D-printers, most of which are about the size of a large photocopier. was pleased with the experiment of semi-live surgery matters.” ERUS17: Anniversary Meeting in Bruges as an addition to the live surgery sessions. “By Dr. Giovannalberto Pini (Milan, IT) presented current showing pre-recorded but unaltered footage, it really Next year’s ERUS meeting, its fourteenth, is taking Junior ERUS - YAU (and upcoming) developments in telementoring. place in Bruges on September 25-27. Prof. Mottrie is allows the presenter to give a practical message. ERUS16 kicked off with a special four-hour Explaining the roots of long-distance surgery the local organiser and already gave a taste of what is From what I can tell the sessions were well received programme, intended to offer beginning urologists setting up to be a special edition of the ERUS Meeting. “It may be our fourteenth meeting, but it’s our tenth as a meeting that’s not industry-driven.” The 2007 meeting in Brussels marked the start of the independent ERUS Society, which itself joined the EAU in 2011. “Now that we’re going back to Belgium, in a sense, this is an anniversary meeting.” “We have some ideas for a new scientific programme that gives a larger role to young urologists than we’ve already given them in recent meetings. We’d like to have the ‘experts of today’ presenting the most advanced surgery and difficult cases, and have the ‘rising stars of tomorrow’ tackle more commonplace procedures in a two-part programme.”

ERUS Chairman Prof. Alex Mottrie and Dr. Guido Giusti (Milan, IT) co-chaired a well-attended Technology Forum in which manufacturers were invited to showcase their upcoming technologies

October/December 2016

For the first time at an ERUS meeting, the Junior ERUS – YAU Meeting had its own live surgery session. Dr. Nicolas Doumerc (Toulouse, FR) and team address the audience before demonstrating the partial nephrectomy using a dual console

“I’ve tasked the Junior ERUS with making the delegates feel welcome in Belgium, so everyone can look forward to a chance to savour some real Belgian hospitality!” European Urology Today

33


Young Urologists/Residents Corner YUO launches new course: Leadership for Medical Professionals Pilot course in London during Annual EAU Congress “The emphasis is on the development and successful implementation of a personal and creative leadership style and business strategy. After the course, participants will learn to be more decisive in reacting on developments within their organisation, more effective and efficient in management-skills,” added Sedelaar. The following are the application criteria: • Urologists under the age of 45; • EAU membership • A letter of motivation stating the applicant’s interest for the course; • Recommendation letter from applicant’s immediate superior or supervisor; • Proven fluency in English; and • Readiness to submit essay-type articles in preparation for the course. “This is an exciting programme for young Developing leadership and management skills urologists and regardless of their career plans will be the core aim of a new course to be offered by the EAU Young Urologists Office (YUO). and ambitions, the course will provide stimulating ideas, tips and other valuable “The pilot course will be held in London in March strategies to boost one’s managerial and decision-making capacities,” said Sedelaar. during the Annual EAU Congress,” said YUO Chairman Prof. Michiel Sedelaar. He mentioned around 30 participants from across Europe will be The YUO board will review all applications on a first-come, first-served basis with the aim to select selected for the three-hour course which will participants from countries across Europe or at provide skills training in various areas including least represent a good cross-section of the region. management, decision-making and presentation skills, among other topics. The course will be handled by a Dutch management and communications specialist team led by Herman Currently, the YUO is working on its Personal Rijksen and Jaap Zijlstra. Development Programme where courses will focus on management and communication skills, For interested candidates, inquire for details or leadership, finances, etc. The first part of this programme is a course on Leadership for Medical email the YUO at a.terberg@uroweb.org Professionals, designed for young (under 45 years) urologists and related health professionals who have the potentials to future leaders in national and international urology.

Luis Guillermo Martínez Bustamante Service-oriented doctor and dedicated friend 1980 - 2016

Luis Guillermo Martínez Bustamante, fondly called the plans and objectives of ESRU. His main interest and project was to get the EAU closer to young by his friends as “Memo,” was a brilliant young non-academic urologists through teaching, urologist, a kind colleague, and a friend to many. education and career development support. He was born 36 years ago in Mexico and during his career in Slovenia he became a well-regarded, His activities within the EAU were matched by his diligent work in Slovenia, where he had a popular young urologist. He served as successful career as a specialist at Izla Hospital, International Federation of Medical Students’ becoming one of the clinical leaders in the region Association’s (IFMSA) Secretary General in 2003, and known for his care and commitment to his overseeing the work from IFMSA’s Geneva office, patients and the training of residents. where he met his future wife, Dr. Masa Sukunda of Slovenia. After receiving his medical degree in 2003 from the Faculty of Medicine, Universidad Through the years, he was a familiar face to many Autónoma de Nuevo León in Mexico, Luis in the ESRU and the YUO. He was always helpful Guillermo did his residency in Slovenia. with residents and young colleagues who needed assistance and advice. His contributions were not During his training, he was an active member of only significant but his enthusiasm impressed many. the European Society of Residents in Urology (ESRU) Luis Guillermo passed away on the 23rd of August, and served as ESRU secretary in 2012. He actively organized and promoted resident-related activities, a victim of a gun shooting incident which occurred while he was on hospital duty. Memo is survived and his ideas, enthusiasm and natural intuition by his wife Maša and two kids, Gael and Adrian. helped to shape the society into what it is today. After doing specialized studies, he joined the Young Urologists Office (YUO) where he became a very active member, focusing on the concerns of non-academic urologists which form a majority of the YUO. Even as YUO member he never neglected the concerns of residents by actively supporting

We miss him and may he rest in peace. -Giulio Patruno Former ESRU Chairman EAU-YUO Member Rome (IT)

25th Turkish National Urology Congress and ESRU Sessions ESRU pursues active role among young Turkish residents Dr. Selçuk Sarikaya Kecioren Research and Training Hospital Dept. of Urology Chairman of ESRU Ankara (TR)

