European Urology Today Official newsletter of the European Association of Urology
Vol. 28 No.2 - March/May 2016
Award Winners Photo Gallery
USANZ signs up
Munich awardees in pictures
USANZ signs up for en-bloc membership
Preparing for future challenges in neuro-urology
Prof. Mark Frydenberg
Dr. Ulrich Mehnert
EAU16: Prospects and progress in urology Munich congress re-examines evidence and role of personalised medicine By Joel Vega With the prospects of technological gains and new research outcomes, issues in standard therapies and personalised medicine were recurring themes at the 31st Annual EAU Congress in Munich which drew more than 12,300 participants coming from at least 119 countries.
In total, 12,389 participants including 9,905 urology professionals, 2,318 exhibitors and 152 media representatives came to Munich. Host country Germany registered the highest attendance, together with Spain, Italy and the United Kingdom. Asia is well represented by Japan, China and South Korea, while Russia and the United States posted higher numbers of participants as well.
Prostate and bladder cancers Gains in diagnostic imaging were highlighted at the ESO Prostate Cancer Observatory with experts noting that its impact on treatment will become more crucial. “We are now seeing new imaging modalities which are revolutionising what we can see and what is treatable. The differences are startling,” said session EAU Secretary General Prof. Chris Chapple set the co-chair Prof. Steven Joniau (BE), a remark which was tone in his opening remarks when he challenged reiterated by Prof. Riccardo Valdagni (IT) who cited urology professionals to cast a critical look at standard PET-CT as a game-changer in PCa diagnostics. therapies while pursuing the goals of innovation. “Metastatic prostate cancer is now becoming “Nothing would happen without being made to treatable, whereas previously patients with one or happen,” Chapple said shortly before honouring two metastatic tumours were almost considered recipients of EAU honours and prize winners during inoperable,” he said. the opening ceremony (See Related Articles and Photo Gallery on Pages 6-8). Europe’s biggest annual urology event, the five-day congress from March 11 to 15 was marked with both optimism and anticipation as urology experts and related healthcare professionals assessed current diagnostic strategies, treatment regimens and optimal follow-up care.
As in previous years, the Urology Beyond Europe sessions preceded the main Scientific Programme with the simultaneous joint meetings of 12 national and international urology groups. Two special events were also held such as the well-attended 6th International Congress on the History of Urology and the 3rd ESO Prostate Cancer Observatory. Both events featured international lecturers and experts. At the annual General Assembly on Day 2, Chapple also reiterated the challenge as he outlined the EAU’s strategies which will be characterised by a more streamlined and efficient organisational base. He noted European urology remains the core priority while underscoring the importance of reaching out to other regions through collaborative projects and educational activities. During the assembly meeting, Prof. Jens Rassweiler (DE) was elected as new chairman of the EAU Section Office, while Prof. Philip Van Kerrebroeck (BE) took over the History Office. Prof. Hein Van Poppel (BE) was re-elected as Adjunct Secretary General for Education.
A well-attended Opening Ceremony
Prof. Arnulf Stenzl (DE), Chair of the Scientific Congress Office (SCO), said five topics dominated this year’s meeting such as prostate cancer, ageing, andrology, infections and bladder cancer with the four Plenary Sessions, 19 Thematic Sessions and around 91 Poster Sessions investigating manifold issues ranging from diagnostics, therapy, drug developments and surgical innovations.
A. Kamat presents results of a bladder cancer study
Radiation oncologists also reaffirmed the key role of imaging with Plenary Session 2 speaker Prof. Harriet Thoeny (CH) pointing out the role of pre-biopsy MRI. “MRI/TRUS fusion-guided biopsies detect more significant PCa with fewer cores and reduces the detection rate of low-risk cancers,” she said. Meanwhile, in a debate on hormonal therapy, Prof. Nicolas Mottet (FR) argued that classical hormone therapy will remain with urologists but only if they adapt to changes and learn new tools. “We must learn new drugs, recognise major disease changes and be involved in all stages including advanced and final disease phases,” he said. During Plenary Session 1 which carried the theme “Evidence-based medicine vs common practice / challenging the evidence,” bladder cancer (BCa) took centre-stage with Prof. Ashish Kamat (US) examining the efficacy of Mycobacterium phlei Cell Wall-Nucleic Acid Complex (MCNA) in BCG-unresponsive patients. “MCNA efficacy in high-risk, unresponsive BCG patients showed that one-year disease-free survival was about 35%, 28% at 2 years and a mean duration of response of 34 months in responders,” said Kamat. Discussant Prof. Joan Palou (ES) noted that BCG treatment or any other medical intervention can lead to progression. “We don’t have many trials with MCNA and there is no measurement of cytokines response in urine. And what is the evaluation of the different doses related to response? Looking at this trial, we do see good tolerance and there is a better disease-free survival in the papillary tumours group (50% at 2 yrs),” said Palou, while adding that MCNA “…does open a new door in managing BCGunresponsive patients.” In a state-of-the-art lecture from Plenary Session 4, Prof. Thomas Powles (GB) tackled the question “Is immunological treatment set to replace chemotherapy in the management of advanced
Profs. A. Stenzl and C. Chapple moderate the concluding Plenary Session in Munich
disease?” He noted the landscape of BCa treatment has remained the same with chemotherapy (cisplatinbased) regarded as the front-line treatment until in recent years when two big changes occurred such as the genetic studies on mutational rates and the identification of molecular sub-types. Threat of infections Urological infections were the focus of several meetings with two EAU Section Offices (Female & Functional Urology and the EAU Section of Infections in Urology) joining forces to hammer in the message of prudent antibiotic stewardship. “Antibiotic consumption is increasing… In Europe, drug-resistant bacteria are the cause of 25,000 deaths annually,” said Prof. Vitaly Smelov (FR) who noted that in the US around 50% of prescribed antibiotics is unnecessary or inappropriate. Speaker Prof. Bela Köves (HU) spoke on catheter use and warned about improper use of indwelling catheters. “Indwelling catheters should be placed only where they are indicated and 30% of initial urinary catheterisations are unjustified,” said Köves. Andrology and treatment issues in the elderly Issues in andrology were also widely discussed with Thematic Session 5 devoting state-of-the-art lectures
with topics such as erectile dysfunction (ED) treatment after radical prostatectomy (RP) and choosing a personalised treatment. Dr. Giorgio Gandaglia (IT) said PDE-5 inhibitors have a role but timing of administration, short follow-up periods and selection criteria are important factors to look into. “A recent study showed that patients at intermediate risk of ED after surgery benefit the most from PDE-5 inhibitors,” he said. Ageing and the lower urinary tract was the theme of Plenary Session 3 with a series of lectures covering issues such as the pharmacology of the lower urinary tract and clinical implications, drug therapy for the elderly, surgery of the lower urinary tract in older patients, and treating urinary tract infections in elderly females. Chaired by Professors Dirk De Ridder (BE) and Francesco Montorsi (IT), Prof. Alan Wein (US), Dr. Adrian Wagg (CA) and Dr. Jean-Nicolas Cornu (FR) spoke on the challenges of treating the elderly. “The state of the function of the LUT in an elderly individual is the result of an interaction (collision) between potential predisposing factors over which we have no or partial control,” said Wein who underscored these are “facts of life” which occur in the physical level. Meanwhile, Wagg said that amongst women previous pelvic surgery, a difficult childbirth and trauma can later on lead to or worsen existing pelvic disorders. “Pelvic organ prolapse affects around 50% of women over the age of 50 years,” he said. Cornu cautioned doctors to be careful with surgical options since the elderly do not only have existing morbidities but are also vulnerable to physical changes while being hospitalised, such as changes in blood pressure, loss of muscle mass and susceptibility to thromboembolism.
Participants exchange views at the Meet-the-Speakers Corner
(With additional reporting from L. Keizer, T. Parkhill and C. De Koning)
Cutting-edge Science at Europe’s largest Urology Congress Abstract submission opens 1 July 2016
European Urology Today
EAU16: Highlights in andrology Emerging prospects in fertility preservation and treatment Christian Fuglesang Skjødt Jensen Herlev University Hospital Herlev (DK)
fullejensen@ gmail.com More than 250 andrological abstracts from around the world were submitted to the 31st Annual EAU Congress. Among these 68 abstracts were accepted for presentation covering both basic and clinical research in infertility and sexual dysfunction. Unfortunately it is not possible to highlight all of the significant contributions. In this article, the focus will be on varicoceles, fertility preservation, erectile dysfunction (ED) after radical prostatectomy (RP) and retrograde ejaculation (RE). It is well known that infertile men with varicoceles have lower semen quality when compared to fertileor normozoospermic men1. However, most studies include only men selected on the basis of their fertility status. Dr. Joensen from Denmark presented an award-winning study (J. Damsgaard et al. #176) on the effect of varicoceles on semen quality in a general population. They recruited more than 7,000 healthy young men with a mean age of 19 years from military review boards in six countries and found that 16% had a clinical varicocele, which was negatively associated with semen quality. In grade 3 varicocele, sperm concentration was reduced to less than half of the concentration in men without a varicocele. In conclusion, this study provides information on the negative effects of varicocele in a general, unselected population.
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)
Regarding fertility preservation, more than 50% of male cancer patient’s aged 14-40 years desire biological children in the future2. As long-term cancer survival rates improve in younger patients fertility preservation becomes increasingly important. The standard approach is to cryopreserve ejaculated sperm3; however this can be complicated by several factors as shown by Dr. C. Poullis and his colleagues from London in their retrospective study (#184) on 1,067 men diagnosed with cancer. Depending on the type of cancer 23.2 to 47.8% presented with azoospermia/oligozoospermia. The same group of authors represented by Dr. S. Abumelha et al. looked at the success rates following onco-microdissection testicular sperm extraction in 19 men diagnosed with cancer and azoospermia (#185). They were able to retrieve sperm for fertility preservation in approximately 1/3 of the patients.
suitable for assistedreproduction3. Dr. M. Komeya and his colleagues from Japan presented a study on the ex vivo maintenance of mouse testis tissue in a microfluidic device (#818). Using this device, mimicking an in-vivo environment, they showed stable spermatogenesis and testosterone production for six months and used generated haploid cells to create healthy offspring. During their presentation it became clear that they have begun using the technique on human testis tissue. Thus, much progress is being made within the area of fertility preservation and new techniques will possibly be available for humans in the near future. Although a great deal of effort has been put into preserving nerve bundles responsible for erectile function, nerves are still affected during real nerve-sparing procedures by stretching, heating and local inflammation. This leads to cavernosal nerve injury, loss of erotic- and nocturnal erections causing cavernous hypoxia and through inflammation increased collagen and fibrosis and apoptosis of smooth muscle fibers ending up with veno-occlusive dysfunction and ED4. Thus, penile rehabilitation aims to secure proper oxygenation of cavernous tissue while the nerves recover after RP. However, as of now, no known regiments have been proven to improve spontaneous erections. Accordingly, there is a need for rethinking penile rehabilitation. Dr. S. Yamashita and his colleagues from Japan hypothesized that the amount of intraoperative bleeding as a marker of surgical stress affects erectile function after RP (#881). They randomized rats into three groups; one with bilateral cavernous nerve dissection (BCND), one had BCND with the use of a tissue sealing sheet (BCND+TS) to attenuate bleeding and the final group was sham operated. Through electrical pelvic nerve stimulation they showed that the intra-cavernous pressure was significantly higher post-operation in the BCND+TS group compared to the BCND group. They also showed that the inflammation markers IL-6 and TGF-β were lower in the major pelvic ganglion (MPG) and cavernous nerves in the BCND+TS group compared to the BCND group. In conclusion, tissue sealing reduced inflammation, thereby protecting cavernous nerves and improving erectile function in this rat model.
sham group for up to 48 hours and immunohistochemistry revealed that osteopontin was present in MPG neuronal cell bodies and surrounding glial tissue. Therefore, they hypothesize that osteopontin could be an important target in the prevention of ED after RP. To conclude, new approaches for penile rehabilitation are appearing in animal models focusing on nerve protection to prevent ED rather than treating ED when it has already occurred. However, the path from bench to bedside is long and strenuous. Retrograde ejaculation is a common side effect to TURP and is highly prevalent in patients with diabetes5. Treatment options include medical treatment with sympathomimetic agents, and for patients with diabetic neuropathy the tricyclic antidepressant imipramine. In the past, bladder neck reconstruction has been tried but the results remained poor and the procedure is generally not recommended today. Thus, treatment so far relies on medications, which sometimes have unpleasant side effects. Dr. D. Kurbatov and colleagues randomized 24 patients with RE due to diabetic neuropathy to collagen injection into the bladder neck submucosa or saline injection (#1126). After treatment, 11/12 patients in the collagen group were able to ejaculate in an antegrade fashion while none in the control group achieved antegrade ejaculation. No side effects were reported; however, it seems possible that men receiving volume-forming injections into the bladder neck might develop voiding dysfunction. Thus, long-term results from this technique are needed but the procedure is innovative and looks promising.
To summarize the highlights of Andrology we have seen that varicoceles negatively impacts semen parameters in a general population and fertility preservation is increasingly important with new therapeutic modalities emerging in the near future. Another challenge in fertility preservation is the Osteopontin secreted from Schwann cells has been In penile rehabilitation, there is a need for new treatment of pre-pubertal boys. One option, that shown to promote neuro-regeneration. Dr. E. Weyne approaches offering nerve protection, and, finally, remains experimental in humans is to cryopreserve and his group compared the protein and gene testis tissue with the possibility for future thawing and expression of osteopontin in the MPG in rats following collagen injection for retrograde ejaculation seems to be a promising new technique. use for either auto-transplantation to restore bilateral cavernous nerve injury (BCNI) or sham spermatogenesis and testosterone production or operation (#885). They showed that osteopontin was References in-vitro spermatogenesis to create sperm cells increased 10-fold in the BCNI group compared to the 1. Agarwal A, Sharma R, Harlev A, Esteves SC. Effect of varicocele on semen characteristics according to the new 2010 World Health Organization criteria: a systematic review and meta-analysis. Asian journal of andrology. 2016 Mar-Apr;18(2):163-70. 2. Schover LR, Brey K, Lichtin A, Lipshultz LI, Jeha S. Knowledge and experience regarding cancer, infertility, and sperm banking in younger male survivors. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2002 Apr 1;20(7):1880-9. 3. Valli H, Phillips BT, Shetty G, Byrne JA, Clark AT, Meistrich ML, et al. Germline stem cells: toward the regeneration of spermatogenesis. Fertility and sterility. 2014 Jan;101(1):3-13. 4. Hatzimouratidis K, Burnett AL, Hatzichristou D, McCullough AR, Montorsi F, Mulhall JP. Phosphodiesterase type 5 inhibitors in postprostatectomy erectile dysfunction: a critical analysis of the basic science rationale and clinical application. European urology. 2009 Feb;55(2):334-47. 5. Althof SE, McMahon CG. Contemporary Management of Disorders of Male Orgasm and Ejaculation. Urology. 2016 Feb 24.
Editorial Team L. Keizer, Arnhem (NL) H. Lurvink, Arnhem (NL) J. Vega, Arnhem (NL) EUT Editorial Office PO Box 30016 6803 AA Arnhem The Netherlands T +31 (0)26 389 0680 F +31 (0)26 389 0674 EUT@uroweb.org 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.
31st Annual EAU Congress 2
European Urology Today
EAU16: Highlights in prostate disease Hot topics in prostate cancer and BPH management A post-hoc analysis of the PCa (268 abstracts) phase 3 COU-AA-302 study of abiraterone acetate (AA) in men with 116 chemotheraphy (CT)-naïve metastatic castration resistant PCa (mCRPC) confirmed the 57 role of AA in early 48 cosimodenunzio@ settings (Miller K et al, virgilio.it 24 #775). Patients were 23 stratified into Group 1 Basic Research Diagnosis Imaging Localized treatment Systemic treatment (surgical, RT, AS) (Brief Pain Inventory [BPI] Prostatic diseases have been the most covered topic Short Form score 0-1, during the EAU Congress in Munich. Out of 1,167 PSA < 80 ng/ml and GS < abstracts presented during the last EAU congress, BPH (100 abstracts) 8) and Group 2 (BPI ≥ 2 368 (32%) were on prostatic diseases and in and/or PSA ≥ 80 ng/ml particular, 268 (73%) on prostate cancer (PCa) and and/or GS ≥ 8). The 100 (27%) on BPH (Figure 1). 31 relative treatment effect 27 27 for AA+P vs. P was Below is a summary and a review of the highlights: greater in Group 1 vs. Group 2 for Overall Prostate cancer: Diagnosis and staging 15 survival (hazard ratio The 4Kallicreine score (4Kscore) calculates the risk of high grade (Gleason score ≥ 7) PCa on prostate biopsy [HR]: 0.61 vs. 0.84), radiological progression by an algorithm including 4 kallikrein biomarkers (tPSA, fPSA, intact PSA, and human kallikrein-2) with free survival (HR: 0.41 vs. 0.59) and time to CT use the patient’s clinical information (age, DRE, prior Basic Research Diagnosis Medical Treatment Surgical Treatment biopsy status). Alcaraz A et al. (#382) and Punnen S et (HR: 0.64 vs. 0.71). al. (#381) showed in a prospective series of 144 men Figure 1: Hot topics in BPH and PCa presented during the 31th EAU Congress in Munich Figure 1: Hot topics in BPH and PCa presented during the 31th EAU congress in Munich BPH: Medical and surgical treated with radical retropubic prostatectomy (RRP) that the accuracy of the 4Kscore was 0.83 for Gleason treatments Matsukawa Y et al (#867) investigated the score ≥ 7 and that the 4Kscore was significantly Two different RCT studies from Europe (Gratzke C et long-term effect of combination treatment (CT) in higher among man who had an upgrade ≥ 7 (15%; al, #1076) and USA (Roehrborn C et al, #1080) 8/25%) compared to men who did not experience an patients with LUTS and BPE in a single-centre showed the long-term results of prostatic urethral lift randomized prospective study involving 120 patients upgrade (7%; 4/14%, p = 0.003) in their final (PUL) versus TURP or sham control in patients with randomly assigned to receive silodosin at 8 mg/day pathology. The authors concluded that the 4Kscore BPE and LUTS. In both studies, the PUL procedure was or silodosin at 8 mg/day and propiverine at 20 mg/ may be used to identify patients at risk of high grade effective to improve LUTS up to four years. In addition, day. None of the patients in both groups had urinary cancer who may benefit from immediate treatment sexual and particularly ejaculatory function (100% versus those who should undergo active surveillance. retention, and no significant difference in adverse versus 64% for TURP) is preserved while TURP effect was observed between the two groups. remains superior in reducing symptoms (91% vs. 31% Although mean IPSS and OABSS significantly Two different studies from Belgium (Tosco L et al, for PUL) and improving peak flow rate. PUL seems an improved in both groups at one year after #564) and Australia (Paffen MLJE et al, #561) innovative option in BPE patients, particularly in those retrospectively, evaluated, using a 68Ga-PSMA PET/CT, treatment, the improvements in IPSS-QOL and not accepting the ejaculatory dysfunction associated a series of 111 pts and 296 pts respectively, affected by OABSS in the CT group were significantly greater. with the TURP. Urodynamic voiding function significantly improved PCa recurrence, with a PSA increase after curative in both groups at one year after treatment without treatment failure. In the Australian study 175 (70%) BPH and PCa: Basic research significant inter-group difference. This study patients had pathological findings on the 68Ga-PSMA Two studies showed autophagy is an interesting confirmed as long term treatment with alphaPET/CT, with an average PSA-level of 5.70 ng/mL molecular mechanism involved in BPH and PCa blockers and antimuscarinic is safe in male patients (0.02-126 ng/mL). Detection rates were 17%, 38%, development. Chen HE et al (#44) demonstrated as with LUTS without significant changes in terms of 63%, 75%, 86% and 100% for PSA-levels <0.2, allyl isothiocyanate induces a ROS-mediated protective bladder outlet obstruction parameters. 0.2-0.5, 0.5-1, > 1-2, > 2-10, and > 10 respectively. In autophagy through the up-regulation of beclin-1 in the Belgian study the area under the ROC curve (AUC) human PCa cells. Vecchione A et al (#106) observed for PSA was 0,79 (95% CI 0,68 to 0,87). A PSA value of Prader B et al (#962) highlighted the role of that high levels of p62 and low levels of LC3B are 0,45 ng/ml was identified as the best cut-off point for photoselective prostatic vaporization (PVP) in the commonly associated with a decreased autophagy in octogenarians. Overall, 147 patients older than 80 balancing the sensitivity and specificity to detect patients with prostatic inflammatory infiltrates. years were evaluated and compared to a younger PSMA positivity. Both experiences confirmed that Further studies should clarify the role of autophagy as 68 group (249 pts). At one year of follow-up, PVP was Ga-PSMA PET/CT is therefore a promising imaging a new therapeutic target for prostatic diseases. effective across all generations, without more technique that allows the detection of metastases at complications in the octogenarians. With an early stage and particularly in lower range The authors of these abstracts, as well as those of the advantages in terms of coagulation and hospital PSA-levels. other 356 on prostatic diseases which were stay, and with similar functional results, PVP presented, are to be congratulated as their research should be a safety surgical strategy for patients ≥80 Prostate cancer: Radiotherapy and medical will represent a new step in the future management years patients with BPH. treatment of BPH and prostate cancer patients. The role of salvage versus adjuvant radiotherapy (RT) has been extensively evaluated during different poster and thematic sessions in Munich. Data from the San Raffaele (Gadaglia G et al, #436 and Fossati N et al, #544) group highlighted the role of salvage radiotherapy for patients with advanced PCa treated with RRP. Overall, the three-year Erectile Function (EF) recovery rate after RT was 18%. When patients were stratified according to adjuvant vs. salvage RT, the three-year EF recovery rates were significantly higher among men receiving salvage RT (31.2 vs. 17.8%, respectively; p = 0.01). The most informative cut-off for time from surgery to RT in predicting EF recovery was 16 months. Dr. Cosimo De Nunzio UOC Urology Ospedale Sant’Andrea Sapienza University of Rome Rome (IT)
Using a multi-institutional cohort, 596 pT3N0 patients with undetectable PSA after RRP were evaluated. Patients were stratified into: aRT (Group 1) versus initial observation followed by early SRT in case of PSA relapse (PSA level ≤ 0.5 ng/ml) (Group 2). Metastasis-free survival at 10 years was not statistically different between the two groups: 89% (95% CI: 82%, 93%) vs. 90% (95% CI: 82%, 95%), p = 0.4 independently from the pathological stage, positive surgical margin or Gleason score. Although we are far from a solution, these two studies confirmed the possible role of SRT particularly when it is administered in patients with a PSA ≤ 0.5 ng/ml.
31st Annual EAU Congress March/May 2016
EAU16 section: EAU16: Prospects and progress in urology . . . 1 EAU16: Highlights in Andrology . . . . . . . . . . . 2 EAU16: Highlights in prostate disease. . . . . . . 3 EAU16: Highlights in Lower urinary tract dysfunction. . . . . . . . . . . . . . . . . . . . . . . 4 Statistics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 EAU16: Highlights in Oncology . . . . . . . . . . . . 5 EAU16: Highlights in Urethral reconstruction. . 5 Overview of prizes and awards. . . . . . . . . . 6-8 Urology Beyond Europe. . . . . . . . . . . . . . . . . 9 USANZ and EAU sign agreement in Munich. . 10 Obituary: Constantinos Dimopoulos. . . . . . . 10 Clinical challenge. . . . . . . . . . . . . . . . . . . . . . 11 Update from the Guidelines Office . . . . . . . . 12 European Tour 2016: Academic Exchange Programme . . . . . . . . . . . . . . . . . . . . . . . . . 13 Key articles from international medical journals. . . . . . . . . . . . . . . . . . . . 14-17 Ten questions with Walter Artibani. . . . . . . . 18 EAU Patient Information. . . . . . . . . . . . . . . . 18 ESUT: Collaborative goals in Africa. . . . . . . . 19 EULIS: Role of diet in urolithiasis . . . . . . . . . 19 ESU section: Who’s Who in the Board of the European School of Urology . . . . . . . . . . . . . . . . . . . . 20 Webinar. . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Impressions of the ESU programme Munich 2016. . . . . . . . . . . . . . . . . . . . . . . . . 22 ESU Laparoscopy & Endourology Course in Caceres. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 European Urology Forum 2016. . . . . . . . . . . 24 EUSP section: European urology under the African Sun . . . 25 EUSP scholarship boosts laparoscopic skills. 25 Introducing ‘My EUSP at a Glance’. . . . . . . . 26 Celebrating the history and culture of urology. . . . . . . . . . . . . . . . . . . . . . . . . . . 26 YUO/YAU section: Spanish WebApp: “The Urology Resident´s book”. . . . . . . . . . ESRU holds HoT courses and webinars. . . . . YUO's Training, Education and Career (TEC) activities . . . . . . . . . . . . . . . . . . . . . . . ESRU at Munich. . . . . . . . . . . . . . . . . . . . . .
27 27 28 28
Urology Simulation Boot Camp. . . . . . . . . . . 29 Teaching neuro-urology to young urologists.30 European Tour 2016: Academic Exchange Programme . . . . . . . . . . . . . . . . . . . . . . . . . 31 ERUS: Training in robotics . . . . . . . . . . . . . . 32 History office: Remembering Wilhelm Sinner (1915-1976). . . 33 EAUN section: Female genital mutilation. . . . . . . . . . . . . . . EAUN in Munich: My experience. . . . . . . . . . Thematic sessions in Munich . . . . . . . . . . . . High quality poster sessions in Munich. . . . .
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European Urology Today
EAU16: Highlights in lower urinary tract dysfunction High-quality abstracts on new diagnostic tools, drug use and combi therapies Mr. Nikesh Thiruchelvam Dept. of Urology Cambridge (UK)
There were many interesting abstracts and this article will focus on lower urinary tract dysfunction but not on male and female incontinence or benign prostatic enlargement. The emphasis is also on presentations regarding investigations, medications, nocturia and emerging technologies. Investigation of lower urinary tract dysfunction Urodynamics remains the gold standard when investigating symptoms of lower urinary tract dysfunction (LUTD) but this test is expensive and can be uncomfortable, and causes haematuria and urinary tract infection. Sanson et al (#271) described a unique study of using Sphingosine-1-Phosphate (S1P), a nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) as biomarker of detrusor overactivity (DO). Using ELISA, they examined the urine of 16 multiple sclerosis patients with lower urinary tract symptoms (LUTS) and found that, compared to 36 patients with LUTS and no neurological disease, urinary levels of S1P were significantly higher (70.10 ± 33.70 ng/ml vs 2.456 ± 1.054 ng/ml, p = 0.0006) and following treatment with an anticholinergic or intradetrusor botulinum toxin, S1P levels fell in the both groups. This study describes a novel potential biomarker to noninvasively diagnose LUTD.
Medications Many patients use statins to improve their cardiovascular risk profile but the effect on LUTD is unknown. Jeong et al (#105) examined prostate volume (PV) in men who were taking statins for at least three years; they found that, as compared to a similar group of men who were not taking statins, PV reduced, although there was no difference in IPSS scores or PSA values. Mirabegron, a β3 agonist, was licenced for use in OAB in 2014 and since then, general confidence in its use has increased. In 2015, in the UK, a safety alert was issued for mirabegron suggesting its use should be avoided in patients with uncontrolled high blood pressure and for patients to have their blood pressure monitored when they are started on treatment with mirabegron. However, Kato et al (#278) conducted surveys in 9700 patients and described only a 6% adverse risk event, including very low rates of tachycardia (0.05%) and hypertension (0.09%). Similarly, in a post-hoc analysis, Drake et al (#872) studied 2200 patients with OAB who were treated with sole agents or a combination of solifenacin and mirabegron. The team found no percentage change from baseline in blood pressure or heart rate in any of the three groups and only a 1mmHg increase in blood pressure in the combination group. Ito et al (#999) also found a low adverse event rate of 6.6% in patients on mirabegron compared to 21.9% of patients suffering adverse events whilst on anticholinergic agents. This group also found that at three years, only 14% of patients were still on anticholinergic medication as compared to 52% that remained on mirabegron (Figure 2). Ito et al (#999) also showed that nearly 69% of patients found mirabegron effective; Kato et al (#278)
described an impressive 80% improvement with mirabegron. Current knowledge primarily describes mirabegron in idiopathic OAB; Andretta et al (#656) also described efficacy with the use of mirabegron in patients with urinary incontinence (UI) in neurogenic bladders (primarily in spinal cord injured patients and those with MS. After mirabegron, UI improved in 70% and quality of life improved in 64% of these patients.
Figure 2: Persistence of therapy with mirabegron (Poster #999)
Nocturia Nocturia is difficult to treat and new avenues maybe helpful. Current regimes include cessation of fluids beyond 7pm, elevating the feet above the hips when sedentary, and the use of an early afternoon diuretic or desmopressin (http://patients.uroweb.org/library/ nocturia/). Rovner et al (#537) showed that in women with OAB and nocturnal polyuria, desmopressin and tolderidine in combination worked better than tolteridine alone in improving time –to-first-void and first-voided volume. Similarly, Yoshida et el (#538) found that mirabegron improved nocturnal frequency and voided volumes in female OAB patients with nocturia. Cho et al (#543) found that in men with LUTS who were already on an alpha-blocker, the addition of desmopressin, compared to placebo, reduced nocturia episodes and volume. As not all patients with nocturnal polyuria (NP) respond to
Another non-invasive possibility is to use transabdominal ultrasound. Chen et al (#101) developed a nomogram that predicted bladder outlet obstruction in male patients with symptoms of overactive bladder (OAB). As compared to standard urodynamics, their nomogram predicted BOO in these patients using flow rates, PSA, bladder wall thickness and intraprostatic protrusion (as measured by transabdominal ultrasound). Flow rates can be difficult to capture in patients with LUTD as they may have difficulties with urgency and holding sufficient volumes. Rogel et al (#99) used a self-reported visual uroflow diagram (Figure 1) and reported strong correlation between self-reported flow rates and traditional maximum flow rates, measure using uroflowmetry. Figure 1: Visual uroflow diagram (Poster #99)
desmopressin, Bruneel et al (#539) studied copeptin, a vasopressin surrogate, to identify which patients may benefit from desmopressin treatment. They found that patients with global polyuria had a significant lower daytime copeptin levels as compared to patients with NP or controls, suggesting the possible role of copeptin in the differential diagnosis of global polyuria and NP. Emerging treatments There were two exciting studies worthy of mention. Firstly, Matos et el (#282) conducted a phase 1 trial injecting bone marrow-derived mesenchymal stem cells directly into lesions following laminectomy and durotomy in 14 patients with chronic traumatic SCI (> 6 months). Nine patients had improvements in bladder function including an increase in bladder capacity and filling volume and development of new bladder sensation. In a rabbit model, Kaya et al (#986) injected decorin (known to inhibit the activity of TGF-beta 1) into the detrusor muscle of obstructed bladders to determine if decorin could prevent bladder fibrosis. The authors found that decorin intradetrusor injection reduced collagenase activity and increased contractility to stimulants and that this agent may have a future role in preventing bladder fibrosis. Take home messages There were a significant number of high quality abstracts on LUTDs. Key points include the development of novel avenues to diagnose LUTD, increasing confidence and knowledge in the use of mirabegron, combination therapies to aid in nocturia treatment and ongoing investigation to treat neuropathic and fibrotic bladders.
31st Annual EAU Congress
31st Annual EAU Congress Delegates per country
The red colour corresponds to the number of delegates per country (the more intense the colour, the larger the representation)
EAU/EAUN 2016 Registrations per category EAU members Non EAU members Residents EAU member Residents non EAU member Total delegates EAU Congress
European Urology Today
3,295 4,564 1,503 267 9,629
Nurses EAUN member Nurses non EAUN member Total delegates EAUN Meeting Total delegates EAU Congress/EAUN Meeting
165 111 276
Exhibitors 2,318 Press 152
EAU16: Highlights in oncology Studies tackle diagnostic tools, treatment and follow-ups Dr. Roman Sosnowski Maria SklodowskaCurie Memorial Cancer Center Dept. of Urology Oncology Warsaw (PO)
cancer, post radiotherapy. However, most interestingly, ADT, in combination with radiotherapy, did not affect the incidence of secondary BC. The authors concluded that there is some significance in the incidence rate of secondary BC, post-radiotherapy; in addition, a patient’s smoking history may be helpful in navigating therapeutic selection for prostate cancer.
