European Urology Today Official newsletter of the European Association of Urology
Vol. 27 No.1 - January/February 2015
The Platinum Journal in the digital age
ESU courses and HOTs in Madrid
Download the App for rapid access to science
Complete overview on page 20 and 22
A network for junior scientists in Germany
Dr. Alexander Kutikov
Dr. Hendrik Borgmann
“The best journey of my life” Challenges lie ahead, but vision and dedication will prevail Common wisdom says it’s not the destination that matters, but how one embarks on and continue a journey. As secretary general in the last eight years, and before that having served as adjunct secretary general for three years, I had the unique privilege to help lead an organisation whose aims are not only focused on achieving optimal urological care, but also in uniting the various urological specialities across a region with its manifold constituents and viewpoints. The challenge for anyone can be intimidating, particularly at a time when my predecessor Prof. Pierre Teillac decided to prematurely end his tenure in 2007. I accepted the challenge confident that with the support of the EAU Board and the capability of the Central Office, the tasks ahead will be properly addressed with the necessary resolve.
Prof. Pierre Teillac (L) receives his honorary membership from Per-Anders Abrahamsson during the 2008 annual congress in Milan
I can say now that my optimism and confidence were matched in the succeeding years with equal responsiveness, thanks to the efforts of colleagues and members of the EAU Board, the executives and staff of the Central Office and the EAU general membership. The inspiration to roll up our sleeves and do the nitty-gritty work was there because the positive energy was not only present but also mutual. Teamwork and the right people helped the EAU in many ways. Our goals to strengthen our Education Office, Guidelines group, the Scientific Office and many other EAU entities have been possible with the appointment of the right people at the right time. I would refrain from mentioning here the names- not only because there are many-- since we all know that any achievements we have seen were the result of collaboration and cumulative effort.
In recent years, we have not only witnessed the growth in our membership, but have reached clear milestones such as the influence of our Guidelines Office, our scientific journal European Urology, the reach and depth of our education projects and the expanding interest for our annual and specialised meetings. From the translation of the Guidelines publications to at least 50 languages, new links made by our International Relations Office to the collaborative work with urology associations in other regions, the underlying motive remains the continued progress of urology, particularly in Europe. Our focus on endemic growth, however, was balanced by our capacity to look beyond borders and consider the views of colleagues in other continents. However diverse the cultural contexts are we still share the same dilemmas and challenges. In the last decade the EAU has entered the global stage and with it comes the responsibility to share resources and help in many worthwhile projects. The financial crises, however, has not only dampened economic growth around the world but has also spilled right into the areas of medical science and research. One of the urgent challenges the EAU faces now is how to overcome financial obstacles that may affect on-going projects. It has always been a challenge to form lasting partnerships with the industry, but with the lingering economic setbacks our goals to address both local and international concerns hang on a delicate balance. Yes, we are aware of the difficulties but we also see the ways on how to best integrate our links with the industry. It won’t be a smooth ride, as they say, but with the right approach a win-win situation is within our reach.
"We persevere because we believe the vision is shared, unbroken, among our membership." Fortunately, both the EAU’s executive and administrative units are solidly grounded and while other associations go through a quick rotation of key people, the EAU relies on the continued transfer of expertise and knowledge, a clear advantage at a time of uncertainty. We persevere because we believe the vision is shared, unbroken, among our membership. Our reach can only go as far if our roots are as deep; equally, the trust we have in our colleagues and partners will sustain this belief.
Prof. Abrahamsson assesses the challenges facing the EAU after more than seven years as secretary general
have been drawn; we only need to find our voice above the tumult.
to medical science and patient care have been deeply inspiring.
In Scandinavia we are known to emphasise the benefits of consensus-thinking, where leadership goes back to its constituents. My mind-set is rooted in this tradition of shared leadership. But in the last eight years it has also dawned on me that it can be a mix of consensus leadership and a reliance on the monopoly of decision-makers, particularly when time or timing is of crucial consequence.
The journey which started eleven years ago has actually not ended, and despite the hours of jetlag, the missed hours for family and friends in Sweden, I remain grateful for this opportunity and the unique chance to make a difference in the continuing effort to see progress in urology. Joy was not in ending long hours of demanding travel but in living out the small details.
I am often asked how I view developments in medicine while in the frontline of leadership. Without doubt I am honoured to meet many key opinion leaders whose ideas, thoughts and visions provided encouragement. Their fortitude, drive and dedication
Yes, the view from the front seat was exhilarating and I can truly say it was the best journey of my life. - By Per-Anders Abrahamsson, EAU Secretary General
30th Anniversary EAU Congress
MADRID Members of the EAU Executive Board in 2012 (From left): Profs. W. Artibani, P.A. Abrahamsson, M. Wirth, C, Chapple and H. van Poppel
We also aim to boost growth in other areas. Our policy on oncology requires further re-thinking, and where we need to be more pro-active amidst fast-changing developments in science and research. On the other hand, I am optimistic the new generation will find ways on how to reach out and convey our views to political decision-makers, particularly in the international level. Boundaries may January/February 2015
20-24 March 2015
Sharing knowledge - Raising the level of urological care
For EAU members only: Abstracts available as of 20 February European Urology Today
Update from the Guidelines Office Meetings, Tweets and The Big Book In recent months the Guidelines Office has been working hard to widen both its on-line presence and print projects. As can be expected, there have been a number of meetings involving the Office, Panels and key collaborators. The following are summaries of some news and developments from the Guidelines Office: Chairmen Meeting in Florence In November, the Guidelines Panel Chairs met with the Guidelines Office Board for a one-and-a-half day meeting. Chaired by Professor James N’Dow, the meeting included presentations from the Methods sub-Committee (Prof. Richard Sylvester, Dr. Thomas Lam, Dr. Lorenzo Marconi and Prof. Steve Canfield) summarising: • The new templates that the Guidelines will follow; • The process for external review of all Guidelines prior to 2015 publication;
Guidelines Office Social Media Group Brainstorming
• The planned workshops on systematic reviews for all panels; and • How to standardise phrasing of guidelines recommendations.
Professor James N'Dow sending the first Tweet from #eauguidelines
EAU Guidelines Social Media Group The Social Media Group are currently collecting key Tweets and Facebook posts from the Guidelines Panels to disseminate through the EAU Twitter (@ Uroweb, #eauguidelines) and Facebook accounts. The first of these tweets was sent out recently from the Male Sexual Dysfunction Panel (shown below). Within just a few days some impressive statistics for this tweet were reached: posts = 88, users = 29, reach = 17,408, impressions = 62,506.
Members of the Guidelines Office Board and Dissemination Committees in Florence
Look out for the #eauguidelines for more Guidelines related social media posts. 2015 Guidelines Print Next month will see the publication of the full text and pocket versions of the 2015 Guidelines. These will
#eauguidelines twitter post from the Male Sexual Dysfunction Panel
be available to collect from the Congress Booth at EAU15, Madrid and they can also be ordered online at www.uroweb.org
Congenital lifelong urology European Urology Today Editor-in-Chief Prof. M. Wirth, Dresden (DE) Section Editors Prof. T.E. Bjerklund Johansen, Oslo (NO) Mr. Ph. Cornford, Liverpool (GB) Prof. O. Hakenberg, Rostock (DE) Prof. P. Meria, Paris (FR) Dr. G. Patruno, Rome (IT) Dr. G. Ploussard, Toulouse (FR) Prof. J. Rassweiler, Heilbronn (DE) Prof. O. Reich, Munich (DE) Dr. F. Sanguedolce, London (GB) Special Guest Editor Mr. J. Catto, Sheffield (GB) Founding Editor Prof. F. Debruyne, Nijmegen (NL) Editorial Team H. Lurvink, Arnhem (NL) J. Vega, Arnhem (NL) L. Keizer, 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.
European Urology Today
The birth of a new working group Mr. Dan Wood Chairman Congenital Lifelong Urology Working Group London (UK) dan.wood@ uclh.nhs.uk There is a growing recognition that patients treated for congenital urological anomalies in paediatric life will need life-long care in many cases. This has been clearly described by paediatric urologists but as yet it has been difficult to identify and engage urologists keen and able to take on this work in adult life. There are a variety of reasons why this might be so. These are challenging patients with complex medical, surgical and, at times, psychological needs. There is a real need for a multidisciplinary team to provide their care and this will need to include specialist nurses, nephrology, radiology, gynaecology and psychology. Others may also be important depending on local needs. Surgical challenges can be varied with the majority of work requiring skills in complex revision surgery. In some environments remuneration for work such as this can be poor and hence there may be difficult to develop institutional support for such a team.
how this translates to later life (Woodhouse, Neild, Yu, & Bauer, 2012). We need to be able to provide safe care for these patients and ultimately better inform paediatric carers about the outcomes of their treatments in early life. The recent ESGURS/ESPU joint meeting in Ghent was a masterpiece in demonstrating the surgical complexities in some of these patients. A wide range of expert presentations and live surgical demonstrations revealed the importance of expertise in managing these patients. Piet Hoebeke and his team in Ghent in combination with both organisations had put together a magnificent meeting to demonstrate the importance of this cause. Congenital Lifelong Urology Working Group Within this meeting was the first meeting of the Congenital Lifelong Urology Working Group. This is a new group chaired by the author and it will be hosted under the umbrella of ESGURS but has received valuable support from ESGURS and the EAU, as well as the ESPU. All of whom have contributed enormously to bringing this into existence. The group has five principle aims:
1. To form and work as a multidisciplinary group aimed at improving the care of patients with congenital urological anomalies; 2. To attract interested practitioners into training in and taking on this work as part of their remit; 3. To form and formalize a network of interested practitioners with the potential for clinical networking that may include (for example) electronic multidisciplinary meetings for complex However, it is clear that surgery in childhood case discussion; represents a contract of care and as we learn more about long-term outcomes the expertise to deliver the 4. The potential for development of treatment guidelines/standardization and metrics; and care described above clearly has its place. Patients 5. The development of education in the care of these with conditions such as bladder exstrophy, cloacal patients – this may include the development exstrophy, hypospadias, posterior urethral valves, fellowship/training programmes in a variety of myelomeningocele, amongst other, will need life-long formats. monitoring to ensure the continued safe function of their surgical reconstruction as well as the impact upon other aspects such as their metabolic status and Full membership will include representation from the ESPU, ESGURS, ESFFU, ESAU, ICCS, gynaecology, renal function. endocrinology, psychology and others. As the group establishes itself it will look to contribute educational For instance, the long-term data for patients with posterior urethral valves shows that in patients with a sessions at meetings of both the ESPU and EAU. We GFR of less that 50 ml/min/1.73 m2 at one year have a look forward to convening our second meeting at the poor outcome but it is very difficult to show exactly EAU Annual Congress in Madrid.
The recognition of the need for this group by such influential societies is an enormous step forward for those of us that are interested to working in this fascinating area. Most importantly, it represents a means by which we can develop care for our patients and a stronger network of professionals focused on providing the care they need. It is vital to acknowledge all the support given by the ESPU and EAU to date. As a group, we are excited to bring together a programme that will show the growing interest and development required.