Dr. Ahmet Ürkmez Haydarpasa Numune Resarch and Training Hospital Dept. of Urology Chair, ESRU Turkey Istanbul (TR)

drselcuksarikaya@ hotmail.com

ahmeturkmez@ hotmail.com

Kyrenia in Northern Cyprus was host city of the 25th Turkish National Urology Congress held from 6 to 9 October. The European Society of Residents in Urology (ESRU) also held its sessions as part of the scientific programme which attracted the participation of both national and international speakers. Sessions The first ESRU session was held on Day 3 of the congress with Dr. Ahmet Ürkmez, Chairman of ESRU Turkey, discussing the recent projects and activities of ESRU Turkey. ESRU chairman Dr. Selçuk Sarikaya

presented the recent activities of ESRU and its role within the EAU. As part of the EAU, ESRU has achieved excellent projects and aims to organise new events and launch new projects that will benefit urology residents. Prof. Ajay Singla gave a lecture on incontinence surgery, tips and tricks of and education of urology residents. Residents and the ESRU team also attended the Gala Dinner at the Bellapais Monastery, which has a wonderful ambience and considered one of the most visited places in Northern Cyprus.

The yearly elections for the new executive committee of ESRU Turkey took place on the last day of the congress in Northern Cyprus

and training opportunities in Europe. Meanwhile, Dr. Tolga Akman gave a well-received presentation on manuscript writing including tips and tricks for writing scientific articles. The last lecture was about robotic urology by Dr. Serkan Altinova with interesting

"The second edition of the Handbook for Residents, the translation of the 2016 EAU Pocket Guidelines, and the webinar education series are some of the recent projects by ESRU Tukey..."

Prof. Ajay Singla giving a lecture on incontinence surgery

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The second and third ESRU sessions were held during the last congress day. In the second session, YAU Chairman Dr. Selçuk Silay provided information on scholarship/fellowship programmes, EAU scholarship

During the 25th Turkish National Urology Congress 3 ESRU sessions were organised

videos particularly for beginners. A roundtable discussion followed covering scientific studies and writing manuscripts during residency training. The last session featured the ESRU Quiz with the participation of six teams with the winner awarded with free registration for the 32nd EAU Congress. Thereafter, the new executive committee of ESRU Turkey was elected. Enthusiastic team As in the past, the ESRU Turkey team has not only shown enthusiasm but remains committed to organise new events and projects. ESRU Turkey is known as one of the most active national groups within ESRU. The second edition of the Handbook for Residents, the translation of the 2016 EAU Pocket Guidelines, and the webinar education series are some of the recent projects by ESRU Tukey, reflecting its active role. Be the part of this great team and benefit from the support it provides to young residents! October/December 2016


Young Urologists/Residents Corner HOT Course at 12th SEEM A junior tutor’s initial experience Dr. Ersin Atabey Kecioren Training and Research Hospital Dept. of Urology Ankara (TR) ersinatabey@ gmail.com

submitting their scientific work, experimental and basic research experience, and by discussing cases and techniques with some of Europe’s renowned urologists. The joint collaboration between the ESUT and EULIS offered young residents the opportunity for an intensive hands-on training using different models that focused on the endoscopic management of urolithiasis.

It was a great honour to participate at the joint EAU Section of Uro-technology (ESUT) and EAU Section of Urolithiasis (EULIS) HOT Course on Ureterorenoscopy during the congress.

Tutorial tasks Looking back, I had an awesome experience as a junior tutor which enabled me to work with European master urologists such as Drs. A.S. Gözen, O. Durutovic, T. Tokas, and A. Papatsoris. The course begun with Dr. Gözen's opening remarks, followed by Dr. Tokas’s excellent presentation on endourology, rigid and flexible uretero-renoscopic techniques. I also had the chance to discuss with expert urologists various techniques, tips and insights on how to be an effective tutor. I am grateful for the valuable advice especially those given by Drs. Gozen and Durutovic.

SEEM is an important meeting for young urologists and researchers with its special events and education programmes. Traditionally, SEEM’s goal is to encourage young colleagues to actively participate by

Moreover, participants from Southeastern Europe and other countries had the opportunity to observe and learn endoscopic management of urolithiasis using rigid, semi-rigid and flexible

I have the privilege to serve as a junior tutor during the Hands-on Training (HOT) Course offered at the 12th South Eastern European Meeting held last 23 to 24 September in Sarajevo, Bosnia and Herzegovina’s beautiful capital and a former Olympic host city.

I was privileged to work as a junior tutor at the 12th SEEM in Sarajevo

ureterorenoscopy techniques, various guide-wires, baskets and intracorporeal lithotripters. Under supervision and direct guidance by course tutors, participants performed and refined their skills with rigid and flexible uretero-renoscopies. The social programme with the excellent dinner also gave us the chance to share experiences and form

Enjoying the local cuisine with some of the EAU staff members.

professional contacts with urologists and researchers from other countries. The friendly and relaxed company was wonderful as we enjoyed the local cuisine in Sarajevo. I do hope that I will have similar opportunities in the future to join as a tutor where I can contribute to the skills training of young urologists.

Nordic Residents in Urology: Exciting plans for 2017 NRU pursues educational and training goals Dr. Peter Østergren Chairman Nordic Residents in Urology ESRU NCO Denmark Herlev and Gentofte University Hospital Herlev (DK)

important for the NRU group to create courses that specifically target residents-in-training. The first two themes were “Benign Urology” and “Urological Emergencies and Trauma.”