Data has been presented (Dell'Oglio et al. #509, Fröhner et al. #510) in which individual co-morbid conditions from the Charlson Comorbidity Index (CCI) are independently associated with the results of radical cystectomy or prostatectomy. One of the In recent years, a clear trend towards ageing, in aforementioned researchers discovered that four of society, vis-à-vis care for the elderly, is evident. the 17 conditions in the CCI, such as chronic This is due to many factors, inter alia, ever more pulmonary disease, diabetes without complications, efficient, oncological treatment. The above also cerebro-vascular disease and congestive heart failure, impacts on that cross-section of our patients who are the most prevalent groupings of co-morbid are simply getting older. conditions, post-radical cystectomy. The other group of researchers discovered that, based on their This situation requires a special approach at each analysis, age, angina pectoris, chronic lung disease, stage of the treatment process. Adequate diagnostic peripheral vascular disease, cerebrovascular disease, tools, a proper assessment of risk factors, the choice of appropriate treatment methods, suitable care, both diabetes mellitus, moderate or severe renal disease, current smoking and ASA class 3-4, are independent during and after surgery and appropriate follow-ups – all these topics were discussed in papers presented predictors of competing mortality, post-radical during EAU16 in Munich. As the space available in this cystectomy or prostatectomy. Based on these results, they have created a combined mortality index, which edition is limited, I would like to present just a few could be used to predict competing mortality in selected papers. candidates for radical cystectomy or radical prostatectomy. A research group from Japan (Shiota et al. #60) analysed the medical history of patients with prostate Recently, sarcopenia has been discovered to be a cancer who had been treated with radiotherapy, surgical therapy and primary ADT. During the median novel, objective and pre-operative prognostic factor in follow-up period of between 45-51 months, secondary various types of cancers. There were two abstracts (Hirasawa et al. #513, Fukushima et al #809) in which bladder cancer (BC) occurred in 14 (2.2%), 5 (1.1%), the authors evaluated the prognostic significance of and 0 (0%), respectively, of those patients whose pre-operative parameters, including sarcopenia, in prostate cancer had been treated with radiotherapy, patients who had undergone radical cystectomy (RC) surgical therapy and ADT. Age and smoking history or nephron-ureterectomy. Based on the results of the were significant risk factors in secondary bladderroman.sosnowski@ gmail.com
second group, sarcopenia, among other parameters, such as clinical T stage, neutrophil-to-lymphocyte ratio, was a significantly independent predictor of an adverse prognosis, post-RC. An important issue regarding urinary diversion, especially orthotopic bladder substitutes (OBS), are long-term complications, particularly in the elderly. Researchers from Berne (Furrer et al. #622) reported their observations, which had taken place over two decades on OBS patients. Firstly, complications can occur; however, the majority of these are diversionrelated; nevertheless, with close follow-up, most of these conditions are treatable endo-urologically. Secondly, with proper patient selection and correct surgical techniques, excellent urinary continence and renal function can be preserved for decades. In spite of this, RC still remains the gold standard in the treatment of muscle-invasive bladder cancer (MIBC) and for that proportion of elderly patients who are unfit for RC because of its significant morbidity rates. Doctors in Japan (Fujii et al. #626) have evaluated the oncological and functional outcomes of MIBC treatment with bladder-sparing protocol. This protocol consists of debulking TURB followed by low-dose chemo-radiotherapy and, for those patients showing no massive residual disease, partial cystectomy. Patients achieved excellent, five-year, survival results (MIBC-RFS, CSS, OS) regardless of the age of the patient, some of whom were more than 75 years old while others were less than that age. Both elderly and younger patients maintained a high QoL with an intact and functioning bladder after their treatment. Partial nephrectomy (PN) is the gold standard for small renal masses. A German team (Pop et al. #984) attempted to discover which groups of patients
profited most by undergoing PN and for whom radical nephrectomy (RN) is still a good option. The team came to the conclusion that there were several significant differences in OS between PN and RN patients. Elderly patients and those patients suffering from hypertension at diagnosis, benefit significantly from NSS. Thus, the presence of cardiovascular risk factors and comorbidities should be the main criteria in decision-making, ahead of surgery. When RN is performed, one of the more important issues is long-term renal function. The Japanese research team (Kawamura et al. #529) presented their results, which were taken from over 700 patients who had undergone RN. Overall, the mean eGFR, which decreased at one-year, post RN, recovered to 51.3mL/min/1.73 m2 at 10 years, post RN. Statistical analysis revealed that more advanced age (≥ 65 years) and diabetes mellitus were independent risk factors for severe renal impairment. They concluded that for those groups of patients, special attention is needed.
EAU16: Highlights in urethral reconstruction Challenges and prospects in urethral reconstruction Prof. Dr. Nicolaas Lumen Dept. of Urology Ghent University Hospital Ghent (BE) nicolaas.lumen@ uzgent.be There is an emerging effort among urethral surgeons to minimize the impact of urethral reconstruction. From a patient’s perspective the hospital stay is important and the question arises whether urethroplasty can be done as a day-care procedure. Zaid et al. (#322) assessed the safety of urethroplasty as day-care surgery (DCS) versus urethroplasty during hospital admission (HA). Emergency room visits (7.8% vs. 15.4%), readmission rates (4.5% vs. 7.7%) and complaints about the urinary catheter (7.8% vs. 15.3%) were lower in the group treated as DCS. A selection bias might be present as “simple” cases are likely to be treated in DCS whereas more complex cases, that are prone for a higher complication rate, are more likely to be treated during HA. At least this abstract shows that it is feasible to perform “simple” urethroplasty in DCS. The non-transection anastomotic repair has been described for short bulbar strictures with the advantage of sparing the urethra’s dual blood supply. Bugeja et al. (#324) designed a modification of the graft augmented anastomotic repair for somewhat longer strictures in which the ventral spongious tissue is spared as well. All 26 patients were successfully treated after a median follow up of 19 months. Persistent erectile dysfunction was reported in 1 (3.8%) patient. This so-called ANTABU (Augmented non-transecting anastomotic bulbar urethroplasty) is a further effort to spare the surrounding tissues during urethroplasty whenever possible.
Many, especially young patients, dislike scars at the penis after penile or penobulbar urethroplasty. Martins et al. (#1158) reported a perineal approach with penile inversion to access the penile urethra without scars at the penis itself (“Kulkarni”technique). The ultimate goal is to preserve the penile appearance. Of 431 patients, 85.4% were treated successfully after a median follow-up of 51 months. Moreover, 92.1% were satisfied with the penile appearance after urethroplasty. Treatment of lower urinary tract morbidity after radical prostatectomy Strictures at the vesico-urethral anastomosis after radical prostatectomy are a challenging problem. Historically, many patients were treated by intermittent dilation and if this was not possible by a suprapubic catheter or by another form of urinary diversion. Rosenbaum et al. (#1153) reported the outcome of endoscopic incision of vesico-urethral strictures (VUS) in 86 patients with a median follow-up of 27 months. Success rate was only 38.4%, but this is in line with more recent studies reporting on the outcome of endoscopic incision for urethral strictures. De novo incontinence was reported in 14%. Median time to recurrence was 3 months. In case of a highly recurrent stricture despite dilation or endoscopic incision, transperineal reanastomosis (TPRA) can be attempted. An advantage is the access to the stricture by tissues that have not been previously operated. Furthermore, TPRA attempts a complete resection of the fibrosis which is not the case with endoscopic incision. Schüttfort et al. (#325) described the outcome of 21 patients with a median follow-up of 46 months treated by TPRA for highly recurrent (≥ 3 previous endoscopic attempts) VUS. Success rate was 85.7% and 18.8% reported worsening of the incontinence. However 80% of patients were already incontinent before TPRA and were later treated by an artificial urinary sphincter (AUS). Improvement in quality of life and patient satisfaction was high (respectively 75 and 80%).
As mentioned, there is a risk of urinary incontinence after treatment. This can be treated by implantation of AUS. Bugeja et al. (#321) reported on the outcome of AUS in patients previously treated for VUS after radical prostatectomy. AUS after endoscopic treatment (n = 50) and TPRA (n = 9) resulted in a favorable result (“dry and unobstructed) in, respectively, 80 and 89% of cases. It is important is to leave a sufficient time interval (at least 3 months) between treatment of VUS and implantation of AUS in order to rule out an early recurrence of VUS. Timing of graft in two-stage urethroplasty Complex penile strictures are usually treated by a two-stage urethroplasty in which the urethral plate is augmented or resected and replaced by an oral graft. This graft is classically incorporated during
the first stage. However, there is a major concern as an oral graft is not used to a dry environment which can lead to graft contraction and need for additional procedures. Therefore, it might be better to incorporate the graft during the second stage. This was the subject of a study by Kulkarni et al. (#1160), in which the graft was incorporated during the first stage (n = 38) or the second stage (n = 30). Stricture recurrence was equal in both groups (resp. 10 and 10.5%). No patient needed an additional procedure because of graft contraction, fistula or dehiscence when the graft was incorporated during the second stage. However, 25%, 20% and 10% of patients needed, respectively, an additional procedure for graft contraction, fistula or dehiscence when the graft was incorporated during the first stage.
31st Annual EAU Congress March/May 2016
European Urology Today
Overview of prizes and awards EAU Willy Gregoir Medal 2016 W. Artibani, Verona, Italy - Handed out by C.R. Chapple
EAU Frans Debruyne Life Time Achievement Award 2016 P. Teillac, Toulouse, France - Handed out by C.R. Chapple
Friday, 11 March EAU Crystal Matula Award 2016 A. Briganti, Milan, Italy Supported by an educational grant from LABORIE - From left to right: A. Briganti, B. Ellacot (LABORIE) and C.R. Chapple
EAU Hans Marberger Award 2016 M. Gundeti, Chicago, United States of America Supported by an educational grant from KARL STORZ GMBH & CO.KG - From left to right: M. Gundeti, S. Storz (KARL STORZ GMBH & CO.KG) and C.R. Chapple
EAU Innovators in Urology Award 2016 J.M. Gil-Vernet Vila, Barcelona, Spain - Handed out by C.R. Chapple
New EAU Honorary Members
P-A. Abrahamsson, Malmö, Sweden - Handed out by C.R. Chapple
J. Hosseini, Tehran, Iran - Handed out by C.R. Chapple
G. Janetschek, Salzburg, Austria - Handed out by C.R. Chapple
V. Tkachuk, St. Petersburg, Russia - Handed out by C.R. Chapple
EAU Prostate Cancer Research Award 2016 J. Pencik, Vienna, Austria Supported by an educational grant from the FRITZ H. SCHRÖDER FOUNDATION - From left to right: Z. Culig, who accepted the award on behalf of J. Pencik, F.H. Schröder (FRITZ H. SCHRÖDER FOUNDATION) and C.R. Chapple K. Parsons, Liverpool, United Kingdom - Handed out by C.R. Chapple
Y. Sun, Shanghai, China - Handed out by C.R. Chapple
M. Marberger, Vienna, Austria - Handed out by C.R. Chapple
Prize for the Best Paper published on Clinical Research in the Urological Literature
Prize for the Best Paper published on Fundamental Research in the Urological Literature P. Uvin, J. Franken, S. Pinto, R. Rietjens, L. Grammet, Y. Deruyver, Y.A. Alpizar, K. Talavera, R. Vennekens, W. Everaerts, D. De Ridder, T. Voets (Leuven, Belgium) For the paper: ‘Essential Role of Transient Receptor Potential M8 (TRPM8) in a Model of Acute Cold-induced Urinary Urgency’ Eur Urol. 2015 Oct;68(4):655-61. doi: 10.1016/j. eururo.2015.03.037. - From left to right: J. Franken, P. Uvin and C.R. Chapple
A. Mitra, L. Lam, M. Ghadessi, N. Erho, I.A. Vergara, M. Alshalalfa, C. Buerki, Z. Haddad, T. Sierocinski, T. Triche, E. Skinner, E. Davicioni, S. Daneshmand, P. Black (Los Angeles, Stanford, United States of America; Vancouver, Canada) For the paper: ‘Discovery and Validation of Novel Expression Signature for Postcystectomy Recurrence in High-Risk Bladder Cancer’ J Natl Cancer Inst. 2014;106(11):1-9. doi: 10.1093/jnci/dju290. - Handed out by C.R. Chapple
Award Gallery Friday, 11 March
Prize for the Best Scientific Paper published in European Urology N. James, M. Spears, N. Clarke, D. Dearnaley, J. De Bono, J. Gale, J. Hetherington, P. Hoskin, R. Jones, R. Laing, J. Lester, D. McLaren, C. Parker, M. Parmar, A. Ritchie, J. Martin Russell, R. Strebel, G. Thalmann, M. Mason, M. Sydes (Coventry, London, Manchester, Portsmouth, Sutton, Hull, Middlesex, Glasgow, Cardiff, Edinburgh, United Kingdom; Chur, Berne, Switzerland) For the paper: ‘Survival with Newly Diagnosed Metastatic Prostate Cancer in the “Docetaxel Era”: Data from 917 Patients in the Control Arm of the STAMPEDE Trial (MRC PR08, CRUK/06/019)’ Eur Urol. 2015 Jun;67(6):1028-38. doi: 10.1016/j.eururo.2014.09.032. Supported by an educational grant from ELSEVIER - From left to right: S. Boer Iwema (ELSEVIER), N. Clarke, who accepted the award on behalf of N. James and J. Catto
Prize for the Best Scientific Paper published on Fundamental Research in European Urology
E. Efstathiou, M. Titus, S, Wen, A. Hoang, M. Karlou, R. Ashe, S. Ming Tu, A. Aparicio, P. Troncoso, J. Mohler, C. Logothetis (Houston, Buffalo, United States of America; Athens, Greece) For the paper: ‘Molecular Characterization of Enzalutamide-treated Bone Metastatic Castrationresistant Prostate Cancer’ Eur Urol. 2015 Jan;67(1):53-60. doi: 10.1016/j.eururo.2014.05.005. Supported by an educational grant from ELSEVIER - From left to right: S. Boer Iwema (ELSEVIER), E. Efstathiou and J. Catto
31st Annual EAU Congress 6
European Urology Today
at the 31st Annual EAU Congress Prize for the Best Scientific Paper published on Robotic Surgery in European Urology
Prize for the Best Scientific Paper published on Clinical Research in European Urology P. Abrams, C. Kelleher, D. Staskin, T. Rechberger, R. Kay, R. Martina, D. Newgreen, A. Paireddy, R. van Maanen, A. Ridder (Bristol, London, Bakewell, United Kingdom; Boston, United States of America; Lublin, Poland; Leiden, The Netherlands) For the paper: ‘Combination Treatment with Mirabegron and Solifenacin in Patients with Overactive Bladder: Efficacy and Safety Results from a Randomised, Double-blind, Dose-ranging, Phase 2 Study (Symphony)’ Eur Urol. 2015 Mar;67(3):577-88. doi: 10.1016/j.eururo.2014.02.012. - Handed out by J. Catto
A. Volpe, K. Ahmed, P. Dasgupta, V. Ficarra, G. Novara, H. van der Poel, A. Mottrie (Aalst, Belgium; Torino, Novara, Udine, Padua, Italy; London, United Kingdom; Amsterdam, The Netherlands) For the paper: ‘Pilot Validation Study of the European Association of Urology Robotic Training Curriculum’ Eur Urol. 2015 Aug;68(2):292-9. doi: 10.1016/j.eururo.2014.10.025. Supported by an educational grant from VATTIKUTI FOUNDATION - Handed out by J. Catto
First Prize for the Best Abstract (Oncology)
First Prize for the Best Abstract (Non-Oncology)
M. Roumiguie, V. Laurent, A. Toulet, F. Zaidi, P. Valet, C. Mazerolles†, B. Malavaud, C. Muller (Toulouse, France) For the abstract: ‘136 Periprostatic adipose tissue acts as a driving force for the local invasion of prostate cancer in obesity: Role of the CCR3/CCL7 axis’ - Handed out by A. Stenzl
Second Prize for the Best Abstract (Oncology) M. Stares, D. Nicol, T. O'Brien, B. Challacombe, A. Rowan, S. Horswell, M. Salm, A. Soultati, S. Hazell, A. Chandra, J. López, R. Fisher, S. Chowdhury, S. Rudman, M. Gore, J. Larkin, N. Matthews, S. Turajlic, C. Swanton (London, United Kingdom; Bilbao, Spain) For the abstract: ‘221 Multi-region whole exome sequencing reveals monoclonal nature of inferior vena cava tumour thrombus extension in clear cell renal cell carcinoma’ - Handed out by A. Stenzl to T. O’Brien who accepted the award on behalf of M. Stares
J. Damsgaard, U. Joensen, E. Carlsen, J. Erenpreiss, M. Jensen, V. Matulevicius, I. Olesen, A. Perheentupa, M. Punab, A. Salzbrunn, J. Toppari, H. Virtanen, B. Zilaitiene, A. Juul, N. Skakkebæk, N. Jørgensen (Copenhagen, Roskilde, Denmark; Riga, Latvia; Kaunas, Lithuania; Turku, Finland; Tartu, Estonia; Hamburg, Germany) For the abstract: ‘176 Varicocele is negatively associated with semen quality and hormone levels: A study of 7067 men from six European countries’ - Handed out by A. Stenzl
Second Prize for the Best Abstract (Non-Oncology) K. Ichihara, N. Aizawa, R. Sugiyama1, H. Ito, J. Kamei, Y. Akiyama, N. Masumori, K-E. Andersson, Y. Homma, Y. Igawa (Tokyo, Sapporo, Japan; Aarhus, Denmark) For the abstract: ‘419 Toll like receptor 7 is overexpressed in the bladder mucosa of Hunner type interstitial cystitis and its activation in the mouse bladder induces cystitis and pain’ - Handed out by A. Stenzl to Y. Igawa who accepted the award on behalf of K. Ichihara
Third Prize for the Best Abstract (Oncology) S. Salami, D. Hovelson, R. Mathieu, M. Susani, N. Rioux-Leclercq, J.Tracey, S. Shariat, S. Tomlins, G. Palapattu (Ann Arbor, United States of America; Vienna, Austria; Rennes, France) For the abstract: ‘142 Next generation sequencing to determine the clonal origin of lymph node metastasis in multifocal prostate cancer: Defining the biologically dominant nodule’ - Handed out by A. Stenzl
Third Prize for the Best Abstract (Non-Oncology) L. Schneidewind, T. Neumann, W. Krueger, M. Burchardt (Greifswald, Germany) For the abstract: ‘269 First results of a prospective study on urological complications under allogenic stem cell transplantation (aSCT) – analysis focused on viral urological infections’ - Handed out by A. Stenzl
The European Urology Platinum Award 2016
International Friendship Dinner Sunday, 13 March M. Gettman, Rochester, United States of America - From left to right: C.R. Chapple, M. Gettman and J. Catto
G. Thalmann, Berne, Switzerland - From left to right: C.R. Chapple, G. Thalmann and J. Catto
First Video Prize N. Doumerc, J. Beauval, M. Roumiguié, X. Game, N. Kamar, F. Sallusto, M. Soulié, P. Rischmann (Toulouse, France) For the video: ‘V47 A new surgical area opened in renal transplantation: A pure robot-assisted approach for both living donor nephrectomy and kidney transplantation using transvaginal route’ - From left to right: F. Gaboardi, N. Doumerc and A. Messas
Video Award Session Sunday, 13 March Third Video Prize
Second Video Prize A. Minervini, R. Campi, A. Mari, F. Sessa, A. Martini, M. Smaldone, S. Serni, R. Uzzo, M. Carini, A. Kutikov (Florence, Italy; Philadelphia, United States of America) For the video: ‘V46 Prospective evaluation of the Surface-IntermediateBase (SIB) margin score for standardized reporting of resection technique during Robot-Assisted Partial Nephrectomy (RAPN) in a high-volume center: A step-by-step tutorial’ From left to right: F. Gaboardi, N. Doumerc and A. Messas
N-S. Vuong, C. Michiels, Y. Grassano, F. Cornelis, P. Tran, H. Siméon, G. Pierquet, M. Yacoub, G. Pasticier, G. Robert, H. Bensadoun, N. Grenier, J-M. Ferrière, J-C. Bernhard (Bordeaux, France) For the video: ‘V45 Benefit of the superselective clamping technique for multiple robot assisted tumorectomies’ - From left to right: F. Gaboardi, N. Doumerc and A. Messas
31st Annual EAU Congress March/May 2016
European Urology Today
Overview of prizes and awards at the 31st Annual EAU Congress Section Awards Saturday, 12 March
René Küss Prize 2016 L. Peri Cusi, Barcelona, Spain For the poster: ‘74 - Maastricht 2 DCD donors with normothermic recirculation: A valuable source for organs to transplant’ - From left to right: E. Lledo Garcia, L. Peri Cusi and A. Figueiredo
ESUI Vision Award 2016
Best Booth Award 2016
M. Ritter, Mannheim, Germany For the study ‘The Uro Dyna-CT Enables Three-dimensional Planned Laser-guided Complex Punctures’ Supported by an educational grant from INVIVO CORPORATION producer of UroNav, a MRI / ultrasound prostate biopsy solution. From left to right: J. Walz, M. Ritter and A. Kypriotis (INVIVO CORPORATION)
IPSEN - From left to right: A. Soares, J. Mallet, H. Arditti, C. Chapple (EAU), P. Cabri, M. Brassart, P. Hazenberg (EAU), M. Alinquant (IPSEN)
Campbell Team Challenge Quiz
EUSP Best Scholar Award 2016
The winner of the Campbell Team Challenge Quiz
I. Lucca, Vienna, Austria For the project: ‘Gene expression of DNA methylation- and histone modification-related genes as epigenetic urinary biomarker panel of bladder cancer: a case-control study’ - From left to right: M. Sedelaar, M. Ribal, I. Lucca, V. Mirone and S. Müller
I. Bláha (Madrid, Spain)
First Prize for the Best Abstract by a resident
M. Roumiguie, V. Laurent, A. Toulet, F. Zaidi, P. Valet, C. Mazerolles†, B. Malavaud, C. Muller (Toulouse, France) For the abstract: ‘136 Periprostatic adipose tissue acts as a driving force for the local invasion of prostate cancer in obesity: Role of the CCR3/CCL7 axis’ - Handed out by G. Patruno
Saturday, 12 March Third Prize for the Best Abstract by a resident
Second Prize for the Best Abstract by a resident
A. Aziz, P. Bes, F. Chun, J. Dobruch, L. Kluth, P. Gontero, A. Necchi, A. Noon, B. Van Rhijn, M. Rink, F. Roghmann, M. Roupret, R. Seiler, S. Shariat, B. Qvick, E. Xylinas, (Hamburg, Herne, Germany; Warsaw, Poland; Turin, Milan, Italy; Toronto, Canada; Amsterdam, The Netherlands; Berne, Switzerland; Vienna, Austria; Paris, France) For the abstract: ‘216 Discrepancy between guidelines and daily practice in the management of non-muscle-invasive bladder cancer (NMIBC): Results of a European survey’ - No photo available
A. Fernando, C. Horsfield, J. Pattison, D. D'Cruz, T. O'Brien (London, United Kingdom) For the abstract: ’27 Exploring the potential of fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) to improve clinical decision making in patients with retroperitoneal fibrosis (RPF)?’ - Handed out by G. Patruno
Resident’s Corner Awards - Awards for the two Best Scientific Papers published in European Urology by a resident A. Azad, B. Eigl, R. Nevin Murray, C. Kollmannsberger, K. Chi (Vancouver, Canada) For the paper: ‘Efficacy of Enzalutamide Following Abiraterone Acetate in Chemotherapy-naive Metastatic Castration-resistant Prostate Cancer Patients’ - No photo available
N. Fossati, N. Buffi, A. Haese, C. Stephan, A. Larcher, T. McNicholas, A. de la Taille, M. Freschi, G. Lughezzani, A. Abrate, V. Bini, J. Palou, M. Graefen, G. Guazzoni, M. Lazzeri (Milan, Perugia, Italy; Hamburg, Berlin, Germany; Stevenage, United Kingdom; Creteil, France) For the paper: ‘Preoperative Prostate-specific Antigen Isoform p2PSA and Its Derivatives, %p2PSA and Prostate Health Index, Predict Pathologic Outcomes in Patients Undergoing Radical Prostatectomy for Prostate Cancer: Results from a Multicentric European Prospective Study’ - Handed out by G. Patruno
First Prize for the Best EAUN Poster Presentation M. Boarin, P.M.V. Rancoita, A. Crescenti, R. D’Onghia, E. Gianandrea, G.Villa (Milan, Italy) For the poster: ‘The early implementation of oral diet in patients undergoing radical cystectomy improves postoperative outcomes’ Supported by an educational grant from AMGEN - From left to right: S. Terzoni, M. Boarin and D. Niepel (AMGEN)
EAUN Meeting Monday, 14 March
Second Prize for the Best EAUN Poster Presentation F. Geese, R. Willener, S. Zehnder, E. Spichiger (Berne, Switzerland) For the poster: ‘Changing perspective! Patients with prostate cancer and their partners giving an insight into their experiences of disease and optimal potential of an advanced practice nurse counselling support program in Switzerland’ Supported by an educational grant from AMGEN - From left to right: S. Terzoni, F. Geese and D. Niepel (AMGEN)
Third Prize for the Best EAUN Poster Presentation
L. Balin (Karmiel, Israel) For the poster: ‘Choice and insertion of the urinary catheter: Comparison of urology vs internal medicine department nurses’ Supported by an educational grant from AMGEN - No photo available
31st Annual EAU Congress 8
European Urology Today
Urology Beyond Europe High attendance at AAU-EAU Joint session Prof. Hassan AbolEnein Past President, Arab Association of Urology Urology & Nephrology Center Mansoura (EG) hassanabolenein@ hotmail.com During the last few years we have witnessed the remarkable efforts in Europe to widen the exchange of urological knowledge beyond its borders. Ever since the EAU has provided an exchange platform during its annual congress for European urologists and their peers from other regions, the Urology Beyond Europe (UBE) sessions have become a much-awaited part of the Annual EAU Congress. Like in the other joint sessions, the Arab Association of Urology (AAU) session with the EAU has attracted urologists from both regions not only to provide updates but also to renew friendships and create new contacts. The sessions also enable some urologists to further discuss a specific urological challenge in their region or to approach an expert and invite them to
A high participation during the AAU-EAU Joint Session
participate in their local meetings and training courses. Thus, the Urology Beyond Europe sessions have provided a reliable window of opportunity for many local organisers to get in touch with international lecturers and speakers. My experience during the last five years has shown that the AAU and the EAU have both maintained a high level of collaboration that enabled them to offer a well-organized programme, and we have seen this in the commitment of EAU Sec. General Chris Chapple to provide active support to the local organisers of the AAU-EAU joint session. This year’s AAU-EAU’s Scientific Programme included well-received state-of-the-art lectures, debates, instructive videos and panel discussions led by speakers from both regions. We organised three sessions with topics that included controversial urology issues, contemporary challenges, debates on conventional standard techniques versus modern minimal invasive interventions, among other areas. We have seen the enthusiastic participation of the invited speakers and the insights they shared were all appreciated by the audience. The author presented a video showing how nervesparing radical cystectomies in male patients were done. Prof. Hein Van Poppel (BE) discussed partial nephrectomy for renal tumours while Prof. Luis Martinez-Pineiro (ES) provided tips and tricks in posterior urethroplasty. The second session took up bladder disorders with Prof. Chapple giving an excellent overview on overactive bladder and Dr. Bulbul (LB ) discussing the timing for cystectomy in non–muscle invasive bladder cancer (NMIBC). Prof. Jens Rassweiler (DE) and the author also debated on the topic “Do we need robotic radical cystectomy versus open procedure?” The debate closely examined the
A meeting between the BOC of the EAU and the AAU to discuss plans and the scope of cooperation
issue, but open surgery remains the preferred technique since robotic technology is still not widely available in the Middle East with the experience of many local surgeons still limited. The last session took up the treatment of erectile dysfunction (ED) in cases when oral medical treatment fails (Dr. Shamsodin, QA), urethroplasty challenges and alternatives (Prof. Chapple), and Prof. Andrea Tubaro (UT) who lectured on prostatectomy for benign prostatic hyperplasia (BPH). We are encouraged by the full attendance with some of the audience standing in the back
rows, and we estimated that there were at least around 700 to 800 urologists, representing 15 Arab countries and a significant number from non-Arab and European countries as well. Last but not least, I thank the EAU for their efforts and commitment to actively involve their non-European counterparts which really makes the Annual EAU Congress a global conference for all.
Moderators Prof. A. Al-Zarooni and N. Al-Hamdani with the Chairs of the AAU-EAU Joint Session, Profs. H. Abdol-Enein and C. Chapple
31st Annual EAU Congress
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USANZ and EAU sign agreement in Munich Non-European group to sign up for block membership Prof. Mark Frydenberg President, USANZ Chairman, Dept. of Urology Monash Health Melbourne (AU)
In addition, it provides our members access to the vast resources of the EAU, including European Urology access, educational products to assist with continuing medical education, access to multiple meetings including sub-speciality meetings, patient information resources, and opportunities for travelling fellowships for both consultants and trainees alike.
Whilst we are aware of the many opportunities that will present themselves to USANZ members by being international members of EAU, we sincerely hope that It was with great pleasure that as president of the our European colleagues will enjoy attending and Urological Society of Australia and New Zealand participating in our high-quality annual scientific (USANZ), I signed the agreement during EAU16 in meeting, and would participate in visiting professor Munich to enable block membership for all Australian programmes to our centres. and New Zealand urologists and residents who are USANZ members to be EAU international members. We also plan to create a robust list of the urology sub-speciality fellowships available in Australia and This initiative followed the successful exchange of New Zealand, accessible via the USANZ website to European residents attending our USANZ trainee encourage applications from European residents. We week, and Australian and New Zealand residents also extend a warm welcome to European consultant attending the EUREP. While this initiative has been urologists who wish to travel to our centres for happening over the last few years and with very observational visit. positive feedback from both organisations, the USANZ/EAU relationship has developed further We firmly believe that this relationship has the following the endorsement of the EAU guidelines enormous potential to benefit EAU members and by USANZ in 2015, and the appointment of residents, as well as the undeniable benefit for Associate Professor Jeremy Grummet as the USANZ members. We look forward to our inaugural USANZ associate of the EAU guidelines membership in the EAU and to further strengthen committee in Munich. this relationship in the coming years. This growing relationship then allowed USANZ and EAU to explore the possibility of a block EAU membership for all USANZ members. This initiative was ratified by the Board of USANZ in late 2015 and the contracts signed in Munich. USANZ hopes that this will further increase the participation of our members in European urological activities in the future such as reviewing abstracts, and participating as chairpersons and speakers for the annual meeting, and serving as reviewers and (hopefully) editorial board members for European Urology.
The membership agreement between EAU and USANZ was signed in Munich
En-bloc membership The EAU offers a range of benefits for national and regional societies which have entered into en-bloc membership agreements. For urological societies where 80% of its current members are also EAU members, the advantages include discounted membership, reduced meeting
registration fees and free access to both print and online versions of the EAU Guidelines, the European Urology, the bi-monthly European Urology Today newsletter, the De Historia Urologiae Europaeae series and Urosource, among other entitlements. En-bloc members
enjoy the same privileges as full EAU members. For more details about the various types of EAU membership, contact us by email at firstname.lastname@example.org or call +31 (0)26 389 0680.
Constantinos Dimopoulos Beloved mentor, educator and urologist 1934-2015
Greek urology pioneer Prof. Constantinos Dimopoulos has recently died in Athens, Greece, following a lingering illness. He was 81. Born in Peloponnese, Greece, Dimopoulos was educated at the prestigious Medical School of Paris where he worked for almost a decade as urologist in several hospitals, specializing in innovative techniques. He returned to his homeland in 1964 and became a director of the Department of Urology at the General State Hospital of Athens. He was elected professor and head of the Department of Urology of the Medical School of the National and Kapodistrian University of Athens at “Laiko” Hospital. Dimopoulos is known for his contributions to Greek urology through his work at Laiko Hospital and for having established the first Endourology Section in Greece. One of the European Association of Urology (EAU) founding members, he actively organised and supported regional and international conferences and helped developed strong bonds among urological professionals. A beloved mentor, he encouraged many young doctors who later became opinion leaders and experts.
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Dimopoulos was elected in 1997 as Rector of the National and Kapodistrian University of Athens. He actively engaged in many academe-based activities such as creating a post-graduate programme at Athens University’s Department of Political Sciences and contributing to the renovation of various administrative departments. In 2000, he helped create the University of Peloponnese and became president of the University’s Steering Committee. He retired in 2001 and received the title of Honorary Professor. For his internationally renowned scientific and academic work, Dimopoulos was honoured in 1989 by the French President François Mitterrand with the Chevalier of the Legion of Honour. In 2003, he also became Foreign Associate Member of the French Academy of Medicine. Dimopoulos is survived by his wife Olga, his children, Athanasios-Meletios, Ioanna and Maria and eleven grandchildren.
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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 email@example.com
Case study No. 46 A 51-year-old man presented with right lumbar pain and gross total haematuria. There were no other voiding symptoms. He works as a police officer and has a history of 30 years of cigarette smoking. Also, a previously asymptomatic 2 cm stone in the right renal pelvis has been present for 15 years. There had been two unsuccessful ESWL sessions several years ago. Due to the lack of effect the patient had decided not to have any more treatments and Figure 1 A and B: Abdominal CT scan before (left) and after (right) injection of contrast material. The thickened wall of the discontinued follow-up. renal pelvis measured less than 10 Hounsefield units.
Physical examination and routine clinical chemistry was normal. On urinalysis, marked leukocyturia as well as gross haematuria were seen. Urine culture and urine cytology were negative. A plain x-ray
Case study No. 47 This 47-year old woman was referred by an office urologist for treatment with the suspected diagnosis of renal cancer. She had been completely asymptomatic and an ultrasound done for a general health check-up had shown a left renal lesion. The ultrasound result was followed-up by computed tomography (CT) scanning (Fig.1 A-C). There was no relevant history of medical disease and the patient had no medications and is a non-smoker. A CT scan of the thorax showed no abnormalities and the full abdominal and pelvic CT did not show other lesions. Physical examination and clinical chemistry results were completely normal.