MADRID 20-24 March 2015 Sharing knowledge - Raising the level of urological care
Get ready for Madrid and join the conversation on Twitter
#EAU15 January/February 2015
Running for men’s health Men’s health problems take centre stage in Budapest marathon Prof. Péter Nyirády Head, Department of Urology Semmelweis University Budapest (HU) nyirady.peter@med. semmelweis-univ.hu The Hungarian Association of Urology and the Department of Urology of Semmelweis University organised a team to join the running competition of Semmelweis University and help raise awareness on the importance of men's health. Prof. Ágoston Szél Rector of Semmelweis University opened the so-called Way of Knowledge running
competition with a quote from Martin Luther King: “If you can't fly then run, if you can't run then walk, if you can't walk then crawl, but whatever you do you have to keep moving forward.” In the “Running for Men’s Health” Team, more than 30 runners (wearing neon yellow shirts) completed either a distance of six kilometres or a half-marathon. Team leader was György Mezey, former football trainer of the national Hungarian football team. The event aimed to draw attention to men’s health. During the press meeting, the author highlighted the importance of regular screening, which can help to prevent the development of serious diseases. The national TV channel had an interview with the author and Prof. Ágoston Szél, rector of Semmelweis University and also member of the team. The interview was later broadcasted during the day’s prime time news segment.
The competition this year attracted twice as many participants than last year and the estimated 500 runners made a total of just 24,000 kilometres, the equivalent of running across Hungary for about 50 times.
“The best journey of my life” . . . . . . . . . . . . . 1 Update from the EAU Guidelines Office. . . . . . 2 Congenital lifelong urology. . . . . . . . . . . . . . . 3 Running for men’s health. . . . . . . . . . . . . . . . 3 ESO Prostate Cancer Observatory: Innovation and care. . . . . . . . . . . . . . . . . . . . 4 12th ESOU: Focus on multidisciplinary teamwork and training. . . . . . . . . . . . . . . . . . 6 The Platinum Journal in the digital age. . . . . . 7 +1 Campaign: Collaboration of urology nurses and doctors. . . . . . . . . . . . . . . . . . . . . 8 Clinical challenge. . . . . . . . . . . . . . . . . . . . . . 9 The “Running for Men’s Health” Team
Accreditation of international Live Education Events. . . . . . . . . . . . . . . . . . 10 Ten questions: Tim Eisen . . . . . . . . . . . . . . . . 11
MADRID 20-24 March 2015
Key articles from international medical journals. . . . . . . . . . . . . . . . . . . . 12-15
Go forward with Flexor®.
EULIS section: eULIS joins International Urolithiasis Meeting in Cape Town . . . . . . . . . . . . . . . . . 16 SEGUR aims to conduct comprehensive stone research . . . . . . . . . . . . . . . . . . . . . . . 16
Sharing knowledge - Raising the level of urological care
Adelaide hosts USANZ Trainee Week 2014 . . 17 USANZ Trainee Week 2014 . . . . . . . . . . . . . . 17
• You can register online until 2 March 2015, after this date you can only still register onsite • Abstracts are available online for EAU Members as of 20 February 2015
ESGURS and ESPU’s 1st Joint Meeting. . . . . . 18 Flexor® Ureteral Access Sheath
Flexor® DL Dual Lumen Ureteral Access Sheath
Flexor® Parallel™ Rapid Release™ Ureteral Access Sheath
• As a delegate you will have direct access to all scientific content of EAU15 in the new Resource Centre on the Madrid website • You can download the EAU15 App from the App Store (Apple) or Play Store (Android) now
Some products or part numbers may not be available in all markets. Contact your local Cook representative or Customer Service for details. © COOK 12/2014
• You can plan your congress in advance via the personal planner online or via the EAU15 app • There is a special quiet area at the congress, to watch best posters in a digital format • The ESUT Live Surgery Session will be on Monday 23 March instead of Saturday • The Certificate of Attendance can be printed from Wednesday 25 March, through the Madrid website • EAU News will sent you daily updates and reports about the congress • You can join the discussion via social media with hashtag #EAU15 • The website http://madrid-explore.com/ offers lots of information about restaurants, nightlife, accommodation, attractions and events in Madrid
European Urological Scholarship Programme (EUSP) Do not forget to submit your online applications for Short Visit, Clinical Visit, Clinical and Lab Scholarship, and Visiting Professor Programme, before the next deadline of 1 May 2015! For more information and application, please contact the EUSP Office – email@example.com or check our website http://www.uroweb.org/education/scholarship/
ESU section: ESU, ESUT hold laser masterclass in Barcelona. . . . . . . . . . . . . . . . . . . . . . . . . 19 60th National Congress of Czech Urological Society. . . . . . . . . . . . . . . . . . . . . 20 ESU Berlin 2014: Extensive state-of-the-art masterclass. . . . . . . . . . . . . 21 ESUT section: Challenges in Endourology & Functional Urology (CIE). . . . . . . . . . . . . . . . 23 Technology and Training in Endourology 2014. . . . . . . . . . . . . . . . . . . . . 23 YUO section: SURG 2014: Our experience . . . . . . . . . . . . . GeSRU Academics – a network for junior scientists . . . . . . . . . . . . . . . . . . . . . . YAU marks third year. . . . . . . . . . . . . . . . . . Joint ESRU and ESRU Turkey Session. . . . . . . YUO Training, Education & Career Development (TEC) Group. . . . . . . . . . . . . . . SUN Congress: Quality and informality. . . . .
24 24 25 25 26 26
50 years of academic urology in Nijmegen, the Netherlands. . . . . . . . . . . . . . 27 Congress calendar 2015 . . . . . . . . . . . . . 30-31 Applying for EUSP research and laboratory scholarship. . . . . . . . . . . . . . . . . 31 EAUN section: Identifying critical points in post PCa treatment support. . . . . . . . . . . . . . . . . 32
European Urology Today
ESO Prostate Cancer Observatory: Innovation and care High quality sessions on selected oncologic diseases Dr. Riccardo Valdagni ESO Prostate Cancer Programme Coordinator Milan (IT)
sonography, elastography and histoscanning, progress was considered essential in fusion tools between MRI and sonography to overcome the difficulty in MRI interpretation reproducibility and the inter-reader correlation.
There was also expectation for cheaper robotic tools to increase the number of robot-assisted prostatectomies. As far as research in urology is concerned, the start of a most awaited trial comparing surgery and radiotherapy in T3 prostate cancer (SPCG 15) was expected in 2014.
Held during the Annual EAU Congress last year, Stockholm welcomed the first edition of the ESO Prostate Cancer Observatory, gathering in one meeting top level experts who examined and carefully discussed the various perspectives on urological malignancies.
Hein Van Poppel
Joining the faculty were Anders Bjartell (Researcher’s perspective), Alberto Bossi (Radiation oncologist), Malcolm Mason (Medical oncologist’s perspective), Nicolas Mottet (Urologists’ perspective) and Hans Randsdorp of Europa Uomo (Patient’s perspective). Coordinated by the author (ESO Prostate Cancer Programme Coordinator), the meeting was chaired by Hein Van Poppel, EAU Adjunct Secretary General – Education, and moderated by Alberto Costa, ESO Scientific Director and CEO.
Trends in research Regarding basic and translational research, the forecast for 2014 presented by Anders Bjartell (urologist at Skäne University Hospital in Malmö), was the development of new genetic markers. To name a few in the diagnostic setting: new panels of single nucleotide polymorphism (SNP) combinations, BRCA2 mutation Anders Bjartell for better prostate cancer risk stratification, circulating tumour cells also carrying characteristic genetic variants like truncated forms of the androgen receptor (AR), single-cell analysis, detecting tumour cell-related DNA, exosomes and miRNA. In the therapy setting, the key question was the understanding of the mechanism behind early and acquired resistance to chemotherapy and resistance to new androgen signalling treatments. Results were expected from studies on the interaction with androgen signalling as co-factors or by cross-talk mechanism, the glucocorticoid receptor taking over activating of some androgen receptor regulated genes, PARP, PI3K, DNA repair mechanism and various transcriptions factors. It would also be helpful to acquire new information on molecular imaging, metabolic tracers and specific antibodies, quantification of tumour burden by automated analysis of bone scans and whole body MRI with 3D-reconstructions, PET in combination with MRI, as well as intraoperative fluorescence imaging during robotic surgery. Last but not least, new research in bioinformatics was considered necessary to make data fully exploitable and understandable.
The Medical oncologist’s forecast, presented by Malcolm Mason, Medical oncologist at Cardiff University in Cardiff, conveyed a detailed scenario of new drugs and research goals. The dominant concern in 2014 Malcolm Mason was whether androgen deprivation therapy would remain the standard of care for first-line treatment of advanced prostate cancer following the results from the CHAARTED, STAMPEDE, and GETUG trials. Enzalutamide and Radium-223 were expected to be established in the treatment pathway. The armamentarium available to the oncologist for metastatic, castrate-refractory prostate cancer makes the sequencing and selection of the right agent, or the right combination of agents, a thorny issue and a challenge. The systemic therapy for high-risk localized disease was considered a very important focus for research, raising crucial questions regarding the optimum form of local therapy and the proper modality (single vs combined). Last but not least, the hope for 2014 was for a cultural and organizational change towards multidisciplinary teamwork.
Moreover, multiparametric MRI and MRI-guided biopsies were considered of benefit for better tumour classification and patient selection for active surveillance. Research had to focus also on the need to reduce cases of complications and infections by different biopsy approaches. As well as in 4
European Urology Today
A patient advocacy group, Europa Uomo’s message is for Hans Randsdorp doctors to consider patients as partners in the decision-making process and to have Prostate Cancer Units which will manage the disease in every stage and can offer the top quality treatments and technologies. The group
also looks forward to more randomised trials and clinical research. Moreover, patients should be offered support for them to recover from or stabilise their disease. It was stressed that a Holistic Needs Assessment could be helpful to address physical or practical concerns, a referral to local or national support groups or Allied Healthcare Professionals, access to advice related to lifestyle, physical activity, diet and nutrition, counselling or psychological support and spiritual needs.
Madrid programme At the EAU 30th Anniversary Congress in Madrid, the 2nd ESO Prostate Cancer Observatory will be held with experts and patient advocates expected to meet on March 20 at 9:45 am at Room Barcelona to hear the forecasts in the next 12 months. Riccardo Valdagni, ESO Prostate Cancer Programme Coordinator, and Hein Van Poppel, EAU Adjunct Secretary General – Education, will be chairing an outstanding faculty. For the Researcher’s perspectives, Frank Claessens, Professor of Molecular Endocrinology Laboratory of the Department of Cellular and Molecular Medicine at the University of Leuven will present his views. The Urologist’s perspective will come from Karim Touijer, Associate Professor of Urology at Weill Medical College of Cornell University and Attending Surgeon in the Department of Surgery at Memorial SloanKettering Cancer Center, New York. The Medical oncologist’s perspective will be discussed by Maria De Santis, faculty member and lecturer in Oncology and Internal Medicine and chair of the
Genitourinary Cancer Service at the Center of Oncology and Haematology, Kaiser Franz Josef-Spital, Vienna. The Radiation oncologist’s perspective will be given by Gert de Merleer, physician for IMRT and IMAT for pelvic tumours (urologic and gynaecologic tumours), Radiotherapy Service at the University of Ghent. Geert Villieirs, Professor in Genitourinary Radiology at Ghent University Hospital is invited to present the Imaging specialist’s perspective. The Patient’s perspective will be presented by Ken Mastris, Europa Uomo Chairman. Alberto Costa, ESO Scientific Director and CEO, and Louis Denis, Strategic Consultant for Europa Uomo, will moderate. All participants registered for the EAU Annual Congress can participate. Don’t miss it!