In January 2017, we will have our third course in Tampere, Finland with “360 degrees Around Prostate Cancer” as course theme (https://confedent.eventsair. com/course-for-nordic-residents-in-urology/ peter.busch.oestergren@ nru-registration/Site/Register). We are very excited to regionh.dk have the commitment of some of the most prominent speakers from the Nordic countries to talk on prostate The Nordic Residents in Urology (NRU), the resident- cancer. Our aim is to discuss the newest research and changes in guidelines regarding all aspects of group of the Scandinavian Association of Urology prostate cancer, ranging from diagnosis and curative (SAU) formed in Copenhagen in 2012, has big plans treatment options to castration-resistant prostate for next year. The NRU Board is organising a cancer and sequencing of newer treatment Resident’s Day during the SUA’s 31st Biennial Conference and the 3rd Course for Nordic Residents in modalities. Urology to be held in Tampere, Finland, in January In 2017 the city of Odense in Denmark will host the 2017. 31st Biennial Conference of the Scandinavian Association of Urology. We are currently finalising the The NRU Board consists of two representatives from Denmark, Norway, Sweden and Finland and an program for the Resident’s Day of this meeting. The theme is already in place and will cover two subjects; Icelandic representative elected from among the stem cells in urology and the upper urinary Tract. The urologists-in-training. NRU aims to facilitate latter sessions will both cover urolithiasis as well as collaboration and networking among the Nordic surgical handling of upper urinary tract malignancies residents. From the beginning, the NRU Board committed to arranging biennial courses for Nordic and surgical skills training of residents. urology residents and the Resident’s Day at the biennial conference of the SAU. Other projects include introducing social media (SoMe) to Nordic Urology, an area which requires further work. SoMe plays an increasingly important So far, the NRU has arranged two well-attended courses for Nordic residents; the first in Copenhagen role in both knowledge exchange and professional and two years ago in Gothenburg. It has been networking. The European Society of Residents in October/December 2016

The 2nd Nordic Course for Residents in Urology took place in Gothenburg, Sweden in 2015

Urology (ESRU) is a front-runner in promoting and using SoMe and the NRU aims to provide the needed support. In addition, the NRU intends to establish more structured exchange programmes

for residents to train in Nordic urological centres. By doing so we hope to improve learning and opportunities for collaboration among Nordic residents. European Urology Today

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www.eulis17.org

EULIS17 4th Meeting of the EAU Section of Urolithiasis 5-7 October 2017, Vienna, Austria An application has been made to the EACCME® for CME accreditation of this event

Improve your surgical skills with top notch videos of urological procedures performed by the best surgeons in the world

• Easy navigating by organ, procedure and/or technique • Step by step explanation in videos of 1-2 minutes • Compare different techniques and different surgeons • Connect, share and learn with colleagues

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ESOU17 #ESOU17

14th Meeting of the EAU Section of Oncological Urology

Prof. Maurizio Brausi ESOU Chairman

20-22 January 2017, Barcelona, Spain The ESOU scientific programme essentials The 14th edition of the ESOU Meeting is the culmination of contemporary ideas and strategies centred on improving patient care. ESOU Chairman, Prof. Maurizio Brausi (IT) states that the core aim of the meeting is to update the onco-urology global community with the latest advancements in research and surgery. The ESOU programme is innovatory; from the management and treatment of patients with urogenital malignancies to ongoing clinical and basic research concerning urological cancers. Europe’s leading opinion leaders will present their valuable insights through Pro-and-Contra debates, panel discussions including multidisciplinary tumour boards, and videos demonstrating various surgical techniques in onco-urology. “New, exciting developments in the field of prostate cancer diagnosis such as new markers, and the state-of-art multiparametric MRI with fusion biopsy will be presented. There will be an examination of the new anatomical classification of renal structure (vessels) utilized for renal surgery. Standard therapy for high-risk, non-muscle-invasive TCC (transitional cell carcinoma) of the bladder will be challenged with sequential BCG (Bacillus Calmette-Guerin) + EMDA MMC (electrically stimulated Mitomycin-C). And the latest updates in surgery for metastatic prostate cancer will also be assessed,” Brausi discloses. One of the most important highlights of ESOU is the highly successful STEPS programme (Sessions To Evaluate ProgresS in the management of urological cancers). Now on its 7th year, STEPS is the definitive podium for promising young clinicians specialising in urological cancers to deliberate with experienced

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international experts. Since its inception, many young urologists have benefitted from the STEPS’ unique learning and networking experience. It has provided them the research opportunities, as well as, opportunities to acquire new perspectives regarding a career in onco-urology. A new and welcome addition to the ESOU programme is the inclusion of an ESU Course entitled “Complications and management of patients undergoing cystectomy”. This course, led by Dr Joan Palou (ES), will take the form of a panel discussion which will allow for an open and interactive learning experience. Brausi also defines the future, possible challenges and breakthroughs in the field. “The major challenges in onco-urology would be the development of biomolecular markers, targeted gene therapy, and immunotherapy. I think that tumour prevention will even be more significant. I anticipate the diffusion of robotic surgery with new robots appearing in the market at lower prices; the standardization of biomolecular markers in diagnosis, focal therapy for prostate and renal cancers, and gene and immunotherapy with new check point-inhibitors,” predicts Brausi. When it comes to urological cancer, Brausi foresees that multidisciplinary teams will become a must in the majority of

the European nations. “There are already countries, such as the United Kingdom, The Netherlands and Germany, where their governments request for a multidisciplinary approach with regard to patients with urological cancers. The Italian Society of Urology (SIU), together with oncological and radiotherapy associations, has developed a programme for multidisciplinary teams to treat uro-oncological tumours. The EAU is supporting the multidisciplinary approach. I think urologists should be the leaders of these multidisciplinary teams as they usually make the first diagnosis and eventually the surgeries in majority of the cases,” states Brausi. The 14th ESOU meeting will deliver the must-have information onco-urologists need; from the ones in training, for those who are mid-career and for the veteran clinicians. Expand your knowledge and hone your skills. We look forward to welcoming you in Barcelona!