(KUB) shows a 25 mm dense opacity projecting on to the right renal area. In addition, a CT scan was performed (Figure 1). Discussion points: 1. What differential diagnosis should be considered? 2. Are further investigations needed? 3. Which treatment is appropriate? Case provided by Dr. Rami Boulma and Dr. Hassen Khouni, Dept. of Urology, Internal Security Forces Hospital, Marsa, Tunisia, email: rboulma@hotmail. com and firstname.lastname@example.org.
Diagnosis and perhaps treatment by flexible ureterorenoscopy Comments by Noor Buchholz Dubai (UAE)
culminating in the above symptoms. However, given long-standing mechanical irritation by the stone and smoking, a urothelial tumour cannot be excluded despite negative cytology (which would have shown inflammatory cells I assume). Also, the extend of thickening would be unusual for a pure inflammatory reaction.
There is a finding of a thickened renal pelvic wall around a renal pelvic stone that has been in place for 15 years at least. In addition, there is the risk of smoking. Manifestation is through macro haematuria and leukocyturia. No UTI. Urine cytology negative. The wall thickening may be a long-standing inflammatory reaction to the stone finally
Therefore, a flexible URS (fURS) with biopsies for diagnostic purposes seems adequate. If easy to do and under good visibility, low intrarenal pressures and a minimum of manipulation, the stone could be lasered in the same session. However, given the impaction on CT this might not be easily possible and could be deferred until biopsy results are available.
Don’t let inflammatory processes fool you Comments by Esteban Emiliani & Oliver Traxer Paris (FR)
2. Are further investigations needed?
With diagnostic uncertainties a proper cystoscopy and an endoscopic evaluation should be done to perform visual diagnosis, biopsies and in situ cytology of the renal cavities, flexible uretroscopy (fURS) being the most appropriate approach. If a tumour is found, the information given by the fURS (especially tumour grade) can change the treatment decision. 3. Which treatment is appropriate?
1. What differential diagnosis should be considered? There are two major diagnosis to be considered based on the patient’s symptoms and CT scan findings. First, the already known homogeneous 2.5 cm stone, hyperattenuated in the non-contrast CT, located in the right renal pelvis. After two failed ESWLs, probably a hard stone (>1000HU). Second, based on the absolute risk factor of a 30-year smoking history, the sudden gross haematuria after 15 years of asymptomatic stone disease and the renal pelvis irregularities with the 10 HU thickened wall in the CT scan, a differential diagnosis of upper tract carcinoma (UTUC) that mimics a benign inflammatory process has to be considered. Negative cytology could be in favour of a low-grade tumour, and it is known that UTUC hyperattenuates urine and the renal parenchyma 5 to 30 HU.
In treating this case there are some considerations: First, the EAU guidelines consider PCNL as the first treatment option for stones >2 cm although, fURS is also a safe and feasible option, with stone free rates up to 96% (with a possible two step procedure). Second, the guidelines also suggests fURS as the first approach for UTUC conservative treatment. Taking this into account, a reasonable surgical approach would be: To position the patient ready for an endoscopic combined supine approach. A fURS (as the less invasive approach) can be initially performed to visualise the pelvic wall lesion and extension and if necessary taking proper biopsies, selected cytology and begin a possible UTUC conservative laser treatment. fURS also allows the use of visual enhancement techniques as NBI to evaluate UTUC, although only initial reports have been published. If the urothelial lesion is not considered suspicious the surgeon may proceed to continue with the stone treatment with fURS or by a combined PCNL. If the urothelial lesion is suspicious, the stone treatment can be postponed after knowing the final pathology report, if a high grade lesion is diagnosed a nephroureterectomy should be done and the renal stone would not be a main concern.
Post-operatively, a JJ insertion and intravesical (plus right refluxive) Mitomycin C instillation would be desirable. If the biopsies come back negative, deferred flexible URS for the stone and follow up with imaging would be required. If clinical signs and thickening on CT recede over time, follow up with imaging might be sufficient, otherwise re-fURS with biopsies may be needed. If biopsies come back positive for tumour, radical treatment seems indicated in view of the age of the patient.
Case Study No. 46 continued The patient underwent surgery and in view of the possibility of renal pelvis malignancy consent was given for nephroureterectomy. Cystoscopy was done first and there was no bladder tumour. A pyelolithotomy through a lumbar approach was done, showing marked thickening of the perirenal tissues with a lot of chronic inflammatory changes of the renal pelvis. The stone was extracted and there were no macroscopic signs of malignancy in the renal pelvis. This was confirmed by histology which showed chronic inflammation and fatty necrosis but no malignancy or specificity. The postoperative course was uneventful and the patient was well on follow-up.
Figure 1 A-C: Abdominal CT scan
Discussion points: 1. What differential diagnosis should be considered? 2. Are further investigations needed? 3. Which treatment is appropriate? Case provided by Oliver Hakenberg, Dept. of Urology, Rostock University, Germany. Oliver.hakenberg@med. uni-rostock.de
References: Türk C, Petøík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016 Mar;69(3):475-82. Rouprêt M, Babjuk M, Compérat E, Zigeuner R, Sylvester RJ, Burger M, Cowan NC, Böhle A, Van Rhijn BW, Kaasinen E, Palou J, Shariat SF. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma: 2015 Update. Eur Urol. 2015 Nov;68(5):868-79. Giusti G, Proietti S, Peschechera R, Taverna G, Sortino G, Cindolo L, Graziotti P. Sky is no limit for ureteroscopy: extending the indications and special circumstances. World J Urol. 2015 Feb;33(2):257-73. Traxer O, Geavlete B, de Medina SG, Sibony M, Al-Qahtani SM. Narrow-band imaging digital flexible ureteroscopy in detection of upper urinary tract transitional-cell carcinoma: initial experience. J Endourol. 2011 Jan;25(1):19-23.
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Update from the Guidelines Office EAU Guidelines 2016 publications 2016 Guidelines print The EAU Annual Congress in March marked the publication of the 2016 EAU Guidelines; both pocket and extended versions.
Consensus-finding Earlier this year the EAU Guidelines Office set up a Consensus finding Committee (CONFIDENCE), chaired by Prof.Dr. Axel Bex supported by Dr. Giorgios Athanasiadis and Dr. Max Bruins.
the Male Sexual Dysfunction Panel (panel social media representative: Dr. Paolo Verze) with a considerable 7,772 impressions. Professor Carlos Llorente The Guidelines Office Board is sad to announce that professor Carlos Llorente, a board member for 8 years and Chairman of the Dissemination Committee has stepped down from the GO Board. However, he will continue to support the Guidelines Office as a member of the International Advisory Board representing South America. We would like to thank him for his unwavering commitment and hard work for the GO Board during his tenure and wish him well for the future. Professor Maria Ribal will be taking over the Dissemination Committee commitments. ASCO® endorses EAU Guideline on Muscle-invasive and Metastatic Bladder Cancer We are pleased to announce that the American Society of Clinical Oncology (ASCO) has formally endorsed the EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer (MIBC). The decision was recently announced and summaries will be included in a number of journals and websites. The first publication has been included in J Clin Oncol. 2015, Milowsky MI, et al. (Epub ahead of print).
The EAU GO aim to base their Guidelines on the highest level of available evidence and process information in a transparent and structured fashion. This resulted in the Guidelines Associates programme which currently supports well over 40 ongoing systematic reviews.
Prof.Dr. Axel Bex, CONFIDENCE Chair
However, high quality evidence is not available for many areas in clinical practice such as evolving fields or diagnostics or if studies are available, findings may be contradictory. If provision of guidelines recommendations is considered of importance, such recommendations can be based on consensus finding.
Traditionally, consensus finding was part of EAU Guidelines Panel dynamics and generally limited to The Chairman of the Board Background information from the Guidelines, within a specific Guidelines Panel. The EAU GO including systematic review protocols, can be viewed professor James N’Dow called considered this a limitation that needed addressing. online on the Uroweb pages under ‘Individual "The CONFIDENCE Committee will ensure that it “an important milestone”. Guidelines’. Some of this information is already consensus finding is done in an organised and available, but these pages will continue to grow in the transparent fashion, based on a standardised protocol coming months. Publication in the Journal of Oncology Practice, both in including involvement of all relevant stakeholders in print and on the website http://jop.ascopubs.org/ will the process." Please note that to access individual Guidelines and follow, as well as inclusion in ASCO’s Guideline Wiki their translations as PDFs, you must log in as a EAU site, www.asco.org/guidelineswiki and ASCO’s Stakeholder selection will depend on the topic member. Non-members are only able to view the guideline website, http://www.instituteforquality. selected, but for any urological guidelines such a documents on the website. org/practice-guidelines. group will include (aside from urologists), consumers (patients, the lay public and their families), clinicians 2017 Guidelines print ASCO has a rigorous set of procedures for endorsing from related areas (oncologists, radiologists, Attention now moves swiftly to the preparation of the clinical guidelines which have been developed by pathologists, physiotherapists, etc.), healthcare 2017 Guidelines. The focus this year will continue to other professional organisations. As part of this be on ensuring all Guidelines are based on detailed process, the EAU guideline was extensively reviewed and evidenced literature searches and standardising for methodologic quality using the Rigour of the phrasing of recommendations. Development subscale of the Appraisal of Guidelines for Research and Evaluation II (AGREE II) and the ASCO Endorsement Panel then reviewed the content "The CONFIDENCE Committee will and recommendations. As a result it was determined that the recommendations from the recently published ensure that consensus finding EAU Muscle-invasive and Metastatic Bladder Cancer is done in an organised and guideline were clear, thorough and based on the most relevant scientific evidence. Along with its transparent fashion, based on a endorsement, ASCO had added qualifying statements.
standardised protocol including involvement of all relevant stakeholders in the process."
Overall, the ASCO Endorsement Panel commended the EAU on the development of its guideline on MIBC and metastatic bladder cancer and stated its intention to disseminate it broadly to specialists and generalists in the United States who provide care for these patients. The Guidelines Board has a policy, as part of its Guidelines and social media dissemination activities, of seeking formal The EAU GO can be found on Facebook and Twitter (#eauguidelines). Look out for our weekly tweets from endorsement of its guidelines from national societies the Guidelines Panels. Our congratulations go to the and is therefore delighted by this endorsement from a most popular tweet from the past few months from world-renowned society such as ASCO.
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administrators, economists, politicians and industry representatives. A two-step process has been developed to ensure 1. A structured selection of topics for consensus finding activities, allowing to optimise resources; 2. A structured selection of the most optimal stakeholders group in this process, which should directly impact on uptake and significance of findings. We expect that not only EAU Guidelines Panels, but also other EAU Offices and partnering organisations will call on the expertise of this Committee. We wish the group the best of luck. For the EAU GO and the EAU in general this is an important activity, the results of which will be of great benefit to urology. Impact assessment Effective dissemination of the EAU Guidelines, whilst important, must be followed-up by assessment of their impact on clinical practice. In order to achieve this, the EAU Guidelines Office has launched the Impact Assessment of Guidelines Implementation and Education (IMAGINE) group, chaired by professor Alberto Briganti. It is the firm belief of the IMAGINE group that evidence-based medicine should be complemented by evidencebased implementation. It is the goal of the group to establish a knowledge translation setting which will allow the gap between evidence and practice to be bridged. Key to this endeavour, in conjunction with effective dissemination and education, is the identification of barriers to knowledge transfer, or more importantly, the identification of the optimum interventions to limit or overcome such barriers; ultimately, making the EAU Guidelines recommendations more relevant and actionable whilst enhancing their influence on patient care.
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Prof. Carlos Llorente receives his farewell gift from Prof. James N'Dow Guidelines Office
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European Tour 2016 Academic Exchange Programme Memorable exchange visits in Austria and Germany for Japanese urologists Dr. Kenji Omae Tokyo Women’s Medical University Tokyo (JP)
Dr. Atsushi Okada Nagoya City University Nagoya (JP)
a-okada@med. nagoya-cu.ac.jp It was our great pleasure and honour to have participated in the EAU-JUA International Academic Exchange Programme from March 5 to 15 this year. It was not only a very well-organised programme, but we also had one of the most wonderful experiences in our lives which deepened our perspectives. For the first four days, we visited the SALK University Clinic and Paracelsus Private Medical University in Salzburg, Austria. Professor Karl-Dietrich Sievert and
his faculty members have organised a special programme for us. We enjoyed a tour of their institutions and the informative briefing of the clinical and research work being done at SALK. We had the opportunity to observe excellent surgeries and procedures, some of which were new to us such as neuromodulation for bladder, UroLift® System for BPH, and photodynamic diagnosis for non-muscle invasive bladder cancer. All of these procedures were so interesting and promising that we are eager to introduce them in our hospitals in Japan. During our free time, we also had the chance to be acquainted with Austrian history, culture and cuisine of Salzburg, and enjoy Mozart, visit the film locations of “The Sound of Music,” Salzburger Nockerln, schnitzel and Schnapps. A concert at the Mozarteum was one of the most amazing experiences we have had in Salzburg. From Salzburg we visited the University Hospital of Tübingen, where we also had valuable experiences and insights thanks to the hospitality of Professor Arnulf Stenzl and his staff. The doctors performed various types of minor and major surgeries that required excellent surgical skills, such as the Reztius-sparing robot-assisted laparoscopic prostatectomy, i-pouch technique in nerve-spring radical cystectomy for female invasive bladder cancer, en-bloc TUR-B using the HybidKnife®, and male-tofemale transgender surgery. Their rigorous approaches for accurate diagnosis of prostate cancer using robotic biopsy or intraoperative frozen section were also very impressive.
events such as the EAU President’s & International Friendship Dinner at the Munich Residenz. To end our 10-day visit memorably, we were granted honours during the International Friendship Dinner. Formally dressed and called to the podium where we received from EAU Secretary General Prof. Chris Chapple the citation plaques, and in the presence of so many prestigious experts and doctors, it was definitely a special moment that we will always remember.
At the Viewpoint of Salzburg with Prof K-D. Sievert, his family and TUA members
Although the time in Austria and Germany was not so long, we have learned a lot and met doctors and experts who are doing inspiring work, and we will certainly treasure this experience. We give our thanks to all the hosts and faculties of the two hospitals and staff members of the EAU and JUA which made this programme a success. We hope to see you all again!
Professor Wilhelm K. Aicher shared with us his distinguished stem cell researches during a tour of his laboratory. We were really inspired by their high-level clinical and basic research at the hospital. After working hours, we had the opportunity to participate in a tour of Tübingen and enjoyed the food at two memorable unique restaurants named “Sternwarte” (Astronomy) and “Boxenstopp” (the pits in a car race). Finally, we visited Munich to attend the 31st Annual EAU Congress (EAU16). We did not have the opportunity to have our own presentations at the congress but participated and attended many meetings of the Scientific Programme and social
Prof. Chapple handed over the awards at the Friendships dinner
EAU Exchange Programme: The Taiwanese perspective Dr. Lee Hsiang-Ying Attending Physician, Dept. of Urology Kaohsiung Municipal Ta-Tung Hospital Kaohsiung Medical University Chung-Ho ashum1009@ hotmail.com
Dr. Yuan-Hong Jiang Attending Physician of Dept. of Urology Buddhist Tzu Chi General Hospital Hualien (TW) redeemer1019@ yahoo.com.tw
From bench to clinic The conscientious, careful and creative researches from University Hospital Salzburg and University Hospital Tübingen about animal/cell-based studies for treating stress urinary incontinence were impressive. During workdays, faculties in both hospitals introduced their research studies, which ranged from basic science, translational science to clinical science. We also had the opportunity to be involved in the operation room and learnt a lot about different operating skills and techniques. These experiences inspired us greatly, and made us want to improve on our original practice and surgery techniques.
Instead of white light cystoscopy only, cases with microscopic hematuria and suspicious bladder cancer benefit from PDD. PDD yielded an excellent sensitivity above 90% and specificity ranging from 70-90% although it requires experience to lower the false positive rates. An effective therapeutic outcome in the treatment of bladder cancer is based on early detection. Photodynamic diagnosis is encouraged to save patients from delayed treatment regardless of cost. MRI–ultrasound fusion image-guided prostate biopsy The MRI–ultrasound fusion image-guided transperineal prostate biopsy helps in the accurate placement of biopsy needles in suspicious lesions. It was reported to be two to three times more sensitive in detecting prostate cancer than non-targeted systematic biopsies. To achieve trifecta outcome (i.e. prostate cancer-free, urinary continence and active sex life) in the laparoscopic/robotic radical prostatectomy, the technique helps a lot in decisionmaking and planning. Besides, transperineal biopsy lowers the febrile UTI rates and acute urine retention post-operatively.
Dr. Bing-Juin Chiang Attending Physician, Cardinal Tien Hospital New Taipei City Taipei (TW)
At the University Hospital of Tübingen, we also had a full agenda, attending and visiting their morning meeting, surgical presentations, iNet meeting, and research laboratories. Prof. Wilhem K. Aicher gave an excellent lecture about the progenitor and stem cells for cell-based therapies, and his valuable insights provided a unique and new direction.
One of us (Dr. Lee Hsiang-Ying) was also fortunate to join an open radical prostatectomy surgery and closely observe the procedure step–by-step in great detail. She was very impressed with the surgical skills Professor Sievert, his family, and urologists from Taiwan and and patience of the professor. Some of the techniques Japan had lunch at Hangar-7 Museum, Austria we learned were the following:
It is with great honour and gratitude that we have been selected as exchange programme participants from Taiwan and Japan, an opportunity that expanded our views and enriched our professional experience.
Professors Karl-Dietrich Sievert in Salzburg (AT) and Arnulf Stenzl in Tübingen (DE) were hospitable and very generous with their knowledge, instructing us as much as possible in both clinical and research work at their hospitals. We learned that the medical system is quite different from Taiwan. And through this programme, we also met with Japanese fellows and understood the differences in medical hardware and software between our countries.
Fluorescence-guided cystoscopy, photodynamic diagnosis (PDD)
Professor Stenzl and urologists from Taiwan and Japan at the Urology Department of the University Hospital Tübingen after the morning meeting
simulators for residency training, which we lack in our country. High technological simulators supported by Karl Storz could provide objective evaluation of surgical skills and concepts. Before performing the operations in the patients, junior residents have to pass the simulator exam, and the stimulator is one of the important teaching materials during resident training. Not only did we gain a lot from the time spent in hospitals, but also from our visits in Salzburg and Tübingen with their historical and cultural legacies. The most memorable was the tour of Salzburg where we experience the birthplace of Mozart and its fantastic classical music with a concert at the Mozarteum.
Endoscopic simulators for residency traineeship The most impressive setting is the endoscopic
The time we spent in Austria and Germany was short but productive. Certainly, our fellow urologists from Japan also made this experience valuable as we all had a very congenial and supportive company. We thank all our hosts and the faculties of the two hospitals. We were touched by their kindness, which made this programme an unforgettable experience which will linger in our memory. We hope to see you all again!
European Urology Today
Key articles from international medical journals Dr. Francesco Sanguedolce Section editor London (UK)
Vascular and chronological age in men with ED Impaired penile colour Doppler ultrasound predicts major adverse cardiovascular (CV) events (MACE), particularly in men at low-risk. However, penile colour Doppler ultrasound is not recommended in routine clinical check-ups. The authors aimed to evaluate whether the difference between vascular and chronological age (Δage), as derived from the SCORE algorithm, is a predictor of MACE in subjects consulting for erectile dysfunction (ED) independently from other CV risk factors, including penile colour Doppler ultrasound parameters. A consecutive series of 1,687 male patients attending the Outpatient Clinic for ED for the first time was retrospectively studied. Among them, the SCORE was applicable in 49.9% (n = 841) men, of whom 87.9% (n = 739) were free from previous MACE and were analysed. Vascular age was derived from the SCORE algorithm and the Δage was considered. Information on MACE was obtained through the City of Florence Registry Office. MACE were identified using the International Classification of Diseases, and fatal and nonfatal MACE were coded as 410-414 (ischemic heart disease), 420-429 (other heart diseases), or 798-799 (sudden death from cardiac diseases), 430-434 or 436-438 (cerebrovascular disease), and 440 (peripheral arterial disease).
The authors concluded that in subjects consulting for ED, Δage is associated with incident MACE, in particular in low-risk men Δage was associated with incident MACE. When dividing the population according to the median age (56 years), family history of CV diseases, and the presence of metabolic syndrome, the association between Δage and MACE was maintained only in low-risk subjects, even after adjusting for confounders [HR = 1.09(1.03-1.16), 1.05(1.01-1.10) and 1.08(1.01-1.16) for younger men, without CV family history or metabolic syndrome, respectively, all p < .05], including penile colour Doppler ultrasound parameters. The authors concluded that in subjects consulting for ED, Δage is associated with incident MACE, in particular in low-risk men. The prediction of MACE by Δage is independent from other risk factors including penile colour Doppler ultrasound parameters, so it can be used as a costless and safe surrogate marker of penile vascular damage.
Source: Vascular and chronological age in men with erectile dysfunction: a longitudinal study. Rastrelli G, Corona G, Mannucci E, Maggi M. J Sex Med 2016;13(2):200-8. doi: 10.1016/j. jsxm.2015.11.014.
Sexual and urinary function before and after total mesorectal excision Although rectal cancer is a very common malignancy and has an improved cure rate in response to oncological treatment, research on rectal cancer survivors' urogenital function remains limited. In this study, urogenital dysfunction after surgical rectal cancer treatment was measured and possible Key articles
predisposing factors that may have an impact on the development of this disorder were discussed. A total of 108 patients undergoing curative rectal cancer surgery from January 2008 to December 2014 were questioned using questionnaires: male urinary function was assessed using the International Prostatic Symptom Score (IPSS) questionnaire, for sexual function-International Index of Erectile Function (IIEF). The Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire and the Female Sexual Function Index (FSFI) were used for female urogenital function assessment prior to the operation and six months postoperatively.
Preoperative genitourinary dysfunction is not uncommon in patients older than 60 years as well A total of 67.0% of male (36) and 33.0% (18) of female patients who completed the questionnaire were included in the study. Preoperatively, male urinary dysfunction was 80.1% and postoperatively-88.9%. In female patients, preoperative urinary dysfunction was seen in 75.0% patients, postoperatively-78.0%. Erectile dysfunction was seen in 41.7% males preoperatively and in 63.9% postoperatively. A total of 83.3% of female patients had sexual dysfunction preoperatively and 94% postoperatively. Sexual and urinary problems after surgery for rectal cancer are common. Preoperative genitourinary dysfunction is not uncommon in patients older than 60 years as well. Female patients reported higher rates of sexual dysfunction than males. These results point out the importance of sexual and urinary (dys) function in survivors of rectal cancer. More attention should be drawn to this topic for clinical and research purposes.
treatment. Benign prostatic hyperplasia (BPH) is a very common problem among older men, which often manifests as lower urinary tract symptoms (LUTS), and can lead to potentially serious side effects. The authors determined that men with mild to no current LUTS but increased prostate size are much more likely to develop LUTS presumed due to BPH in the future.
Mr. Philip Cornford Section editor Liverpool (GB)
Source: Does prostate size predict the development of incident lower urinary tract symptoms in men with mild to no current symptoms? Results from the REDUCE trial. Simon RM, Howard LE, Moreira DM, Roehrborn C, Vidal AC, Castro-Santamaria R, Freedland SJ.
Eur Urol 2015 Dec 24. pii: S0302-2838(15)01210-5. doi: 10.1016/j.eururo.2015.12.002. [Epub ahead of print]
Internet-based treatment of stress urinary incontinence: Is a non-face-to-face treatment effective? First-line treatment of stress urinary incontinence (SUI) includes pelvic floor muscle training (PFMT), information and lifestyle advice. However, access to this type of care highly depends on location and the healthcare system and not all women motivated by treatment receive the best treatment given these potential difficulties.
The aim of the present study was to assess in a randomised controlled trial the efficacy of two non-face-to-face treatment programmes based on PFMT. Overall, 250 community-dwelling women with at least one urinary leakage per week were recruited and followed during two years. Inclusion criteria were checked by a self-assessment with validated questionnaires, a telephone interview with one urotherapist, and two-day bladder diaries. Then, Source: A prospective study of sexual and women were randomised to internet-based urinary function before and after total mesorectal excision. Dulskas A, Samalavicius NE. programme or to postal treatment programme. Both Int J Colorectal Dis 2016 Mar 9. [Epub ahead of print] interventions included PFMT with at least eight contractions three times per day and detailed information. Previous incontinence surgery was one of the exclusion criteria. The duration of programmes was three months. During follow-up after this first Does prostate size predict three-month period, participants in the internetLUTS in men with mild to no based group received individually tailored e-mail support as well as escalating levels programmes and current symptoms? specification for continuing training at the end of the treatment period. Patients in the postal group trained It has been shown that increased prostate size is a on their own. There was no face-to-face contact with risk factor for lower urinary tract symptom (LUTS) the participants at any time. progression in men who currently have LUTS presumed due to benign prostatic hyperplasia (BPH). Outcomes were assessed by the symptom severity The investigators conducted a post hoc analysis of the (ICIQ-UI SF) and condition-specific QoL (ICIQREDUCE study, which contained a substantial number LUTSqol). Satisfaction with treatment was also of men (n = 3,090) with mild to no LUTS (International evaluated as secondary endpoints with a fourProstate Symptom Score [IPSS] < 8). question scale. The analysis was intention-to-treat, meaning that participants who had surgery or other The primary outcome was determination of the effect treatment during follow-up period were included in of prostate size on incident LUTS presumed due to the final analysis. BPH defined as two consecutive IPSS values > 14, or receiving any medical (α-blockers) or surgical treatment for BPH throughout the study course. To The internet-based treatment determine the risk of developing incident LUTS, the authors used univariable and multivariable Cox programme seemed to be more models, as well as Kaplan-Meier curves and the effective, and this could be log-rank test.
explained by the regular e-mail Men with mild to no LUTS but support that was not given in the increased prostate size are at higher postal group risk of incident LUTS presumed Approximately, one-third of included women were due to BPH. This association was lost during the study period. Both groups were negated by dutasteride treatment comparable at baseline including no significant
specific QoL. The use of incontinence aids was decreased by 37% in the internet group compared with 22% in the postal group. Further treatment was not considered necessary by 65% of internet group patients and by 59% of postal group patients. The study shows that non-face-to-face treatment of SUI with PFMT provides interesting outcomes. Significant improvements have been reported in both groups. The internet-based treatment programme seemed to be more effective, and this could be explained by the regular e-mail support that was not given in the postal group. These programmes could be relevant in the setting of a lack of healthcare resources and could improve the quality of care given in a sustainable way. However, its effectiveness should be compared with a standard face-to-face PFMT, supervised by an expert nurse or physiotherapist, in order to evaluate whether such a strategy could be successfully implemented in everyday practice.
Source: Internet-based treatment of stress urinary incontinence: 1- and 2-year results of a randomized controlled trial with a focus on pelvic floor muscle training. Sjöström M, Umefjord G, Stenlund H et al. BJU Int 2015;116:955-64.
Therapy combination in overactive bladder patients Incontinence due to overactive bladder may be insufficiently treated by antimuscarinics or mirabegrom monotherapy. Increasing the antimuscarinic dose exacerbates adverse effects and impacts treatment compliance. In case of failure and persistent incontinence, various options are available including percutaneous tibial nerve stimulation, sacral nerve stimulation, and intravesical onabotulinumtoxin A, but their penetrance in clinical practice remains limited. In the present phase 3 study, the authors compared the efficacy and tolerability of combination treatment (solifenacin plus mirabegron) with one treatment alone in urge incontinent patients with inadequate response to initial four-week solifenacin monotherapy. This trial was randomised and double-blinded and has included 2,174 patients with urge incontinence. The primary efficacy endpoint was the change from baseline to end of treatment in mean number of incontinence episodes per 24 h (three-day diary). Secondary end points included change in the mean number of urgency episodes, volume of micturition, nocturia episodes and number of pads per 24h. All end points were assessed at weeks 4, 8, and 12. After an initial four-week treatment period with 5 mg solifenacin, patients with persistent incontinence (one or more episodes during the three-day diary) were randomised between 5 mg solifenacin plus 25/50 mg mirabegron, 5 mg solifenacin, and 10 mg solifenacin. Patients’ demographics and baseline characteristics were similar across the treatment groups.
Significant improvements in all secondary efficacy end points (except nocturia) were reported with combination versus solifenacin 5 mg. Significantly differences in terms of incontinence severity or more patients became dry with combination (46%) Among men treated with placebo during the REDUCE education and internet usage. The overall surgical study, those with a prostate size of 40.1-80 ml had a rates were comparable between both groups (5.2% at versus solifenacin alone (5 mg: 38%; 10 mg: 40%). 67% higher risk (hazard risk 1.67, 95% confidence two years). Improvements occurred mainly within the Efficacy of combination was superior to solifenacin 5 mg alone, mainly in the number of incontinence interval 1.23-2.26, p = 0.001) of developing incident first four months. Within both groups, there were episodes per 24 h and daily micturitions. Combination LUTS compared to men with a prostate size 40.0 ml or significant improvements in the primary outcomes was also superior to solifenacin 10 mg for the smaller. There was no association between prostate without strong differences between internet-based reduction in micturition frequency. Comparison for size and risk of incident LUTS in men treated with 0.5 and postal treatment programmes. the others parameters including the reduction of mg of dutasteride. The post hoc nature of the study incontinence episodes showed a non-inferiority design is a potential limitation. However, significantly more patients in the internet between combination and solifenacin dose increase. group rated their leakage as much improved than in Dry mouth and constipation were more frequently Men with mild to no LUTS but increased prostate size the postal group (39.2% versus 23.8%, p = 0.03). reported in the solifenacin 10 mg group, compared are at higher risk of incident LUTS presumed due to Similar difference favouring the internet-based with the two other arms. No occurrence of acute BPH. This association was negated by dutasteride programme was also noted regarding the health-
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Prof. Oliver Hakenberg Section Editor Rostock (DE)
Oliver.Hakenberg@ med.uni-rostock.de urinary retention was noted. The highest incidence of side effects was reported in the solifenacin 10 mg group (39.4%), then the combination group (35.9%), then the solifenacin 5 mg group (33.1%).
In the population of overactive bladder patients with urge incontinence and inadequate response to initial antimuscarinic drug, both therapy combination and dose escalation are adequate options to improve urinary symptoms In the population of overactive bladder patients with urge incontinence and inadequate response to initial antimuscarinic drug, both therapy combination and dose escalation are adequate options to improve urinary symptoms. Combination of solifecin 5 mg with mirabegron seemed to be more effective than solifenacin 10 mg, mainly for the reduction of micturition episodes. Antimuscarinics side effects were also decreased by the use of this combination. Such a combination may represent an interesting therapy option in case of antimuscarinic drug failure, particularly in patients suffering from anticholinergic side effects, and a relevant alternative to dose escalation. This could also add a new step in OAB management before progression to a more invasive therapy such as nerve modulation and intravesical onabotulinumtoxin A.
Source: Efficacy and safety of mirabegron add-on therapy to solifenacin in incontinent overactive bladder patients with an inadequate response to initial 4-week solifenacin monotherapy : a randomised double-blind multicentre phase 3B Study (BESIDE). Drake MJ, Chapple C, Esen AA et al. Eur Urol 2016 doi :10.1016/j.euruol.2016.02.030.
Lower risk of long-term urinary incontinence after caesarean delivery: A metaanalysis Vaginal childbirth is known to be a major factor of pelvic floor trauma that can impact on the risk of future incontinence. Caesarean delivery might offer potential protection against risks of per-partum trauma whereas assisted vaginal delivery using vacuum or forceps has been suggested to be predictive for long-term pelvic floor diseases such as organ prolapse and stress urinary incontinence. In this systematic review of the literature and meta-analysis, Tähtinen et al. have compared the risk of long-term incontinence according to the type of delivery: vaginal versus caesarean. The review was performed following the established guidelines: protocol registered into PROSPERO; PRISMA guidelines.
…this meta-analysis confirmed the significant impact of the delivery mode on long-term incontinence, mainly on SUI An experienced research librarian collaborated in planning the search strategy, starting from 1946 to present. Inclusion criteria were any randomised trial, cross-sectional, or cohort study that recorded both the mode of delivery and the urinary continence outcomes at least one year after childbirth. Interestingly, only non-randomised studies that included an adjusted or matched Key articles
analysis for established prognostic factors for urge (UUI) or stress urinary (SUI) incontinence (age, BMI, parity) were taken into account. Given that UUI and SUI have different aetiologies, two separate meta-analyses were performed in order to dichotomise both types of incontinence. Overall, 15 and eight studies were included for SUI and UUI analyses, respectively. The calculation of the absolute risk increase of incontinence was as follows: from population-based studies, the absolute risks of SUI and UUI after caesarean section have been estimated at 12.2% and 10.1%, respectively (5% only in case of elective caesarean section). These estimates were then used to calculate the odds ratio with vaginal delivery. The most common comparison was any vaginal delivery (with or without instrumental delivery) versus caesarean section. Few studies compared spontaneous vaginal delivery versus assisted vaginal delivery. Prevalence of long-term SUI and UUI varied from 9% to 68%, and from 8% to 27%, respectively. Evidence synthesis showed that the odds of reporting SUI was almost double after any vaginal delivery compared with caesarean section (aOR 1.85). This was related to an absolute increase of approximately 8% when compared to caesarean section. The risk was over three times higher when comparison was done with elective caesarean section (aOR 3,53). Instrumental delivery did not seem to significantly increase the risk of both SUI and UUI in the pooled analysis. The risk of UUI was moderately affected by the type of delivery with an adjusted odds ratio at 1.30. Even if this systematic review was performed with a good and well-explained methodology and an accurate data analysis, high risk of bias was reported in one-third of the included studies. Moreover, no series collected information regarding pre-existing SUI or UUI before delivery. The small number of studies also limited the power of meta-regressions and of the impact on outcomes of hypothesised effect modifiers. In summary, the impact of delivery mode on UUI is too small (3%) to conclude at a population level. Nevertheless, this meta-analysis confirmed the significant impact of the delivery mode on long-term incontinence, mainly on SUI. Any vaginal delivery (with or without instrumental help) is associated with a risk of SUI increased by almost two times. Given the impact of incontinence on quality of life and societal costs, such conclusions may have a not negligible impact on women and physician discussions and decisions regarding the mode of delivery.