Research trends in radiation oncology 20-24 March 2015 For Alberto Bossi, Radiation Sharing knowledge - Raising the level of urological care oncologist at Institut Gustave Roussy in Villejuif, four areas of research were identified for radiotherapy and brachytherapy. Cartolina_PCO_(19 Jan)_screen 19.01.2015 10:32 Pagina 1 The first is the availability of new imaging and technologies such as multi-parametric-MRI Alberto Bossi and spectroscopy, the ability to ESO OBSERVATORY better define the target volumes and identify intraprostatic sub-volumes that can be targets for intra-glandular boost in a substantial number of patients. This was considered the first step towards biologicaldriven dose distribution with a more efficient sparing of the organs at risk and a more accurate and effective dose-escalation. On-board imaging devices were expected to allow the spread of image-guided irradiation technique and safe dose-escalation. The second area of research was the role of doseescalation and the association of radiotherapy with androgen deprivation therapy in treating (very) high-risk patients. The complexity of treatment choice and modalities can be best addressed by multidisciplinary management, which should be promoted. The third research area concerns the prediction of treatment-related toxicities. Bottom-line was the assumption that pure dosimetric data do not fully explain why 1 to 4 % of the irradiated patients develop late severe toxicities. It was suggested that other factors such as lifestyle habits and genetic profiles should be considered.
Urology’s viewpoint The Urologist's forecast was for a better definition of patients at risk through improved PSA use and its derivatives. According to Nicolas Mottet, Urologist at the University Hospital in Saint Etienne, multiparametric MRI and MRI guided biopsies were Nicolas Mottet considered the first step to reduce the number of biopsies and of the cores taken during biopsy and of the induced complications.
in general (and prostate cancer in particular), and patientrelated events on early diagnosis.
The therapeutic salvage options for radiotherapy and brachytherapy failures were underlined as the fourth area of research. Contrary to patients failing radical prostatectomy and showing a rising PSA, for whom a standard approach of salvage external beam radiotherapy is nowadays accepted, patients failing after radiotherapy and brachytherapy are managed with a plethora of several therapeutic options. The highlight from radiation oncology was the importance of identifying patients for whom an aggressive, local salvage approach is needed and the standardization of treatment options following well-designed trials. Patient’s perspective The Patient’s hope for 2014, as conveyed by former Europa Uomo chairman Hans Randsdorp, was for accurate, updated and unbiased information to patients, education on all aspects of prostate diseases
The Observatory will be held during the
MADRID 20-24 March 2015 Sharing knowledge - Raising the level of urological care
INNOVATION AND CARE IN THE NEXT 12 MONTHS 2ND ESO PROSTATE CANCER OBSERVATORY 20 March 2015 - Madrid, Spain
PANELISTS F. Claessens Leuven, BE
New York, US
M. De Santis Vienna, AT
G. De Meerleer Ghent, BE
Chairs: H. Van Poppel, BE R. Valdagni, IT Moderators: A. Costa, IT L. Denis, BE
G. Villeirs Ghent, BE
Clayhall Ilford Essex, UK
Under the auspices of
9:45 - 11:15 - Room: Barcelona
MADRID 20-24 March 2015
30th Anniversary Congress
Sharing knowledge - Raising the level of urological care
EAU Opening Ceremony & Networking Reception
EAU15 will mark the introduction of e-Posters: a new medium to translate science to the congress delegates. e-Posters will explain the science in a new way: they can include oral explanations, videos, additional statistics, PowerPoint presentations etc. The possibilities are numerous! In addition to the Poster Sessions, where data will be presented by the authors themselves, all e-Posters will be made available at the: • e-Poster area, which offers multiple viewing stations • EAU15 Website • EAU15 Congress App • EAU15 Resource Centre • EAU15 Poster DVD
On Friday, 20 March the EAU launches the 30th Anniversary Congress with an official Opening Ceremony. During the 1,5 hrs programme, EAU Secretary General P-A. Abrahamsson will welcome everybody to Madrid and give a general update on what to expect during the congress. Also prestigious EAU Awards will be handed out: the EAU Willy Gregoir Medal, EAU Frans Debruyne Award, EAU Hans Marberger Award, EAU Crystal Matula Award, EAU Innovators Award and the Prostate Cancer Research Award.
Poster presenters have been informed on how to submit e-Posters.
Your Personal Planner Do not miss anything during this year’s congress, use the EAU Personal Planner!
Opening Ceremony & Networking Reception Friday 20 March 2015 18.00 – 21.00 eURO Auditorium & Foyer
• You can select your priority sessions • You can export it to your Outlook, Google Calendar or print it out Visit the congress website for more information: http://www.eaumadrid2015.org/scientific-programme
Do not want to carry your poster to Madrid? The European Association of Urology has chosen the innovative web-based platform, PosterSessionOnline, to organise printing of posters for this year’s event in Madrid. This service prints and then delivers your poster to the congress venue, thus guaranteeing that all posters
After the Opening Ceremony you will have the chance to catch up with your colleagues from all over the world and make new contacts and appointments during the EAU Networking Reception. Join us at the eURO Auditorium to celebrate the start of this anniversary congress!
arrive in perfect condition. The cost will be 59 EUR per poster (Excluding 21%VAT). Deadline for sending posters: 12 March 2015 at 23:59:59 hrs (Central European Time)
Abstracts outcome Over 1,100 abstracts were selected for the 30th Anniversary Congress, some 28% of the total submissions. These will be presented in 90 poster sessions, and there will be 10 video sessions in Madrid to cover the 77 accepted videos. The most popular categories for submissions as well as accepted abstracts and videos are: Prostate cancer treatment; surgical management of urothelial tumours and nephron-sparing surgical treatment for renal tumours. A new topic was also added to the programme: Survivorship and supportive care following treatment for prostate cancer. Abstracts will be online for EAU Members as of 20 February 2015. Congress delegates will have access to the abstracts from 20 March.
All you need to know about Relive thirty years of EAU EAU15, right in your smartphone Congress History in Madrid With the EAU15 App you have instant access to the most important information of the 30th Anniversary Congress via your smartphone. You will be able to browse the complete scientific programme by day, topic, speaker, and create your own personal programme thanks to the planner. You can easily find the rooms and exhibitor stands on the floorplans and receive daily news. In your personal congress bag you can save all relevant information, which you can email after the congress so you can easily review all scientific content at a later stage. And you can use the EAU15 app offline. How to download the app and add an event Step 1: Download the app from the iTunes store or Google Play – please search for “EAU 15” Step 2: When you have installed the app, you can access the content with the same login details as you used for the registration of the congress or your EAU member login Step 3: Your app is ready to use!
www.eaumadrid2015.org January/February 2015
As part of the celebration of the European Association of Urology’s 30th Anniversary Congress, the History Wall –last seen in Vienna in 2011- will receive a digital makeover. Thirty EAU Congresses, going back to the very first in 1972, will be included in the interactive overview. You can visit the special Congress History website at: www.eaucongresshistory.org You can also access the interactive timeline in the EAU15 app. At the Congress in Madrid, you can use the interactive screens to browse through the history of the EAU’s congresses at the EAU Booth, or in the foyer of the eURO Auditorium. The website will feature past Congress Presidents, an overview of all the prizes awarded at the meetings, and many other facts and figures from the past forty years. A chronological overview gives the most complete picture, allowing viewers to scroll through a timeline with all sorts of relevant information: artwork from each congress, the ever-increasing numbers of participants, and a mention of major developments in the Congress and the EAU in
EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
general. This includes the foundation of new Offices, or the use of new Congress technology. A geographical overview will reveal how the EAU has convened for Congresses all across Europe, from Budapest to Stockholm and from Birmingham to Madrid. Take a minute to admire the scope of the Annual Congress’s growth and maturation to its current state as one of the largest urological events of the year! Join us in celebrating the 30th Anniversary Congress in Madrid!
www.eaucongresshistory.org European Association European Urology Today 5 of Urology
12th ESOU: Focus on multidisciplinary teamwork and training 900 participants gather in Munich to examine trends in onco-urology By Alba Leon
requires having a dedicated radiologist and an interdisciplinary setting which are crucial for the best Close to 900 urologists, oncologists and other medical diagnosis and decision-making. Although this can be specialists gathered in Munich on January 16 to 18 found in interdisciplinary centres, there are only a few January to discuss how to improve treatment in Europe and they are unevenly distributed and with outcomes in urological cancers during the 12th EAU limited coverage. Besides, the high technology costs Section of Oncological Urology (ESOU) Meeting. make it less available than other diagnostic methods. However, as technology advances, the possibilities The annual ESOU meeting highlights advances and and capabilities of MRI are gaining ground and it is the latest developments in onco-urology through relevant to follow future developments. education and plenary meetings where controversies are addressed. The sessions ranged from heated A recurring debate: open or laparoscopic? The debate regarding open and robotic surgery, debates on techniques to showcasing collaboration among disciplines for improving treatment outcomes. particularly for prostate cancer, continues. While it has been established that oncological outcomes are Personalised medicine and MRI advances not superior in robotic surgery, functional outcomes can be better. One area where the advantages of a “The issue of the year is multi-disciplinarity. For onco-urologists, the future lies in teamwork. We must minimally-invasive approach may prove more beneficial is in cases of complicated reconstruction work together with pathologists, radiotherapists, surgery, said Axel Heidenreich (DE). radiologists and medical oncologists,” said ESOU chairman Maurizio Brausi (IT). For Herbert Lepor (USA), the technique used is much less relevant than the experience of the surgeon. Thus, the debate should focus on training of surgeons, regardless of technique used. While robotics is expensive and not widely available in many parts of Europe, as technology evolves perhaps robotic surgery will become more widespread which B. Rocco, Chair, and speakers of the ESOU Journal Club session requires trained doctors. In line with these developments, and to The patient is central to these developments in light of strengthen the ESOU’s educational goals, the 2015 the growing importance of personalised medicine. edition also featured Hands-on Training (HoT) The idea that each patient should have a course of sessions with simulators which provided an treatment tailored to individual needs requires an introduction into standardised surgical steps in entire team of different oncological specialities, robot-assisted procedures. according to Brausi. As Professor Reinhard Büttner (DE) explained, personalised medicine is already a Training for the future: STEPS sessions reality in urological cancers, especially in bladder and ESOU2015 marked the 5th anniversary of the prostate treatment. Büttner stressed the importance of data from different sources. In his view, personalised cancer therapy treatment requires “a strong basic, diagnostic, and clinical pathology, as well as interdisciplinary diagnostics in specialised centres where there is a team of different specialists that can provide the information Professor Imre Romics (HU) receiving the honour for lifetime achievement from from different angles.”
clinical decision-making processes. It covered quite remarkably the unmet needs of urologists interested in uro-oncology and what they see in daily practice,” said Heidenreich. The three-day event in Munich ended with the award ceremony with Professor Imre Romics (HU) receiving the honour for lifetime achievement and his commitment to improve urological practice in
his home country and beyond. In his closing remarks, Brausi underscored the annual meeting will pursue its aim to bring together various oncological specialities in a bid to enhance networking and collaboration. He added that mutual confidence underpins not only the success of multidisciplinary teams but is also crucial to the diagnosis and treatment of urological cancers.