Register now at www.esou17.org

October/December 2016


2nd ESUN Course on Neurogenic detrusor overactivity Managing OAB: Insights and best practices in Rome Stefano Terzoni, Rn, PhD EAUN Chair Milan (IT)

s.terzoni@eaun.org

urologist of the hospital. The course took place under the patronage of IPASVI, the Italian National Board of Nurses, and was supported by an educational grant by Astellas Pharma Europe Ltd., which enabled the delegates to attend at very reduced fees. The course provided an overview of the pathophysiology of lower urinary tract dysfunction in OAB and neurogenic detrusor overactivity, relating to neurophysiological mechanisms, and current evidence-based management strategies. EAU

Twenty-four nurses from 11 European countries attended the two-day 2nd European School of Urology Nurses (ESUN) Course on Neurogenic detrusor overactivity and overactive bladder in Rome, Italy last November 4 and 5.

Twenty-four nurses from 11 countries attended the latest state-of-the-art course on OAB, with the organisers, Dr. Stefano Terzoni and Rosita Ceccarelli (front row, right)

The participants, selected by the organisational committee from 40 applicants based on their curriculum, benefited from quality lectures and insightful clinical cases on neurogenic detrusor overactivity and overactive bladder (OAB).

"The cases included relevant information about symptoms and patient characteristics, and the delegates were asked to indicate the proper nursing approach for each situation, presenting their solutions to the audience..." The course was hosted by the San Giovanni Addolorata Hospital, with logistic support from AIURO (the Italian Association of Urology Nurses, chaired by Rosina Ceccarelli, RN) and Dr. Gianluca D’Elia, chief

Wendy Naish discussing the assessment and management of the impact of OAB on daily life European Association of Urology Nurses

The participants were then divided into groups to analyse clinical cases of real patients. The cases included relevant information about symptoms and patient characteristics, and the delegates were asked to indicate the proper nursing approach for each situation, presenting their solutions to the audience with help from Van De Bilt and Prof. Del Popolo. Social programme The social dinner presented an opportunity for participants to share experiences, exchange points-ofviews, and establish new contacts. All delegates received the full address list of participants for optimal networking. Additional course materials were also provided in digital format.

Launched by the EAUN in 2015, the European School of Urology Nursing introduced in that year a successful course on urinary tract infections, which has already been repeated in a Dutch version organised by the V&VN Urologie (Dutch urology nurses association). The course on neurogenic detrusor overactivity and overactive bladder is the second of a series of initiatives, and the organisers are currently looking into other interesting topics. To further improve the quality of the course, the EAUN welcomes suggestions and ideas for potential topics. For comments and inquiries contact us at: eaun@uroweb.org. We look forward to see you at the International EAUN Meeting in London!

Dr. Bertil Blok (NL) during his lecture on 'Disorders of the urinary tract'

Secretary General Prof. Christopher Chapple discussed the neurophysiology of the lower urinary tract and the onset mechanisms of neurogenic detrusor overactivity and OAB. Wendy Naish, Nurse Consultant, Continence (UK) discussed the impact of such problems on quality of life and potential management strategies, with practical suggestions for patient assessment and examples of nursing records. On the second day, Prof. Enrico Finazzi Agrò (chair of the Italian Society of Urodynamics or SIUD) and Prof. Giulio Del Popolo (former chair SIUD) closely examined urodynamics, and provided detailed information on when to use it and how to avoid artifacts in neurologic patients. Lisette Van De Bilt, Nurse Specialist Urology, and member of the EAUN Scientific Committee lectured on management strategies such as sacral neomodulation and percutaneous tibial nerve stimulation. Speakers Profs. Del Popolo and Finazzi Agró with the organisers.

EAUN-CUAN ties enter new phase EAUN opens collaborative training school for nurses and signs membership agreement Lawrence DrudgeCoates Urological Oncology Clinical Nurse Specialist Past Chair, EAUN London (UK)

It was an honour for me to finally open the centre after many years of negotiations and hard work. This represents the first ever collaborative centre for training in China and I’m delighted that urology nursing is the first. The centre will provide key training opportunities for urology nurses not only in the locality, but across China.

l.drudge-coates@ eaun.org

In acknowledgement of his efforts to develop the centre and academic work in urology nursing, the author was honoured by the university as a visiting professor and co-director of the training centre. The honour also reflects and acknowledges the crucial role played by the EAUN and its partnership with CUAN.

After two years of careful planning, this November saw, EAUN membership and the opening of a collaborative training centre for urology nurses in China, finally come to fruition, as part of the EAUN's goals to expand links with urology nurses overseas.

Mr. Lawrence Drudge-Coates delivers the opening speech at the new collaborative training school on behalf of EAUN chair Mr. Stefano Terzoni

In his role as former EAUN chair, the author attended the First Affiliated Hospital at Zhejiang University School of Medicine in Hangzhou, host city and venue of the recent G20 summit, to formally open the only collaborative training centre for nurses in China. The collaborative project is a first not only for the EAUN but also for nursing in China, marking it as a real and unique achievement.

European Association of Urology Nurses

October/December 2016

The formal opening of the collaborative training centre was attended by the heads of the university and medical deanery, vice chair of the Chinese Urology Association (CUA) Professor Xie and Head of the Chinese Urological Nursing Association Committee (CUAN).

Members of the CUAN board with Professor Zhang-Qun Ye during the formal signing ceremony of the membership agreement

A 1,000-km journey by train took the author to the annual CUA conference in Tianjin in northeast China, for the signing of the CUAN board membership with the EAUN. The signing was an auspicious occasion, with a packed house, standing-room-only attendance. In attendance was former CUA president Prof. Zhang-Qun Ye who lauded the closer partnership with the EAUN.