Source: Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence: A systematic review and meta-analysis. Tähtinen RM, Cartwright R, Tsui JF et al.
Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalisation, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with in-hospital mortality greater than 10%.
Prof. Oliver Reich Section editor Munich (DE)
Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone.
Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65mmHg or greater and serum lactate level greater than 2 mmol/L (> 18mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%. In out-of-hospital, emergency department, or general hospital ward settings, adult patients with suspected infection can be rapidly identified as being more likely to have poor outcomes typical of sepsis if they have at least two of the following clinical criteria that together constitute a new bedside clinical score termed quickSOFA (qSOFA): respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100mmHg or less. These updated definitions and clinical criteria should replace previous definitions, offer greater consistency for epidemiologic studies and clinical trials, and facilitate earlier recognition and more timely management of patients with sepsis or at risk of developing sepsis.
Source: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Mervyn Singer; Clifford S. Deutschman; ChristopherWarren Seymour; Manu Shankar-Hari; Djillali Annane; Michael Bauer; Rinaldo Bellomo; Gordon R. Bernard; Jean-Daniel Chiche; Craig M. Coopersmith; Richard S. Hotchkiss; Mitchell M. Levy; John C. Marshall; Greg S. Martin; StevenM. Opal; Gordon D. Rubenfeld; Tomvan der Poll; JeanLouis Vincent; Derek C. Angus. JAMA. 2016;315(8):801-810. doi:10.1001/ jama.2016.0287.
Eur Urol 2016 doi.org/10.1016/j.eururo.2016.01.037.
Defining sepsis and septic shock Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for re-examination and an update of definitions for sepsis and septic shock. A task force with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases, and voting, followed by circulation to international professional societies, requesting peer review and endorsement. Limitations of previous definitions included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. The task force concluded the term severe sepsis was redundant.
Using cystoscopy in evaluating recurrent female UTI Due to a paucity of evidence-based guidelines, anecdotal practice patterns often dictate clinical management of recurrent urinary tract infection (UTI) in women. The aim of the present study was to identify pathologic findings of the urinary tract through cystoscopy and imaging in women with recurrent UTI, and to determine if specific risk factors are associated with a higher rate of abnormal findings.
A total of 163 women (mean age 60.6 years) were included in final analysis. Abdominopelvic imaging was available in 133 (82%) cases. Cystoscopy identified 9 (5.5%) cases of significant clinical findings. Of these only 5 (3.8%) cases were uniquely identified on cystoscopy and missed on imaging modalities. When imaging was normal, cystoscopy was also normal in 94% of cases. The examined clinical risk factors were not associated with higher risk of abnormal cystoscopy (p = 0.49) or imaging (p = 0.42). The authors concluded that cystoscopy performed solely for recurrent UTI is low yield in patients with normal imaging studies, but a small number of abnormal findings may be missed by foregoing this element of the patient workup. No studied risk factor was predictive of an abnormal workup.
Source: Diagnostic yield of cystoscopy in the evaluation of recurrent urinary tract infection in women. Pagano MJ, Barbalat Y, Theofanides MC, Edokpolo L, James MB, Cooper KL. Neurourol Urodyn 2016 Mar 21.
Is conventional laparoscopic surgery dead? Not yet perhaps Stage migration of renal masses which are accessible by minimally invasive surgery has reduced the indication to open surgery to very large lesions with or without involvement of renal vein, IVC and regional lymph nodes. However, as well known, open surgery in these cases exposes the patients to the risk of a longer and more painful post-operative time. While there are mounting evidences for the feasibility of robotic surgery in treating renal masses with IVC thrombus up to level III (though in selected cases and in the hands of highly experienced surgeons)1, a niche of conventional laparoscopic surgery may be still be applied to large renal masses. A recent retrospective, multi-centre study reviewed the results of a cohort of patients treated in France, Turkey, the Netherlands, Czech Republic and US with conventional Laparoscopic Radical Nephrectomy (LRN) for renal masses larger than 10 cm, without evidences of venous thrombus or regional nodes involvement. Median blood loss was minimal (200 ml) and median hospital stay was six days.
…this paper provides further evidence in support of feasibility of LRN for large renal masses raising the bar from previous reports -where lesions were sized mostly from 7 to 10 cm- to renal tumours > …cystoscopy performed solely for recurrent UTI is low yield in patients 10 cm with normal imaging studies, but a The most interesting findings were the relatively high small number of abnormal findings rate of conversion (20.7%) mostly because of intense bleeding or tumour adhesions (54% and 46%, may be missed by foregoing this respectively), and complication rates comparable to open surgery (intra-operative: 19%; post-operative: element of the patient workup In a single-institutional cohort, cystoscopy was performed for women with recurrent UTI between 1/2010 and 7/2014. All eligible patients were included in a maintained database and those with gross or microscopic haematuria were excluded. Abdominopelvic imaging was recommended and included in study data when completed. Associations between clinical risk factors (history of renal transplant, urogynaecologic surgery, or urolithiasis) and abnormal findings were analysed by Fisher's exact test.
33% with Clavien ≥ 3 in 8.6%). At multivariate analysis, significant predictive factor for conversion to open surgery was the occurrence of intraoperative complication (HR: 26.3; 95% CI: 3.62-191. p = .001), while none variable could predict significantly the event of complication. However, the authors did not specify whether the multivariate analysis included only the major complications (Clavien ≥ 3), all the post-operative ones or the combination of the intra- and post-operative complications, altogether. Notably, the authors highlighted the association (significantly or approaching significance) of surgical
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Prof. Truls Erik Bjerklund Johansen Section editor Oslo (NO)
email@example.com expertise, with less experienced ones having more conversions and complications. However, definition of “experienced surgeon” was somehow simplistic as reported for surgeons having performed at least 20 LRN. Surely, this definition may better define the achievement of a level of proficiency while expertise necessarily implies an overall higher number of cases as well as a high volume of cases per year. On the other hand, this paper provides further evidence in support of feasibility of LRN for large renal masses raising the bar from previous reports -where lesions were sized mostly from 7 to 10 cm- to renal tumours > 10 cm. Interestingly, the measurement of the lesions was based on the pathology report which obviously underestimates the original size of the lesions in site because of the blood supply. Better definition of expertise would be important to better identify who are the appropriate surgeons or centres where this procedures can be performed to reduce the risk of conversion and complication rates. Also, a major difference of outcome may be noted with the measurement of the whole specimen rather than of the actual renal mass: it is easily understandable that it is technically more challenging to perform a nephrectomy on kidneys with a mass rising from a renal pole (where maximum volume of specimen is given by the addition of normal plus neoplastic tissue) rather than on kidneys where the neoplastic tissue has totally replaced the normal parenchyma (a situation in which minimal volume is likely to be added to the whole specimen). Finally, no difference of recurrence/progression rates (8.7%) was noted with respect to historical one reported in literature (8.3% to 9.3%), which once again rules out the supposed possibility of tumour seeding with laparoscopic manipulation.
included cervical (39%), thoracolumbar (44%), and unknown (17%). The incidence of serious UTIs (requiring emergency room visit or hospital admission) was 40%. Thoracolumbar lesion TSCI patients had significantly greater risk of serious UTIs (HR 1.3, 95%CI 1.1-1.7, p < 0.01) compared to those with a cervical lesion.
The authors reported one case of peri-operative complication in a patient who undertook a resection of a diverticulum close to the ureteric orifice: the Urologic reconstruction/urinary diversion were carried oedema caused by manipulation obstructed the urine out on 2.4% of patients. New onset renal dysfunction flow and a ureteric stent was deemed to be inserted. was identified in 4.2% (84) TSCI patients. The rate Because of that, authors recommended preventive insertion of ureteric stent in such situations. ratios for serious UTIs (10.59, 95%CI 8.71-12.89), urologic reconstruction/urinary diversion (6.48, 95%CI At almost one year of mean follow-up, neither late 3.07-13.68), and renal dysfunction (2.55, 95%CI 1.70-3.83) were significantly increased among TSCI complications nor recurrence were reported. patients compared to matched controls. The authors concluded that urologic disease is still an important Overall, this is an elegant example of what innovation means in urology, which can be summarised in three source of morbidity for contemporary TSCI patients, and is more common compared to the general words: plasticity, dynamicity…and geniality! population.
Source: Urinary tract infections, urologic surgery, and renal dysfunction in a contemporary cohort of traumatic spinal cord injured patients. Welk B, Liu K, Winick-Ng J, Shariff SZ.
Eur Urol. 2011 Jun;59(6):1019-25. doi: 10.1016/j. eururo.2011.03.021. Epub 2011 Mar 23.
Laparoscopic transvesical bladder divertulectomy: New points of technique by using Natural Orifice Transluminal Endoscopic Surgery (NOTES)
The objective of this study was to measure the incidence of urinary tract infections (UTIs), urologic reconstruction/urinary diversion, and renal dysfunction after a traumatic spinal cord injury (TSCI).
…urologic disease is still an important source of morbidity for contemporary TSCI patients, and is more common compared to the general population A retrospective cohort study using administrative data from Ontario, Canada was performed. All incident adult TSCI patients (2002-2013) admitted to a rehabilitation centre were included. The impact of lesion level on each outcome was assessed. The rate of outcomes was further compared to an age and sex matched sample from the general population. A total of 2,023 incident TSCI patients were identified (median follow-up of 4.8 years). Most patients (73%) were male and median age was 50 years. Lesion level Key articles
Source 2: Natural orifice transluminal endoscopic surgery-assisted laparoscopic transvesical bladder diverticulectomy: Feasibility study, points of technique, and case series with medium-term follow-up. Magdy A, Drerup M, Bauer S, Colleselli D, Hruby S, Mitterberger M, Janetschek G J Endourol. 2016 Feb 9. [Epub ahead of print]
Source 3: A simple and safe extracorporeal knotting technique. Kothari R, Somashekar U, Sharma D, Thakur DS, Kumar V.
In the last decade, Natural Orifice Transluminal JSLS. 2012 Apr-Jun;16(2):280-2. Endoscopic Surgery (NOTES) has been regarded as the latest advancement of minimally-invasive surgery, together with LaparoEndoscopic Single-site Surgery (LESS). Due to their challenging aspects, a wider use of these techniques is yet to happen. A proper/pure NOTES technique has been described only for nephrectomies retrieved from the vagina1.
…the authors reported one case of peri-operative complication in a patient who undertook a resection of a diverticulum close to the ureteric orifice... However, there are several point of techniques preliminary to the NOTES assistance via the urethral access that need to be considered: 1) patients were treated for the primary disease (i.e. enlarged prostate) beforehand (mean interval of 94 – 5.47 months) in order to make easier the urethral access of instruments. 2) The authors used V-lock sutures which were secured with absorbable LAPRA-TY clips: these technology may increase cost, which may be avoidable by using normal Monocryl or Vicryl 3-0 and knotting them up with extra-corporeal technique3. 3) They used one 10 mm port (for the scope) and two 5mm ports; sometimes they used the 10 mm port for the insertion of instruments (stitches, LAPRA-TY clips, etc.) under cystoscopic control. 4) The urethral access was also used for grasping large diverticula or even to extract the specimen. 5) Contraction of fluid infusion during the procedure was agreed with the anaesthetist to reduce urine volume in the surgical field.
Dr. Guillaume Ploussard Section editor Toulouse (FR)
difficult. It is a matter of fact that it was in this group of stone which had a higher rate of insufficient quantity of material retrieved (only 67% suitable for IRS analysis), as well as a mismatch of the constituents, with significant inconsistency between pure vs mixed stones. This latter event was likely due to the 10% variability of stone composition revealed at IRS which may have played a role in misclassifying a pure stone (defined as main constituent in more than Source 1: Feasibility of transvaginal natural 90% of the material) as mixed stone or vice-versa in orifice transluminal endoscopic surgery-assisted borderline conditions.
living donor nephrectomy: is kidney vaginal delivery the approach of the future? Alcaraz A, Musquera M, Peri L, Izquierdo L, García-Cruz E, Huguet J, Alvarez-Vijande R, Campistol JM, Neurourol Urodyn 2016 Feb 29. DOI: 10.1002/nau.22981. Oppenheimer F, Ribal MJ.
Another ingenious but also simple application has Source 1: Robot-assisted laparoscopic inferior been recently described by the group of Prof. vena cava thrombectomy: Different sides require Janetschek. They presented their (small) series of different techniques. Wang B, Li H, Ma X, et al. Laparoscopic transvesical bladder divertulectomy with Eur Urol. 2015 Dec 16. pii: S0302-2838(15)01209-9. doi: the assistance of the urethra as natural orifice2. 10.1016/j.eururo.2015.12.001. [Epub ahead of print] Source 2: Safety and feasibility of laparoscopic They adapted the concept previously described as a nephrectomy for big tumors (≥ 10 cm): transvesical access (i.e. with trocars inserted directly A retrospective multicentric study. Verhoest G, through the bladder wall) for the resection of Couapel JP, Oger E, et al. bladder diverticula with the opportunity to use the urethral access for a more ergonomic grasping and Clin Genitourin Cancer. 2016 Jan 27. pii: S1558suturing. In particular, the usual site of the bladder 7673(16)30007-6. doi: 10.1016/j.clgc.2016.01.007. diverticula in the posterior bladder wall makes more [Epub ahead of print] natural the stitching with a laparoscopic needleholder passed through the urethra as it stands parallel to the target, rather than perpendicular which would be the case by stitching through the UTI, surgery, and renal laparoscopic trocars.
disease in traumatic spinal cord-injured patients
Mean size of bladder diverticula was 4.4 – 1.83 cm; mean operative time was 134.25 – 44.92 minutes (range: 83–179). Hospital stay was 10 days as patient was discharged after catheter removal, which happens after successful retrograde cystogramme.
Stone analysis in the era of stone-dusting with laser ureteroscopy The widespread use of laser during semi-rigid or flexible ureteroscopy (URS and fURS) for upper tract urinary stones facilitated the ability of surgeons to dust the stones: this technique reduces further manipulation of the ureter by limiting the use of basketing for stone fragments retrieval.
The worst results were even reported for struvite and calcium phosphate stones where mismatching was prevalently qualitative, with different constituents detected at the specimen and dust. There are some important take home messages from this study: 1) Stone analysis can also be done with dust as long as it is performed with IRS; 2) Stone analysis is more reliable for bigger and softer stones, where a sufficient amount of dust is possible to collect (2 mg at least); moreover, material collected should be free as much as possible of blood contamination; 3) It is likely that stone analysis of the dust may reflect more the external layers composition of the stones as the inner part is usually harder and more difficult to dust; 4) Concerns about processing of dust remain unresolved, especially in the case of struvite or calcium phosphate stones, as it may be responsible for the poor concordance reported in the paper for these stones. Finally, the lack of a gold standard for comparison, which could have been only the whole stones, limits the results. It is interesting to note that the final recommendation of the authors for practitioners is to collect both dust and fragments for a more appropriate stone analysis.
Source: Biochemical composition of urolithiasis from stone dust - a matched pair analysis. Ray ER, Rumsby G, Smith RD.
On the other hand, the lack of stone composition reduces the information needed by the practitioner to fully assess risk of recurrence of stone formers and prevent eventual treatments for secondary prevention.
BJU Int. 2016 Feb 24. doi: 10.1111/bju.13448. [Epub ahead of print]
A recent paper from a group of researchers at the University College London Hospital – UK has investigated the possibility of using the dust material retrieved during URS/fURS for a proper stone analysis at the Infrared Spectroscopy (IRS).
No role for adjuvant chemotherapy in renal cancer
The study was based on the simple observation that the spectrum of stones at IRS are obtained after pulverization of the specimen, with only a small portion being subjected to the spectroscopic analysis. In other words, the authors supposed that dusted stone during laser fragmentation of stones would be qualitatively and quantitatively comparable to the same kind of material of a fragment after processing. They were able to retrieve both dust and stone fragments in 97 patients affected by ureteric or renal stones. Dust was collected through aspiration directly from the ureteroscopes. Quantitative analysis was possible in 68% of cases, while in 31 cases dusted material was deemed not sufficient for IRS analysis.
…the lack of a gold standard for comparison, which could have been only the whole stones, limits the results Interestingly, in the remaining matched cases there was a complete consistency (100%) between dust and specimen in the case of uric acid stones. On the other hand, concordance between calcium stones was lower especially for calcium oxalate stones (56%). This latter result was partly explained by the fact that calcium oxalate stones are harder and dusting is more
Approximately a third of the people diagnosed with renal-cell carcinoma will die from metastatic disease. Risk of disease recurrence can be estimated based upon algorithms incorporating clinical and histological features with TNM staging. Antiangiogenic therapies have been shown to be active in advanced disease extending both progression-free survival and overall survival. This study is the first randomised trial to compare disease-free survival with adjuvant sorafenib or sunitinib versus placebo in patients with apparently completely resected primary renal-cell carcinoma at high-risk for recurrence. This study done across 226 centres in USA and Canada enrolled patients with histologically proven, completely resected high-risk clear cell or non-clear cell renal carcinoma (but not medullary or collecting duct kidney cancer), within 12 weeks of removal of the primary tumour. Patients were required to have good ECOG performance status (0 or 1) eGFR > 30mls/min, normal liver function and haematological function plus a left ejection fraction of 50%. Patients were stratified by recurrence risk, histology, Eastern Cooperative Oncology Group (ECOG) performance status, and surgical approach, and double-blind randomisation was done centrally with permuted blocks. Patients were randomly assigned (1:1:1) to receive 54 weeks of sunitinib 50 mg per day orally throughout the first four weeks of each six week cycle, sorafenib 400 mg twice per day orally
EAU EU-ACME Office
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throughout each cycle, or placebo. Placebo could be sunitinib placebo given continuously for four weeks of every six-week cycle or sorafenib placebo given twice per day throughout the study. Dose reductions were allowed for grade 3 or 4 toxicity and from May 2009 starting doses were amended to 37.5 mg (for sunitinib or matching placebo) or 400mg (for sorafenib or matching placebo) for the first one or two cycles to address toxicity issues. Patients were assessed every six weeks for toxic effects and were imaged every three cycles (4.5 months) during treatment then every six months for two years then once a year for 10 years. The primary objective was to compare disease-free survival between each experimental group and placebo in the intention- to-treat population. All treated patients with at least one follow-up assessment were included in the safety analysis.
ranging from five to seven months and no known life-prolonging treatments. Programmed death ligand 1 (PD-L1) is an immune checkpoint that negatively regulates T-cell function by binding to its receptors programmed death 1 (PD-1) on activated T lymphocytes and other immune cells. Because T lymphocytes have a central role in mediating acquired anti-tumour immunity, expression of PD-L1 in the tumour microenvironment endows tumours with a mechanism to evade eradication by the host immune system. PD-L1 is broadly expressed across a wide range of malignancies, including TCC, and blockade of the PD-L1–PD-1 pathway has been shown to produce overall survival benefits in non-small-cell lung cancer, melanoma, and renal cell carcinoma.
Source: Atezolizumab in patients with locally advanced and metastatic urothelial carcinoma who have progressed following treatment with platinum-based chemotherapy: a single-arm multicentre, phase 2 trial. Rosenberg JE, Hoffman-Censits J, Powles T, et al. Lancet 2016; http://dx.doi.org/10.1016/S01406736(16)00561-4.
should not routinely replace biopsy as a method with which to rule out the presence of csCaP. The advantages of this new biopsy method are apparent, but issues of cost, training, and reliability await resolution before its widespread adoption.
Source: Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: the role of systemic and targeted biopsies. Filson CP, Natarajan S, Margolis DJA et al. Cancer 2016; 122: 884-92.
MR-USS fusion prostate biopsies: Is it time to adopt this?
Targeted prostate biopsy using multiparametric magnetic resonance imaging (mpMRI) can improve Atezolizumab is an engineered humanised monothe detection of prostate cancer. However, the 1943 patients were randomized between 24th April clonal immunoglobulin G1 antibody that binds predictive value of a “normal” mpMRI and the 2006 and 1st September 2010. 647 patients were selectively to PD-L1 and prevents its interaction with significance of “normal” regions on mpMRI is not assigned to sunitinib, 649 assigned to sorafenib, PD-1, while sparing the interaction between PD-L2 clear. The negative predictive value (NPV) of mpMRI is and 647 assigned to placebo. 18 patients in the and PD-1. Atezolizumab has shown durable responses critical because of claims that mpMRI may have value sunitinib group, 17 patients in the sorafenib group, in a cohort of patients with metastatic bladder cancer as a cancer screening tool for men with an elevated and 14 patients in the placebo group did not receive in a phase 1 study, with higher response rates prostate-specific antigen (PSA) level or abnormal study drug, but were included in the main efficacy recorded in patients with higher levels of PD-L1 digital rectal examination. In previous studies, analysis. On Oct 16, 2014, because of low conditional expression on tumour-infiltrating immune cells than approximately 28% of prostate tumors with a Gleason power for the primary endpoint, the ECOG-ACRIN in those with lower PD-L1 expression. This multiscore (GS) ≥ 7 went undetected by mpMRI, based on whole-mount prostatectomy specimens. The key Data Safety Monitoring Committee recommended centre phase 2 study assessed the efficacy and safety questions are whether a “normal” mpMRI should that blinded follow-up cease and the results be of atezolizumab and evaluated the association with released. Median disease-free survival was 70 PD-L1 expression. preclude immediate biopsy and, if guided biopsy is months (5·8 years) for sunitinib, 73·4 months (6·1 performed, whether targeting alone can suffice. This Patients (aged ≥ 18 years) with inoperable locally study mandated both systemic biopsy (SB) and years,) for sorafenib, and 79·6 months (6·6 years,) targeted biopsy (TB) in all participants regardless of for placebo. advanced or metastatic TCC whose disease had mpMRI findings to test whether SB are required. progressed after previous platinum-based chemotherapy were enrolled. Included patients had VEGFR inhibitors are active as single good performance status (0 or 1), measurable All men who underwent a first MR-ultrasound fusion between September 2009 and February 2015 either disease defined by RECIST, adequate haematological agents in patients with advanced for diagnosis or staging were included. Scans were and end-organ function, and no autoimmune renal-cell carcinoma. However, performed using a 3-Tesla magnet and a disease or active infections. Formalin-fixed paraffintransabdominal phased array coil. Regions of interest embedded tumour specimens with sufficient viable despite the positive effects in tumour content were needed from all patients before (ROIs) were delineated and graded as 1 to 5 using the advanced disease this study failed to enrolment. Patients received treatment with Prostate Imaging Reporting and Data System (PI-RADS) scoring system. MRI images were show any benefit from these agents intravenous atezolizumab (1200 mg, given every 3 transferred electronically to an Artemis fusion device weeks). Dose interruptions were allowed for toxicity, in the adjuvant setting immediately before a transrectal ultrasound was but dose reductions were not permitted. Patients performed. The fusion of MR and real-time underwent tumour assessments with cross-sectional ultrasound images was then completed. Men with Disease-free survival did not differ significantly imaging at study sites every nine weeks for the first between groups. In addition, in the clear cell RCC ROIs underwent TB, with approximately one core per 12 months following day 1 of cycle 1. These tumour sub-group there was also no difference in disease3 mm of the longest ROI axis. After TB was obtained, assessments were done by an Independent Review free survival. The most common grade 3 or worse patients underwent 12-core SB via a scalable grid Facility (BioClinica, NJ, USA) and by the local adverse events were hypertension (105 [17%] patients investigator. After 12 months, tumour assessments incorporated into the software of the device. on sunitinib and 102 [16%] patients on sorafenib), were done every 12 weeks. Patients underwent PD-L1 hand-foot syndrome (94 [15%] patients on sunitinib Of 1,042 patients, 324 (31%) had csCaP found on expression on tumour-infiltrating immune cells (ICs) and 208 [33%] patients on sorafenib), rash (15 [2%] biopsy of which 289 had at least 1 ROI and 35 had a was assessed prospectively by patients on sunitinib and 95 [15%] patients on normal mpMRI. A total of 825 men (79%) had ≥ 1 ROI immunohistochemistry. The percentage of PD-L1sorafenib), and fatigue (110 [17%] patients on of ≥ grade 3, and 217 patients had no suspicious positive immune cells were grouped: IC0 (< 1%), IC1 sunitinib and 44 [7%] patients on sorafenib). lesions on mpMRI. Men were divided nearly evenly (≥ 1% but < 5%), and IC2/3 (≥ 5%). The co-primary Although the reduction in starting dose somewhat into those with no prior biopsy (33%), those with a endpoints were the independent review facilityameliorated this effect, the proportion of grade 3 or prior negative biopsy (31%) and those with a previous assessed objective response rate according to RECIST worse adverse events in patients starting at reduced positive biopsy (i.e. active surveillance patients) v1.1 and the investigator-assessed objective response dose still exceeded 55% in both the sunitinib and rate according to immune-modified RECIST, analysed (37%). With regard to the maximum ROI grade, 42% sorafenib groups. had a low-suspicion grade 3 lesion, 29% had a by intention to treat. moderate-suspicion grade 4 lesion, and 8% of VEGFR inhibitors are active as single agents in patients had a high-suspicion grade 5 ROI. Powerful Between May and November 2014, 486 patients patients with advanced renal-cell carcinoma. predictors of csCaP were ROI grade (grade 5 vs grade were screened and 315 patients enrolled of which However, despite the positive effects in advanced 3: odds ratio, 6.5 [p < 0.01]) and prostate-specific 310 received at least one dose of atezolizumab. At disease this study failed to show any benefit from antigen density (each increase of 0.05 ng/mL/cc: odds the time of data cut-off (September 2015) 202 these agents in the adjuvant setting. In addition, there patients had discontinued treatment of whom 193 ratio, 1.4 [p < 0.01]). Combining systematic and was substantial treatment discontinuation because of had died, eight had withdrawn from treatment and targeted biopsies resulted in the detection of more excessive toxicity despite dose reduction. These results one discontinued for other reasons. Atezolizumab patients with csCaP (289 patients) than targeting (229 which are supported by similar outcomes in other patients) or systematic (199 patients) biopsy alone. resulted in a RECIST v1.1 objective response rate tumours argue against the use of anti-angiogenic Among patients with no suspicious ROI, 35 (16%) that appeared to correlate to each prespecified therapy in the adjuvant setting and suggest the were found to have csCaP on systematic biopsy. immune cell group (IC2/3: 27% [95% CI 19–37], biology of cancer recurrence might be independent of IC1/2/3: 18% [13–24],) versus all patients (15% angiogenesis [11–20],). With a median follow-up of 11·7 months The combination of targeted and (95% CI 11·4–12·2), ongoing responses were Source: Adjuvant sunitinib or sorafenib for recorded in 38 (84%) of 45 responders. The median systematic biopsy detected more high-risk, non-metastatic renal-cell carcinoma time to response was 2.1 months. Exploratory csCaP than either modality alone; (ECOG-ACRIN E2805): a double-blind, placebo- analyses showed The Cancer Genome Atlas (TCGA) controlled, randomised, phase 3 trial. Haas NB, subtypes and mutation load to be independently systematic biopsies revealed csCaP Manola J, Uzza RG et al. predictive for response to atezolizumab. Grade 3–4 in 16% of men with no suspicious Lancet 2016. http://dx.doi.org/10.1016/S0140treatment-related adverse events, of which fatigue 6736(16)00559-6 . was the most common (five patients [2%]), MRI target occurred in 50 (16%) of 310 treated patients. Grade 3–4 immune-mediated adverse events occurred in In this prospective trial, MR-ultrasound fusion biopsy 15 (5%) of 310 treated patients, with pneumonitis, allowed for the detection of csCaP, with a direct increased aspartate aminotransferase, increased New options for metastatic relationship noted with ROI grade and PSA density. alanine aminotransferase, rash, and dyspnoea TCC The combination of targeted and systematic biopsy being the most common. No treatment-related detected more csCaP than either modality alone; deaths occurred during the study. Although immunotherapy, in the form of BCG, has systematic biopsies revealed csCaP in 16% of men been used in non-muscle-invasive urothelial with no suspicious MRI target. The concept of using This study in a heavily pre-treated population shows carcinoma (TCC) for many years there is no accepted mpMRI to obviate prostate biopsy, if the imaging atezolizumab to have acceptable toxicity and that role for immunotherapy in the treatment of advanced treatment responses are more common in patients reveals no targets, should be regarded with caution. disease. Platinum-based chemotherapy is the In a recent meta-analysis, the NPV of mpMRI was with a higher levels of PD-L1 expression on immune standard of care in metastatic TCC and is associated found to range from 65% to 94%, depending on how cells. It offers the promise of a new strand of therapy with an overall survival of nine to 15 months. The in the area of undoubted need but without a phase 3 that finding was validated. In the current study, NPVs prognosis for patients who relapse after platinumstudy it is difficult to quantify the response to this new of 56% for any cancer and 85% for csCaP were based chemotherapy is poor, with median survival observed. These data suggest that a negative mpMRI class of drugs.
Belatacept better than cyclosporine in renal transplantation Belatacept has been newly introduced into transplantation medicine and offers new mechanisms and potential advantages. It needs comparison with cyclosporine, which for over 40 years has been the backbone of immunosuppression in renal transplantation. This paper is based on the BENEFIT study, a phase 3 study of belatacept-based immunosuppression in renal transplantation as compared to cyclosporinebased immunosuppression and reports long-term results. Previously, belatacept had already been reported as providing similar patient and graft survival with, however, significantly improved renal function in kidney-transplant recipients. This study reports the final results of BENEFIT. Kidney-transplant recipients had been randomly assigned to three arms: a more-intensive belatacept regimen, a less-intensive belatacept regimen or a cyclosporine-based regimen. Efficacy and safety outcomes for all patients who underwent randomisation and transplantation were now analysed at seven years since transplantation (month 84).
A 43% reduction in the risk of death or graft loss was observed for both the more-intensive and the less-intensive belatacept regimens as compared with the cyclosporine regimen A total of 666 participants were included and randomised. Of the 660 patients who were treated, 153 of the 219 patients treated with the more-intensive belatacept regimen, 163 of the 226 treated with the less-intensive belatacept regimen, and 131 of the 215 treated with the cyclosporine regimen were followed for the full 84-month period; all available data were used in the final analysis. A 43% reduction in the risk of death or graft loss was observed for both the more-intensive and the less-intensive belatacept regimens as compared with the cyclosporine regimen (hazard ratio with the more-intensive regimen, 0.57; 95% confidence interval [CI], 0.35 to 0.95; p = 0.02; hazard ratio with the less-intensive regimen, 0.57; 95% CI, 0.35 to 0.94; p = 0.02), with equal contributions from the lower rates of death and graft loss. The mean estimated glomerular filtration rate (eGFR) increased over the seven-year period with both belatacept regimens but declined with the cyclosporine regimen. The cumulative frequencies of serious adverse events at month 84 were similar across all three treatment groups. Seven years after transplantation, patient and graft survival and the mean eGFR were significantly higher with belatacept (both the more-intensive regimen and the less-intensive regimen) than with cyclosporine. These results seem extremely clear and should be taken into consideration by all renal transplant centers. The study was funded by Bristol-Myers Squibb and registered as ClinicalTrials.gov number NCT00256750.
Source: Belatacept and long-term outcomes in kidney transplantation. Vincenti F, Rostaing L, Grinyo J, Rice K, Steinberg S, Gaite L, Moal MC, Mondragon-Ramirez GA, Kothari J, Polinsky MS, Meier-Kriesche HU, Munier S, Larsen CP. N Engl J Med. 2016 Jan 28;374(4):333-43. doi: 10.1056/ NEJMoa1506027.