Residents and Young Urologist Day Organised by the Young Urologists Office (YUO) in collaboration with the European Society of Residents in Urology (ESRU) and the Young Academic Urologists Working Parties (YAU) Dear Colleagues and Friends, With the upcoming EAU Annual Congress, the European Society of Residents in Urology (ESRU), the Young Urologist Office (YUO) and the Young Academic Urologists (YAU) invite you to this year’s Residents and Young Urologist’s Day. We are proud to present a programme that will not only cover various key topics but is also tailored to the needs of residents, and we hope that our colleagues from all over Europe will find the programme relevant to their practice. The morning sessions will consist of several presentations such as training opportunities within the EAU and other benefits for residents and young urologists, while the afternoon programme will cover clinical topics. After its success during last year's edition, there will be another Surgical Tips session to be led by renowned experts who will examine the basics and share insightful tips and tricks. Meanwhile, the "Challenge the Experts" session will present tricky day-to-day scenarios to trigger a dynamic discussion. A well-loved classic of the Resident's Day is the famous Campbell Quiz which always attracts enthusiastic participants. The day will end with the social programme and the Residents Night, certainly a unique opportunity for participants to get to know their colleagues. We look forward to welcome you in Spain. Hasta pronto en Madrid! Giulio Patruno ESRU Chairman-Elect EUT Section editor
Programme Saturday 21 March, 10.15 – 17.25 hrs. Location: Chairs:
Room N105-106 F. Sanguedolce, London (GB) J.P.M. Sedelaar, Nijmegen (NL) J.L. Vasquez, Copenhagen (DK)
10:15 - 10:30
Introduction J.P.M. Sedelaar, Nijmegen (NL) J.L. Vasquez, Copenhagen (DK)
Prof. A. Heidenreich
The first session included presentations regarding the use of MRI, particularly multiparametric MRI (mpMRI) in the diagnosis of prostate cancer. In the past, detection of cancer tumours was considered sufficient, but as technology evolved, mpMRI has become an interesting tool to detect clinically significant cancers, as underscored by Bob Djavan (AT) in his lecture. However, for Jonas Hugosson (SE) it could still be too early to dismiss systematic biopsy, particularly when up to 15% significant PCa has been identified at radical prostatectomy in patients with negative MRI. There are other hurdles to MRI adoption since it
successful “Sessions To Evaluate ProgresS” in the management of urological cancers (STEPS). This partnership between ESOU, IPSEN and the EAU provides the opportunity for around 15 and 20 participants to engage with world-class experts in urological cancers during the ESOU meeting. To date, 78 fellows from 22 different countries have participated and gained access to a unique network, and have received expert advice in difficult cases and how to improve strategic thinking regarding treatment options. Clinically relevant presentations Heidenreich reiterated that in line with ESOU’s main goal to strengthen education and knowledge sharing, the organising committee invites doctors who are not only research experts but are also practising physicians who confront clinical challenges and complications in their daily routine.
J. Hugosson at the lectern during a debate comparing PIVOT and the SPCG4-trial
European Urology Today
10:30 - 11:30 What residents need to know about the EAU Organisation Moderators: D. Duijvesz, Rotterdam (NL) M. Stepanchenko, Chernivtsi (UA) 11:30 - 12:30 YAU session 1 12:30 - 13:30 YUO/EUSP joint session Moderators: V.G. Mirone, Naples (IT) J.P.M. Sedelaar, Nijmegen (NL) 13:30 - 14:15 Campbell Team Challenge Quiz Quizmasters: M. Cechová, Prague (CZ) Á. Rosecker, Szeged (HU) Panel: O.W. Hakenberg, Rostock (DE) 14:15 - 15:55 Surgery: Tips and tricks Moderators: P. Uvin, Erembodegem (BE) S. Sarikaya, Samsun (TR) 15:55 - 16:15
YAU Session 2: The other face of the coin
16:15 - 17:00 Challenge the Expert(s): professor/YAU/resident Moderators: R. Pereira e Silva, Lisbon (PT) J.A. Gómez Rivas, Madrid (ES) 17:00 - 17:25
Prizes and awards J.L. Vasquez, Copenhagen (DK)
“This year’s scientific meeting was based on January/February 2015
The Platinum Journal in the digital age Harnessing digital media to propel academic urology into the future Dr. Alexander Kutikov Associate Editor for Digital Media, European Urology Philadelphia (USA)
accessible on the web (http://europeanurology. com/articles/digital-issue/current-issue). Furthermore, in addition to access to Surgery in Motion Videos, the website also now offers targeted content for patients, ready links to EAU Guidelines, and much more. The site has enjoyed nearly 1.5 million page views since its re-launch. Navigate your browser to www.europeanurology. com and bookmark the page!
References 1. Cress PE. Using Altmetrics and Social Media to Supplement Impact Factor: Maximizing Your Article's Academic and Societal Impact. Aesthetic Surgery Journal 2014;34:1123–6. 2. Kutikov A. Social media and the busy clinician. European Urology Times Congress News 2014;3:18. 3. Loeb S, Catto J, Kutikov A. Social media offers unprecedented opportunities for vibrant exchange of
professional ideas across continents. European Urology 2014;66:118–9. 4. Loeb S, Bayne CE, Frey C, Davies BJ, Averch TD, Woo HH, et al. Use of social media in urology: data from the American Urological Association (AUA). BJU Int 2014;113:993–8. 5. Nason GJ, O'Kelly F, Kelly ME, Phelan N, Manecksha RP, Lawrentschuk N, et al. The emerging use of Twitter by urological journals. BJU Int 2014: in press.
Figure 2: PDF files can now readily be viewed and shared via email within the European Urology and Android applications
Figure 3: Screenshot of the iPhone version of the iOS app showcasing the Docphin module that allows access to latest relevant peer-reviewed literature using one’s institutional library login
Mr. James Catto Editor in Chief, European Urology Sheffield (UK)
European Urology mobile applications for iOS and Android The European Urology iOS Mobile Apps for the iPhone and iPad were first launched in April of 2014. The European Urology Android App also recently became available in the Google Play Store. These apps now include several key features that can help urologists rapidly access and share not only content form the Platinum Journal, but also from other relevant peer-reviewed sources.
1. Rapid access to latest manuscripts from European Urology. • Users can now quickly access and review all In 2013, the European Urology journal initiated a current and in-press manuscripts. Sharing major effort in expanding its digital media footprint. through email and social media is effortless. To replicate the printed journal’s success to a • In addition to device-friendly formatting, web-based publication, the transition strategy has users can also view PDF files of each had a three-pronged approached, which included manuscript and share the file through email optimisation and creation of quality web, mobile, and with colleagues (Figure 2). social media channels that focus on lowering barriers for urologists to access and share the Platinum 2. Surgery-in-Motion Videos can be accessed Journal’s content. through the main European Urology Application. • In the past a free-standing iOS App was Our goal has been to capture the spirit of the necessary to view Surgery in Motion videos. Platinum Journal through digital media, while Now videos can readily be viewed (and maintaining the journal’s academic integrity and shared) through the main application. legitimacy. 3. Social Media Portal Website • European Urology app has a built-in Twitter In January of 2014, a completely reorganised and portal that allows viewing of various Twitter redesigned website was launched. The goal has been feeds for Social Media novices who are to offer the user a clear and intuitive interphase with curious about professional social media but a responsive design that renders well on any screen are yet to open a Twitter account. size or device. 4. Docphin Integration We have focused on utility, making sure the site is • European Urology has partnered with the simple to navigate. The backend structure of the Docphin portal. Users of the iOS Apps can site was adjusted so that adjunct content pieces now harness their institutional login accounts such as editorials, responses, and letters and have seamless access to most recent seamlessly link to appropriate manuscripts and relevant flagship peer-reviewed literature vice-versa. Search functionality also has been resources through the European Urology App markedly improved. (Figure 2). @jimcatto
Excellence knows no bounds.
Download the European Urology App on your Apple or Android device and give us your feedback! http://europeanurology.com/ download-app Social media Social Media use amongst urologists has been unprecedented2-4. European Urology has made a significant effort in harnessing the power of social media to lower barriers of access to the Platinum Figure 1: Altmetric feature that allows user to quickly review Journal’s content. Social Media platforms such as traditional media and social media conversations surrounding Twitter, Facebook, LinkedIn and Google+ help both each Platinum Journal manuscript. Simply click on the Altmetric physicians and patients access and engage in button in the header of each manuscript’s web page. discussions around the latest European Urology content. Content from the site can now be effortlessly shared via email or social media. Furthermore, the Altmetric service has been integrated in order to track social media engagement around European Urology’s content1. By clicking on the Almetric button in the header of each article page, the user can readily review both media coverage and social media conversation surrounding each article (Figure 1). For users who like to interact with the journal in a format that is similar to a hardcopy version, the DigiIssue is now emailed monthly and is readily European Urology
The @EUPlatinum Twitter account recently passed the 5,000 follower mark, while the European Urology Facebook page now enjoys over 7,000 “Likes.” Indeed, the Platinum Journal’s Social Media efforts were recently recognised in a peer-reviewed analysis assessing Social Media use by urologic journals5. Please visit our Social Media page (http://www.europeanurology.com/social-media) and engage with Platinum Journal’s accounts! In summary, European Urology is fully committed to not only providing the highest quality peer-reviewed content to its readers, but also to harnessing the latest tools in digital publishing to facilitate access to this content by busy clinicians and scientists.
Across seas, disciplines and cultures we work together to meet and exceed expectations. Science knows no boundaries. Excellence is a never-ending quest. We owe it to each other to reach beyond; we owe it to our patients to strive to be the best we can be.
European Urology Today
+1 Campaign: Collaboration of urology nurses and doctors Chapple and Drudge-Coates speak on +1 Campaign there is an imbalance in the training given in one hospital compared to another. There is a need for consistency. For nurses, there is a greater need for protocol-led or clinical assessment competencies to be obtained and the necessity to standardise approaches, where possible. This is where organisations can help in education and competency development which is recognised as the standard – and again of paramount important is the EAU-EAUN collaboration.