Signing of the board membership agreement CUAN & EAUN: Mr. Lawrence Drudge-Coates Past EAUN chair & CUAN chair Ms. Wei He

To finally formalise the agreement and with the EAUN-CUAN entering a new phase in its partnership, the author is grateful to all those who made this key achievement possible, and also for the hospitality and friendship shown throughout the visit. European Urology Today

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Patient empowerment in urology Delivering patient information – An inter-professional approach Franziska Geese Advanced Practice Nurse University Hospital Berne, Inselspital Dept. of Urology Berne (CH) franziska.geese@ insel.ch

Prof. Dr. Thorsten Bach Chairman Patient Information Group Asklepios Klinik Harburg Dept. of Urology Hamburg (DE) t.bach@asklepios. com In 1998 the WHO defined an empowerment initiative to support patients, vulnerable groups and give direction for health professionals. Empowering in health promotion is defined by the European Association of Urology Nurses

WHO as “(...) a process through which people gain greater control over decisions and actions affecting their health,“ (WHO, 1998).

"The EAU adopted this strategy to create an interprofessional working group, called “Patient Information“ in 2012 to promote need-oriented patient information."

At present, nurses and urologist are still working towards realising the empowerment strategy of the WHO. Implementing a patient-centred pathway is only possible when we as health care professionals know the individual needs of our patients. But how does As a Clinical Nurse Specialist for patients with that work? prostate cancer I feel privileged to be part of this inter-professional working group and to improve the Two approaches are necessary. On the one hand, care offered to patients with urological illness. During researchers have to perform phenomenological the past years the working group, beside other topics, studies to understand patients’ experiences with urological illnesses. On the other hand, opportunities has created information leaflets, posters about for inter-professional communication, among urologists, nurses, psychologists, social workers etc., support empathy for each profession. With these two approaches health professionals can indirectly empower patients through adapting care pathways. Direct patient empowerment can be performed, for example, through the development of a website where evidence-based illness information is available.

urinary incontinence, bladder cancer, prostate cancer, kidney cancer, erectile dysfunction, kidney ureteral stones, nocturia, benign prostatic enlargement and overactive bladder syndrome. The information is based on EAU and EAUN guidelines and prepared for use in all European countries rather than to one specific country or system. More information including animated videos is planned in the coming months and will soon cover all topics addressed in our guidelines. How to navigate the website and the patient information in clinical settings will be discussed at the Patient Information Special Session at the Annual EAU Congress next year in London.

The EAU adopted this strategy to create an interprofessional working group, called “Patient Information“ in 2012 to promote need-oriented patient information. The website (http://patients. uroweb.org) is accessible for patients and health professionals who are looking for resources to support their patients.

Asia–Pacific Prostate Cancer Conference Insights and best practices in prostate cancer care from Down Under EAUN Board Sue Osborne Urology Nurse Auckland (NZ)

sue.osborne@ waitematadhb.govt.nz It has become a tradition for me to regularly attend the Asia–Pacific Prostate Cancer Conference since my advanced nursing practice focuses mainly on prostate cancer and this multidisciplinary meeting consistently ticks all the boxes for updating knowledge from medical, nursing, allied health, general practice and translational science fields. I was fortunate to be a participant in the 2016 meeting, which ran from 31 August to 3 September at the Melbourne Convention and Exhibition Centre on the banks of the Yarra River. This wonderful venue was ideal for the plenary sessions, breakout ‘stream’ presentations, workshops and trade displays, all housed conveniently in a bright and airy space. The riverside, central city location offered wonderful walking and cycling routes, as well as renowned shopping spots and restaurants to visit during education down-times. This year’s conference programme once again reinforced the expert opinion and evidence that underpin our local practices, as well as giving me a preview of emerging technologies and scientific breakthroughs. Let me summarise some of the thought- provoking sessions I attended. Canadian urologist Dr Robert Nam presented a provocative session outlining a pilot study at his centre examining whether MRI is feasible as a prostate cancer screening test. The clinical trial was advertised in a Toronto newspaper for a week which surprisingly elicited 300 responses for only 50 places in the study. Dr. Nam commented that the protocol was attractive to men as it included a free MRI to screen for prostate cancer. The potential downside was the requirement to proceed to prostate biopsy regardless of the MRI findings, but this did not seem to be a big deterrent to recruitment.

PSA at diagnosing prostate cancer. It also performed better at predicting aggressive prostate cancer (Gleason 7 / ISUP 2 or above). Inter-observer variability in interpreting MRI scans was noted to be a potential weakness of this screening approach. The pilot study results were however adequate enough to prompt the research team to roll-out the first randomised clinical trial of MRI versus PSA for prostate cancer screening in a general population. Sessions on MRI studies In a further MRI-focussed session UCLA Urologist Dr. Rob Reiter asked if prostate biopsies were really needed in men with an elevated PSA but negative multiparametric MRI scan result. He reported that MRI will miss 20% of Gleason 4+5 (ISUP 5) lesions if they are small, so there is a risk that a negative MRI scan could falsely reassure a man whose prostate harbours a potentially life threatening cancer. He stated that where clinical suspicion remains due to elevated PSA velocity and density, a prostate biopsy should always proceed. Dr. Reiter went on to advocate the usefulness of MRI in selecting active surveillance patients, stating that a negative MRI together with low-risk prostate biopsy features significantly reduces the likelihood of missing a significant prostate cancer. With New Zealand having recently acquired our first 68Ga-PSMA scanner, I was particularly interested in sessions that explored how this imaging modality is influencing clinical practice overseas. The conference programme included many sessions focussed on the clinical relevance of PSMA scans in evaluating high-risk prostate cancer patients prior to treatment choice, as well as for men with biochemical failure following primary treatment, and in assessing disease burden and treatment response in castrate resistant prostate cancer. This relatively new modality brings promise in all of these scenarios, but the need for clinical trials to evaluate clinical outcomes was stressed throughout the meeting.