European Urology Today
TEN QUESTIONS Interview and Photograpy by Joel Vega
Age: 66 Specialty: Urology City: Verona, Italy Recent Awards & Current Post: EAU Willy Gregoir Award 2016, Professor and Chairman, Department of Urology, University Hospital of Verona, Italy; Former EAU Adjunct Secretary General for Science
• What is the most rewarding aspect about urology? Urology is amazing being at the same time a medical and surgical specialty. Urologists are in charge of all the pathways of the patient, from prevention to diagnosis, medical and surgical treatment, and follow-up. It is great to be a urologist! • If you were not an urologist, what would you be? I didn’t choose to become urologist when I was a medical student. My main goal was to become a neurologist and my motivation was my father who had multiple sclerosis. His disease started when I was three years old and he died just a year after I obtained my degree in medicine. My aim then was to do basic research on multiple sclerosis. • What is your most important piece of advice for doctors just starting out today? My first and main advice would be about the value of passion in daily work and professional honesty, doing always the best for a patient. Secondly, I would advise to focus on a subspecialty aiming at excellence. • What is your tip to other physicians on how to avoid burnout? Difficult and easy to answer this question because if you love what you do, you will never burn-out. Every day is a joy for me to work and I feel privileged because I do what I like. • If you could change something in the healthcare system, what would it be? There is the huge focus, today, on costs and cost-effectiveness, which is understandable. To save or prolong a single life should be without price, and the clash between the effective use of limited resources and the goal of providing the best possible care raises difficult ethical issues. I would like to see outcomes evaluated more than cost. • What do you most often wish you could say to patients, but didn’t? In clinical practice you don´t only have to be a technician, you also need to be empathic and know how to communicate well with the person in front of you who is by chance a patient. Some patients tune out your message, but there are also those who are difficult to communicate with, and this can be a real challenge. • What’s the last thing that surprised you? I am surprised by the brilliance of the human mind and how our minds can be innovative and see reality in different ways. I see this from my own colleagues, how sharp their views and ideas are. • What’s the last wonderful book you have read? I have two books now on my bedside. ‘The Second Brain’ (ed. by Dr. Michael Gershon) which is about the physiologic neural ‘independence’ of our bowel activity. I am also reading `God and His destiny` by Vito Mancuso (ed Garzanti), where the image we have of God is depicted in various times and cultures. • What’s your favourite hour in a day and why? Usually at 8 or 8.30 at night when I´m back home relaxing. I must confess that nothing is more relaxing for me than watching, or playing, a football game (laughs). • What is your biggest fear? I have no real fear, although in present times you could fear the resurgence of violent and crazy regimes, but I rely on the resilience of the silent majority. The global scientific community is one of the best examples of how you can effectively overcome any cultural barrier.
EAU Patient Information ‘Newbie’ in Munich draws enthusiastic visitors
firstname.lastname@example.org The EAU Patient Information was the newbie in this year’s exhibition floor at the 31st Annual EAU Congress in Munich-- and with great success! The EAU Patient Information desk triggered a lot of interest and urologists from all over the world offered their assistance, particularly with the translation into languages not yet available such as Hebrew, Portuguese, Italian and French. Aside from English, contents of the Patient Information website are available in 14 languages, mostly European. Translating is a time-consuming process, and no translation is published without the approval of the National Society. The approval procedure aims to ensure good quality and adequate adaptation to local circumstances, if needed.
“This is an exciting time and new products such as animated videos and 3D images are explored to keep ahead with developments in health care…” A re-structured and restyled website was launched at the time of the congress. It now includes patient summaries of recent research, news items and other resources such as a database of patient support groups throughout Europe - all to create a 18
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comprehensive platform that is used by patients and medical practitioners alike. And there is more: the newly established EAU Patient Information Working Group met in Munich for the first time. The group consists of members from the Young Urologists Office (YUO/YAU), ESRU, EAUN, and the author. Each member will serve a term of two years during which they are responsible for developing new patient information, updating existing topics and exploring new ways to further expand the Patient Information initiative. This is an exciting time and new products such as animated videos and 3D images are explored to keep ahead with developments in health care and to improve our reach of the patient and doctor – it is time to get involved! Visit us at patients.uroweb.org for details. For more information or suggestions email us at: email@example.com
Esther Robijn (Patient Information Coordinator) at the Patient Information booth in Munich
Prof. Thorsten Bach Chairman EAU Patient Information Urology Centre Hamburg Asklepios Klinikum Harburg Hamburg (DE)
Collaborative goals in Africa Emerging opportunities for ESUT collaboration with Sub-Saharan Africa Dr. Edet Ikpi Deputy Director, Clinical Services Senior Lecturer/ Consultant Urologist University of Calabar Teaching Hospital Calabar (NG) firstname.lastname@example.org The recently concluded 31st Annual EAU Congress in Munich, Germany, has opened up many opportunities for the expansion of the international collaboration between the EAU Section of Uro-Technology (ESUT) and Sub-Saharan Africa. Although the number of Nigerian urologists who participated in the EAU congress was small, discussions were initiated between the major Sub-Saharan urologists from Nigeria, the EAU and the ESUT.
"Bilateral issues of interest that were discussed included collaboration between the ESUT and NAUS on training, technology transfer and personnel support."
satisfaction. During my stay in Munich for the EAU congress, as chairman of the local organizing committee for the Nigerian Association of Urological Surgeons Annual Congress (scheduled in November this year at the ancient city of Calabar in southern Nigeria), I met with the EAU board members, Professors Chris Chapple, Joan Palou, Manfred Wirth and the leadership of the ESUT. Bilateral issues of interest that were discussed included collaboration between the ESUT and NAUS on training, technology transfer and personnel support. I also met with Dr. Ali Serdar Gözen and invited the ESUT training group to visit and participate in the November congress of NAUS. It was also a pleasure to see that the ESUT team looks forward to this collaboration. After the congress I visited the SLK-Kliniken Urology Department in Heilbronn. The three days were very productive, professional and socially as I had the chance to observe the work at operating theatres and experienced the warm welcome from the urology team. I met Prof. Jens Rassweiler and discussed the possibilities for collaboration to raise the level of urology in Nigeria. As an initial project we are planning, together with ESUT experts,
hands-on training courses for the NAUS congress, particularly the basic laparoscopy training programme E-BLUS which will be adapted in the NAUS education programme.
It should be appreciated that there are very few highly equipped urological training centres in Nigeria but the scope of collaboration with the EAU and ESUT may provide an opportunity to improve the equipment profile of these centres and, more importantly, open up the opportunity for training young Nigerian urologists on newer technological application that will facilitate and improved patient EAU Section of Uro-Technology (ESUT)
At the EAU Congress in Munich with Profs. Chapple, Wirth and Montorsi
We also aim to organise a fellowship programme and send Nigerian urologists to well-known European centres for advanced training in laparoscopic, robotic and other minimal invasive surgery.
Me and Dr. Ali Gözen in Munich
The ESUT training group aims to support the training of Sub-Saharan urologists through these collaborative programmes and thereby improve the quality of urological services in Nigeria.
Prof. Jens Rassweiler and me during my visit to the SLK-Kliniken
Role of diet in urolithiasis Dietary measures to reduce stone formation risk Prof. Roswitha Siener University Stone Centre Dept. of Urology University of Bonn Bonn (DE)
24 hours will reduce the supersaturation of stoneforming salts1. Depending on the environmental temperature and the degree of physical activity, it is usually necessary to drink more than two litres per day to achieve this. Tap water, mineral water with a low mineral content, fruit and herbal teas are suitable for stone formers if stone type is unknown.
An increased dietary intake of animal protein favours increased urinary excretion of calcium, as well as decreased excretion of citrate, which is a crystallisation inhibitor. It produces a metabolic acid load that causes bone calcium mobilisation and an increase in urinary calcium. Purine overload causes an increase in uric acid. These factors therefore favour the appearance of calcium oxalate and uric acid stones2.
Dr. Noor Buchholz Sobeh’s Vascular and Medical Centre Dubai Health Care City Dubai (UAE) noor.buchholz@ gmail.com
Normal protein intake is recommended for patients suffering from calcium oxalate and/or uric acid stones. The recommended daily protein intake is 0.8 g/kg body weight/day3. An increased intake of sucrose should be avoided in patients with urolithiasis as this can promote not only increased urinary calcium, but also the appearance of insulin resistance phenomena that increase the risk of suffering metabolic syndrome.
addition of these foods to the diet of hypocitraturic stone formers not only significantly increased citrate excretion, but also decreased calcium oxalate and uric acid relative saturation.
"A low-calcium diet presents a serious problem, involving the accelerated loss of bone mineral density in patients with idiopathic hypercalciuria favouring a negative balance of calcium in the bones." Urinary oxalate is predominantly derived from endogenous production of oxalate from ingested or metabolically generated precursors and from the diet. A high dietary intake of oxalate can significantly increase urinary oxalate excretion5.
For stone formers, a normal daily calcium intake of 1000-1200 mg is recommended3. A low-calcium diet Co-Authors: Miguel Angel Arrabal Polo (ES), Attila presents a serious problem, involving the accelerated Szendroi (HU) loss of bone mineral density in patients with idiopathic hypercalciuria favouring a negative balance Prevalence and incidence of urinary stone disease are of calcium in the bones6. Increased salt (sodium rising in the last decades due to inappropriate dietary Fat intake and stone risk chloride) intake produces a rise in extracellular habits, overweight and lack of physical activity. The association between dietary fat intake and the risk volume and decreased tubular reabsorption of calcium, which induces increased urinary calcium of stone formation is unclear. Specific dietary fatty Diet plays a crucial role in the recurrence prevention acids are suggested to influence calcium oxalate stone excretion. Salt intake should not exceed 6g per day, of urolithiasis. Specific dietary factors can alter formation. An increased phospholipid arachidonic acid meaning a significant reduction in the normal intake3. composition and supersaturation of urine, which can level may induce hyperoxaluria. Long-term fish-oil affect the process of crystallization and stone supplementation has been shown to be effective in General recommendations for patients with reducing urinary oxalate excretion and the risk of urolithiasis include the following: formation. calcium oxalate crystallization in healthy subjects4. The most important dietary measure for recurrence • Sufficient fluid intake to maintain a urine output Omega-3 fatty acids might reduce the risk of calcium of > 2.0 litres/day, evenly distributed over the day; prevention of stones is a high urine volume. An stone formation. Omega-3 fatty acids are present in • Dietary protein maximum 0.8-1.0 g/kg body increase in urine output to more than two litres over fish oil, salmon, herring, tuna, mackerel and sardines. weight/day; 50% of vegetable origin; In general, fruits and vegetables provide an alkali • Fruits and vegetables daily; however, consider EAU Section of Urolithiasis (EULIS) load mainly due to their alkaline citrate content. The oxalate content; March/May 2016
• Daily calcium intake 1000-1200 mg/24 h; • Salt intake limited to 6 g per day, and avoid sugar. Specific measures for calcium oxalate and uric acid stone formers should be directed towards alterations of lithogenic risk factors: • In hyperoxaluria, avoid intake of oxalate-rich foodstuffs (e.g. spinach, rhubarb, mangold, beetroot, black and green teas); • In hypercalciuria, correct the consumption of dietary protein, calcium and salt to meet the daily recommendations; • In hyperuricosuria, limit the intake of purines (meat, fish, innards and legumes) and avoid alcoholic drinks; and • In hypocitraturia, increase fruits, vegetables, citrus juices and bicarbonate-rich waters. References 1. Siener R, Hesse A. Fluid intake and epidemiology of urolithiasis. Eur J Clin Nutr. 2003;57, Suppl 2: 47-51. 2. Nouvenne A, Meschi T, Guerra A, Allegri F, Prati B, Borghi L. Dietary treatment of nephrolithiasis. Clin Case Miner Bone Metab. 2008; 5: 135-141. 3. Siener R, Hesse A. Dietary assessment and advice. In: Rao PN, Preminger GM, Kavanagh JP, Editors. Urinary Tract Stone Disease. Springer, London, 2011, 687-694. 4. Siener R, Jansen B, Watzer B, Hesse A. Effect of n-3 fatty acid supplementation on urinary risk factors for calcium oxalate stone formation. J Urol. 2011; 185: 719-724. 5. Siener R, Bade DJ, Hesse A, Hoppe B. Dietary hyperoxaluria is not reduced by treatment with lactic acid bacteria. J Transl Med. 2013; 11:306. 6. Heilberg IP, Goldfarb DS. Optimum nutrition for kidney stone disease. Adv Chronic Kidney Dis. 2013; 20: 165-174.
Acknowledgement: This article is an abbreviated version of an article with the same title submitted to a special edition of the Egyptian Journal of Urology on conservative stone treatment on behalf of EAU-EULIS. European Urology Today
Who’s Who in the Board of the European School of Urology Marko Babjuk: Maintaining urology’s crucial role Q: What are your goals for the European School of Urology?
By Joel Vega The European School of Urology (ESU) is running an interview series with its board members to share their insights on various issues such as the role of technology, future prospects in urology, training and education, among other topics.
Babjuk: The ESU’s main goal is to deliver education to urologists. We must cover the professional needs of all urological specialties. Moreover, we must focus not only on established methods of management, but actively look into new perspectives, approaches and areas of potential. Thanks to a dynamic research environment, we now have breakthrough discoveries in diagnostic approaches, surgical and, particularly, medical treatment strategies. These gains lead to changing treatment principles and algorithms. Thus, the ESU must take the lead by exerting sustained efforts to adapt to all these new developments and play a leading or active role in translating them into routine clinical practice. Within this context, education plays a crucial role in maintaining the reach and quality of urology in the future.
Board member Prof. Marko Babjuk shared his thoughts on the role of the ESU and its plans for training and education. Below is a transcript of the Q&A interview with Prof. Babjuk: Q: Can you tell us a bit more about your background, specialty and experience? Babjuk: I obtained my University degree and was trained in Prague at the 1st Faculty of Medicine. I also spent a year at the Department of Urology in Wuppertal, Germany with Professor Thüroff, which helped me establish contacts with other European urologists. In 2009, I was assigned as chairman of the Department of Urology at Motol Teaching Hospital and since 2014 I am the vide-dean at the 2nd Faculty of Medicine in Prague.
"...the ESU must take the lead by exerting sustained efforts to adapt to all these new developments and play a leading or active role in translating them into routine clinical practice." My clinical activities are mostly in onco-urology, including major open procedures, endourology and minimal invasive surgery (laparoscopy and robotics). My research projects and published papers were focused mainly on bladder cancer.
Prof. Marko Babjuk, ESU Board Member
I finished in 2001 my PhD thesis on cell experiments with photodynamic therapy with the support of the Laser Research Centre of the Klinikum Grosshadern in Munich, Germany. With the EAU, and aside from my tasks with the Education Office, I am involved with the Guidelines Office where I chair since 2011 the EAU Guidelines Panel for Non-Muscle Invasive Bladder Cancer (NMIBC). Q: What is your role in the ESU board? Babjuk: Besides supporting the basic agenda of the ESU Board, I participate in teaching projects involving onco-urology, particularly bladder cancer. We prepared, for instance, the on-line E-learning course on the diagnosis and treatment of NMIBC. Currently, we are working on the programme for a masterclass regarding the surgical treatment of bladder cancer. I am also responsible for promoting ESU activities through the EAU’s publications and other media channels.
Q: How do you see the future of education and urology? Babjuk: We must implement new technical developments in our teaching practice. Several information and training courses are already made available on-line by the EAU. We should also exhaust or make good use of new communication media in delivering information. Another challenge is the teaching of new surgical methods. Applying modern simulators will be important for boosting the skills of the new generation of urologic surgeons which, of course, lead to better surgical outcomes. At the same time, we must maintain or boost the quality of education and the level of evidence and information we provide. The link between teaching and scientifically proven information through guidelines (recommendations) is very important.
Teaching activities 2016 European School of Urology May 20-21 27 28
1st ESU-ESUT Masterclass on Operative management of benign prostatic obstruction, Heilbronn (DE) ESU course on Urolithiasis at the national congress of the Kosovo Urological Association, Pristina (KO) ESU course on Urethral reconstruction and urogenital fistulae repair at the EAU Baltic Meeting, Tallinn (EE)
ESU course on High risk prostate cancer and Male infertility at the national congress of the Romanian Association of Urology, Bucharest (RO) 16 ESU course on Management of muscle-invasive and metastatic bladder cancer at the national congress of the Slovak Urological Society, Žilina (SK) 23 ESU course on Locally advanced and metastatic prostate cancer at the national congress of the Polish Urological Association, Katowice (PL) 26 – 2 July ESU – Weill Cornell Masterclass in General urology, Salzburg (AT)
1st ESU-ESUT Masterclass on Operative management of Benign Prostatic Obstruction
2-7 14-16 21-23 23 23/24
14th European Urology Residents Education Programme (EUREP), Prague (CZ) ESU-ERUS courses at the 14th Meeting of the EAU Robotic Urology Section (ERUS), Milan (IT) ESU-ESAU course at the 9th Congress of the European Academy of Andrology, Rotterdam (NL) ESU course on General update on oncological urology at the national congress of the Armenian Urological Society, Yerevan (AM) ESU course at the time of the EAU 12th South Eastern European Meeting (SEEM), Sarajevo (BA)
20-21 May 2016, Heilbronn, Germany
EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
7/8 20 21 21 22 29
3rd Confederación Americana de Urologia Residents Education Programme (CAUREP), Panama City (PA) ESU course on at the time of the EAU 16th Central European Meeting (CEM), Vienna (AT) ESU course on Assessment and management of LUTS at the national congress of the Czech Urological Society, Ceske Budejovice (CZ) ESU course on Stone disease at the national congress of the Russian Society of Urology, Oefa (RU) ESU course on Pelvic floor dysfunction; patient selection and surgery at the national congress of the Tunisian Urological Society, Hammamet (TN) ESU course at the Hellenic Urological Association, Rhodes Island (GR) ESU course on Bladder cancer at the national congress of the Hungarian Urologic Association, Debrecen (HU)
November 3-4 17-18 24-27 25 30
3rd ESU Masterclass on Lasers in urology, in collaboration with the EAU Section of UroTechnology (ESUT), Barcelona (ES) 9th ESU Masterclass on Female and functional reconstructive urology, in collaboration with the EAU Section of Female and Functional Urology (ESFFU), Berlin (DE) ESU courses at the 8th European Multidisciplinary Meeting in Urological Cancers (EMUC), Milan (IT) ESU course at the national congress of the Lithuanian Association of Urology, Vilnius (LT) ESU course on Urooncology at the national congress of the Egyptian Urological Association, Sharm El-Sheikh (EG)
ESU course at the national congress of the Georgian Association of Urology, Tbilisi (GE)
European Urology Today
UROwebinars: ESU’s newest educational tool Next UROwebinar will take place on 24 May, 6.30 PM CEST Dr. Joan Palou Chairman ESU Barcelona (ES)
jpalou@ fundacio-puigvert.es The European School of Urology is introducing a new online educational tool, UROwebinars. Each month a 30-minute webinar will be organised, addressing current treatments and controversies in various fields within urology. Expectations for urological residents and surgeons are high to possess adept surgical skills with new technologies, while facing the current reality of less training hours due to work-hour restrictions and lack of opportunities. This requires new educational tools with the flexibility to study and
train at a time that suits you, wherever you are. The UROwebinars are a perfect educational source to get updated, outside of work, and at your convenience and pace. Expert urologists and urologists-in-training can participate the webinars for free via desktop, tablet or mobile phone. Participants have ample opportunities to interact and pose questions. All webinars will be recorded and can be reviewed at a later stage. In the coming months leading international experts will explain the latest developments in concise presentations. Prof. Morgan Roupret kicked off with Update on bladder cancer management: What are we doing wrong? In the next webinar Prof. Marcus Drake will address the contribution and limitations of Urodynamics. And more controversial topics are scheduled for this year. If you have a certain urological topic that you think should be covered in one of our webinars, do let us know. Please send an email to Mr. Ton Brouwers at email@example.com.
Prof. Morgan Rouprêt
Prof. Marcus Drake
The first webinar on bladder cancer, presented by Morgan Rouprêt, can be viewed at www.Uroweb.org/webinar
Join Us Next Month for a New UROwebinar on Urodynamics Many patients with lower urinary tract symptoms consider surgical treatment, and selecting appropriate interventions is crucial for a successful therapy. Urodynamics has a major role as part of the treatment selection, but urologists need to understand the strengths and limits of testing to make sensible recommendations to their patients. This webinar will discuss the importance of understanding the contribution and limitations of Urodynamics such as:
This webinar, which aims to challenge how urologists currently manage bladder cancer patients, addresses contemporary concepts and controversies in bladder cancer such as: • Accurate staging and its role in clinical decision making/risk stratification; • Risks, benefits, and side effects of current and novel therapeutic approaches including endoscopic and minimal-invasive surgery; and • Systemic therapy for high-risk and metastatic patients.
• Who should have urodynamic tests? • What are the features of a trace that confirm a study has been done well? • What artefacts might lead to a wrong conclusion on diagnosis?
Title: How to interpret a urodynamic study: Fact and artefact Presenter: Marcus Drake Date: May 24, 2016 at 6:30 PM CEST
Register now at www.Uroweb.org/webinar
Education Online Upgrade your knowledge online
Improve your skills: e-learning at your own convenience
Education is one of the most important drivers to get urological care to the next level. The EAU Education Online platform aims to provide easily accessible educational material to urological health professionals from all over the world. In close cooperation with European urologists, EAU Education Online has developed several accredited online educational activities. All courses are freely accessible at uroweb.org, using your computer, tablet or smart phone.
Overactive Bladder (OAB) • mechanisms & management • onabotulinumtoxinA as treatment
Update on bladder cancer management
Guidelines Prostate Cancer
By Prof. Marcus Drake, Bristol (GB)
Laparoscopy • Peg transfer • Cutting a circle • Needle guidance • Suturing
Risk profile-oriented management of BPE/LUTS
Emerging evidence on PSA in the Diagnosis of Prostate Cancer By Prof. Michael Marberger, Vienna (AT)
Non-Muscle Invasive Bladder Cancer
By Prof. Morgan Roupret, Paris (FR)
Visit uroweb.org/education and test your knowledge! March/May 2016
European Urology Today
Impressions of the ESU programme Munich 2016 ESU courses, Hands-on training and Innovation in Education
New ESU courses • Adrenalectomy • Basic surgical and endo urological skills • Update renal, bladder and prostate Guidelines 2016, what is changed? • A tool-kit for practising evidence based urology • Video and imaging urodynamics
New HOT courses in Munich 2016 • ESU/ESUT/ESUI Hands-on training in MRI fusion biopsy • ESU/ESFFU Hands-on training in Sacral neuromodulation procedure standardisation • ESU/ESUT Hands-on training with Thulium laser for vaporesection of prostate • ESU/ESUT Hands-on training in Fluorescence guided laparoscopic surgery • ESU/ESUT Hands-on training in HoLEP
3rd ESU Masterclass on Lasers in urology
9th ESU Masterclass on Female and functional reconstructive urology
In collaboration with the EAU Section of Uro-Technology (ESUT)
In collaboration with the EAU Section of Female and Functional Urology (ESFFU)
3-4 November 2016, Barcelona, Spain EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
European Urology Today
17-18 November 2016, Berlin, Germany EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
ESU Laparoscopy & Endourology Course in Cáceres Stressing the value of actual training Dr. Spyridon Kampantais Dept. of Urology University Hospital of South Manchester Manchester (GB) kabspir@ hotmail.com
Dr. Vasileios Kakamoukas 2nd Dept. of Urology Aristotle University of Thessaloniki Thessaloniki (GR) vkakamoukas@ gmail.com It was a great honour to participate in the ESU Hands-on Training (HOT) Course on Laparoscopy and Endourology held from February 2 to 5 this year at the Centro de Cirugia de Minima Invasion Jesus Uson (CCMIJU) in Cáceres, Spain.
Participants selected to this course were qualified by their high ranks at the eBLUS or previous EAU HoT courses. The ESU sponsored the participants’ fees and travel expenses, underlining the ESU’s commitment to support the training of young urologists. Twenty two young urologists from all over Europe participated in the course which gave them the opportunity to exchange ideas and share experiences regarding surgical training. Designed to offer intensive hands-on training, the course offered two full days of training on laparoscopic procedures and another two on endourology training in one of Europe’s wellequipped training centres. Simulators and live animal models were offered and all trainees could perform repeat exercises in various procedures including laparoscopic pyeloplasty, radical and partial nephrectomy, prostatectomy, flexible ureteroscopy and PCNL. The newest equipment and sufficient disposables were provided by co-sponsors Karl Storz and Cook Medical which generously support the annual course.
Family picture of hosts, tutors & trainees
not been for the JUMISC’s staff members, Dr. Idoia Díaz-Güemes, Dr. Francesco Soria and their collaborators. They have given their best to cater to our training needs. The ESU’s expert tutors, Dr. Ben Van Cleynenbreugel and Dr. Oscar Rodriguez also shared tips and tricks to push our surgical skills to the highest level.
This well-organised and structured “HOT” course exceeded all our expectations with its emphasis on practical insights and the refinement of surgical skills. Apart from the centre’s impressive facilities, our experience would not have been so fulfilling had it
Daria Chernysheva: “The HoT course was not only amazing, I enjoyed every minute of it! The Center, the staff, the operation rooms and the organisation were just excellent and couldn't be any better! I was impressed by the variety of instruments and the high-level quality. Because of the training I had in Cáceres, I successfully performed my first (human) kidney resection and nephrectomy. Thank you!”
ESU Laparoscopy course Refining skills in advanced training centre
firstname.lastname@example.org The European School of Urology’s (ESU) intensive course on Laparoscopic and Endoscopic Urology, which took place from February 2 to 5 in Cáceres, Spain, distinguishes itself from other ESU courses with its focus on fully training and mastering surgical skills using the most modern equipment in laparoscopic and endoscopic urology. Centro de Cirugía de Mínima Invasión Jesús Usón (CCMIJU or the Jesús Usón Minimally Invasive Surgery Centre) serves as the venue and with good reason. Although located around 250 km from Madrid, the CCMIJU is the most developed training centre in Spain with the latest state-of-the-art equipment in laparoscopic, endoscopic and reconstructive surgery,
and offers the opportunity to train and improve professional skills using unique simulators that were built in the centre itself. Moreover, the centre has a powerful scientific core consisting of pharmacology and medical engineering, vivariums and a Guidance Department that trains physicians from various disciplines. This year, 22 young urologists from all over Europe took part in minimally invasive urology training. Participants were from Belgium, Germany, Spain, Italy, Lithuania, Latvia, Romania and Russia, among other countries. The participants were selected based on the results of their previous participation in various training and contests organised by the ESU. Besides English proficiency and an EAU membership, accepted candidates must possess good skills in urologic surgery demonstrated during an ESUorganised HoT session. The course programme included a two-day masterclass on laparoscopic and endoscopic urology led by Ben Van Cleynenbreugel (BE) and Oscar Rodriguez Faba (ES). Training on stimulators and animals, the participants could refine their skills in major surgeries in various urological approaches such as semi-rigid and flexible ureteropyeloscopy, transurethral and percutaneous nephro and ureterolithotripsy, partial nephrectomy, adenomectomy and others. ESU Chairman Dr. Joan Palou emphasised in his remarks during the last day the need for efficiency and the crucial role of offering comprehensive training to urological specialists. He also encouraged participants to take an active part in urological education and sharing their skills with colleagues to boost the services of their home clinics. Undoubtedly, the knowledge and skills acquired by young urologists who have participated in Cáceres will not only help in strengthening their skills but would also contribute to the aim of urology to provide optimal healthcare.
Pavel Gavrilov: “Everything was fantastic during the course!“ Predoiu Gabriel: “Cáceres HOT was a truly wonderful experience that helped me grow as a surgeon. Remarkable training facility, wonderful staff, amazing colleagues-- all in all a truly enriching experience! “
Dr. S. Reva N.N.Petrov Research Institute of Oncology Dept. of Oncourology Saint-Petersburg (RU)
We quote ESU Chairman Dr. Joan Palou who stressed the importance of actual training: "We are surgeons and we want to be trained and not only with lectures…” Indeed, we have truly benefited from this course and we strongly recommend this training at the JUMISC in Cáceres.
Sorin Nedelea: “I thank the ESU for the great opportunity to join this programme. The four days of intensive hands-on training were very interesting. Both training teams from the Jesus Uson Center and the ESU were amazing.”
David Hernández Hernández: “I thank the ESU for giving this great opportunity to improve my skills in endourology and laparoscopy. I strongly recommend this course. It was a great experience meeting young urologists and residents from all over Europe.”
Renán Javier Otta Oshiro: "Excellent facilities, outstanding tutors and great organisation." Hendrik-Jan Florin: “The course in Cáceres was an unforgettable experience. Four days of non-stop hands-on training. In my whole career as a young doctor, I have not experienced such a top-notch training where I can improve my skills in a wonderful center. The tutors, the staff, the animal models, the materials supplied by Storz and Cook were just all high-quality. Thank you to the ESU for this opportunity.”
Leonardo Tortolero Blanco: "A really wonderful experience which helped me improve my endourology and laparoscopy skills and share experiences and knowledge with other European residents and urologists. I highly recommend this course." Maris Vlaznevs: “Everything was excellently organised from the instrumentation, tutorials and accommodation. It was a unique training experience and the knowledge I gained is priceless. I thank the organisers for this great opportunity where I have not only trained thoroughly but also had the opportunity to meet other urologists. And my special thanks to the tutors for their patience, dedication and friendliness. Thank you!”
Klim Leonenko: “One of the best organised courses I have ever been. Each pair of trainees had a personal tutor who explained every movement, showed tips and trick and went through from basic to more complex procedures using simulators and animal models. The atmosphere was very motivating. Thanks a lot to the ESU for this training opportunity.”
European Urology Today
European Urology Forum 2016 Urological Challenge participants commend insightful debates By Joel Vega At the European Urology Forum held last February 13 to 16 in Davos, Switzerland, the Urological Challenge sessions have triggered a dynamic discussion among the panel experts and participants, highlighting the diverse challenges in urology particularly with regard the role of emerging treatments vis-a-vis standard strategies. Five contestants from Hungary, France, Poland, Germany and Spain presented three topics of their choice in three sessions before a panel of experts, sharing insights from their clinical findings, research studies and opinions on key issues such as managing prostate disease, infections, incontinence, bladder cancer and regenerative therapy among others. Jean Nicholas Cornu (Paris, FR) emerged as winner with succinct presentations on ablative surgery for benign prostatic obstruction relief, the role of male slings for post-prostatectomy incontinence management, and regenerative therapy of the urinary sphincter. Béla Köves (Budapest, HU) took the second place with his comprehensive examination of issues in urological infections. He discussed current and future directions in the managing recurrent urinary tract Infections (UTI), the role of prostate biopsy in the era of multi-resistant infections, and looked into evidence-based management of catheter-associated UTI. Marcel Fiedler (Heilbronn, DE) bagged the third spot, ahead of Miguel Ramirez Backhaus (Valencia, ES) who placed fourth and Anna Katarzyna Czech (Cracow, PL). Fiedler tackled topics such as reporting complications after urologic procedures, imagefusion-based prostate biopsy (comparison of different devices and techniques) and the oncologic and functional outcomes after laparoscopic and roboticassisted laparoscopic radical prostatectomy. Ramirez Backhaus discussed sentinel lymph node dissection in prostate cancer (PCa), the role of chemotherapy and androgen deprivation therapy in first-line PCa treatment, and salvage radical prostatectomy following initial active surveillance. Czech explored questions such as the importance and role of standard TURBT, laparoscopic artificial urinary sphincter implantation, and the evolution and evaluation of repeat prostate biopsy strategies.
Below are the comments of each participant and how they looked back at the annual event which gathers every year mid-career urologists and upcoming talents for a comprehensive update on major issues in urology: Jean Nicholas Cornu: “Davos is the place to be!” It was a great pleasure to be involved in this year’s European Urology Forum. Given the outstanding quality of the talks by internationally recognised speakers, and the high level of interactivity, it was a wonderful opportunity to get cutting-edge information in all urological issues. As a challenger, I was really focused on my talks, eager to give the best performance in the presence of well-known EAU experts. Everyone played the game with wonderful talks and intense discussions. All of us were impressed by this meeting. Last but not least, we enjoyed a very special social programme. These are some of the reasons why Davos is the best place to network, share knowledge and promote academic excellence in urology.
their questions to push the envelope. Prof. Frans Debruyne as eloquent moderator guided the challengers, experts and the audience through the Béla Köves: “An experience of a lifetime” sessions and created a very pro-active atmosphere. This was my first time to participate in the Forum, and All five of us were kept busy with three lectures held I really enjoyed the unique atmosphere of the in three days. Nevertheless, there were a lot of nice meeting. As there are fewer participants than at the moments, especially in the evenings- conversing with annual congresses, it creates a rare opportunity to colleagues, sharing ideas and enjoying the forum’s engage in scientific discussions and knowledgeunique ambience. sharing with some of the best academic urologists. Being a challenger made the whole meeting even Miguel Ramirez Backhaus: “Intense discussions and more interesting. There was real tension during the debates” three sessions as the expert panel and the challengers It was a great honour to take part in the European examined their views in earnest. I think all the Urology Forum, which this year marked its 25th challengers gave very high- quality presentations, and anniversary. The Forum is the perfect opportunity for I am honoured that I was given the chance to young urologists with academic interest to share participate. Giving the lectures, getting into spirited knowledge, boost their motivation in clinical and discussions and being criticised by such a prestigious basic research and network with some of the best panel of experts is really an experience of a lifetime. European urologists. The inspiring professors of the ESU and challenger winners from the last 10 years Marcel Fiedler: “Pushing the envelope” gave high-quality presentations. There were intense Five experts wearing EAU logo-printed shirts and EAU discussions with the well-prepared challengers and baseball caps, a very interested audience and five well-prepared challengers – I have never experienced a meeting comparable to the European Urology Forum. Giving a talk was nothing new for all challengers, but this situation was really special. After the experts had been challenged by the five participants, the challengers themselves were challenged by the experts who discussed every detail of the lectures and prompted the challengers with
The growing incidence of urological infections has nowadays increasingly been at the forefront of research and the concern is justified considering not only the alarming rate of occurence but also the severity of infections and their impact on a patient’s quality of life. At the upcoming 25th European Urology Forum to be held in Davos, Switzerland from 13 to 16 February, the issue of urological infections will take centre stage during the “Challenge the Experts” sessions with Dr. Béla Köves (Budapest, HU) presenting a series of lectures on recurrent urinary tract infections (UTI), catheter-associated UTIs and multi-resistant infections due to prostate biopsies. “In our era of antibiotic resistance urological infections represent one of the biggest threats to urological communities all around the world, so it is important to talk about this issues,” said Koves. “The Challenge the Experts session is a very good opportunity to highlight this growing problem. The lectures about recurrent urinary tract infections, catheter-associated infections and the infections caused by prostate biopsies are all relevant topics covering the the most frequent problems encountered by any urologist,” he added. Koves also noted that regarding research, the increase of antibiotic resistance remains a very serious threat. 24
European Urology Today
Prof. Debruyne led an interactive session during the debates. I congratulate Dr. Cornu on his work and remarkable career, and also thank the ESU for choosing me as one of the challengers. Anna Katarzyna Czech: “Unique and enlightening experience” I had the pleasure to participate in the Challenge the Experts session which I found really challenging. The bar is set very high, and being “grilled” by the critique panel, though stressful, is a very enlightening experience. We also had the opportunity to meet top European urologists, including urology legends, key opinion leaders and participants of previous editions of Challenge the Experts sessions in an more informal setting. Davos’ wintry mountain landscape makes this annual meeting also unique. Participating in the Forum is an eye-opener and I express my gratitude for the invitation and opportunity to be a part of it. My thanks to Professors Frans Debruyne, Chris Chapple and Joan Palou for their mentorship and congratulations to all challengers!