The EAU and the EAUN have embarked on a long-term plan to effectively boost the collaboration of urology nurses and urologists, while at the same time focusing on the challenges posed by cultural diversity across Europe. The EUT spoke to EAU Secretary General-Elect Prof. Chris Chapple and EAUN Chair Lawrence DrudgeCoates regarding the goals of the +1 Campaign, to review the potential obstacles to any programme directed at the education of European nurses. The question is how to reach the goal of best integrating the work of urologists and nurses in achieving optimal patient care. Below is the edited transcript of the Q&A interview with Prof. Chapple and Mr. Drudge-Coates: Q: In what specific ways can the teamwork between urologists and urology-specialised nurses be further improved considering that more clinical tasks are being performed by nurses? Drudge-Coates: The purpose of the +1 campaign is for clinicians to invest in their clinical staff ( i.e. urology nurses) as part of a multiprofessional approach to help optimise patient care through education – the team being only as good as the weakest link. For urologists their role is often very finite but for the nurses it’s how nurses can impact on, for example, the initial assessment diagnosis, follow-up care and long-term management and their roles alongside other areas like oncology, etc. However not all urology nursing areas are as developed and as new treatments occur nurses need to know about these as they are often involved in their delivery. The focus of education through the EAUN and the +1 campaign is to provide education either through online courses, or the annual EAUN meeting. The +1 campaign recognises that while urology nurses and urologists have different roles, it’s the recognition that they are working towards the same goal of optimising patient care. Chapple: Accredited education and training are an important potential in order for nurses to be signed off, but the tasks and subjects tackled will be influenced by the individual health care system that the nurse works in. Much of the training at present is on a local or ad-hoc basis rather than being based on national standards for nursing. Nevertheless currently certainly in our health care system, it produces the desired outcome for any local needs. In the UK nowadays, there are more training options being offered to nurses because of the pressure on clinical services and need to have more nursing colleagues involved more directly in aspects of urological care which in the past were considered to lie within the realm of the urologist. I realise that this is not considered appropriate or necessary though in a number of other European healthcare systems. Q: In your respective clinics, have you seen more training opportunities or education programmes in recent years being offered to nurses? If yes, what was the impact on the daily work routine and if there are none, what could be the obstacles? Drudge-Coates: Yes, more and more courses are being made available but are not urology nursingspecific. They are also costly and can be difficult to access. Since nurses are unable to take time off, they often have to pay for these courses themselves which I see as counterproductive when this education will positively impact on patient care and treatment outcomes. The EAUN bridges this gap by providing up-to-date nursing education. For example the Evidence-based Guidelines for Best Practice in Urological Care cover a number of topics including catheterisation. In my own clinic, with rapid advances in treatment, there is the need to always be ahead of the game in terms of education – but it is difficult to get time off and other ways of getting this education have to be looked at. Chapple: The amount of work that we are trying to do has been gradually increasing because of increased demand for urological services – particularly with the aging population and therefore the extended role of nursing colleagues has become important in helping us to deal with the daily work routine and provide the best quality of care, in particular relating to follow up 8
European Urology Today
Mr. Lawrence Drudge-Coates, EAUN Chair
Prof. Chris Chapple, EAU Secretary General-Elect
management, diagnostic care and counselling. This (+1 Campaign) therefore in our context would be considered to be a very positive initiative. Q: The EAUN as an international organisation faces the challenge of addressing the concerns of nurses coming from various cultures and in a region where language and mobility present obstacles. In what ways can the EAU and the EAUN work together to offer education and training programmes? Chapple: The major challenges the EAUN has in addressing the ideal role for nurses from different cultures and regions are as follows. Firstly, relating to linguistic issues. Secondly, to the way in which the local urological practice is structured, which is dependent on the number of urologists per capita in the population and the way in which healthcare is reimbursed, in particular whether there is direct payment to doctors per case, or whether as part of a national health system. Doctors are usually salaried in the government sector in a number of countries such as the UK and are therefore only too grateful for help in dealing with the workload in the most effective fashion. Drudge-Coates: There will always be challenges to meeting the needs of nursing education. The benefit of a EAU-EAUN approach allows the potential for areas of education to be highlighted through existing EAU relationships with national organisations, where there is no urology nursing society. Thus, it is important for the EAU to advocate not just the development of urologists but also urology nurses as a multiprofessional approach to care. There are huge opportunities to collaborate and complement existing meetings held by the EAU or for the EAU to advertise the role of the EAUN at these meetings. Ultimately, we have to listen to our members to determine what their needs are. We have to be flexible, current and innovative. Q: Can you cite specific examples of good hospital practices from your experience where urologists and nurses effectively complement their work to achieve better or optimal patient care? Chapple: It is very clear the extended role of nurses has proved to be enormously successful in the UK where nurses deal with catheter care and continence management. In hospitals, nurses can prescribe drugs after suitable certification and can provide specialist roles, particularly in oncology and continence management. In addition, nurses can carry out a number of procedures, not only relating to catheters and bladder instillations, but also in the context, for instance, of conducting urodynamic evaluations and minor procedures such as cystoscopies under local anaesthesia. There is also the potential for nurses to be involved as surgical assistants. Drudge-Coates: In my experience, urology nurses are a part of the team for robotic surgery preoperatively, during surgery and postoperatively, and in stream-lining patient care, providing consistency in patient care and follow-up as part of the urology team approach. They provide clinical input for oncology patients managed initially by urologists. They work alongside urologists when patients are given their diagnosis by providing support and organising timely approaches to diagnostic investigations. Q: More and more urology procedures use minimal invasive technology which lead to clinical practices where nurses assume a crucial role. Do you think this challenge is being systematically addressed by hospital decision-makers and professional organisations? Drudge-Coates: I don’t think this challenge is being met consistently by hospital decision-makers and this relates to providing the necessary training. So often
Chapple: The EAU and the EAUN should work together to identify the perceived needs in terms of education and training for nurses in different cultural settings, rather than trying to dictate a model which is based on the personal experiences of particular individuals involved in running either of these organisations. The challenge is that there is disparity across Europe in terms of the way in which urology is provided and funded. Q: There is the challenge of cost-cutting among hospitals and lack of personnel across Europe. At the same time there is the pressure for more efficient work procedures. How would the EAU and the EAUN address these issues? Chapple: The integrated approach between nurses and urologists working closely together is very successful in our system. In particular, nurses also have the opportunity to take more time to discuss matters with patients and their role in counselling is very important, particularly those related to cancer and surgical procedures, such as for stress incontinence, reconstructive urology, urinary diversion and stoma care. The EAU and the EAUN are working together to formulate policies; but recognise that it is essential to work CLOSELY with the National Urological Societies to address the issue of how best to deliver support to urological nurses in each individual country. This is considered to be such an important issue that it will be an important point of discussion at this year’s EAU National Urological Societies Meeting.
Drudge-Coates: The work force issue is one of the ever growing problems that we face. We have to consider current clinical roles for urology nurses perhaps more, for example, in hybrid oncologyurology nurses role (across specialities). We also have to consider how we protect urology as a speciality and the specialised work force required and how we develop newly qualified nurses in urology areas and core training needs so that skills are transferable across the European Union. These discussion are already taking place and the EAUN is involved. Q: Finally, how would you envision the future of collaborative teamwork among urologists and nurses? Do you expect tangible achievements in the next five years or would it take some time before real changes can be realised? Drudge-Coates: Urologists need to invest in the education of their nurses such as supporting them for EAUN membership and not assume it’s being done or leave it to their managers. There is a need for a change in mind-set, change in pre-conceived ideas for urologists to look outside what they perceive as the roles of nurses, and consider the possibilities of what the role of urology nurses could be. Changes have already happened but it’s how urologists can champion the role of their urology nurses that will maintain this momentum. Chapple: Certainly, there is a lot to do and achieve and we are basically building the support systems in the best possible way that we can. This, of course, takes time. The potentials are there, we just need to create bridges and effective links and continue the dialogue, and widen our understanding of the challenges and their possible solutions based on realistic expectations. To reiterate my previous comment, the EAU should closely collaborate with the EAUN by identifying the needs in education and training for nurses in each country, but within the context of Europe’s diverse cultural settings and in close collaboration with each Urological National Society.
Apply for your EAU or EAUN membership online!
By Joel Vega
Would you like to receive all the benefits of EAU or EAUN membership, but have no time for tedious paperwork?
Becoming a member is now fast and easy! Go to www.uroweb.org and click EAU or EAUN membership to apply online. It will only take you a couple of minutes to submit your application, the rest is for you to enjoy!
European Association of Urology January/February 2015
Clinical challenge Prof. Oliver Hakenberg Section editor Rostock (DE)
The Clinical challenge section presents interesting or difficult clinical problems which in a subsequent issue of EUT will be discussed by experts from different European countries as to how they would manage the problem. Readers are encouraged to provide interesting and challenging cases for discussion at firstname.lastname@example.org
Case study No. 41 This 35-year-old man suffered a motorcycle accident. There was a fracture of the right hand and otherwise no bony injuries at all. He was seen at Accident & Emergency where right flank pain and some abdominal distension was noted. A urinary catheter was inserted and marked microscopic hematuria noted. The abdominal CT scan is shown in Figures 1 and 2.
There were no other associated injuries except the hand fracture and the patient was hemodynamically stable at all times.
Case study No. 42 This 65-year-old man suffers from severe peripheral vascular disease including an abdominal aortic aneurysm with bilateral ureteral obstruction. This was initially treated by bilateral DJ stenting and systemic prednisolone which did not have any effect on the obstruction. In 2010, a transfemoral aortic stent was successfully inserted into the infrarenal aortic aneurysm. Over the following years, two attempts to permanently remove the ureteral stents with continued prednisolone treatment failed. With stents in situ, the patient is well, serume creatinine is 163 µmol/l and renal parenchyma is as shown on CT scan (Fig. 1). The patient is tired of having to undergo regular changing of stents and would prefer a definitive solution.
Discussion points: 1. What type of injury is present? 2. Are further investigations needed? 3. What treatment should be done?
Figures 1 and 2: Abdominal CT scan
Case provided by Oliver Hakenberg, Department of Urology, Rostock University Hospital, Germany.
Grade 5 renal lesion for revision and a salvage attempt Comments by Andrej Grajn Slovenj Gradec (SI)
The motorcycle rider suffered a blunt abdominal contusion and deceleration injury. Thick motorcycle protective gear has probably shielded him from external bruising; however the internal injury has occurred. The CT shows a large retroperitoneal haematoma with left-medial displacement of abdominal viscera. The haematoma seems to be contained
with, however, medial extension therefore indicating a pedicle lesion. The remnants of renal tissue seem to be still properly enhanced indicating that at least some arterial perfusion is left intact. Venous injury seems likely but since the patient is stable, renal vein avulsion is probably not the case, although there is, nonetheless, laceration of one major tributary. The collecting system is also breached. Since the CT does not provide detailed vascular anatomy, CT angiography would be helpful.
decompensation can be rapid, facilitated by the compression of the inferior vena cava seen on CT. The problem is that a dangerous cascade may develop very quickly.
Although conservative management in a stable patient even with high-grade injury has shown acceptable outcomes, in this case the surgical exploration would be feasible with the goal of organ salvage. Since a vascular pedicle lesion is likely,
does not require surgery. The surgical treatment of choice is challenging and would be the retroperitoneal resection of the aneurysm instead of a classical transperitoneal approach.
Surgical revision when the patient is stable is much safer as when decompensation has occurred, it is also easier and has a higher chance of organ salvage. Therefore, I would proceed with revision via median laparotomy.
Conservative treatment is preferred: bed rest and close monitoring Comments by Efraim Serafetinides Athens (GR) and Duncan Summerton (GB)
is well defined and stabilised. The left kidney is well and the lower part of the left ureter is also visualised.
difficult to undergo reconstruction and the most probable result of an operation would be nephrectomy. Since a small part of the organ is visualised the possibility of partial recovery cannot be excluded.
There is no need for further investigations. A repeat scan is recommended if the patient has complications (fever) or his clinical course suggests a missed injury. E. Serafetinides A renal scintigraphy may reveal function of the injured Morbidity and possible dangers of an exploration kidney after a period of recovery. can be avoided while the organ can be saved. If the The patient had a grade 5 parenchymal blunt renal patient remains stable after three days of injury. CT scan reveals a very large hematoma. The Since the patient is stable and there are no intrahospitalisation, he can be discharged from the CT (Fig.1) suggests that renal vasculature is intact abdominal associated injuries the preferred treatment hospital with instructions for a follow-up visit in since the upper pole and the collecting system are is conservative (bed rest, monitoring, support with IV three months (blood chemistry and renal visualised although more than 50% of the organ is fluids and blood products and prophylactic scintigraphy). shattered. At the time of the CT scan the hematoma antibiotics). CT findings suggest that the organ is very
The patient has a blunt kidney trauma secondary to a deceleration injury. He is hemodynamically stable albeit having a grade 4 or 5 trauma. Interestingly there are no associated injuries other than fractures of the extremities. Again, it is shown that the grade of haematuria is not a surrogate for the severity of a kidney trauma. The CT scan is the first diagnostic measure after deceleration accidents and microscopic haematuria in adults. In this case -as the patient is stable- angiography with subsequent embolization of active arterial bleeding would be the first choice. Immediate surgery inevitably would lead to nephrectomy. In recent times, a more conservative approach even to complex grade 4 trauma has been shown to be safe and feasible with a high rate of kidney preservation in the long-term. A follow-up
CT-scan two days later is recommended to assess the degree of urinary extravasation, as there is frequently no contrast media excretion in the acute phase. If bleeding ceased after angiography and urinary extravasation was present 48 hours after the trauma, a stent would most likely be beneficial to reduce urinary extravasation. Additional supportive measures such as antibiotics and analgesics are required in any case. The patient should be further monitored either on ICU or intermediate care for the first 72 hours. The scenario can then develop in two ways: spontaneous resolution or persistent urinary extravasation. In the latter, secondary drainage is reasonable either percutaneously or via open surgery supplemented by kidney debridement following the principles of partial nephrectomy. Hence, relevant kidney function may be preserved even in high-grade renal trauma using such a step-wise algorithm in case of hemodynamic stability. However, a potentially prolonged hospital stay and repeat surgical interventions as well as long-term bladder drainage have to be taken into consideration. Secondary nephrectomy may therefore only be done in case of uncontrollable infection or secondary haemorrhage.