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The nursing programme was again excellent in its diversity and calibre of speakers. There were many highlights to share from this interesting stream, so I have written a further column to be included in a

Ms. Osborne in front of the Melbourne Convention and Exhibition Centre on the banks of the Yarra River

Chair Vice Chair Past Chair Board member Board member Board member Board member Board member Board member

Stefano Terzoni (IT) Susanne Vahr (DK) Lawrence DrudgeCoates (UK) Paula Allchorne (UK) Simon Borg (MT) Linda Söderkvist (SE) Corinne Tillier (NL) Jeannette Verkerk (NL) Giulia Villa (IT)

www.eaun.uroweb.org

future edition of this newspaper. Needless to say I returned home with revitalised passion for our speciality, feeling rested from the break away from daily routines, in a city that offers so much to see and do. I would like to acknowledge the Prostate Cancer Foundation of New Zealand for their educational scholarship facilitating my attendance and to the conference organisers for an excellent event. I am sure I will be back!

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:

During the study each man underwent a PSA test, digital rectal examination, 3-T multiparametric MRI and finally a prostate biopsy. The pilot study results observed that MRI was nearly three times better than European Association of Urology Nurses

Belgian Prof. Bertrand Tombal presented an excellent summary session entitled ‘Evaluating new imaging in prostate cancer'. He noted that clinicians are looking for imaging modalities that offer improved diagnostic accuracy and assessment of treatment response. He stated that the ideal imaging technique would have high diagnostic value, be reproducible, affordable, minimise radiation exposure, be ‘one step’, with high efficacy for monitoring treatment response. He stated that the individual benefit of imaging will be influenced by an assessment of the modalities negative predictive value- that is, those patients you don’t treat who should have been treated -and its positive predictive value- that is, those patients you treat for no benefit. In this context while he noted that 68Ga- PSMA scan is a significant advance on the traditional CT and bone scan imaging modalities, the technique still appears to miss approximately 20% of prostate cancer lesions, leaving clinicians with many difficult patient-focussed questions to answer.

• 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

October/December 2016


EAUN Fellowship Insights on best practices: Observer fellowship at Dutch cancer centre Helen Attard Bason, Rn Urology Department Mater Dei Hospital B'kara (MT)

helen.attard-bason@ gov.mt For the last five years I have been working as a charge and urology ward nurse at Mater Dei Hospital in Malta which is the country’s only acute general university teaching hospital that offers full-range hospital services. Since my nursing registration in 1982, I have always worked in the acute general hospital of Malta although for 28 years I worked mainly in the obstetrics, gynaecology and Neonatal Intensive Care departments. Thereafter, I worked at the Adult Urology Department.

Master Advanced Nursing Practice – good Luck Eva!) and CNS Erik Van Muilekom, past president of the EONS. My fellowship programme schedule from September 26 to 30 consisted of the following: Monday: • MRSA tests. • Review of patient post-robotic prostatectomy • Observing Corinne during a telephone help-line service (all urological patients who will be having treatment at AVL can call, either for counseling or urological emergency issues that the CNS has to resolve. • Fast– track renal cell carcinoma followed by MDT meeting. Tuesday: • MDT meeting before fast-track prostate carcinoma. • Fast-track prostate carcinoma. • OR urology surgery – Robotic prostatectomy (RALP – Da Vinci Robot) • Prostate biopsy – day care surgery. Wednesday: • Bladder instillation/ cystoscopy • OR – Penectomy and Sentinel lymph node biopsy Thursday: • Fast-track bladder cancer. • Followed patient from the consultation with the CNS until the consultation with the urologist (with all the necessary investigations required such as flexible cystoscopy, PET/CT scan) Friday: • Urology ward

Mater Dei hospital provides an extensive range of specialist services including urology. The Department of Urology has four consultants, two wards with 36 beds, a nurse-led outreach service and a preoperative assessment unit. Our urologists use the general outpatients department and operating theatre for outpatient’s visits and surgical interventions. We do not have a urology department that caters specifically for procedures related to urology since other minor interventions such as flexible cystoscopies, prostate biopsies and ESWL are done at the day care theatre. Urology Ward 2, where I am assigned, is an 11-bed inpatients mixed ward and I am supported by 11 senior professional nurses who have a vast experience in urology and a support staff. The host institution We have a 1:6 patient-nurse ratio allocation. The Netherlands Cancer Institute and the Antoni van Leeuwenhoek (AVL) Oncology Hospital is the only For the last five years, since I started working in the dedicated cancer centre in The Netherlands and urology department, I had been running the maintains an important role as a national and Intravesical therapy and the bisphosphonate international centre of scientific and clinical expertise, treatment for prostate cancer patients with bone development and training. The Antoni van metastasis. My aim is to further develop this service Leeuwenhoek Hospital has 185 medical specialists, especially with regards to the training of the staff who 45 Clinical Nurse Specialists, 180 beds, an outadministers such a therapy. Although my staff are patients clinic with around 106,000 visits, 12 operating very competent and have the necessary expertise to theatres and 11 irradiation units for radiotherapy. This administer treatment, they are still not recognised as oncology centre offers a state-of-the art oncology competent practitioners to administer intravesical specialists’ consultation that is made up of a treatment as required by international guidelines. multi-disciplinary team (consisting of an oncology and urology clinical nurse specialists (CNS), a clinical EAUN Fellowship urologist, a clinical oncologist, radiologists, radiation My applying for EAUN fellowship was motivated when I oncologists and a pathologist). Such services are realised that delivering the highest standard of integrated with compassionate care for clients visiting urological nursing can be best achieved through the the AVL hospital. The urology ward is integrated exchange of best practices and the application of within the surgical department and deals with guidelines in hospital practice, one of the main goals of conditions related to both female and male pelvic the EAUN. Moreover, I believe that having the organs (urology and gynaecology). opportunity to observe a nursing team in another European country is a great learning experience which It is impressive how nursing care in this hospital is can help improve one’s own practice and nursing skills. provided in a friendly, caring and a quiet environment, and there is an emphasis on effective Finding out what differentiates the uro-oncology communication especially with the patients and their practice at Antoni van Leeuwenhoek (AVL) Hospital families. Although there was a time when I could not from our practice at Mater Dei Hospital was high on understand what was being said with the patient my agenda since this will inform my work with because of the language barrier, I, however, noted the urology cancer patients. Furthermore, I also believe sense of satisfaction and collaboration within the that as the complexity of the healthcare delivery nurse-patient relationship. All the staff made me feel system increases, the need to intensify the knowledge welcome and they also tried to explain (in English) through research, networking and exchange of best what was being said so that I can understand and practices is crucial. I had applied for the Netherlands follow the conversation. because AVL Hospital specialises in uro-oncology and I would like to apply the best standards of care in our Effective communication was also evident between department. Besides I also believe that crossing the the physician and the uro-oncology nurse specialist at borders across the EU to experience another AVL. A close working relationship exists between environment in healthcare systems would eventually nurses and physicians. There is a physician-nurse benefit my organisation and help me build contacts team collaboration environment with an open for learning and practice exchanges. First, I would like to mention the remarkable organisation of my visit at AVL hospital, which was well-prepared by Ms. Corinne Tillier, a Uro-Oncology Clinical Nurse Specialist (CNS) responsible for localised prostate and renal cancer patients, and who also chairs the EAUN’s Scientific Congress Office. I had also worked with CNS Jolanda Bloos-van der Hulst who is responsible for bladder and penile cancer patients and current chair of the network urooncology nurses in North Holland. Working with Corinne and Jolanda were Eva Offringa, a CNS student (another year and she will have the title of MANPEuropean Association of Urology Nurses