Threat of urological infections at “Challenge the Experts” By Joel Vega
The five challengers of 2016 (from left), Dr. M. Fiedler (DE), Dr. A.Czech (PL), Dr. B. Köves (HU), Dr. J.N. Cornu (FR), and Dr. M. Ramirez Backhaus (ES) together with the faculty (from left) Dr. H. Hashim (GB), Prof. L. Türkeri (TR), Dr. A. Breda (ES), Mr. A.Patel (GB), Prof. M. Wirth (DE), Prof. P. Abrams (GB), Prof. C. Chapple (GB), Dr. J. Palou (ES), Prof. M. Roupret (FR)
“A better understanding of the pathogenesis and molecular genetic background of urinary tract infections is of utmost importance,” he said. In other areas he mentioned that nocturia is also a common problem with a very negative impact in the patient’s quality of life. “The topic of nocturia, its correct diagnostics and management is also under-represented in urological lectures and discussions,” he said.
European Urology Forum 2017 Challenge the experts 4-7 February 2017, Davos, Switzerland EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
Koves is one of five presenters invited by the European School of Urology (ESU) who will participate in the sessions which test the participants’ expertise on their chosen topics. The other participants are Drs. Jean-Nicolas Cornu (Rouen,FR) , Marcel Fiedler (Heilbronn, DE), Miguel Ramirez-Backhaus (Valencia, ES) and Anna Katarzyna Czech (Krakow, PL). Topics selected by the presenters ranged from reconstructive surgery, functional urology, onco-uro-logy to minimally invasive procedures, among others. Now on its 25th edition, the European Urology Forum is one the longest-running scientific and educational events organised by the ESU for mid-career urologists with special focus on discussing major and controversial issues in various urological specialities. Combining state-of-the-art sessions, case studies and the “Challenge the Experts,” the programme provides a a critical update not only on what’s new in urology but also the impact on current treatment procedures, management strategies and future prospects in both medical and surgical therapies. March/May 2016
European urology under the African Sun An EUSP-sponsored clinical visit in Tenerife Dr. Saskia Morgenstern, FEBU University College London Hospitals Dept. of Urology London (UK)
email@example.com Winter 2015 I had the great opportunity to experience a “clinical visit” at the University Hospital of the Canary Islands in Tenerife as a scholar of the European Urology Scholarship Programme (EUSP), a project of the EAU which supports knowledge exchange among European urology departments. As a person who is on the one hand a urologist from her deepest conviction and on the other hand strongly interested in people from different backgrounds and cultures, the EUSP perfectly helped me to broaden my horizons in both aspects. The EUSP offers clinical and laboratory work programmes ranging from six weeks to one or two-year periods where urologists under the age of 40 can apply for the most preferred option that matches their career plans.
Practising my skills at the simulator European Urological Scholarship Programme Office
I chose a three-month clinical visit to deepen my education in Functional Urology, a urology specialty which is not usually offered in the urological department where I work. Besides widening my expertise in this particular area, I was also curious to see how familiar urological treatments were carried out in unfamiliar settings. I was invited to observe Prof. Castro Diaz, a world-leading expert in functional urology who had immense expertise in both clinical and surgical practice.
"...I assisted in many other urological procedures including cadaver and live kidney transplantations performed by exand implantation teams..." I attended all the activities of the Urological Department including daily clinical briefings, weekly multidisciplinary meetings, regular journal club sessions, out-patient clinic, daily operating theatre as well as kidney transplantation programme activities. Prof. Castro Diaz also scheduled a number of functional procedures during my stay, where I assisted in the implantation of different male and female sling systems and artificial sphincters, pelvic organ prolapse surgery, submucosal botox injections and sacral neuromodulation. I attended the activities of the Pelvic Floor Unit, which also included video-urodynamics, consultations and the after-care of patients who have had neuromodulation. Besides the functional urology activities, I assisted in many other urological procedures including cadaver and live kidney transplantations performed by ex- and implantation teams and exiting advanced multidisciplinary tumour surgery where plastic surgeons or gynaecologists also participated. In addition to this wide range of clinical activities, I participated in international meetings such as a two-day congress and neuro-urology workshop of the Sociedad Iberoamericana de Neurourología y Uro Giencología (SINUG) on mainland Spain. Furthermore, I deepened my skills with high-level laparoscopic simulator training at the neighbouring
Prof. D. Castro Díaz and me in front of the facilities in Santa Cruz de Tenerife
island of Gran Canaria and took part in a publication regarding overactive bladder, which was published during my stay. Prof. Castro Diaz and his colleagues (in particular the outstanding urologist Dr. Barbara Padilla) introduced me to the Spanish lifestyle. Both are great hosts who quickly made me feel at home. I was invited to many dinners where I enjoyed the extraordinary Canarian food and the most spectacular wines I have ever tasted. We went out for traditional sport and music events in the evenings and we met nearly every week to play the traditional sport Padel. Finally, we had a sailing trip together where dolphins and even a whale followed our boat. Assisting in a surgical procedure
My stay was a fantastic experience and I returned to my home clinic professionally and personally enriched. And now I have another reason to look forward to every Annual EAU Congress as I can reunite with my former short-term colleague and newfound friends.
EUSP scholarship boosts laparoscopic skills Spanish resident benefits from comprehensive training in Heilbronn Dr. Antonio Tienza University Hospital son Espases Urology Service Palma de Mallorca (ES)
firstname.lastname@example.org Last winter I participated in a fellowship sponsored by the European Urology Scholarship Programme (EUSP) at the SLK-Kliniken in Heilbronn, Germany. I spent three months in Heilbronn to improve my laparoscopic skills and participate in research.
As part of the fellowship, everyone should complete a laparoscopic programme which aims to improve the skills needed for urological surgery by using conventional material, 3D camera, 7-degrees of freedom instruments or Da Vinci System.
Prof. Dr. Jens Rassweiler is the medical director of the Department of Urology in SLK-Kliniken and leads the teaching of laparoscopic surgery to urologists from all over the world. I applied for the scholarship programme a year ago after reviewing the conditions and requirements which include prior publications and recommendations from senior urologists.
Taking a break with Dr. A. Gözen and Dr. R. Rosini
I recommend applying for a EUSP fellowship. I am also thankful to Prof. Rassweiler and Dr. Gözen, Dr. Robles, Dr. Pascual and all the staff from Pamplona. With this experience, I successfully defended several months later my PhD work regarding functional outcome after surgical treatment. Certainly, opportunities such as scholarships will benefit and enrich the young careers of many urologists.
European Urological Scholarship Programme (EUSP)
The Department of Urology at Heilbronn has a strong focus on oncological pathology and is equipped with the latest technology. I had some experience in laparoscopic oncological surgery, but to train in a high-volume centre has given a boost to my career. Since in my hospital back home laparoscopic surgeries are performed almost all transperitoneally, in Heilbronn every case is done retroperitoneally, an approach that is considered “more urological.”
European Urological Scholarship Programme Office
With the scholarship I was also invited to attend to the 30th Annual EAU Congress in Madrid, one of the most important events of the year, where I could learn a lot from many experts in urology, stay up-to-date with the latest developments and participate in the E-BLUS exam.
Dr. Ali Gözen is the physician in charge of the fellows, patiently guiding all trainees in all basic procedures such as how to prepare the patient, the surgical site, how to put the trocars and create an appropriate space to work. All the work has to be done with precision and as efficient as possible. But despite that he provided useful commentary and some tips and tricks. We also collect all the data regarding the patient and surgery to create a database, which enables us to properly monitor the patient’s status and our work.
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 September 2016! For more information and application, please contact the EUSP Office – email@example.com or check our website http://www.uroweb.org/education/scholarship/ The front view of the SLK Kliniken in Heilbronn
European Urology Today
Celebrating the history and culture of urology More from the History Congress attracts over 400 delegates at EAU16 By Loek Keizer “Stimulating the study of history opens windows to the future,” was how Prof. Frans Debruyne eloquently opened the 6th International Congress on the History of Urology yesterday morning. It became clear over the course of the day-long congress that it celebrated not only the history, but also the culture of urology by highlighting its social and artistic aspects. Fifteen experts from five continents took part in the day-long scientific programme that explored the worldwide origins of urology. Over 400 delegates attended the History Congress, which was organised
EAU History Office at EAU16
by the EAU History Office and its international partners in conjunction with the 31st Annual EAU Congress. Former EAU Secretary General Prof. Debruyne was its Honorary Congress President, with Prof. Dirk Schultheiss sharing ceremonial duties as Chairman of the EAU History Office. Naturally, the congress included topics on the origins of certain procedures, biographies of known and unknown pioneers and even the prehistoric evidence of cultures of sexuality. What made the 6th International Congress unique, was the often first-hand accounts given by veteran speakers like Prof. Claude Schulman (Brussels, BE), Mr. John Pryor (London, GB) and Prof. Christian Chaussy (Regensburg, DE). Their reflections on their experiences working with Willy Gregoir, in the burgeoning field of Andrology or on their own innovations in ESWL respectively made for an unforgettable afternoon.
Aside from the 6th International Congress on the History of Urology, which naturally attracted most of the attention, the EAU History Office could be proud about several other accomplishments marked at EAU16. The unique congress gift Forbidden Fruit: Sex, Eroticism, Art by Dr. Johan Mattelaer was launched, proving to be a popular gift for delegates, particularly due to its limited run.
The History Congress was an occasion for some familiar faces to make an appearance. This included prominent urological pioneers, and two former EAU Secretary Generals (Prof. Per-Anders Abrahamsson pictured)
Organisers were also most pleased with the participation of speakers from as far away as Egypt, Argentina and China. Each presented unique insights from the medical history of their respective countries, in some cases decidedly longer histories than others.
Prof. Mohamed Eissa (Cairo, EG) gave a talk on some of the earliest written evidence for urological procedures in Ancient Egypt
EAU History office
Didusch Center for Urologic History in Baltimore (US). His talk on the American Civil War delved into some 19th century urology-related procedures on the American battlefields, as well as touching upon the Historian’s plight of having to rely on centuries-old Also in attendance and chairing the session on Politics documentation which might not answer the and Urology was another former EAU Secretary modern-day questions. General: Prof. Per-Anders Abrahamsson. He made his return to the Annual EAU Congress after being Away from the spotlights of hard science succeeded by Prof. Chris Chapple in Madrid last year. elsewhere at EAU16, many speakers told personal “I am happy to co-chair this session at the History anecdotes and shared insights from their many Congress, now that I myself have become a person of decades of experience. Prof. Jerzy Gajewski history”, he quipped. (Halifax, CA) kept it light after his detailed history on the Canadian Urological Association, ending “Deaf people” with a quote from Leo Tolstoy: “Historians are like The Politics and Urology session, the second of four, deaf people who go on answering questions that included Dr. Mike Moran, curator of the AUA’s William no one has asked them.”
A new volume of De Historia Urologiae Europaeae was also published, a gift to all EAU members. This 23rd volume is the first edition to feature a full-colour cover and new design, revamping the series for a few years to come. The cover features a portrait of the late Dr. Jos De Vries, whose vast instrument collection was acquired by the EAU in 2015. This treasure trove of rare items is an opportunity for many years of research and exhibitions to come. The first selection of items was already displayed at the Historical Exhibition, next to the EAU Booth in the Exhibition area. The exhibition was compiled by the curator of the EAU’s online museum, Michaela Zykan, and its contents, among others can be admired on history.uroweb.org. Finally, in the spirit of furthering research: the History Office hosted a poster session that featured new findings of an historical nature. Several of the speakers will be invited to contribute their research to upcoming publications.
Introducing ‘My EUSP at a Glance’ Regular EUSP column gives tips and pointers to potential candidates Dr. Ricardo Pereira e Silva Chairman, Portuguese Residents Society ESRU NCO Portugal Lisbon (PT) ricardomanuelsilva7@ gmail.com
Dr. Giulio Patruno Past Chairman, ESRU Rome (IT)
Prof. Vincenzo Mirone Chairman, EUSP Naples (IT)
The EUSP offers four different fellowship options including Visiting Professor (participating institutes invite a leading urologist to visit a department for a four-day stay), the Short Visit (two to three weeks preceding a one year scholarship or fellowship – see below), a Clinical Visit (a period of six weeks or three months) and a Clinical/Lab Scholarship (one year duration). For the latter scholarship, it’s important that the applicant states clear objectives and searches for the ideal match or institute to ensure the best educational experience possible during a scholarship. After selecting a possible centre, a Short Visit is highly recommended to prepare for the one-year scholarship. Although reports written by EUSP scholars have been published in this newsletter in the past few years, the ESRU Board has noted the need for a different kind of feedback to reach as many people as possible. Thus, we have introduced a new sub-section of the Young Urologists/Resident’s Corner in this newsletter, under the supervision of the chairmen of the ESRU and EUSP. In My EUSP at a Glance section, young and upcoming urologists interested in applying for an EAU/EUSP scholarship will find in each European Urology Today issue two brief reports of previous scholars giving a brief summary of their experience.
The European Association of Urology (EAU) offers remarkable educational opportunities to its members through various platforms, one of which is the outstanding European Urological Scholarship Programme (EUSP).
This new section aims to help potential candidates who are considering a scholarship but are uncertain on how to properly proceed and to provide motivation to those who are not aware of the benefits of a EUSP scholarship. My EUSP at a Glance also intends to reflect a more personal view on both the positive and negative aspects of accepting a scholarship abroad and provide some advice on how to properly integrate into the host country, city or hospital, and take into account the cultural differences and how to deal with them.
We are aware that although the EUSP Board exerts efforts to raise awareness about the EUSP, many young European urologists are not very familiar with the EUSP programmes and are missing out on the excellent opportunities to improve their knowledge and skills.
Peer experience When deciding to apply for a EUSP scholarship, especially for the one-year period, learning from peer experience on how to tackle the most common difficulties will certainly contribute towards a better experience and a higher
European Urology Today
likelihood of achieving pre-defined objectives. Additionally, reading other people’s personal account of their experience can also help future scholars to get a clearer idea which institute would be the best choice for them based on their expectations of the programme’s goals.
“The EUSP Board is ready to provide assistance for you to fulfil your objectives, and potential candidates can count on full scientific and financial support once their application gets approval.” This can be particularly true for upcoming urologists in the early phase of their careers, since we believe there are many candidates who may fit a suitable profile to undergo a period of basic or translational research, for instance, and for whom the exceptional structure and support from the
EUSP may be the help they need to succeed in their particular areas of scientific research and clinical interest. In many places in Europe, it may be easier to go through a research fellowship during residency since interrupting clinical activities in a department is often allowed than during the time when the resident becomes a certified urologist. From this viewpoint, My EUSP at a Glance can also serve as a valuable tool to inspire those who feel the need to deepen their research work. The EUSP Board is ready to provide assistance for you to fulfil your objectives, and potential candidates can count on full scientific and financial support once their application gets approval. Don’t forget the application deadlines! These are January 1, May 1 and September 1. If you are in your residency or a young urologist (under 40 years of age), read My EUSP at a Glance and prepare for your application. A unique opportunity awaits you! The EUSP believes that “knowledge shared is knowledge multiplied.”
Looking for you colleague's contact details? Please log in to our website to consult the EAU membership roster online: www.uroweb.org March/May 2016
Young Urologists/Residents Corner Spanish WebApp: “The Urology Resident´s book” Handy reference tool for Spanish-speaking urology residents Dr. Juan Gómez Rivas Chairman, RAEU ESRU Internal Coordinator La Paz University Hospital Madrid (ES) juangomezr@ gmail.com
Mr. Moisés Rodríguez Socarrás Spain NCO ESRU RAEU Team Member Urology Resident Vigo (ES) moisessocarras@ hotmail.com
Education during the training period in urology is a constant process which requires the most modern and actual tools available to a urologist-in-training. To achieve this aim, it is necessary to have a book to guide residents in their duties in daily clinical practice.
to prioritize its goals in educating young urologists and this book is a good example. Informative contents The book has 79 chapters divided into three main sections (Urological Emergency, Urologic Pathology and Urology Surgical Patient Management). Topics cover a wide range of subjects of interest from emergencies such as haematuria, renal colic, and renal trauma, oncological diseases such as prostate, renal and bladder cancers to renal transplantation or genital skin diseases. Each topic is enriched with tables, amazing pictures, flow diagrams, photos, diagnostic algorithms and even surgical videos. This new edition of “The Urology Resident´s book” also reflects the evolution in and adaption of new technologies, and complemented by videos, images and algorithms that helps to clearly illustrate the contents. The book has three versions (full online, summarized version and off-line version for hospitals). Users can install the book on five devices such as a laptop, tablet, personal computer, mobile, and other mediums compatible with operating systems Windows, MAC OS, Linux, iOS, Android and web browsers like Chrome, Safari, IE and EDGE.
"Third edition of the Spanish urology resident's book enters a new era of user-friendliness as it can be used on all computers and hand-held devices"
In Spain “The Urology Resident´s book” is a handy reference tool, and last January, the third edition of this important book was launched for residents in One of the advantages is that pharmaceutical drugs Spain and all Spanish-speaking countries. This new are linked to the Vademecum, enabling easy access to edition has been adapted to current needs and has exceeded all expectations including a web App format. wide dosage and adverse effects. Moreover, the references of the chapters are linked to the abstract The new version is a result of the work from 74 and, in some cases, to the full version of the articles. hospitals and by more than 200 authors including From the Spanish Residents Workgroup residents and experts. Preparations for the book and the App were led by the Board of the Spanish (@ResidentesAEU), we are proud to have in our hands a new modern edition of the “The Urology Association of Urology (AEU) @InfoAeu with Resident´s book.” This WebApp claims to be the Professors JM Cózar (Chairman of the AEU) and Bernardino Miñana (Scientific Activities Coordinator of reference for urology residents in Spain and all Spanish-speaking countries and will be continuously the AEU) as heads and main editors of this project. Clearly, the Spanish Association of Urology has shown edited in coming years.
ESRU holds HoT courses and webinars Upcoming ESRU-endorsed courses and activities Dr. Selcuk Sarikaya Chairman, ESRU Kecioren Research and Training Hospital Department of Urology Ankara (TR) drseluksarikaya@ hotmail.com The European Society of Residents in Urology (ESRU) has taken many active roles in national and international acitivities and organisations in recent months. On February 26 and 27 this year, ESRU endorsed an international Uro-Oncology Symposium and E-Blus Course in Ankara Yildirim Beyazit School of Medicine, Turkey, a unique course with emphasis on major topics in uro-oncology. Following this author’s opening remarks, the prostate cancer symposium opened with a lecture by Prof. Balbay who discussed recent developments in genomics in prostate cancer. Prof. Turgut examined the newest technologies in diagnosing prostate cancer. Other issues included risk
classification and ergonomic robotic surgery with Prof. Omer Karim (GB) discussing the latter topic with a video presentation. In the symposium’s second part, Prof. Akduman took up the issue of relapse following curative treatment of prostate cancer. There were also presentations regarding the latest developments in postprostatectomic urinary incontinence and penile rehabilitation. Bladder cancer was discussed in the third session with presentations on controversial issues in diagnosis and treatment. After the session, a live surgery followed with Prof. Karim performing an excellent robotic radical prostatectomy, which he completed without any complication. During the surgery, Prof. Karim also demonstrated his technique for bladder neck preservation.
Another ESRU activity was last March 26 with a webinar on ‘How to write a manuscript?’ held in collaboration with ManuscriptEdit, a professional editing team. Held online, the webinar attracted many participants from all over the world who joined via mobile phone, tablet or PC. The presentation included
Upper urinary tract tumors and testicular cancer were also examined in another session with Dr. Erdem Canda showing surgical videos and Dr. Ozdal discussing the role of lymphadenectomy in upper urethelial system transitional cell carcinomas. The last session featured Nightmare Cases with the residents presenting challenging uro-oncology cases. The audience commented on the cases which made the session very interactive. March/May 2016
The second day featured the E-Blus hands-on training course for residents and young urologists with mentorship from local and international instructors. The participants benefited from the hands-on training course using fully-equipped training boxes.
basic information for manuscript writing and various tips and tricks. Since we believed that these webinars are effective in engaging residents and young urologists easily, the ESRU will continue the webinar series featuring various topics. On May 23 and 24, ESRU will also organise the first European Basic Robotic Surgery Course in collaboration with ERUS and ORSI. This unique course will offer residents the chance to learn basic robotic surgery skills. The reduced fee for residents is €450, including two nights accomodation and hands-on training. Certificates will be given to all participants. Join the activities of ESRU and we hope to see you in the upcoming robotic courses! European Urology Today
Young Urologists/Residents Corner YUO's Training, Education and Career (TEC) activities A productive day for YUO in Munich Dr. Guillermo Martinez TEC Coordinator Young Urologists Office
esrusecretary@ gmail.com It was an interesting, productive and exciting five days for the Young Urologists Office (YUO) in Munich this year with several sessions highlighting development plans for young urologists. On Friday, March 11, the first special session on leadership was held with an introductory talk by YUO's chairman Michiel Sedelaar (@sedelaar) on how the current EAU structure and leadership works. Management coach Herman Rijksen (@HermanRijksen), meanwhile, gave an elightening lecture on leadership in clinical organisations which was followed by a discussion. I also had the chance to interview both Michiel and Herman for our first Periscope Live streaming. The replay was available on @eauyoungurology's Twitter wall and generated hundreds of views.
Friday was also a busy congress day for our friends at ESRU (@ESRUrology). During their board meeting, they elected a new executive and identifed the workplan for the next six months. Planning for #YUORDay17 started right away and we anticipate that this will be one of the most productive years for our residents.
"Stay tuned for future updates, the easiest way is to create a Twitter account and join the conversation." In another meeting on the same day, the Young Academic Urologists (YAU) held a special session with YAU's chairman Selcuk Silay (@SelcukSilay) giving an overview on completed projects which was followed by a sub-session on career development. Prof. Luis Martínez-Piñeiro and Morgan Rouprêt (@MRoupret) delivered insights on what it takes to become a successful academic urologist and opinion leader. Morgan gave a very informative Periscope Live interview as well and we discussed the importance of having a mentor. On Saturday, March 12, the traditional YUORDay16 special session took place, organised by the YUO with the coordination of ESRU. This year's session, which marked ESRU's 25th anniversary, broke attendance records with 600+ participants. The session took up
relevant themes and issues that affect residents and young urologists. We interviewed Campbell Quiz Expert and EUSP member Maria Ribal (@MariaJRibal) for Periscope Live where she gave tips on how to secure a successful research grant application.
among the Top 10 influencers during the meeting. We talked with one of the top SoMe influencers in urology, Stacy Loeb (@LoebStacy) who spoke about Twitter and how it can help in everyday work and networking.
The following day, March 13, featured two new and important special sessions with the morning session examining updates in urological education and training. The afternoon session discussed setting up standards in urological training throughout Europe. Both sessions focused on the collaboration between the European School of Urology (ESU) and the European Board of Urology (EBU). This collaboration intends to cover many areas of education and training, and creates the needed synergy between the EAU and EBU.
The YUO Board held its meeting on March 14, and reported on the gains in 2015 and its plans. The meeting also discussed the adoption of a Training, Education and Career development general strategy which streamlines the YUO's communication work and how it fits with other EAU's affiliates. There was a discussion on projects benefitting young urologists and residents such as EUSP scholarship grants to issues on how to transform and boost urological education and training in Europe.
We also had the opportunity to interview the EBU's Prof. Stephan Muller for Periscope Live who discussed the EBU's role and the ESU's Prof. Joan Palou who explained how a young urologist can benefit from the ESU's educational programmes. This congress also featured the ESU's Social Media Training sessions. Run by some of the top SoMe influencers in Europe and the US, the sessions received very good feedback and were highly rated by participants. Social Media, mainly Twitter activity during EAU16 was high, and the YUO and ESRU were
We invite you to watch all of our Periscope Live interviews which will be available at the YUO website at uroweb.org soon. Aside from the web casts regarding TEC, there are also webcasts of plenary lectures at the EAU16's meeting website (Resource Centre). Simply use your registration barcode number for the log-in. And stay tuned for future updates, and the easiest way is to create a Twitter account and join the conversation. You can start by following the top influencers of EAU16, among them are: @uroweb, @eauyoungurology, @ESRUrology and @EAUYAUrology.
ESRU at Munich #YUORday16: A forward leap for ESRU Dr. Selcuk Sarikaya Chairman, ESRU Kecioren Research and Training Hospital Department of Urology Ankara (TR) drselcuksarikaya@ hotmail.com During the second day of Annual European Association of Urology Congress in Munich (EAU16), the European Society of Residents in Urology (ESRU) Board organised #YUORday16, an excellent programme which covered both scientific and social activities in nine very well-designed sessions. Dr. Giulio Patruno gave the introductory talk while Prof. Michiel Sedelaar discussed the activities of the Young Urologists Office (YUO). The ESRU has been more active within the YUO and since it officially became part of the EAU. ESRU has organised many activities in the past year and also endorsed several national and international activities.
Group-picture after a successful #YUORday16 at the EAU in Munich
During the third session, there were presentations about the European Urology Scholarship Programme (EUSP) with Prof. Maria Ribal giving an excellent interactive presentation about educational opportunities. Prof. Jack Schalken provided tips regarding scholarship application while Prof. Stephan Müller discussed the partnership between the European Board of Urology (EBU) and the EUSP.
answers via an audience response system with automated vote count. Presentations also included tips and tricks on basic surgical operations for residents and young urologists. Dr. E. Finazzi Agrô discussed male incontinence surgery, Prof. L. Martínez-Piñeiro presented tips and tricks for TURP, Prof. J.P. Norgaard took up TRUS and MRI-guided prostate biopsy, and finally Prof. A. Kadioglu shared tips and tricks for penile emergencies.
Dr. Selçuk Silay, chairman of Youg Academic Urologists (YAU), presented the activities of YAU and highlighted the interest of young urologists in research. Finally, Dr. Mark Behrendt presented his experience of a two-year EUSP scholarship. Following the presentations, Prof. V. Mirone led the ceremony for the best scholar award.
EAU Secretary General Prof. Chris Chapple gave an inspiring and interesting presentation about the role of the ESRU within the EAU, which highlighted ESRU’s 25th anniversary. Meanwhile, Prof. Frans Debruyne led the ‘Old School versus New School’ session with his excellent talk about his experience in treating large prostates, while Prof. P. Schatteman discussed new technologies. Radical cystectomy issues were discussed by Prof. Jørgen Bjerggaard Jensen and Prof. Joan Palou.
The social programme included the Residents Dinner and the residents joined the after party with enthusiasm. #YUORday16 provided a comprehensive and quality programme and it was wonderful to see the residents’ enthusiastic engagement during the sessions. Our thanks to the EAU and the Young Urologists Office for their support in organising this special day. Also my special thanks to the attendees of #YUORday16.
The last two parts of the #YUORday16 were more social. Dr. N.W. Clarke has given an interesting talk
Follow us on Twitter and Facebook and see you next year at #YUORday17 in London!
"Old School vs. New School" Session with Prof. Frans Debruyne
The YUO meeting in Munich at the EAU Congress
The second part focused on the EAU and its affiliates with Prof. Bob Djavan discussing the recent activities of the EAU Regional Office, Prof. Joan Palou presenting the programme of the European School of Urology (ESU), Prof. Peter Mulders describing the plans and work of the European Research Foundation (EAU-RF) and, finally, Prof. Thorsten Bach talking about the projects of the EAU’s Patient Information. The ESRU has been actively involved in the Regional Office activities and has organised a successful session during the South East European Meeting last year. For the Patient Information, ESRU Board members and executive committee members have been closely involved in almost every part of the project.
Challenging questions The fourth session featured the traditional Campbell Challenge Quiz which has become a highly anticipated event during #YUORdays. The audience was presented with a series of challenging questions and gave their
Annual ESRU board meeting at the EAU
Prof. Chris Chapple joining the #YUORday16 dinner
European Urology Today
on how to deliver bad news, a very relevant topic which doctors will always encounter in their career. Dr. P. Sooriakumaran tackled new developments regarding oligometastatic prostate cancer, while Dr. Domenico Veneziano gave a very interactive presentation, complemented with interesting videos. He showed simulators used for urological training and discussed the technological improvements regarding simulation techniques as educational tools.
Urology simulation boot camp A pilot course to develop urological skills proficiency Mr. Shekhar Biyani St. James’s University Hospital Dept. of Urology Leeds (GB)
Mr. Andrew Myatt Castle Hill Hospital Dept. of Urology Hull (GB)
Many higher specialty training programmes provide their incoming trainees with an orientation period to help prepare for their new environment and training. We created a curriculum for a five-day “urology simulation boot camp” to develop urological skills proficiency among core surgical trainees entering the scheme. This curriculum emphasised attaining proficiency on basic endoscopic urological procedures and common urological emergency surgical procedures.
“A boot camp is a focused course designed to enhance learning, orientation, and preparation for learners entering a new clinical role. This is achieved through the use of multiple educational methods...”
“There is no excuse today for the surgeon to learn on the patient” 1. Changes in health care across the globe have had a profound impact on the number of hands-on surgical training opportunities that are available to urology trainees. The transition from core surgical trainee to first-year urological specialty trainee (ST3) can be a time for significant stress and insecurity.
What is a boot camp? In the context of medical education, “A boot camp is a focused course designed to enhance learning, orientation, and preparation for learners entering a new clinical role. This is achieved through the use of multiple educational methods with a focus on deliberate practice with formative feedback”2.
ST3 urology curriculum The course followed the ST3 urology curriculum from Higher Specialty Training Syllabus3. The aim was to provide hands-on experience in common urological procedures. In addition, enhancing their professional development by improving ability to solve problems, Trainees enter the programme with varying levels of think creatively and independently, and communicate knowledge and procedural skills. Trainees at the same clearly with patients. The added dimension of training level may be at different proficiency levels, targeted training on state-of-the-art virtual reality and simulation-based learning is one means to assess simulators (TURP Mentor, LapMentor and UroMentor) and improve proficiency. made this course unique (Table 1).
By the end of the course each delegate did five TURP, Table 2: Assessment and Evaluation Forms Completed TURBT, ureteroscopy and basic laparoscopic skills (Figure 1-3). Stepping up in the new role requires professional attitude and leadership skills and, therefore, we arranged evening talks on medico legal matters, professionalism and human factors by a barrister, the vice-president of the Royal College of Surgeons of England and a leading national expert on simulated medical education. Course assessment It was vital to assess all participants regularly and continuously throughout the course. Assessment tools were designed to test performance in three domains: knowledge, technical skills and non-technical skills (Table 2). • (a) Knowledge assessment - This was assessed via 20 multiple-choice questions. The questions were completed prior to and upon completion of the course. • (b) Technical skills - Prior to the course, all delegates were asked to complete a pre-course questionnaire assessing the previous experience in performing the procedures included in the course and their confidence to perform each skill prior to the course, graded on a modified Likert Scale (1-5). In addition, procedure specific assessment forms were used to assess technical skills. • (c) Non-technical skills - A generic formative assessment form was designed to score participants at all stations during rotation through the session. Faculty members scored participants on knowledge, technical abilities and nontechnical skills, with the latter focused on teamwork skills. A feedback form to assess each session was designed. A perception survey was done at the conclusion of the boot camp, and participants were asked to assess curriculum topics and overall value of the boot camp using a Likert-type scale. In addition, faculty were asked to provide feedback on the course. Individual trainee summary reports were produced to show competence progression and recommendations for ongoing training. The pilot course was delivered at the Leeds Institute for Minimally Invasive Therapy at St James’s University Hospital (http://www.medicaleducationleeds.com/) with 16 participants and an equal number of faculty members. The skills were divided into eight sessions and in four days all participants managed to practice required procedures.