Discussion point: What management options are advisable?
Case provided by Oliver Hakenberg, Department of Urology, Rostock University Hospital, Germany.
Readers are encouraged to provide interesting and challenging cases for discussion.
Angiography with embolization to stop arterial bleeding Comments by Christian Schwentner Tübingen (DE)
Figures 1 and 2: Abdominal CT scan
Case Study No. 41 continued This patient had a complete right kidney rupture with an intact Gerota’s fascia (Fig. 1) and was completely stable. As surgical intervention would have come with a high likelihood of removing the kidney, a conservative strategy was chosen with bed rest immobilisation. After three weeks of uneventful in-patient bed rest a CT was done (Fig. 2) followed by open exploration with evacuation of large amounts of fluid and adaptation of the two
remaining renal poles with a vicryl net, as well as DJ insertion. Seven days later, a perirenal abscess had to be drained. Otherwise, recovery was uneventful and the patient was eventually discharged in good physical condition after another CT (Fig. 3). The follow-up CT three months after the trauma that caused the injury (Fig. 4) shows a remnant kidney with perfusion. A renal function scan is not yet available.
Fig. 1: Initial CT scan after the accident
Fig. 3: CT after surgical reconstruction and before discharge home
Fig. 2: CT three weeks after complete renal rupture contained within Gerota’s fascia
Fig. 4: Follow-up CT 3 months after the trauma
European Urology Today
Free Social Media webinar for EAU members Want to learn the basics of Social Media, but you don’t know where to start?
Accreditation of international Live Education Events Introduction of the concept of “frequent applicant” by the UEMS-EACCME® In 2013 the UEMS-EACCME® has implemented the new regulations for accreditation of Live Education Events (LEE) (UEMS 2012/30) with the new timescales for the submission of applications - 14 weeks prior to start of the event. The UEMS-EACCME® found that some providers had difficulties meeting this new deadline and therefore had looked at a reduction of these timescales to 12 weeks in response to requests from providers.
Does your mind start boggling from terms like tweets, hashtag, share/like and avatar? Don’t worry, we will help you to get started in a free Social Media webinar for EAU members by the social media specialist and urologist, Stacy Loeb.
To reward applicants who frequently submit applications and who are considered trustworthy and performing very well, the UEMS-EACCME® has decided that it could go one stage further and has developed the concept of “frequent applicant” which will allow them to apply 10 weeks prior to the start of an event.
What will be discussed: • The impact and terminology of social media • How to set up a Twitter or Facebook account? • What is interesting medical news to share on social media and how to share this? Join us from your couch, office or on the go on one of the following dates:
To obtain the status of “frequent applicant”, providers need to meet a certain number of criteria: - More than 10 applications / year - Consistent record of high quality applications - In case of problems or questions, amendments should be made rapidly (within less than one week) - The applicant must provide feedback on his/her applications. So far the UEMS-EACCME® has received more than 30 applications and will soon be going through these applications in order to consider granting the status of “frequent applicant” to providers. In order to submit an application to be considered a “frequent applicant” the provider has to send an e-mail request to the UEMS-EACCME®. More details and full text of the document is available on the UEMS website www.uems.eu.
25 February: 12.00 hrs CET 9 March: 20.00 hrs CET
EU-ACME MCQ winners 2014
You can register by sending an email to email@example.com. The maximum number of participants is 25 per webinar. So subscribe today and be sure to get updated on the basics of social media! When you are enrolled, you will receive a link to join the webinar.
From January 1 to December 31, 2014, EU-ACME members answered multiple questions published in European Urology. Participants who answered the most questions correctly were awarded with free registration for the 30th Annual EAU Congress in Madrid to be held from March 20 to 24 this year. European Association of Urology
In 2015, join us Down Under
The 2014 winners are: 1. Mr. Norbert Bosch, The Netherlands (CME-112865) 2. Mr. Mark Saxby, United Kingdom (CME-000243) 3. Mr. Franz-Josef Schattka, Ireland (CME-110659) On behalf of the EU-ACME, EU-ACME committee, chairman Prof. R. Nijman congratulated the winners for their successful participation in our online CME programme!
European Foundation Award 2015 The Société Internationale d’Urologie and the Astellas European Foundation (AEF) are pleased to sponsor a $20,000 USD award granted to a scientist of notable professional and ethical standing. In preparation for the 35th SIU Congress, to be held October 15-18, 2015 in Melbourne, Australia, the SIU and the AEF solicit nominations for this prestigious award. Nominations should include a detailed curriculum vitae and a letter with a full explanation of the candidate’s merit, and must be submitted to the Awards Committee, SIU-Astellas European Foundation Award 2015 c/o SIU Central Office at the coordinates below no later than March 1, 2015. The Awards Committee, appointed by the SIU’s Board of Chairmen, will review all applications and announce the SIU-Astellas European Foundation Award 2015 laureate at the 2015 SIU Congress in Melbourne. Previous laureates were Dr. Donald S. Coffey (1994), Dr. Nils Kock (1997), Dr. Emil Tanagho (2000), Dr. Alvaro Morales (2002), Dr. Michael Marberger (2004), Dr. Frans Debruyne (2006), Dr. Andrew Novick (2007), Dr. Peter Alken (2009), Dr. Fritz Schröder (2011), Dr. Peter Scardino (2012), Dr. Ralph Clayman (2013), and Dr. Urs Studer (2014).
Abstract Submission Deadline: April 3, 2015
Research Fellowship The California Urology Foundation, in association with the Société Internationale d’Urologie, announces the availability of a Research Fellowship for a fully- trained Urologist from Africa to do research for one year in a medical laboratory of the University of California in San Francisco (UCSF).
Featuring the SIU-ICUD Joint Consultation on Image-Guided Therapy in Urology
This award is intended to prepare the candidate for an academic career in his or her home country; a firm commitment to return will be a material consideration in the evaluation of candidates. This fellowship carries a stipend of $50,000 USD, of which $14,000 is used to cover medical insurance and administrative fees.
Visit Us at EAU 2015 at Booth #D86
Applications for this fellowship will be evaluated by a joint SIU/UCSF Committee and should include a proposed area of study, a detailed CV, and a minimum of 2 letters of professional references. An application missing any of the items listed above will be considered incomplete. The deadline for the January-December 2016 Fellowship will be February 28, 2015. Application forms are available on the SIU website www.siu-urology.org under the Training Scholarships tab. Applications can be submitted by mail, fax or e-mail to UCSF-SIU Research Fellowship c/o SIU Central Office at the coordinates below.
A powerful resource for urologists
At your fingertips, anywhere, any time.
SIU CENTRAL OFFICE 1155 University Street, Suite 1012, Montreal, Quebec, Canada H3B 3A7 Telephone: +1 514 875 5665 Fax: +1 514 875 0205 firstname.lastname@example.org
2015-01-14 9:04 AM
European Urology Today
Client: SIU 2015 Docket number: 25-5005 Description: MELBOURNE - SIU ACADEMY
File Size: Trim Size:
100 % 133,4 mm X 194,3 mm
SIU 2015 ASTELLAS - UCSF
Docket number: 24-4134
14-10-02 9:36 AM
File Size: Trim Size:
100 % 133,4 mm X 194,3 mm
• What do you think is the biggest challenge in oncology?
To have a very significant impact on diseases where there is currently no identified driver abnormality, which is the majority of solid tumours. The other major thing is early diagnosis. We should go for cure, ultimately.
• If you were not an oncologist, what would you be?
My other great interest-- when I was doing a lot of lung cancer work- is looking for genetic predisposition. We identified the genes encoding sub-units of the nicotinic acetyl choline receptors as predisposing to smoking and hence to lung cancer. I’d like to contribute to the work on these receptors which are of importance in a wide range of psychiatric and dependency conditions.
• What is your most important piece of advice for doctors just starting out today? To enjoy what they’re doing and choose their mentors carefully because there will be people who will support and stimulate you to produce your best work- and for young doctors to retain their sense of wonder in medicine.
• What is the most rewarding aspect of being a doctor?
Medicine is one of the most rewarding things one can do since it goes to the heart of humanity. It’s a tremendous privilege to do medicine.
• What is your advice to other physicians on how to avoid burnout?
Medicine can be a physically and emotionally exhausting job. You need to change what you do and keep yourself excited and fresh by looking for new ideas, for instance, researching into a new field.
• If you could change something in the healthcare system, what would it be?
Frequent major changes in policy direction are most damaging. Reorganisations are often conducted by people who are capable but are not well-versed in change management. These changes are very expensive and disruptive.
• What’s the last wonderful book you have read?
“The Betrothed” by Alessandro Manzoni- a well-known historical novel in Italy. The story takes place in the 17th century during the Hapsburg rule of northern Italy when the region went through plague and strife.
• What’s the last thing that surprised you?
That the new immunotherapies look quite as exciting as they do is a surprise. We now have a more profound understanding of the immune system and there is enormous potential in these advances.
• What’s your favourite hour in a day and why?
I enjoy the first hour after I wake up. I get up and I love the birds singing. I live in the rural part of Cambridge. Yes, I’m a morning person.
• What do you most often wish you could say to patients, but didn’t?
TEN QUESTIONS Interview by Joel Vega Photography by Jack Tillmanns
Age: 50 Specialty: Oncology City: Cambridge, United Kingdom On-going project: Vice President and Head of Clinical Discovery Unit, AstraZeneca; Professor, Medical Oncology, University of Cambridge
That’s difficult to answer because patients differ from each other in what they need. Some patients want strict honesty, others want reassurance. What I would like to do is to gauge what the patient needs and be able to provide that.