October/December 2016

it is clinical, administrative or research-based is necessary and can benefit or help improve our healthcare system. I have also realised that through networking, we can break our comfort zones and become key players in healthcare.

Ms. Attard Bason visiting the harbour of Rotterdam (NL)

attitude, mutual respect and trust which facilitates the decisions taken by the CNS. This mutual collaboration was also evident during the multidisciplinary meetings that were held regularly to plan care and treatment. As an outside observer and with the language barrier, it was difficult for me to identify who was who during the meeting because all the members had collaborated well together. However, the CNS whom I was observing gave a quick account of the patient’s history. She also has the task of informing her clients about the decisions taken on their care pathway. The CNS has an important role in the care pathway starting from the first referral and down to the follow-up and any post-surgical intervention. I had followed the CNS during a telephone advice line and during a CNS-led preadmission clinic where newly referred patients can discuss their concerns and when their care pathway would be explained before any other investigations and surgical interventions are performed. Learning points From this experience not only have I reached my objectives but have also reflected on the importance of networking in nursing. This fellowship has also helped me in analysing the level of care that we deliver in our country compared with other European countries. Furthermore, sharing information whether

One important observation that I had was the fast-track cancer diagnosis which in Malta is only applicable for colorectal cancer. If introduced locally within the urology specialty, this system can be beneficial because not only will it minimise the waiting time for the patient to receive treatment but it will also reduce patient anxiety which follows after a cancer diagnosis. Throughout the fast-track service after patients are referred by other hospitals or their GP, and within the first 24 hours of referral, the CNS will organise everything for the patient including the appointment for assessment, the required scans/ MRI and biopsies after which the results are discussed in an MDT meeting. These are very often done within the same day and during the MDT a treatment plan is prepared and proposed to the patient. It means that patients in one day would know the definitive diagnosis and stage of her/his disease and which treatment the MDT has advised. This minimises the trauma and anxiety for patients and their families. Every year about 210 patients with bladder cancer, 60 with penile carcinoma, 680 with prostate cancer and 160 with renal cell carcinoma are seen at AVL hospital’s fast-track urology cancer pathway. Finally, I would like to thank everyone, especially all the team members involved in organising my visit at AVL hospital, for their warm welcome, and particularly Corinne Tillier who really went out of her way to mentor me and make my visit truly productive. The experience I gained will surely boost my knowledge with regards uro-oncology and the way I organise patient care. I would really encourage everyone to apply for a fellowship programme. Last and not the least, my sincere gratitude to the EAUN for this great opportunity.

Fellowship Programme European Association of Urology Nurses

Visit a hospital abroad! 1 or 2 weeks - expenses paid Application deadline: 31 January 2017 • Only EAUN members can apply • Host hospitals in Belgium, Denmark, the Netherlands, Sweden, Switzerland and the United Kingdom • A great way of widening your horizon For Fellowship application forms, rules and regulations and information on which specialities the hosting hospitals can offer please visit the EAUN website.

Me and my host Ms. Corinne Tillier, who perfectly organised my observational visit

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

European Association of Urology Nurses

European Urology Today

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ERUS EAUN Robotic Nurse Meeting in Bruges, Belgium A new educational platform for operating room nurses Linda Söderkvist, RNFA, RN, CNOR, MSc. EAUN Board Member Karolinska University Hospital Stockholm (SE) l.soderkvist@ eaun.org In 2004 a group of physicians gathered in France to look into the latest technology that enabled surgeons to perform surgery with robotic-assisted technique, this meeting became the very beginning of ERUS. This rather new field of performing minimally invasive surgery with the help of a robot was already introduced in 1999, when the first surgical system entered the market. Some might say this is the greatest development in medical technology since the laparoscopic boom in the late 1980s and beginning of 1990s. Laparoscopy was a milestone in surgical care and quickly became a popular, widely-used operating technique around the world. The minimally invasive technique led to shorter hospital stay and a more rapid postoperative recovery for the patient. Laparoscopy was the precursor to what would again revolutionise the performance in surgical techniquerobotic-assisted surgery. Superior to laparoscopy, robotic-assisted surgery presented an enhanced vision due to a wider scope, and also enabled the surgeon to work in 3D. Unlike in laparoscopy, the surgeon controls the instruments with an endowrist technique, allowing the instruments to move just like the human hand. Urologists saw the potential in using this technique in urological surgery and embraced the new technology early on. Today, urology surgery is European Association of Urology Nurses