Figure 1: A. Testicular fixation on bull’s testis; B. Scrotal examination model (Limbs & Things); C. Small bowel anastomosis model; D. Laparoscopic dry box training (EBLUS exercises)
Table 1: Course Curriculum Day
Procedures Circumcision Scrotal examination Testicular fixation Hydrocele Suprapubic catheterisation (SPC)
Friday 18 September Saturday 19 September
Bowel anastomosis Stoma formation
Basic lap skills Access Lap trainer box E-BLUS exercises Lap mentor exercises
Rigid and flexible ureteroscopy TURP TUBT Green Light laser prostatectomy
Bulls’ Scrota Circumcision and SPC Model from Limbs and Things
EBLUS exercises on Lap trainers. LapMentor
Bench top models for rigid ureteroscopy UroMentor TURMentor (TURP/TURBT)
AM 8:30 to 12:30 A C Scenario
AM 8:30 to PM 13:00 12:30 to 15:00 C D A B Botox, urodynamics TOT/TVT
AM 8:30 to PM 13:00 12:30 to 15:00 B C D A Cystoscopy stent Bladder wash out Instruments, Laser Energy source talk Synthetic models, synthetic clots, original equipment AM PM B C D A
AM 8:30 to PM 13:00 12:30 to 15:00 D A B C URS/TURP/TURBT/GLL
PM 13:00 to 15:00 B D
SimMan 3G and actors
Sunday 20 September Monday 21 September Tuesday 22 September
AM PM AM A B C C D A Assessment and post-course MCQ
Synthetic models PM D B
On the last day, all delegates were assessed on (a) ureteroscopy on UroMentor (b) TURP on TURmentor (c) circumcision (d) suprapubic catheterisation (e) cystoscopy and stenting (f) instruments (g) basic lap skills and (h) Botox & TVT. We had two stations for each skill and a faculty member on each station assessed each delegate. An objective structured tool was used for assessment and performance. Participants enjoyed one-to-one teaching and many delegates in feedback mentioned this. Virtual reality simulators (VRS) provided an extra dimension to this course and were useful tools to assess progression. Scenario session was very well received. Overall all the sections of feedback received a score of over 4.5/5, with the hands-on training on simulators getting the best score (4.8/5). When trainees were asked “The training has equipped me with enhanced knowledge, understanding and/or skills,” the average score was 4.9/5.0.
PM A C
B Figure 3: A. Instrumentation familiarisation; B. Bladder washout simulation with artificial blood clots
In brief, we have developed and delivered a structured, standardised and quality approach to simulation training in urology for new urology trainees. We have planned a 2nd course in September 2016. References 1. William J. Mayo, Medical Education for the General Practitioner, JAMA 88:1377-9, 1927. 2. Blackmore C, Austin J, Lopushinsky SR, Donnon T. Effects of Postgraduate Medical Education "Boot Camps" on Clinical Skills, Knowledge, and Confidence: A MetaAnalysis. J Grad Med Educ. 2014;6(4):643-52. 3. https://www.iscp.ac.uk/surgical/SpecialtySyllabus.as px?enc=j4VfyFXq6Hwh0loAlHujtkAs51pAIsNQGJa4+ri 5KE0=
As above AM D B
Figure 2: A. Rigid ureteroscopy dry box model; B. Virtual retrograde intrarenal surgery (Symbionix); C. Virtual TURP (Symbionix); D. SimMan clinical scenario; E. Urodynamics simulation
Steering Group members: Mr. I Eardley, Mr. T Terry. Module Leads - Ms M Garthwaite, Mr. R Gowda, Mr. S Jain, Mr. P Koenig, Ms F Reeves, Mr. K Rogawski, Mr. B Somani. Expert Faculty - Mr. J. Bhatt, Mr. J. Cartledge, Mr. P. Cornford, Mr. W. Cross, Mr. J. Gill, Mr. V. Hanchanale, Mr. A. Joyce, Mr. M. Kimuli, Mr. T. Page, Mr. S. Rajpal, Mr. N. Rukin, Mr. M. Simms, Ms. S. Symons, Mr. J Taylor, , Ms. B. Wilkinson, Ms. M. Yiasemidou. LIMIT Staff – J. Johnson, M. Flanagan, M. Sedler. Funding – Yorkshire & Humber Deanery, Storz, Coloplast, AMS and Ethicon Equipment support – Symbionix, Storz, AMS, June Medical, Allergan, Mediplus, Dantec Dynamics
European Urology Today
Teaching neuro-urology to young urologists Are we prepared for future challenges? Prevalence and incidence of several neurological diseases is already high and neurodegenerative disorders such as Alzheimer’s disease will further increase in the course of a continuously ageing population so that more and more neurological patients will require professional neuro-urological management. However, this can only be provided by adequately trained clinicians and highly motivated researchers are needed since many questions regarding neuronal control of lower urinary tract function and its alterations through the course of a neurological disorder remain unclear.
Dr. Ulrich Mehnert Balgrist University Hospital Neuro-Urology Spinal Cord Injury Center Zürich (CH) ulrich.mehnert@ balgrist.ch
Neurogenic urinary tract, sexual and bowel dysfunction is highly prevalent and affects the lives of millions of people worldwide. It has a major impact on quality of life and, besides the debilitating manifestations for patients, it also imposes a substantial economic burden on every healthcare system.
EAU Section of Female and Functional Urology
the European Association of Urology (EAU) Section of Female and Functional Urology (ESFFU), the International Continence Society (ICS) Neuro-Urology Promotion Committee, and the International NeuroUrology Society (INUS). References 1. Panicker JN, Fowler CJ, Kessler TM. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol 2015; 14:720-32. 2. Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, Karsenty G, Kessler TM, Schneider M, t Hoen L, Blok B. Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol 2016; 69:324-33. 3. Mehnert U, Kessler TM. The Swiss Continence Foundation Award: promoting the next generation in neuro-urology and functional urology. BJU Int 2015; 115 Suppl 6:26-7.
Neuro-urology needs outstanding young researchers and clinicians – they are our speciality’s future! We look Neuro-urology is a highly dynamic, rapidly developing forward to receive your applications and to welcome and relevant speciality bridging both neurological and you in Zürich for the 5th International Neuro-Urology urological aspects of diagnosis and management Meeting, a collaboration of the Swiss Continence allowing a significant look beyond each medical Foundation (www.swisscontinencefoundation.ch), speciality. Nevertheless, for us to meet the future challenges in teaching neuro-urology, it is our responsibility to pave the way for further scientific Figure 1: The pattern of lower urinary tract dysfunction following neurological disease is determined Figure 1. The pattern of lower urinary tract dysfunction following neurological disease and clinical development and support the next by the site and nature of the lesion (with permission from (1)). is determined by the site and nature of the lesion (with permission from (1)). generation in neuro-urology now!
Ass. Prof. Thomas Kessler Balgrist University Hospital Neuro-Urology Spinal Cord Injury Center Zürich (CH) thomas.kessler@ balgrist.ch
The site and nature of the lesion in the neurological axis determine the general pattern of lower urinary tract dysfunction (Figure 1), which is reflected in the patient’s symptoms1,2. Due to the complex, multilevel control of the lower urinary tract, it is not surprising that many neurological disorders such as multiple sclerosis, Parkinson’s disease, stroke, spinal cord injury, spina bifida, diabetic neuropathy, Alzheimer’s disease, etc., frequently results in lower urinary tract dysfunction.
Continence Foundation Award (Figure 2). This prestigious award has been launched to promote the next generation in the field of neuro-urology3. It comes with a cash prize of 10,000 Swiss francs and is awarded to the best contribution from a young neuro-urology talent during the 5th International Neuro-Urology Meeting (Figure 3) to be held in Zürich, 26 to 28 January 2017. Save date and visit www.swisscontinencefoundation.ch for details on application and award criteria.
Providing a platform for knowledge transfer, exchange of experiences, research collaboration, education, and networking in neuro-urology might be key to attract young academics into this field, to advance medical and scientific practice, and finally to see considerable improvement in both quality of care and quality of life of the neuro-urological patient. Hence, it is our great honour and pleasure to organise since 2012 the International Neuro-Urology Meeting in Zürich. The world’s leading experts in neuro-urology provide overviews on this rapidly developing and exciting discipline. This unique meeting combines keynote lectures, interactive panel debates, clinical case discussions, live urodynamics, and live surgery. Emphasis is placed on the interactive component. There are many opportunities to exchange thoughts, experiences and ideas and also make new friendships. A special feature of the International Neuro-Urology Meeting is the awarding of the Swiss
Featuring the SIU-ICUD Joint Consultation on Urologic Management of the Spinal Cord InjuredCongress Patient 36th the 36thofCongress of Symposium the and the 2nd SIU Nurses’ Educational Société Internationale d’Urologie
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European Urology Today
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European Tour 2016 Academic Exchange Programme Our European sojourn: Lively exchange and professional collaboration Dr. Ithaar H. Derweesh UC San Diego, Moores Cancer Center San Diego (USA)
Dr. Rose Khavari Houston Methodist Hospital Texas (USA)
Dr. Sean P. Stroup Naval Medical Center San Diego San Diego (USA)
sean.p.stroup.mil@ mail.mil We would like to thank the AUA and the EAU for the opportunity to participate in the EAU-AUA 2016 International Academic Exchange Programme. This programme truly represents a once in a lifetime experience, and has been one of the most rewarding professional experiences of our careers. As scholars we come from a variety of different personal and professional backgrounds in the United States, but share a common dedication for research, scholarship, innovation, and teaching. This programme helped to foster these passions through a lively exchange of ideas, professional collaboration, and most importantly, friendship. Sheffield Teaching Hospitals, Sheffield, UK We are grateful to Sheffield Teaching Hospitals in Sheffield, UK under the leadership of Professors Chris Chapple and James Catto for their warm hospitality and outstanding programme. Our experience began on Saturday, 27 February, with an excursion through the beautiful countryside and moors of South Yorkshire with Prof. Chapple. On Sunday, we visited Hardwick Hall which served as a microcosm and encapsulates English history from the Elizabethan era to the 1950’s. We strolled through the ruins, the meticulously landscaped English Gardens, and enjoyed a tour of the preserved country house. On February 29, our academic activities kicked off in earnest with a tour of Swann-Morton, one of the world’s pre-eminent manufacturers of surgical
scalpels and blades (nothing like “cold British steel” to get a group of surgeons fired up at the beginning of the day). Swan-Morton’s success is attributed to its unique culture and the philosophy of its founders where all the employees are shareholders, and its success has symbolized the Sheffield’s (and indeed the UK’s) transformation as an economic and industrial power. As surgeons we truly enjoyed learning about every step of the process that involves manufacturing 70 different high quality, precise, and reliable blades that we hold in our hands every day. Later that day we were introduced to the Department of Urology at Royal Hallamshire Hospital by Dr. Richard Inman. Dr. Inman provided a thorough overview of the clinical, research, and educational components of the Urology Department. This was followed by an excellent lecture on evidence-based approach to urethral reconstructive surgery. While there, we discussed some of their cutting-edge research in tissue engineering and afferent signalling pathways in lower urinary tract and their application in functional urology. Prof. Chapple provided a historical overview of the EAU and its activities, growth and outreach, and Prof. Catto discussed his vision for European Urology and the publication of European Urology Focus. We also observed oncologic (radical cystectomy and nephrectomy) and functional (vesicovaginal fistula repair and urethroplasty) procedures performed routinely at the Royal Hallamshire. It was a pleasure observing and learning from our master-surgeon colleagues in the UK, and their surgical philosophy with its emphasis on evidence-based clinical care and tradition, which gave us a foretaste of the further wonderful experiences to follow. UZ Leuven Gathuisberg Hospital, Leuven, Belgium We then travelled to Leuven, Belgium, where we stayed in the Begijnhof Hotel, which is part of the enchanting Grand Béguinage of Leuven, a UNESCO world heritage site dating to the 13th century. We were welcomed to the department by Professor Dirk De Ridder and his team during their morning report. Here we observed the residents transitioning care to the on-call staff. The UZ Department of Urology is a busy service with many complex patients; however, we were all very impressed with their ease of doing the handoff so effectively and proficiently in English. Later, Prof. De Ridder gave an overview of the department and of the Belgian healthcare system. Their comprehensive and integrated electronic health record, which was developed ‘ground-up’ and with extensive physician input, was not only state-of-theart, but combined ease of use and was portable, and facilitated efficient communication between caregivers across the health system. It also included cost information at the point of care, which was remarkable. The teamwork and collaboration amongst medical students, residents, and faculty of the Urology team at UZ Leuven clearly stood out. We enjoyed our oncological and functional operative observations with Professors De Ridder, Steven Joniau, and Frank Van Der Aa—indeed, we marvelled at the combined force of surgical leadership and excellence and systems integration in the operating room. We were also honoured to share our own research endeavours in the special setting of the Faculty Club at the Béguinage and toured the
Tour of Harwick Hall in South Yorkshire with Prof Chapple and scholars
The display of work by Kandinsky, Marc, Münter, and many others at Lenbachhaus all fit together to give the visitor an understanding of how the Blue Rider school of art developed
Department’s research facilities and heard about the ground-breaking research in developing animal models for studying underactive bladder. Our time in Belgium ended with a sampling of the rich culinary (world famous chocolates and regional beers) and cultural delights of Belgium. Prof. De Ridder and his faculty and house staff’s hospitality was wonderful and our hosts ensured that we had had a comprehensive understanding of the scope and breadth of urological practice and academics at UZ Leuven, and ensured that we experienced the culture and history with wonderful walking tours of Leuven and Brussels.
for us to scrub into many of their surgical procedures. While there we enjoyed the culture of innovation and high-volume surgical prowess which pervaded the Department and its operating rooms. Our presentations generated spirited discussions which will hopefully lead to further collaborations. Our experience was rounded up by an unforgettable walking tour of the heart of Munich and its historical medieval origins, Baroque splendour, and modern synthesis. We were graciously welcomed to Professor
University Vita-Salute San Raffaele, Milan, Italy We arrived in Milan under rainy and cloudy skies, but the warm reception by Professor Montorsi and his Department at the University Vita-Salute San Raffaele Hospital more than made up for the chilly conditions. The accomplished surgical and research team led by A highlight of the EAU Congress was to receive our plaques from Prof. Chapple at the EAU Professors Montorsi, Friendship dinner Briganti, Salonia, Suardi and colleagues presented some of most thought-provoking research on Stief’s home for a wonderful lunch followed by a prostate and kidney cancer that we heard during our special tour of the Lenbachhaus Museum, whose visit. We were impressed by the world-class collection highlighted Munich’s role as a focal point in investigational infrastructure and the interactive the birth of modern art and the “Blaue Reiter” research presentations and operating room movement. observations, which enhanced our shared understanding and will certainly foster future Annual EAU Meeting, Munich, Germany collaborations. The echoes of history were constantly Attending the 31st Annual European Association of present during our walking tours where we viewed Urology (EAU) Congress was the highlight of our trip. the impressive Duomo, the Sforza Palace, and the We were impressed with the programme’s emphasis historic Teatro alla Scala, as well as the Futurist on innovation and world-wide dissemination of architecture. Our hosts went above and beyond to knowledge to improve patient care. The sessions and ensure that we had a special experience by visiting ensuing discussions were wonderful forums to learn one of the world’s most famous and treasured and presented myriad opportunities to question and paintings: The Last Supper by Leonardo da Vinci. to collaborate. Our nearly three-week adventure as Gazing at this late 15th century fresco painted in the EAU-AUA International Academic Exchange Scholars refectory of the Convent of Santa Maria delle Grazie culminated with the Friendship Dinner at the and listening to our guide detailing the expressions Residenz Munich. It gave us a chance to reconnect and emotions of each of the characters was an with the friends and colleagues we had just made unforgettable and awe-inspiring experience. The trip and to make plans to welcome them in America at the ended with the delightful, avant-garde and regional next AUA congress. cuisines and wine pairings and brilliant conversations that we shared with our Italian friends. We were shaken by the recent terrorist attacks in Brussels and we stand in solidarity with our friends LMU-Klinikum der Universitat Munchen, Munich, DE and colleagues in Belgium. We left with the deepest The final stop in our itinerary was with Professor Stief gratitude and appreciation to the institutions we and the Department of Urology at LMU in Munich. We visited, the friends we have made, the future were briefly immersed in the clinical life and activity collaborations we hope to build upon, and the AUA of the Department. Our hosts, Professors Stief, and EAU for supporting such a wonderful and Gratzke, Staehler, and their team graciously arranged worthwhile endeavour. European Urology Today
Training in robotics Aalborg University Hospital’s unique facilities: ERUS’s latest host centre Dr. Francesco Sanguedolce King's College Hospital Dept. of Urology Northampton (UK) fsangue@ hotmail.com My first visit to Aalborg, Denmark was way back in January 2014, a cold day for someone used to Europe’s southern temperatures. I was a fellow in laparoscopic surgery of the upper urinary tract at King’s College Hospital-London which offered the opportunity to train in an advanced laparoscopic and robotic course at Aalborg’s University Hospital. Aalborg is Denmark’s third biggest metropolitan city with good shops, remarkable architecture, restaurants and a world-class university hospital. The town welcomed me with a white carpet of snow, which doesn’t exactly suit my Mediterranean temper. The city, however, later showed its amazing, hidden side. I was the sole participant (a unique case, I later discovered) in the course with the advantage that I have full use of or can operate for two days using a Da Vinci console with live porcine models. In Italy we say that nothing is wasted with a pig and that, definitely, was the case with my first experience in Aalborg. The courses are offered under the collaboration of two institutions in London and Denmark and led by Mr. Johan Poulsen, a former full-time Consultant Urological Surgeon at King’s College Hospital and currently responsible for the Urological Robotic programme in Aalborg University Hospital. EAU Robotic Urology Section
These courses have been running regularly in the last seven years for almost every month and are offered to British and Danish trainees. Since 2011, the centre has been equipped with a DaVinci system for wet laboratory using real-life procedures in porcine models under general anaesthesia. More recently, the training facilities have been expanded with the use of a double console in theatre and the Symbionix and Da Vinci simulation systems. Finally, Mr. Poulsen’s unit is one of six Danish referral centres in uro-oncology for patients suitable for robotic surgery, with a volume of more than 350 robotic cases per year. All of these make this centre an ideal setting for robotic fellowship programmes, according to the EAU Section in Robotic Surgery’s (ERUS) standards. As Honorary Consultant at both King’s College HospitalLondon and Aalborg University Hospital, I have been instructed last autumn by Mr. Poulsen to coordinate the process for the centre for it to become a certified robotic training centre of the ERUS. This process has been recently launched by ERUS Chairman Prof. Mottrie to recruit European robotic centres where high quality training programmes could be offered based on ERUS standards. This represents a turning point in the way surgical training should be done to guarantee safety and efficacy to
patients and optimise costs at the same time and with consistency across Europe. It includes a well-defined staged programme which consists of a first phase where the fellow learns the basics of robotic surgery such as patients’ positioning, docking, ports insertion and bed-side assistance. Further phase involves intense cognitive and simulation training which is preparatory to a four-month period when the trainee will perform robotic-assisted radical prostatectomy (RARP) steps, according to a modular programme. A certification of proficiency will be issued at the end of the training, provided the fellows can demonstrate appropriate robotic surgical abilities with an unedited video of a Mr. Poulsen holding the much-coveted certificate of accreditation RARP evaluated by blinded reviewers. This training curriculum has been recently developed and validated1. both on a local base and/or in cooperation with Aalborg has gained accreditation as a robotic training international networks. centre under the supervision of Prof. Mottrie (ERUS), Prof. Joan Palou (European School of Urology) and Stay tuned. Aalborg is waiting for you! Prof. Hein Van Poppel (EAU Executive Committee). Reference: We are now refining the way to enable the ERUS 1. Eur Urol. 2015 Aug;68(2):292-9. doi: 10.1016/j. fellowship programme to be practically established in eururo.2014.10.025. Epub 2014 Oct 31. Pilot Validation Aalborg, opening the centre for official applications in Study of the European Association of Urology Robotic the near future. Another goal is to provide future Training Curriculum; Volpe A, Ahmed K, Dasgupta P, fellows the opportunity to develop research projects Ficarra V, Novara G, van der Poel H, Mottrie A.
Impressions of the training at the ERUS Robotic Training Centre in Aalborg, Denmark
American Urological Association (AUA)
A chance to join the ...
International Academic Exchange Programme American Urological Association (AUA) in collaboration with the European Association of Urology (EAU)
2017 American Tour To date 12 American and 12 European tours have been organised and each of those proved extremely successful. Therefore the European Association of Urology (EAU) and the American Urological Association are pleased to announce the 2017 American tour! The AUA/EAU International Exchange Programme will send American faculty to Europe and European faculty to the United States. The programme aims to promote international exchange of urological medical skills, expertise and knowledge. This upcoming 2017 American Tour will provide grants which will enable 3 EAU members to travel to and attend the AUA congress in Boston (May, 12-16, 2017) and to participate in an extended ten days travel programme, taking them to several urology centres in the United States. EAU Section of Urolithiasis (EULIS)
European Urology Today
Eligibility criteria • Less than 42 years of age • Minimum academic rank of assistant professor • Letter from the departmental chairman of the applicant’s commitment to academic medicine • Membership of the EAU Information and application forms For all further information and programme application forms please visit www.uroweb.org, and select 'our partners' at the bottom of the page, AUA-EAU International Academic Exchange Programme or contact the EAU Central Office, T +31 (0)26 389 0680, F +31 (0)26 389 0674, E: firstname.lastname@example.org. We look forward to receiving your application before 1 November 2016. EAU Central Office, Attn. Secretariat, P.O. Box 30016, 6803 AA Arnhem, The Netherlands
Remembering Wilhelm Sinner (1915-1976) The founder of independent urology in Rostock Dr. Thaddaeus Zajaczkowski Senior urologist. Muelheim an der Ruhr (DE)
For his specialisation in urology, in 1954 he moved to Halle/Saale, where he worked as an assistant in the university's surgical clinic, specialising urology under Professor Martin Stolze (1900-1989). He became urologist in 1955.
Pioneering urologist In September 1957 Sinner accepted the invitation from Professor Walter Schmitt, a head of the surgical clinic of Rostock University (340 beds), to take up the position of adjunct at the clinic. His brief was to organise and run a 36-bed urological department, as part of the surgical clinic.
The 6th of January 2015 marked the 100th anniversary of the birth of Wilhelm Sinner. Sinner worked as a professor of urology at the University in Rostock, where he established and headed a urology department within the framework of the University's surgical clinic. Wilhelm Sinner was born on the 6th of January 1915 in the village of Krepa near Ostrów, now a district of the city of Ostrów Wielkopolski, Poland. (Figure 1) He attended a Polish secondary school in Ostrów, where he obtained a Polish high school-leaving certificate and graduated, as the last German student, in 1934. Thereafter he studied evangelical theology at universities in Warsaw, Poznan, and Erlangen, completing his studies in Göttingen in 1938 with the degree of Master. In the words of Professor Sinner: “to avoid to being drafted into the German army (Wehrmacht) I decided to study medicine.” He studied medicine at several universities, beginning in Breslau (now Wrocław) and continuing in Prague, Königsberg (now Kaliningrad), Freiburg, Vienna, and Kiel. In Kiel he completed his studies, passed the final state examinations, and graduated, in 1945. There too in the same year he received his doctorate for historical thesis entitled "On the Matter of the Significance of Paracelsus' Theory" (Über den Begriff der Theoria bei Paracelsus). In 1940 Sinner was called up for service in the German Navy (Kriegsmarine), and served in a minesweeper squadron in the Atlantic. He served in the navy until 1946, in the last few years as a junior doctor. Making use of brief periods of leave, he completed his studies in 1945. Between 10th May 1945 and 8th January 1946 he was interned in the Navy Hospital in Eckernförde.
In Rostock he went through all stages of an academic career, rising from senior assistant to lecturer (1963) and finally to a full professor at the university (1970). As a scientist and publicist, Sinner was at that time among the most active urologists in the German Democratic Republic (GDR). In 1962 he received his habilitation in urology on the basis of a post-doctoral thesis "Significance of Suture Material and Suturing Technique for the Results of Partial Kidney Resection". He demonstrated experimentally on animals that neither polyamide fibre (Perlon) nor cotton should be used in surgery of the upper urinary tract because of the possibility of late complications, such as the formation of urinary fistulas or calcifications. For this dissertation he also received, in 1963, the second prize from the Northwest German Surgical Society. A year after the dissertation, in 1963, Dr. Sinner was appointed to the position of university lecturer, and in 1970 became an associate professor at the university in Rostock.
Figure 2: Opinion in BJU, 1967
Being completely fluent in Polish, early on Sinner made contact with the Polish Urological Society (PTU) and with many Polish urologists. He took active part in PTU congresses, among them in the 10th Jubilee Congress in Szczecin in 1966, and he arranged schooling in Rostock for numerous Polish doctors. Prof. Sinner was awarded prestigious title of Honorary Member of the PTU, in 1974. Among others, in 1970 he made it possible for the author of this article to join his department within the framework of assistant exchange between Rostock and Szczecin universities. I found him to be particularly kind and helpful. It was there at the Institute of Surgery that I became familiar with the good organisation of work and with the activity of the urology department of this clinic. In passing, however, I must say that I was greatly taken aback by the enormous operating theatre, in which five operations could be carried out at the same time on patients from various hospital departments. It was all rather noisy, people were talking all the time, and voices coming from various operating tables were all mixed together. I have never seen anything like it since. From urology department to independent university urological clinic In Central Europe the separation of urology from general surgery was a slow and laborious process, associated with many difficulties. In Rostock too urology long remained under the patronage of major surgery before it won its independence. All Sinner's negotiations with the authorities of the Medical Faculty and with the Ministry, proved to be unsuccessful.
Figure 1: Prof. Wilhelm Sinner
He devoted much time and effort to organisation of the department. He was a comprehensively educated and Wilhelm Sinner is mentioned in an unpublished work skilled surgeon. The department was engaged mainly "Okupacyjne Losy" (Experiences during the German in diagnostics of urinary system disorders by methods occupation) by Doctor Alfons Gdyra. Here is a quotation available at that time and in urological surgery. During from page 6 of the typescript: "Several times I took his nearly 20 years in Rostock Prof. Sinner won advantage of the intercession of a younger colleague particular esteem among his countless patients, who from Ostrów – now an urologist in Rostock, offered him their trust without reservation. As a Dr Willy Sinner, who was at that time serving in the urological surgeon he performed a broad spectrum of German Navy. With the authority of his officer's uniform, urological procedures in both adults and children, but he has helped to admit to the hospital the women who his particular interest were disorders of the required surgery during difficult delivery whenever I genitourinary system in babies and small children. asked him". Sinner was a good organiser and practical urologist. Surgery and Urological training He lectured at Rostock University in urological In the years 1945-1948 he was in charge, as an diagnostics and also trained doctors in other assistant, of an 80-bed Polish ward in Eckernförde specialties. He took pride in emphasising that he was a hospital intended for patients with surgical, internal, teacher and mentor of his students, who in turn liked dermatological, and venereal diseases. In addition to and valued him as a man, educator, and scientist. He this he ran, in part independently, a surgical division of was a catalyst on the path towards independence of a field hospital with patients suffering from war academic urology in Rostock. injuries and its complications. In the operating theatre he was often the anaesthetist or assisting in Scientific activity operations. Beginning in 1954, Sinner engaged actively in scientific work. He published over 30 clinical and experimental In the years 1948-1951 he worked in the surgical papers, and contributed chapters to a number of department (120 beds) in Wismar City Hospital, where medical books. He also published his own books, he performed minor and moderately complex among them "A collection of X-ray reproductions of operations. During the final 18 months of his residence upper urinary tract diseases in babies and small there he was concerned largely with urological surgery children". This publication attracted considerable and X-ray diagnostics. In 1951 he became a full interest and won recognition not only in the socialist surgeon. countries but also in the West, above all because of its rich documentation and the large number of X-ray In August of 1951 he took up a position as an assistant images. (Figure 2) in the surgical clinic of the City Hospital in Schwerin, and quickly adapted to the rhythm of the work. In line Sinner was a polyglot; he could speak and write Polish with his interests, he was assigned to the urological and he was a fluent speaker in Russian, Czech, and division, which he soon led independently. While in Slovak. this hospital he carried out, among others, 130 cystoscopies, 60 retrograde pyelographies, removed He took active part in Congresses of the German ureteral stones with a Zeiss loop, removed kidney Surgical and Urological Society, and was highly stones with the aid of pyelotomy, performed respected in medical circles for his extensive and nephrectomies, and 56 adenomectomies of the comprehensive knowledge. He was one of a group of prostate. He worked as a surgical duty doctor and also urologists who contributed to the emergence and operated on surgical patients. development of academic urology in Rostock. His 20 years of activity provided the impetus for the development of urology in the entire region of EAU History office Mecklenburg. March/May 2016
He was a member of many scientific societies, both at home and abroad. He was on the editorial board of Zeitschrift für Urologie und Nephrologie, he took active part in urological congresses held in countries belonging to the eastern bloc, and especially in Poland. Maintaining good relations with fellow urologists living in the socialist countries, he made a significant contribution to promoting clinical and scientific exchange of experience between these countries and the GDR.
important East German kidney transplant centre. Following Prof. Erdmann's arrival in Rostock, Prof. Sinner received sincere thanks for his work; at the same time, for reasons of bad health he was relieved from performing operations and was instead appointed the director of the clinic's urological outpatient department. He remained in this post until his retirement on account of invalidity in 1975. Paramedical activity On the 3rd of April 1947 Sinner married Carla Gresens. The marriage was childless. In his memoirs, dated 31st August 1970, Sinner describes his paramedical activity and justifies an important life decision. He states that the era of fascism filled him with disgust and loathing for dictatorship and brutal overpowering fascist violence. In 1948 he moved from the British zone to Wismar in the Soviet zone, where in addition to his hospital work he became active in the Free German Trade Union Federation (FDGB), an activity that he continued in Schwerin and in Halle and in Rostock. While acting as the Clinic's director he took part in many cruises as a ship doctor on board the MS Völkerfreundschaft, which gave him an opportunity to visit West Germany and many other countries. After a long and severe illness, Professor Wilhelm Sinner died in Rostock on the 8th of May 1976 at the age of 61. (Figure 3) Literature available from the author
The opponents of the divergence of urology from surgery in Rostock were at that time the few directors of urological clinics in the GDR, who justified their opposition by the lack of suitable premises and suitable infrastructure for an independent urological clinic. In the end the Ministry accepted only the application of the Medical Faculty, agreeing to a post of professor and the title of full professor for Dr. Sinner. In the meantime the required conditions were fulfilled. Prof. Thomas Erdmann (1933) from Berlin succeeded Prof. Sinner, and became the first director of the independent Urological Clinic of the University in Rostock. On the 1st of September 1973 Erdmann took over the newly built 57-bed Urological Clinic fitted out with modern equipment. He belonged at that time to a relatively small group of urologists in the GDR, who in addition to training in classic urology had extensive practical experience in kidney transplantation. Erdmann thus successfully initiated and developed kidney transplantations, bringing into existence an
Figure 3: An obituary, 1976
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European Urology Today
EAU 16th Central European Meeting
EAU 12th South Eastern European Meeting
7-8 October 2016, Vienna, Austria
23-24 September 2016 Sarajevo, Bosnia and Herzegovina EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
Call for Abstracts
Call for Abstracts
Deadline 15 June 2016
Deadline 15 June 2016
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3rd EAU Baltic Meeting 27-28 May 2016, Tallinn, Estonia
Baltic16 widens regional collaboration A wide-ranging Scientific Programme awaits participants of the 3rd EAU Baltic Regional Meeting (Baltic16) in the Estonian capital of Tallinn from May 27 to 28 with onc-urological malignancies, andrology, urolithiasis, male and female incontinence surgery and a course on urethral reconstruction and urogenital fistulae repair as main topics during the two-day meeting. Right on the opening session, Axel Heidenreich (DE) will give the EAU lecture on bladder cancer surgery with emphasis on avoiding complications and achieving better curative outcomes. Two other lectures from Maria Ribal (ES) and Hing Leung (GB) will follow to highlight the meeting’s emphasis on improving management strategies in urological cancers. Session 2 will follow-up with more onco-urological topics with speakers from the Baltic region providing a series of lectures on immunotherapy to perioperative developments in bladder cancer, epidemiology of renal cancer, quality of life after curative prostate cancer (PCa) treatment, and delayed versus immediate PCa treatment, with lecturers V. Kozirovskis (LV), Teemu Murtola (FI), A. Kotsar (EE) and R. Adomaitis (LT), respectively. Local organiser Dr. Toomas Tamm noted that since the Baltic meeting was revived in 2014, the annual event has drew the attention of urologists in the region while providing a reliable platform to exchange ideas and strengthen regional links.
European Urology Today
“We are happy to see that both veteran and young urologists regard this meeting as a means to directly get in touch with their colleagues not only from the region, but also from other countries. This dynamic exchange is essential to fine-tune our clinical practices and stay open to new ideas and approaches,” said Tamm. Five sessions, three symposiums and a European School of Urology (ESU) course on urethral reconstruction and urogenital fistulae repair form the scientific programme with the ESU course to be led by Dmitry Pushkar (RU) and EAU Secretary General Chris Chapple (GB). Pushkar will present the EAU Guidelines recommendations on urethral surgery and will discuss in a lecture and video presentation how to manage urogenital fistulae. Chapple will tackle urethral surgery in male patients, discussing pre/intra and post-operative decision-making, and the limits of urethral substitution. Tamm also noted the meeting’s goal to closely examine various clinical practices, especially their applications in actual hospital settings. “What makes this meeting unique is our goal to present both regional and international perspectives, learn from the synergies between inter-regional collaborations at the same time presenting and highlighting the work of young, promising urologists,” said Tamm. Selected abstracts will be presented in several sessions and the best studies will be awarded cash prizes.