Innovators in BC® topic of the year Biomarkers for prediction of outcomes in Urothelial carcinoma of the bladder (UCB) Urine Biomarkers • Solid malignancies develop their own vessel Voided urine cytology is an easy assessable, costsystem by a process called angiogenesis. effective and frequently utilized tool for early detection Promising therapeutic targets include a variety of biomarkers associated with angiogenesis like MVD and surveillance of bladder cancer and it is recommended by the EAU guidelines. However, there (Microvessel density), VEGF (Vascular endothelial are significant limitations in terms of sensitivity, growth factor, Thrombospondin-1 and bFGF). especially for low-grade diseases. Other commercially • Another approach for new therapeutic targets are available tests include nuclear matrix protein signaling proteins, having genetic alterations or (NMP-22), BTA tests, ImmunoCyt/uCyt+ and Urovysion. altered expression or both in bladder cancer. To date, bladder cancer displays the fourth most Some of these tests (NMP-22 and BTA) might have high Several of these oncogenes like FGF receptor 3 common cancer in men in the Western world2. The false-positive and false-negative rates while others (FGFR3), the ErbB family receptors, RAS majority of patients with newly diagnosed bladder (Urovysion) show a high sensitivity but being relatively oncogenes, and the PI3K pathway genes have a cancers present a non-muscle invasive bladder cancer cost-intensive at the same time. There are further urine dominant effect on cell phenotype. (NMIBC) with a high risk of recurrence and of biomarkers currently under investigation like Aurora • Hormone receptors are another set of promising progression. This progression considerably increases kinase A (AURKA), UBC-tests, Survivin and BLCA-1/4. biomolecular targets, considering that UCB’s the risk of metastasis and subsequent mortality3,4,5. differential disease behavior between genders Therefore, early detection of tumors is essential for Tissue-based biomarkers has been suggested to be associated with sex improved prognosis and long-term survival. Although several potential immunohistochemical steroids. Currently under investigation are human epidermal growth factor receptor 2 (HER2), tissue biomarkers for bladder cancer have been Dr. Aziz (University Medical identified and extensively studied, their application in androgen and progesterone receptor. Center Hamburg-Eppendorf): daily clinical practice has been treated with “Despite better understanding of reluctance. Tissue-based biomarkers cover the Blood-Based Biomarkers the disease’s biology and following pathways implicated in bladder cancer: Similar to tissue-based biomarkers, no blood-based improvements in perioperative Cell-cycle, apoptosis, angiogenesis, signaling, and molecular marker is used in clinical routine today. management and therapy, hormonal regulation. Hemoglobin, Platelets, C-reactive proteine, Neutrophilrespectively, the identification of • The Cell-cycle is based on a succession of carefully Lymphocyte-ratio, Transforming growth factor (TGF)-β1, patients that suffer from an adverse coordinated and regulated steps that govern cell Matrix metalloproteinase (MMP), Plasma-Insulin outcome after surgery is still challenging. Identifying proliferation. Mutations of cell cycle-regulatory growth factor, Insulin growth factor binding proteins patients of higher risk for a poor outcome might help to genes are the most common genetic alteration that (IGFBP), Urokinase plasminogen activator (uPA), include those patients in clinical trials or administering can lead to UCB development. Markers of Soluble E-cadherin (sE-cadherin) and circulating tumor additional therapy. At this glance, biomarkers can serve therapeutic interest include the p53 protein; the cells (CTC) have been investigated in the past years. as useful tools for the identification of high-risk cell-cycle regulator retinoblastoma protein (pRb); patients. Several biomarkers have been detected to date, the tumour suppressor protein p16; the inhibitors Urothelial carcinoma of the bladder (UCB) is a very however, their clinical use has been treated with p21, p27; cyclins (D and E) and the marker of cell complex and heterogeneous disease. Tumorigenesis reluctance due to undulant sensitivity and specificity proliferation Ki-67. and progression of UCB is a process involving multiple rates. The following summary aims to give a brief • Apoptosis is critically important in bladder cancer genetic and epigenetic alterations. Therefore, the overview of the currently used biomarkers and also of development, progression and metastasis. search for specific genetic alterations that determine promising biomarkers that are under investigation in Markers like Fas (CD95), Caspase-3, Survivin and UCB biological nature and behaviour are important to bladder cancer which have attracted the clinician’s Bcl-2 are involved in this complex and highly optimize individual therapy. However, such reliable attention.” regulated process of programmed cell death. biomarkers are still substantially limited.
Biomarkers in the diagnosis of bladder cancer have been identified as “Innovators in BC®” topic of the year by a large number of experts and announced at the 29th annual EAU congress 2014 in Stockholm. Xylinas and colleagues1 conducted a comprehensive literature search on the subject, selecting the publications with the highest level of evidence to provide an updated review on molecular biomarkers in UCB.
Combinations of different biomarkers may provide a more accurate prediction of outcome compared with any single marker. Further efforts will most probably focus on promising biomarker combinations that encompass a variety of different pathways to increase the predictive value and possibility for targeted therapy. In the future molecular profiling would eventually allow for a more personalized and comprehensive treatment plan. Innovators in BC® Innovators in BC® (www.innovators-in-bc.com) has been established to offer science-based information in order to raise awareness of bladder cancer in general, and to share information, experience and material with in-depth educational background. Its content is regularly updated. Innovators in BC® is a restricted area for medical practitioners only from Austria, Belgium, the Czech Republic, France (www.innovators-in-bc.fr), Germany, the Netherlands, Spain and Switzerland, developed by Ipsen. Without any commercial purpose the platform aims to be neutral and independent. References 1. Xylinas E, Kluth LA, Lotan Y, et al. Urologic oncology 2014;32:230-42. 2. Burger M, Catto JW, Dalbagni G, et al. Eur Urol 2013;63:234-41. 3. Sylvester RJ, van der Meijden AP, Oosterlinck W, et al. Eur Urol 2006;49:466-5; discussion 75-7. 4. Witjes JA, Comperat E, Cowan NC, et al. EAU guidelines on muscle-invasive and metastatic bladder cancer. EAU 2014;April 2014. 5. Aziz A, May M, Burger M, et al. Eur Urol 2014; 66: 156-163.
European Urology Today
Key articles from international medical journals Dr. Francesco Sanguedolce Section editor London (UK)
Latest update of ERSPC Although the European Randomised study of Screening for Prostate cancer (ERSPC) has shown a reduction in prostate cancer mortality, screening remains controversial as a consequence of over diagnosis and over treatment. This paper updates results with mortality from prostate cancer and includes data from France for the first time. This multicentre randomised screening trial was initiated in 1993 in the Netherlands and Belgium. Between 1994 and 1998 others centres in Sweden, Finland, Italy, Spain and Switzerland joined the study and two French centres started in 2000 and 2003. 162,388 men aged 55-69 years were randomised to either be invited for PSA screening or standard care. The screening interval was four years in all centres except Sweden where it was two years and a cut off of 3.0 ng/ml was used as an indication for biopsy. The primary endpoint was prostate cancer mortality, but overall mortality was also collected. There was also a secondary analysis that corrected for selection bias due to non-participation. The median age at randomisation was 60.2 years and 20,188 men underwent a biopsy (85.6% of the men with an indication for biopsy). At a maximum 13 years of follow-up 7,408 prostate cancers were diagnosed in the intervention group against 6,107 cancers in the control group giving a risk ratio of 1.57 (1.51-1.62). At this time point 355 men had died of prostate cancer in the screened group and 545 in the control group. After adjustment for non-participation RR was 0.73 (95% CI 0.61-0.88, p < 0.0007). This means that 781 men are needed to be invited for screening and 27 extra men are needed to be diagnosed to save one life.
…the recently updated PCLO study continues to show no benefit for PSA screening As the data become more mature there is no further increase in the relative effect on prostate cancer mortality but an enhanced absolute mortality reduction. However the effect is not even, with reduction in prostate mortality in Sweden and Holland but not Finland. This might be related to different treatment regimes and possibly because median follow-up following a cancer diagnosis is just 6.4 years. In addition, the recently updated PCLO study continues to show no benefit for PSA screening. This study will continue to be of interest for many years but is not yet sufficiently persuasive to lead to the introduction of population-based screening.
Source: Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Schroder FH, Hugossan J, Roobal MJ, Tammela TLJ, Zappa M, Nelen V, Kwiatkowski M, Lujan M, Maattanen L, Lilja H, Denis LJ, Recker F, Paez A, Bangma CH, Carlssan S, Puliti D, Villers A, Rebillard X, Hakama M, Stenman U-H, Kujala P, Taari K, Aus G, Huber A, van der Kwast TH, van Schaik RHN, de Koning HJ, Moss SM, Auvinen A for the ERSPC Investigators.
be effective in patients with muscle-invasive bladder cancer remains experimental in part because of the difficulties of accurately staging upper tract tumours. Elevated platelet count has been frequently observed with other cancers and, in bladder cancer, has been associated with poor prognosis. This study evaluates the possibility of using the prognostic significance of platelet count kinetics in patients undergoing radical nephroureterectomy for upper tract TCC. Data was analysed from three prospectively maintained databases at tertiary academic centres. 269 consecutive patients undergoing radical nephroureterectomy without perioperative treatment between 1996 and 2011 were included. Lymph node dissection was performed at the discretion of the surgeon. Platelet count was measured one to three days prior to surgery and seven to 10 days after the procedure. It was considered to be elevated if greater than 400 x 109/L. Unfortunately median follow up was just 24 months.
This study raises the possibility of identifying a high-risk group of patients who might benefit from an adjuvant therapy after radical nephroureterectomy Of the 269 patients 31 (11.5%) had thrombocytosis of which 15 also had elevated platelets postoperatively whilst in 16 patients platelet counts fell to normal. A further nine patients exhibited elevated platelet counts post-operatively only. Post-operative thrombocytosis was associated with advanced clinical stage (p = 0.034) advanced pathological stage (p = 0.027), positive surgical margin and tumour grade (p = 0.050). Recurrence occurred in 92 patients and was related to platelet could (see Table 1) and returned towards the norm for those patients whose platelet count drop within the normal range post-operatively (3 year recurrence free rate 52.2%) Table 1 3 yr recurrence free survival
5 yr recurrence free survival
In multivariable analysis postoperative elevated platelet count (HR 3.27 [1.41-6.89; p = 0.007]), advanced pathologic tumour stage, positive ureteral margin and lymphovascular invasion were independent predictors of tumour recurrence. Preoperative thrombocytosis is thought to relate to the malignant potential of primary tumours. Interestingly it is suggested that post-operative elevated platelet counts could be associated with the presence of micrometastases, which produce cytokines stimulating the increase of megakaryocytes. In support of this, six of the seven patients with an elevated platelet count pre-operatively but confined tumours (< pT2) the post-operative platelet count fell to normal whilst this occurred once in a patient with pT3 disease. This study raises the possibility of identifying a high-risk group of patients who might benefit from a adjuvant therapy after radical nephroureterectomy.
Source: Prognostic relevance of postoperative platlet count in upper tract urothelial carcinoma after radical nephroureterectomy. Gakis G, Fritsche H-M, Hassan F, Kluth L, Miller F, Soave A, Otto W, Schwenter C, Todenhofer T, Dahlem R, Burger M, Fisch M, Stenzl A, Aziz A, Rink M. Euro J Cancer 2014; 384: 2583-91.
Predicting drug response from circulating tumour cells
The acceptance that castration-resistant prostate cancer (CRPC) continues to rely on androgen Radical nephroureterectomy is the standard signalling has led to the emergence of new agents management of upper tract urothelial carcinoma. that either suppress synthesis of extragonadal However, recurrence occurs in up to 50% of patients. androgens (abiraterone) or target the androgen Neoadjuvant chemotherapy, which has been shown to receptor directly (enzalutamide). Key articles
This study assessed the presence of AR-V7 messenger RNA in circulating tumour cells. Men with metastatic CRPC who were beginning treatment with either enzalutamide of abiraterone were included. Peripheral-blood samples were obtained prior to starting treatment, at the time of a clinical or biochemical response (if a response occurred) and at the time of clinical or radiographic progression. In addition patients were encouraged to undergo core-needle biopsies of metastatic tumours at baseline and at the time of progression. Quantitative reverse-transcriptase-polymerase-chainreaction (RT-PCR) assays were used for mRNA detection. Clinical investigators were unaware of the AR-V7 status of the patients. The primary endpoint was the proportion of patients with a > 50% decline in PSA level maintained for at least four weeks. Data was also collected on PSA progression-free survival, progression-free survival, and overall survival. Between September 2012 and September 2013 62 men with detectable circulating tumour cells, from 71 screened men, were enrolled. 12 of 31 enzalutamidetreated patients had detectable AR-V7 mRNA while just six of 31 abiraterone-treated men had detectable AR-V7 mRNA. Interestingly 11 of 20 men who had been previously treated with abiraterone had AR-V7 present.