one of the surgical specialities that have the longest experience in robotic-assisted surgery. As a fast-growing field already from the start, the European Robotic Urologic Society became a section within the EAU structure in 2011, and next year the 14th EAU Robotic Urology Section (ERUS) meeting will be held in Bruges, Belgium. ERUS has become the educational platform for urologists to gain in-depth knowledge in roboticassisted urological surgery. Next year, ERUS will also involve nurses working in the operative settings by offering a three-day congress on the three most common urological diseases such as prostate, bladder and kidney cancers. The meeting will take place on September 25 with a programme that includes the nurse´s role in robotic-assisted surgery, lectures on human factors in robotic surgery, team efficiency in the operating room, and how to avoid and manage surgical complications. The meeting aims to improve the competencies of both junior and senior nurses. Interactive sessions followed by hands-on simulator training and courses will be available for nurses who are seeking a more confident and safe way of working in the operating room during surgery. Prominent urologists will give presentations and provide practical insights.

www.erus17.org

ERUS17 14th Meeting of the EAU Robotic Urology Section

Robotic Live Surgery

26-27 September 2017, Bruges, Belgium

Special ERUS-EAUN Robotic Urology Nursing Programme

An application has been made to the EACCME® for CME accreditation of this event

The ERUS EAUN Robotic Nurse Meeting also aims to build an educational platform for nurses for them to network and actively take part in the latest developments and research in robotic-assisted urology surgery. We expect this meeting to provide crucial skills to nurses, both practical and theoretical, enabling them to take a more active role in the robot-assisted surgical team. The Special ERUS-EAUN Robotic Urology Nursing Meeting starts with a one-day special nursing programme followed by HOT sessions for less experienced nurses. The following days the regular ERUS live-surgery programme will be attended.

Early registration deadline: 16 January 2017

25-27 March 2017, London, UK

A varied, in-depth EAUN programme in London An in-depth and comprehensive Scientific Programme awaits urology nursing specialists at the 18th International Meeting of the European Association of Urology Nurses to be held from 25 to 27 March 2017 in London, the United Kingdom, with a variety of challenging issues to be closely examined by cancer experts, urologists and other healthcare professionals. Onco-urology care “When we planned the Scientific Programme, we aimed to focus not only on urology nursing, in general, but also on uro-oncology nursing care. Some examples are the sessions “Challenges and Opportunities in Geriatric Onco-urology Care,” and the exciting “Tomorrow is Already Today: Urology healthcare in the near future and Illiteracy and health literacy in patients,” said EAUN board member Corinne Tillier (NL) who led in organising the EAUN Scientific Programme. “We also wanted to deeply go into specific topics in sessions such as “Advanced urodynamics and Drug-resistant microorganisms in urology: An avalanche is coming?” to address core and urgent issues,” added Tillier. That a lot of careful preparation went into creating a thorough three-day programme is reflected in the new segment called “Westminster House of Common’s Session,” which posed the provocative statement “This house believes that patients do not know what treatment is best for them.” Aimed to trigger a lively debate and ferret out insights and best practices in patient education, nursing communication, patient advocacy, among other issues, Tillier said the session should provide various viewpoints on these topics.

in conjunction with

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European Urology Today

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“Other highlight topics are “The urology nurse as patient advocate: Forgotten role?” A few years ago we often heard the view that nurses play an important role as a patient’s advocate. Nowadays, patients, through the internet and patients groups, are very well-informed of the latest treatment innovations. Thus, we should ask: Are urological nurses still the patient advocate? Do patients still need us?” commented Tillier. Antibiotic resistance Another focus in London is the ongoing demand for nurses to be well-informed and thereby help in addressing antibiotic resistance. Tillier noted that two years ago the EAUN meeting in Madrid examined this challenge. “Resistance rates of most uropathogens against antibiotics are still high, especially with multidrug resistance. And now-- two years later-- we are wondering if this threat or urological time bomb has indeed exploded,” she said. Responsiveness to current and controversial issues is another feature that distinguishes the EAUN’s programme, which fulfils the EAUN’s goal to provide continuing education and skills training to its members. Fostering the highest standards of urological nursing care throughout Europe and facilitating the continued development of urological nursing in all its aspects remains a top priority of the EAUN, according to Tillier, as she noted that they consulted the EAUN membership to provide suggestions in terms of topic selection.

Stefano Terzoni, Chair EAUN

Corinne Tillier, Chair SCO

Needs of nurses “It is important to respond to the needs of nurses. We have asked the nurses and nurses’ associations for specific subjects and we have received so many enthusiastic replies that it could be possible to organise a six-day congress instead of three days,” said Tillier. Providing a responsive programme is not only the priority as nurses also need to look into best practices, anticipate change and evolve considering the fast-changing developments that occur in urological healthcare. “Urology care is in constant flux and there are always areas for improvement. As urology nurses we have to help in the delivery of innovative care which doesn’t only include new technologies such as robotics but also the way we approach the patient. I believe this is the strength of all the EAUN meetings- to inform and motivate its members on how best to tackle this evolution,” Tillier said.

For detailed information and updates of the Scientific Programme, visit the EAUN’s meeting website at: www.eaun17.org

www.eaun17.org October/December 2016

European Urology Today October/December 2016  

European Urology Today (EUT) October/December 2016. EUT is the official newsletter of the EAU.

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