In collaboration with: EAU Section of Andrological Urology
Cutting-edge Science at Europe’s largest Urology Congress
ISSAM 2016 10th Congress of the International Society of Men’s Health and Aging 3-5 November 2016, Berlin, Germany Topics • Men’s health for urologists • Urological men’s health for nonurologists • PRISM Global Summit • The EAU Munich 2016 resolution and statements on TRT • The Prague resolution on TRT and cardiovascular diseases • Penile diseases • LUTS and prostate diseases • Treatment with testosterone in prostate cancer patients • Aging male and general medical problems • How to set up and organize a Men’s Health Institute
Participants Urologists, endocrinologists, general practitioners, geriatricians, cardiologists Programme Plenary sessions, simultaneous sessions, moderated poster sessions and industry sponsored symposia Faculty Multidisciplinary leaders and experts in the care of the aging male
32nd Annual EAU Congress www.eau17.org
For more information and registration go to
ESUR16 23rd Meeting of the EAU Section of Urological Research
Abstract submission deadline 1 July 2016
20-22 October 2016, Parma, Italy EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
24-27 November 2016, Milan, Italy
Consolidating multidisciplinary strategies
8th European Multidisciplinary Meeting on Urological Cancers In conjunction with the • European School of Urology (ESU) • 5th Meeting of the EAU Section of Urological Imaging (ESUI) • 2016 EMUC Symposium on Genitourinary Pathology and Molecular Diagnostics (ESUP) • EAU Young Academic Urologists Meeting (YAU)
www.emuc16.org March/May 2016
European Urology Today
Robotic Live Surgery
13th Meeting of the EAU Robotic Urology Section 14-16 September 2016, Milan, Italy
ERUS16: Taking robotic urology to the next level
Early Registration deadline: 15 June 2016 Abstract Submission deadline: 1 June 2016
Milan to welcome leading surgeons and specialists for three-day meeting For three days this summer, Milan, city of cuisine, fashion, and technological innovation, will host the EAU Robotic Urology Section for its annual meeting. We spoke to Prof. Montorsi (Milan, IT) on behalf of the local organising committee and Prof. Alex Mottrie (Aalst, BE) as ERUS Chairman. Prof. Montorsi: “This year, the organizing committee tried to emphasize several important aspects of robotic surgery in urology, such as patient selection and preoperative patient preparation; the management of complications; and rare indications.” ERUS16 will also include lectures given by non-urological experts. “These sessions will focus on how to perform non-urological procedures robotically. This will include typical scenarios of everyday surgical Prof. Alex Mottrie, Aalst (BE) practice that might occur during ERUSurologic Chairmanminimally invasive surgery.” Live and semi-live surgeries will include rare indications and will describe possible novel areas of applicability of robotic surgery in urology. Prof. Mottrie: “For example, a particular attention will be given to the role of tridimensional reconstruction during robotic surgery. Moreover, the possible applicability of robotic surgery during renal kidney transplantation will be discussed and the proposed techniques in this setting will be described.” Innovations in Robotic Technology ERUS16 features a specialised symposium, specifically dedicated to novel robots and novel technologies applied to robotic surgery. Manu-
facturers and expert surgeons will have a dedicated time to announce and demonstrate their latest developments and the newest introductions in the market. Prof. Mottrie highlights the advantages of being able to give direct feedback to the industry: “This separate symposium is the ideal platform to share information and ideas between surgeons and developers in order to facilitate the design of novel systems that might significantly improve everyday clinical practice and overcome problems observed with currently available devices.” Live Surgery Live surgeries will be performed by expert surgeons coming from all around the world at the Department of the Urology San Raffaele Hospital in Milan, Italy. Surgery will naturally follow the EAU’s guidelines for Live Surgery, always putting the patient first. Prof. Montorsi, also based at the San Raffaele Hospital: “This year the organizing committee tried to focus on all the major areas of application of robotic surgery in urology. Live surgeries will show the latest developments of well-established surgical procedures and will describe areas of improvement in the knowledge of the surgical anatomy.” In addition, live surgery sessions will highlight the advantages and limitations of robotic surgery in special indications and extreme cases. One of the main elements of novelty in this year ERUS program is represented by the introduction of semi-live surgeries. Prof. Mottrie:
“These 15-minutes lectures will include videos of procedures performed by experienced surgeons in a step-by-step fashion. This approach will allow to carefully analyze all the principal parts and to discuss the tips and tricks of an entire surgical procedure.” Semi-live surgeries will include also lectures by non-urologic robotic surgeons focused on how to perform common procedures that might be needed in the everyday clinical practice. Some highlights In terms of topics and speakers that are particularly noteworthy in 2016, Profs. Montorsi and Mottrie mentioned the “pearls from my practice” session on radical prostatectomy. This session will focus on how to properly select patients for surgery and how to reduce the risk of positive surgical margins, urinary incontinence, and erectile function, which represent important outcomes in the follow-up period. “In particular, Dr. Tewari (USA) will give a lecture that will analyze the relationship between nerve sparing approaches and the risk of positive margins, focusing on how to find the right balance between oncologic and functional outcomes. In addition, Dr. Evans will describe the practical role of genetic markers in the surgical management of prostate cancer patients.”
For more information please visit
5th Meeting of the EAU Section of Urological Imaging
Imaging and shifting paradigms in urology
In conjunction with the 8th European Multidisciplinary Meeting on Urological Cancers
24 November 2016, Milan, Italy ESUI16: A glimpse into future technologies Milan meeting will examine the impact of new imaging techniques How new imaging developments impact current urological treatment strategies will be the central focus of the 5th EAU Section of Urological Imaging (ESUI16) Meeting in Milan on 24 November, a day before the opening of the 8th European Multidisciplinary Meeting on Urological Cancers (EMUC16). With “Imaging and shifting paradigms in urology” as theme, speakers and participants will examine the various challenges brought by the introduction of new diagnostic techniques and surgical procedures that are expected to define future treatment protocols. “We aim to provide participants insights on how these emerging techniques impact on standard treatment and the management of disease progression. With experts from across Europe and outside the region, we will discuss their best practices and how accumulated knowledge and experience can inform our own clinical practices,” said ESUI chairman Dr. Jochen Walz. In the tradition of previous ESUI meetings, the Scientific Programme will present the views not only of urology but also of related disciplines such as radiation and medical oncology whose perspectives have a direct bearing on multi-disciplinary approaches needed to provide optimal care for onco-urological patients. Walz underscored the importance of exchanging views with other cancer experts since modern therapeutic care relies on effective collaboration
among various specialists. He said the panel discussions and interactive sessions will provide participants the opportunity to address and examine unresolved questions. Among the topics in the agenda are multiparametric MRI and PET with new tracers such as PSMA, with speakers examining in detail their limits and benefits, recent research and the areas which require further investigations. Researchers are also encouraged to submit their abstract and poster and to link up with other researchers and urology professionals. The best poster presentation will be awarded with a cash prize of €500. Topics of submitted abstracts will be on imaging for prostate, renal, bladder and testicular/penile cancers, image-guided therapies in urology and related issues. “A dynamic exchange is needed for us to come up with the best possible diagnostic and treatment strategies, while at the same time taking time to look into finer details of new technologies, their potentials and also the repercussions on standard practices,” added Walz. The online abstract submission is open with the deadline on 1 July 2016 23.59 hrs. (CET). Abstract submitters will be notified by email of the outcome and final selection at the beginning of August 2016.
Jochen Walz (FR) ESUI Chairman
early registrants with the deadline on 22 August and the late registration fee which ends on 24 November. Registrations can also be made onsite at the congress venue. Walz added what makes the ESUI meeting a well-attended event is its emphasis on a comprehensive and critical update on urological imaging issues while looking into potential developments that will influence current treatment practices. “We do not only highlight what is new in the field but also look into the repercussions on diagnostic and treatment practices. Collaboration is therefore important and the motivating factor to coincide this meeting with the EMUC,” he said.
Participants interested to join the 8th EMUC, can join both meetings for 55 euros on top of the EMUC fee. There are also reduced fees available for Events
For additional information visit the ESUI meeting website at www.esui16.org 36
European Urology Today
Download the EA U Events app in your store for all information on thi s meeting
ESUT16 5th Meeting of the EAU Section of Uro-Technology (ESUT) Late fee registration deadline: 1 July 2016
Friday, 8 July State-of-the-Art lecture: Anatomic enucleation of the adenoma: Does it really make a difference how we do it? Live surgery I • Bipolar prostate enucleation (live) • Plasma prostate enucleation (live) • Plasma prostate vaporisation (pre-recorded) • HoLEP (live) • ThuLep (pre-recorded) • Greenlight (pre-recorded) • Aquablation (pre-recorded) • Urolift (pre-recorded) • i-TIND (pre-recorded) • Thulium Vaporesection of the prostate - Oyster technique (pre-recorded) • Laparoscopic enucleation (pre-recorded) Stone disease - A continuous evolution of treatments • Metabolic evaluation: Is it a tool or a tale? • Is there still a role for SWL? Debate: Miniaturizing instruments for PCNL - A step towards the right or wrong direction? Debate: Prone or supine? The big fight Live surgery II • Prone conventional PCNL (live) • Micro PCNL (pre-recorded) • Mini PCNL (pre-recorded) • ECRIS (live) • Combined PNL/URS- Prone (live) State-of-the-Art lectures: Ureteroscopy (stones/ upper tract TCC)
8-10 July 2016, Athens, Greece • Has anything changed in ureteroscopy? • Access sheaths: Are they a tool or a tale? • Endoscopic Upper tract TCC: Where are the safe limits? Debate: Real life scenario: 2cm renal stones- PCNL or FURS? Live surgery III • Digital ureteroscopic lithotripsy (live) • Single use ureteroscopic lithotripsy (live) • Ureteroscopy unplugged (pre-recorded) • Digital ureteroscopic lithotripsy (live) • Robotic ureteroscopic lithotripsy (pre-recorded) • Digital ureteroscopic lithotripsy (live) ESU-ESUT Hands-on-Training courses Endo-urology & Laparoscopy E-BLUS examination
Saturday, 9 July State-of-the-Art lectures: Prostate Cancer • Guided biopsy: What are the options in image fused biopsy, what are the benefits • Anatomical and technical update on radical prostatectomy Debate: Surgical treatments - Lap and robotic prostatectomy State-of-the-Art lecture: Watchful waiting: Do we have tools that make it a real option? Live surgery IV • Transperitoneal Lap 3D wide excision + LND (live)
• Low-risk patient - Extraperitoneal Lap 3D nsRP (live) • Low-risk patient - Robotic assisted nsRP (pre-recorded) Sexual Rehabilitation after treatment Debate: Kidney - Surgical approaches • Laparoscopic nephrectomy (radical, partial, donor): Are there any limits for laparoscopy? • Robotic nephrectomy (radical, partial, donor): Is it really necessary? Live surgery V • 3D Radical nephrectomy (live) • 3D Nephroureterectomy (pre-recorded) • 3D Partial Nephrectomy (live) • 3D Radical Nephrectomy (live) • Robotic partial nephrectomy (pre-recorded)
Robotic Live Surgery TOOKAD Soluble European Phase 3 Clinical Trial Results ESU-ESUT Hands-on-Training courses Endo-urology & Laparoscopy E-BLUS examination
Sunday, 10 July Pre-recorded surgery Lap/Robot • Upper tract TCC (pre-recorded) • Upper tract TCC (pre-recorded) • Single use ureteroscope: Upper tract TCC (pre-recorded) • NMIBC en block resection (pre-recorded) Guidelines in Endourology: A tool or a tale?
Scarless Surgery - Reconstruction - Miscellaneous
Urothelial cancer • Imaging of urothelial cancer • Management of non-muscle-invasive disease
State-of-the-Art lecture: LESS and NOTES: An attempt of the past or an operation of the future?
Management of muscle-invasive disease Comparative debate minimally-invasive cystectomy
Live surgery VI • LESS/NOTES nephrectomy (pre-recorded) • SMART pyeloplasty (live) • Single Port and needlescopic neprectomy (live) • Laparoscopic Hysterectomy (pre-recorded) • Pudendal nerve decompression (pre-recorded)
Pre-recorded surgery lap/robot • Laparoscopic radical cystectomy - pelvic lymph node dissection- intracorporeal Y neobladder • Robotic radical cystectomy - pelvic lymph node dissection • Robotic intracorporeal Studer neobladder • Nightmares in Laparoscopy and robotics
Focal treatments • Focal therapies on renal cancer: Any chance to survive competition? • HIFU for prostate cancer: Technique and evidence • Stereotactic body radiation therapy as treatment for organ confined prostate carcinoma
For a detailed version of the programme go to www.esut16.org
Download the EAU Events app in your store for all information on this meeting
8th Meeting of the EAU Section of Genito-Urinary Reconstructive Surgeons
14th Meeting of the EAU Section of Oncological Urology 20-22 January 2017, Barcelona, Spain
In conjunction with the Spanish Genito-Urinary Reconstructive Surgery Group (CRU-AEU)
EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
7-8 October 2016, Madrid, Spain EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
European Urology Today
Female genital mutilation Challenges for professionals Dr. Comfort Momoh, MBE FGM/Public Health Specialist Guy's and St Thomas Foundation Trust London (UK) Comfort.Momoh@ gstt.nhs.uk Female Genital Mutilation (FGM) is recognised worldwide as a fundamental violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes and constitutes an extreme form of discrimination against women. FGM involves violation of rights of the children and violation of a person's right to health, security, and physical integrity, the right to be free from torture and cruel, inhuman, or degrading treatment, and the right to life when the procedure results in death. Furthermore, girls usually undergo the practice without their informed consent, depriving them of the opportunity to make independent decision about their bodies (Okeke 2012). World Health Classification of FGM There are four main types of FGM. These are: • Type 1, also known as "clitoridectomy," is the excision of the clitoral prepuce (or "hood") and may also involve excision of all or part of the clitoris; • Type 2 is the excision of the clitoris and may also involve excision of all or part of the labia minora (the smaller, inner vaginal lips); • Type 3, also known as "infibulation," involves excision of part or all of the external genitalia and the stitching or narrowing of the vaginal opening, and • Type 4 refers to all other genital procedures (WHO 2014). FGM has no medical or health benefit and the procedures are irreversible and their effects last a lifetime, although the health impacts of FGM may be reduced in some cases. Reasons behind FGM Communities that practise FGM put forward many reasons and beliefs for the practice. Some of the most common beliefs about FGM are that it promotes chastity, prevents promiscuity, promotes cleanliness and helps to secure a good marriage for one's daughter. Some people also believe that FGM is a European Association of Urology Nurses
12-14 March 2016, Munich, Germany
4. Empower frontline professionals; 5. Identify girls at risk and refer them as part of child safeguarding obligation; 6. Report cases of FGM; 7. Hold frontline professionals accountable; 8. Empower and support affected girls ang young women (both those at risk and survivors; and 9. Implement awareness campaign.
religious obligation. This is not true, FGM is not in the Bible or in the Koran; it has nothing to do with religion. Most communities that practise FGM believe they are doing the best for their daughters and they sometimes do not see FGM as a form of abuse. This can be challenging to professionals and it is our legal duty to provide information to these communities and help to safeguard girls that might be at risk of FGM. Who performs FGM? FGM is commonly performed by traditional birth attendants, local women or men, or female family members. Such individuals do not have formal medical training and usually perform FGM without anaesthesia or sterilisation. It is not uncommon for those who perform FGM to cut or damage more of the genital area than they intend. For example, an unskilled person may intend to perform Type 1 FGM, but do more damage to adjacent organs resulting in Type 3 FGM. Dangers FGM can be potentially very dangerous for women's health and psychological well-being. It can lead to severe health problems, and in some cases, to death. FGM causes gynaecological, urological, and obstetric problems in women. Indeed, FGM doubles the risk of the mother's death in childbirth and increases the risk of the child being born dead by three to four times. During and immediately after the FGM procedure, women can experience significant pain and may suffer haemorrhage, shock, infection, urine retention, and injury to adjacent tissue, and ulceration of the genital region. In extreme cases, women may die from severe haemorrhaging. Key facts • FGM includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. • The procedure has no health benefits for girls and women. • Procedures can cause severe bleeding and
"Female Genital Mutilation" was published by Radcliffe Medical Press (2005)
problems urinating, and later cysts, infections, as well as complications in childbirth and increased risk of newborn deaths. • More than 200 million girls and women alive today have been cut in 30 countries in Africa, the Middle East and Asia where FGM is concentrated1. • FGM is mostly carried out on young girls between infancy and age 15. • FGM is a violation of the human rights of girls and women (UN 2016).
FGM and the law FGM is a crime in the UK and has been a specific criminal offence since the Prohibition of Female Circumcision Act 1985 came into force on 16 September 1985. The 1985 Act was replaced by the Female Genital Mutilation Act 2003. It’s also illegal to take abroad a British national or permanent resident for FGM, or to help someone trying to do this. There is up to 14 years in prison for carrying out FGM or helping it to take place. The FGM protection orders and the Serious Crime Act 2015 allows judges to remand people in custody, order mandatory medical checks and instruct girls believed to be at risk of the practice to live at a particular address so that authorities can check whether they have been subjected to it. Victims are also given lifelong anonymity.
Role of professionals Professionals have a pivotal role to play in identifying, sharing information and reporting cases of FGM. Professionals must assess risk of FGM and treat it as a Key facts child abuse-safeguarding and make referrals of under • FGM includes procedures that intentionally alter or cause injury to the female genital organs for 18 years of age to the police-101. This is a legal non-medical reasons. requirement and responsibility. • The procedure has no health benefits for girls and women. Risk assessment • Procedures can cause severe bleeding and Indicators that FGM may already have occurred problems urinating, and later cysts, infections, as included absence from school or other activities with well as complications in childbirth and increased noticeable behaviour change on return. Physical risk of newborn deaths. indications include recurrent urinary tract infection, • More than 200 million girls and women alive pain or frequenting toilet. today have been cut in 30 countries in Africa, the Middle East and Asia where FGM is concentrated. If concern or worried that a girl might be at risk of • FGM is mostly carried out on young girls between FGM, please call your local helpline. infancy and age 15. • FGM is a violation of the human rights of girls and Intercollegiate recommendations (2013) women. 1. Treat FGM as a child abuse; 2. Document and collect information; Convention and Charter 3. Share that information systematically; • Convention against Torture and other cruel, Inhuman or Degrading Treatment or Punishment. • The African Charter on the Rights and Welfare of the Child, 1981 • African Charter on Human and Peoples’ Right (the Banjul Charter) and it’s Protocol on the Rights of Women in Africa. • The convention on Elimination of All forms of Discrimination Against women 1979 – The Vienna Declaration and Programme of Action 1993 • The Beijing Declaration on Women’s Right 1995 and the United Nation Convention on the Right of the Child 1989.
EAUN in Munich: My experience Poster Sessions reflect the dynamic work of urology nurses the presenters. I believe the idea of the poster session is to encourage urological nurses to become autonomous practitioners, build on our existing service provision, challenge the need for change and our existing thinking. To be inspired by our fellow colleagues both on a national and international level in order to challenge practices and at the same time work towards consistency amongst urology nurse practitioners and encourage forward thinking. It was particularly impressive to observe the social email@example.com networking these sessions provoked. Direct links were forged with speakers and audience participants, exchanging of service provision and ideas were The 17th EAUN meeting was particularly interesting As an audience we appreciated the novice to expert genuinely given and received, contact links were for me as it highlighted a range of interesting topics speakers, this in itself sums up the nature and and features that were applicable to my field of objective of this session. The variation in topics of made to ensure ideas were followed through and urological nursing and which enabled me to apply interest by participants highlighted the wide spectrum services could be forged in a similar fashion. The current practices. For the purpose of this article the in the roles of Nurse practitioners in different parts of one session I felt had a significant impact on my the world - from the different approaches to practice and thought process was the poster sessions. evaluating areas of practices, setting up and The variation in topics showcased that as delivering new services, bringing forward new autonomous practitioners in the field of urology we agendas and stimulating new ideas for the future in feel the need to explore these areas further. It also urological nursing. It allowed the presenters the highlighted the sheer dedication and determination platform to showcase their areas of interest and the to move forward in our practice and thinking. dedicated work it entailed to highlight areas we are moving forward in for urology nurse practitioners. At the same time it also provided the audience the grounds in which to scrutinise such practices, European Association of Urology Nurses question practices and ideas and show support for Mrs. Vitra Khati King's College Hospital Dept. of Urology London (UK)
European Urology Today
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sheer enthusiasm the poster sessions generated showed the scope of hard work and determination by the dedicated participants and organisers alike, of course without the interested audience the success of the session would not be possible. This simple realisation I believe is a powerful tool in gaining momentum for expansion in service provision and roles of urology nurse practitioners in our arena.
EAUN Board Chair Past Chair Board member Board member Board member Board member Board member Board member Board member
Stefano Terzoni (IT) Lawrence DrudgeCoates (UK) Paula Allchorne (UK) Simon Borg (MT) Linda Söderkvist (SE) Corinne Tillier (NL) Susanne Vahr (DK) Jeannette Verkerk (NL) Giulia Villa (IT)
www.eaun.uroweb.org March/May 2016
Thematic session in Munich Issues in nursing care for teenagers in transition to adulthood Winifred Nugent Young Onset Urology CNS Urology Centre Guy's Hospital London (UK) winifred.nugent@ gstt.nhs.uk The Benign Section of the EAUN held an exciting thematic session discussing the challenges regarding teenagers in transition into adulthood. I was delighted and honoured to present the service I deliver within Guys and St Thomas NHS Trust incorporating Evelina London. My exciting role involves managing a clinical commitment in both paediatric and adult urology; ensuring patients receive an individual, timeappropriate seamless transition to adult services. I hope that my passion for addressing the practical challenges often associated with this client group was evident in the delivery of my session.
options have increased life expectancy for this client group. As a result, roles have developed to proactively manage this transition period and facilitate the transfer of care from paediatric to adult services. There is also recognition that encouraging the development of patients’ independence and involving them in their treatment options and decision-making are vital components in maintaining treatment compliance and providing ongoing support. The session opened with clear outline of the aims and objectives for discussion. It allowed time to introduce the Young Onset Urology client group consisting of patients with childhood complex urological conditions, including patients with congenital conditions such as bladder extrophy, cloacal anomalies, spina bifida, posterior urethral valves, hypospadias, and patients with neurogenic bladders. A number of these children have had reconstructive surgery in childhood. They are at risk of bladder dysfunction, metabolic disorders, neoplastic changes and potential deterioration in their renal function. It is therefore imperative that these young people require ongoing care as they move on from children services. My aim was to define and acknowledge the client group and demonstrate the importance of
maintaining good health and preventing deterioration in renal function, all of which was positively received by the audience. The challenges often associated with this client group and their families were discussed and the positive benefits of the CNS role, providing clinical expertise in both paediatrics and adult services were clearly demonstrated. The early identification of transition patients, relationship forming, confidence and trust building are considered as key to maintaining patient engagement and compliance with treatments and follow-up and continuing client and family engagement. The session generated lively discussion with exceptional interaction from audience and panel members, demonstrating the positive benefits of a key worker to support young adults during the time of transition into adulthood. I provided evidencesupporting transitions as a multi-dimensional and multidisciplinary approach with consideration to health, psycho-social, educational and vocational needs. The need for individualised seamless transition was highlighted. I have built and developed my service with user involvement and demonstrated this with results of surveys and discussed about how this data was used in the development of patient information and in benchmarking and shaping the service. I also discussed the need to formalise and develop a transition pathway. The audience reacted positively and I was delighted to encourage them to develop similar pathways. The audience were curious to know how discussions are facilitated between adult and paediatric teams. There was open conversation on the role of the multi-disciplinary team meetings in identifying patients requiring transition which facilitated a forum to discuss conditions and previous treatments received by patients.
I have over 12 years’ experience as a Clinical Nurse Specialist (CNS) and four years ago initiated the Young Onset Urology (YOU) service at Guys and St Thomas NHS Trust. My unique post as the Urology CNS supporting young adults as they prepare for transition to Adult services is the first of its type in the United Kingdom. I am based in adult urology but also have a clinical commitment in paediatrics where I first meet patients, and then assist in their transition to adult services. My role also provides ongoing support to patients, their caregivers and families. The transition of healthcare from paediatric to adult services has become ever more significant during the past 20 years as care delivery has become more complex. Advances in paediatric medical and surgical management, and greater availability of treatment European Association of Urology Nurses
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Winifred Nugent during the lively discussion in the teenager transition session
Questions about the age at which patients are transitioned were asked. Several opinions and debate followed. It was agreed that transition should be viewed as a process not a single event and that early identification of patients requiring transition was of
Kate Fitzpatrick (Chair) and Hanny Cobussen in discussion with the author
paramount importance. I explained the benefit of being reviewed in paediatric services prior to transition, from patient and caregiver’s point of view, and describe the reassurance offered to patients as a result of this review. I have previously presented the YOU service at the European Society of Paediatric Urology, (ESPU) incorporating ICCS, raising awareness of this client group and highlighting the importance of providing ongoing support as they enter adult life.
Ms. Vestermark poses a question
Sharing best practices Session examines best practices in major surgical care Mr. Fabio Scordia, Rn IRCCS Hospital San Raffaele Milan (IT)
firstname.lastname@example.org Nursing collaboration started in 1993 with first the International Nursing Conference, a dialogue between the University of Jordan and the Institute of Health and Caring Science in Sweden. The results of this abovementioned meeting led to cultural exchanges, job satisfaction, establishment of nursing councils, empowerment of the nurses, strengthening nursing care, increasing knowledge and skills needed to care for patients and the development of curriculum that included nursing issues.
variability in funding and scientific review processes and the differences in drug distribution issues.
The session and its focus on the two projects were very interesting because it showed the importance of using evidence in practice and how they impact on Examples of international nursing collaboration are and improve clinical practice. My experience in Munich projects-in-progress in Denmark and in the US. The was an incentive for me to look at my own practice first project, a prospective randomized controlled trial, and helped me reflect on and identify some aspects in examines the efficacy of a multi-professional my clinical practice which need improvement or closer rehabilitation programme in radical cystectomy examination. Participating at the EAUN Meeting in pathways (Aarhus University - Denmark). The focus of Munich also promotes a continuous exchange of the second project is the evaluation of the adherence, experience among one’s peers. impact on length of stay and complications in pre-operative nutritional intervention in radical The session also yielded insights regarding the cystectomy (Memorial Sloan Kettering Cancer Center, pathways in major urological surgery, the promotion New York, USA). This second project provided some educational interventions during the preoperative period (nutritional education, physical education, health related quality of life, baseline measurements, demographics) and collected some data during hospital stay and at discharge (co-morbidities, Body Mass Index, six-minute walk, caloric and protein intake, supplements, dietary diary, exercise programme, evaluation of preoperative programme, health-related quality of life).
During Thematic Session 9 in Munich, in the presentation “Sharing practice across the pond”, N. Love-Retinger (US) discussed the advantages and challenges in international collaboration with regards cancer treatment trials. The most important advantages are the continuous exchange of competencies for patients with common cancers and rare tumours, the broader applicability of research results and the more rapid dissemination of advances in cancer treatment. Despite the benefits there are also challenges that pose difficult barriers, such as the different levels of infrastructure support for cancer clinical trials among countries, different rules, European Association of Urology Nurses
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of multi-professional intervention following the pre-operative phase, evaluating adherence practices and the monitoring of outcomes (complications, length of stay, patient satisfaction).
Mrs. N. Love discussing international collaboration and challenges
“It was a great experience to visit the University Hospital of Munich. We saw their newly built operation theatre, and wauw, some surroundings!” The second lecture of the thematic session was covered by Mrs. He, Chair of NUrsing Committee, Chinese Urological Association, from Wuhan (CN)
Annette, Maysa & Rikke Århus University Hospital, Denmark European Urology Today
High quality poster sessions Italian research bags top prize with study on bladder cancer patients Stefano Terzoni, RN, PhD. EAUN Chair Milan (IT)
practice. Balin enrolled 193 nurses in four hospitals in Israel, and found statistically significant differences in favour of urology nurses in terms of knowledge and correct management (e.g. meatal care), and regardless of age and work experience. Balin’s work provided objective data on the well-known, but often underestimated, problem of providing evidencebased education and applying guidelines in nonspecialist clinical settings; for this reason, her work won the third prize.
The second prize was awarded to Mrs. Franziska Geese (CH), with her poster “Changing perspective! Patients with prostate cancer and their partners giving an insight into their experiences of disease and optimal potential of an advanced practice nurse counselling support program in Switzerland”. Geese presented a very interesting programme of support provided by We had presenters from across Europe and beyond, an Advanced Practice Nurse with a psychowith some from Israel and Japan, giving the sessions oncological approach, before radical prostatectomy a broader view of urological nursing. This year, thanks and during follow-up sessions, with positive results to the support by AMGEN, the three best posters were and high satisfaction levels reported by patients and awarded a grant of 500, 300, and 200 euros partners. respectively. Finally, the first prize was granted to Mattia Boarin The third prize was awarded to L. Balin (IL), whose (IT) who presented the poster titled “The early poster entitled “Choice and insertion of the urinary implementation of oral diet in patients undergoing catheter: comparison of urology vs. internal medicine radical cystectomy improves postoperative outcomes.” department nurses” addressed education in clinical The study reported on the results of a preliminary study on 23 patients with ileal conduit, and examined bowel function, mobilization, personal hygiene, tolerance of oral feeding, quality of sleep, intensity of pain, post-operative complications (e.g. bleeding) and length of stay.
in PDF format from the EAUN website (www.eaun.uroweb.org). Overall, the posters provided evidence results, as well as practical information that could be used in everyday practice and this fulfilled the objective of the sessions which aim to serve as a platform for knowledge sharing. All presented abstracts, posters and webcasts can be found in the Resource Centre at www.eaun16.org. The EAUN Scientific Committee exerts efforts to come up with interesting poster sessions and is ready to provide support to all colleagues who are interested to join the abstracts sessions in London next year. Don’t miss this opportunity! Abstract submission is open from 1 July until 1 December 2016 at www.eaun17.org
Two moderated poster sessions took place during the 17th EAUN Meeting in Munich but due to the higher number of high quality abstracts, an extra unmoderated session was organised, for the second time in the history of the EAUN’s annual meeting.
European Association of Urology Nurses
The other posters also addressed important topics such as urinary tract infections, prostate cancer survivorship pathways, patients’ information on erectile dysfunction and incontinence, catheter blockage at home, bladder exstrophy, shockwave therapy, urodynamics in neurogenic bladder, stoma siting, nurse-led prostate clinics, nephrostomas, TRUS biopsies, and sexual health. All the posters presented are accessible for free download
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Munich, Germany 12-14 March 2016 EAU16 app: Your smart congress companion Download the EAU16 app (EAUN16 Meeting included) via iTunes or Google Play • One, two and three-day registration fees • For all enquiries on registration, the Nurses’ dinner, Hospital visits and First Prize for Best EAUN Poster Presentation Urowalk please contact email@example.com Boarin M., Rancoita P.M.V., Crescenti A., D’Onghia R., Gianandrea E., Villa G. (Milan, Italy) For the poster: "The early implementation of oral diet in patients undergoing radical cystectomy in conjunction with improves postoperative www.eaun16.org outcomes."
EAUN Award Winners
Second Prize for Best EAUN Poster Presentation Geese F., Willener R., Zehnder S., Spichiger E. (Berne, Switzerland) For the poster: "Changing perspective! Patients with prostate cancer and their partners giving an insight into their experiences of disease and optimal potential of an advanced practice nurse counselling support program in Switzerland." Third Prize for Best EAUN Poster Presentation Balin L. (Karmiel, Israel) For the poster: "Choice and insertion of the urinary catheter: Comparison of urology vs internal medicine department nurses." Prizes supported with an educational grant from AMGEN For photos please check page 8.
Neurogenic detrusor overactivity and Overactive bladder 2nd Course of the European School of Urology Nursing
25-27 March 2017, London
4-5 November 2016, Rome, Italy
Join us at the 2nd ESUN Course in Rome Are you looking for an update in the field of neurogenic detrusor overactivity and overactive bladder? Do you appreciate hands-on and applicable recommendations from Europe’s top experts? Are you an experienced practising nurse specialist who treats these patients and teaches other health care professionals to treat them?
Only 25 places available
If so, you will most certainly want to join us at the 2nd ESUN Course in Rome, 4-5 November 2016. This course combines all the best features of an educational event – interaction, group work, latest updates and established evidence-based recommendations. We have invited renowned experts in the field, from a theoretical and practical point of view. Abstract and Video Submission
The preliminary programme consist of the following modules:
Difficult Case Submission
Module 1 - The physiology of bladder control Module 2 - Disorders of the lower urinary tract Module 3 - Pathophysiology of OAB symptoms Module 4 - The impact of OAB on daily living Module 5 - Diagnosis of OAB and neurogenic detrusor overactivity Module 6 - Management of neurogenic OAB Module 7 - Management of neurogenic detrusor overactivity Module 8 - Group work
Research Project Plan Submission
Deadline: 1 December 2016
Registration fee for the full course is €100 for EAUN members and €130 for non-EAUN members. The EAUN covers your hotel arrangement for one night and reimburses your flight or train ticket.
Please send an email to firstname.lastname@example.org before 27 June to receive an application form, the application deadline is 1 July 2016. A selection will take place based on experience, work environment and educational background. For more info please visit eaun.uroweb.org We are looking forward to receiving your application! Stefano Terzoni EAUN Chair in conjunction with
European Urology Today
This course was supported with an educational grant from ASTELLAS