The presence of AR-V7 reliably predicted a lack of response to both enzalutamide and abiraterone and … may be the first biomarker directed clinical intervention in CRPC
Mr. Philip Cornford Section editor Liverpool (GB)
philip.cornford@ rlbuht.nhs.uk Delayed graft function was seen in 36.9% of patients. BMI was the only anthropometric variable associated with a higher likelihood of DGF (odds ratio = 1.25, 95% confidence interval = 1.07-1.47) after adjusting for age, gender, donor group, donor age and years of dialysis before transplantation. Obesity was associated with a higher frequency of DGF (83.3% versus 31.1%, p = 0.001) compared to normal weight. GFR at discharge was negatively associated with BMI [β = -0.014 (0.005), p = 0.004], being overweight [β = -0.151 (0.041), p < 0.001] and obesity [β = -0.188 (0.053), p = 0.001], after adjusting for age, gender, donor group, donor age and years of dialysis, but was not associated with indices of muscle reserves.
This study clearly indicates that recipient BMI seems to correlate with delayed graft function (DGF) if the patients are obese … This study clearly indicates that recipient BMI seems to correlate with delayed graft function (DGF) if the patients are obese and discharge GFR is negatively associated with being overweight and obesity. These findings are clinically relevant; however, long-term outcomes of transplant function versus body weight need to be looked at.
Source: Exploring associations between anthropometric indices and graft function in patients receiving renal transplant. Tsirigoti L, Kontogianni MD, Darema M, Iatridi V, Altanis N, Poulia KA, Zavos G, Boletis J. J Hum Nutr Diet. 2014 Dec 18 [Epub ahead of print]
Lancet 2014; 384: 2027-35.
Predicting outcomes after radical nephroureterectomy
Although both drugs represent a significant improvement in the treatment of men with prostate cancer, 20-40% of patients have no response and eventually nearly all men develop resistance. It has been proposed that this is at least in part due to the presence of androgen-receptor splice variants that lack the C-terminal ligand-binding variant but retain the transactivating N-terminal domain. One such variant is the androgen-receptor splice-variant 7(AR-V7), which has previously been shown to be present in clinical specimens.
In both groups the response rate for men with detectable AR-V7 was 0% whilst the rate among AR-V7 negative patients was 53% in the enzalutamide group and 68% in the abiraterone cohort. This data was supported with AR-V7 patient having shorter PSA progression-free survival, shorter progression-free survival and decreased overall survival. The presence of AR-V7 reliably predicted a lack of response to both enzalutamide and abiraterone and if confirmed in a large-scale prospective study may be the first biomarker directed clinical intervention in CRPC. It also opens the exciting possibility that circulating tumour cells could be used for repeat sampling of a patient’s tumour burden.
Source: AR-V7 and resistance to enzalutamide and abiraterone in prostate cancer. Antonarakis ES, Lu C, Wang H, Luber B, Nakazawa M et al. NEJM 2014; 371(11): 1028-38.
Clear relationship between early transplant function and obesity Disparities between recipient and donor as well as recipient’s anthropometric condition have become the focus of consideration in renal transplantation as there are many indications that these significantly influence outcome. This prospective study was intended to identify indicators of malnutrition as obtained by anthropometric measurements that might be potential predictors of transplant outcomes.
Randomised controlled ZEUS study supports CNI-free longterm immunosuppression This paper reported the results of the randomized ZEUS study, the prospective comparison of long-term cyclosporine-based immunosuppression or calcineurin-inhibitor-free immunosuppression. The study was not blinded. 300 de novo kidney transplant recipients were randomised to continue receiving cyclosporine (CsA) or convert to everolimus early after renal transplantation, i.e. at 4.5 months posttransplant. Five-year follow-up data were available for 245/269 patients (91.1%) who completed the core 12-month study (123 everolimus, 109 CsA). At five years, adjusted estimated GFR was 66.2 mL/min/1.73 m2 with everolimus versus 60.9 mL/min/1.73 m2 with CsA; the mean difference was 5.3 mL/min/1.73 m2 in favour of everolimus (95% CI 2.4, 8.3; p < 0.001 in an intent-to-treat analysis. In a post-hoc analysis of patients remaining on study drug at five years (everolimus 77, CsA 86), the mean difference was 8.2 mL/min/1.73 m(2) (95% CI 4.3, 12.1; p < 0.001) in favour of everolimus.
The authors suggested that conversion of kidney transplant recipients to everolimus early after transplantation is associated with a significant improvement in renal function that is maintained to at least five years
103 patients receiving a renal allograft from a living or a deceased donor were included. Body mass index (BMI) based on pre-transplant dry body weight, triceps skinfold, mid-arm muscle circumference and corrected mid-arm muscle area were measured. Post-transplant data on delayed graft function (DGF) and glomerular filtration rate (GFR) at discharge were The cumulative incidence of biopsy-proven acute collected as primary outcome parameters until patient rejection after randomisation was 13.6% with everolimus versus 7.5% with CsA (p = 0.095), largely discharge.
EAU EU-ACME Office
European Urology Today
Prof. Oliver Hakenberg Section Editor Rostock (DE)
Overall, this study shows that older women with stress urinary incontinence are more likely to have voiding dysfunction. The decrease in detrusor function and efficiency with age should be kept in mind when assessing an older woman complaining about urinary symptoms.
Source: Effect on Aging on Storage and Voiding Function in Women with Stress Predominant Urinary Incontinence? Zimmern P, Litman HJ, Nager CW, Lemack GE, Richter HE, Sirls L, Kraus SR, Sutkin G and Mueller ER.
J Urol 2014; 192 :464-468. accounted for by grade I rejection (16/21 patients and 7/11 patients, respectively). The rates of graft loss, mortality, serious adverse events and neoplasms were similar in both arms.
Importance of patientreported outcomes for postradical prostatectomy functional recovery prediction
The authors suggested that conversion of kidney transplant recipients to everolimus early after transplantation is associated with a significant improvement in renal function that is maintained to at least five years. This seems to provide evidence supporting CNI-free immunosuppression and the Functional urinary and erectile recovery is a major increase in early mild acute rejection seen was not concern for patients undergoing radical considered important as it did not affect long-term prostatectomy. Characteristics at the time of surgery graft function. such as age, baseline continence, erectile status and Source: Five-Year Outcomes in Kidney Transplant nerve-sparing techniques are meaningful for recovery prediction. Future recovery is also intuitively Patients Converted From Cyclosporine to Everolimus: The Randomized ZEUS Study. Budde correlated with current function and time since surgery. However, these variables are not yet K, Lehner F, Sommerer C, Reinke P, Arns W, integrated into predictive models for patient Eisenberger U, Wüthrich RP, Mühlfeld A, Heller K, Porstner M, Veit J, Paulus EM, Witzke O; ZEUS counselling.
Am J Transplant 2015;15(1):119-28.
Impact of age on urodynamic parameters in women planning stress urinary incontinence surgery
In this article, the authors assessed the predictive value of these variables in a large cohort of 2,162 patients who underwent radical prostatectomy at a single centre between 2007 and 2012. All patients received questionnaires with items on urinary and erectile function. Completion rates at 1 and 2 years after surgery were 44% and 36%. The overall two-year regained urinary and erectile function was 74% and 36%, respectively.
Outlet resistance increases with age in men, mainly due to prostatic enlargement. No anatomical corollary exists in women although voiding dysfunction is a common disorder in older women. Such voiding symptoms such as incomplete bladder emptying or straining to void correlate poorly with urodynamic parameters in women.
…they found that no variable other than the current functional score was independently predictive for functional status at 1 and 2 years
In this article, authors obtained urodynamic studies from 945 patients participating in two clinical trials (SISTEr and TOMUS) assessing stress urinary incontinence surgery. Their aim was to investigate the age-related changes in urodynamic parameters, mainly non-invasive flow and pressure flow study. Propensity score analysis controlled for the potential bias of combining participants was used. Thus, comparisons of most baseline covariates between the two studies did not differ significantly after controlling for propensity quintile. The variable “age” was assessed as continuous variable and as a qualitative one using the cut-off of 65 years.
After data collection, the authors created logistic regression models predicting function at 1 and 2 years after surgery. Classical variables such as age, nerve-sparing status, baseline functional score, stage, grade, and PSA levels were also taken into account.
Detrusor hypocontractility was three times more present in older women…Voiding time increased with age, 2.7 seconds for each 10-year age increment The authors found that the noninvasive maximum flow decreased significantly with age (26.2 versus 22 ml per second) as well as detrusor pressure at maximum flow. Detrusor hypocontractility was three times more present in older women. Voiding time increased with age, 2.7 seconds for each 10-year age increment. The bladder contractility index was inversely related to age (-2.1 cm H2O for each 10-year increase). No difference in post-void residual (PVR) urine volume was reported but women with increased PVR were excluded at study inclusion. Women with pelvic prolapse graded III or more and those with previous incontinence surgery were also excluded from this secondary analysis. It is worthy to note that only 10% of women were older than 65 years and the number of patients > 70 was too small, highlighting the need for more specific studies in the geriatric population. Moreover, although analyses performed separately in the two different cohorts confirmed overall findings and that all urodynamic studies were done according to a standardised protocol, this pooled analysis of two separate trials may be questionable regarding the validity of grouping urodynamic data. Key articles
Interestingly, they found that no variable other than the current functional score was independently predictive for functional status at 1 and 2 years. The patient’s probability of regaining function is mainly explained by the current functional score at 3, 6, or 9 months after radical prostatectomy. The area under curves for predicting function at 2 years based on current function alone at 3, 6, 9, and 12 months improved with increasing follow-up: 0.796, 0.831, 0.882, and 0.885. Objective analysis using pad free rate rather than function score led to similar results. These findings supported the need for systematic patient-reported functional outcome assessment during the post-radical prostatectomy follow-up for improving patient counselling and decisions regarding rehabilitation therapies.
Source: Counseling the Post-radical Prostatectomy Patients About Functional Recovery: High Predictiveness of Current Status. Vickers AJ, Kent M, Mulhall J and Sandhu J. J Urol 2014 ;84:158-163
Cuff sizing, spongiosal atrophy and outcomes after artificial urinary sphincter surgery The incomplete coaptation between urethra and the artificial urinary sphincter (AUS) cuff has been suggested to be one of the most common reasons for persistent incontinence after AUS surgery, resulting in AUS revision. Besides tandem cuff placement and transcorporal cuff placement, cuff downsizing may improve this coaptation. Nevertheless, such an option was limited in men with spongiosal atrophy due to a smallest available cuff at 4.0 cm until 2010. A 3.5 cm cuff is now available since 2010.
In this article, authors compared the rate of revision for cuff downsizing before and after 2010. They assessed their centre experience and validated their findings using a national AUS patient database. All consecutive patients undergoing AUS placement by a single surgeon between 2007 and 2013 were included. Patients receiving a 4.5 cm or greater AUS cuff were excluded from analysis to limit the analysis of men with potential spongiosal atrophy. Overall, 170 patients were included and 88 received a 4.0 cm cuff placement.
These findings highlighted that a not negligible group of patients receiving AUS before 2010 would have benefited from a 3.5 cm cuff at initial surgery
Prof. Oliver Reich Section editor Munich (DE)
oliver.reich@ klinikummuenchen.de 2.93, p = .86) or for the presence vs the absence of diabetes mellitus (3.00 vs 2.88, p = .85), hypertension (2.94 vs 2.80, p = .75), and obstructive sleep apnoea (3.29 vs 2.83, p = .50).
However, nocturia severity was significantly different based on a nocturia index of less than 2 vs 2 or higher (1.39 vs 3.60), a nocturnal polyuria index of less than 33% vs 33% or higher (1.83 vs 3.65), and nocturnal Revision due to persistent incontinence was required urine production of less than 90 vs 90 mL/h or higher in 22% of patients before 2010 compared with 4.7% in (2.27 vs 3.77) (p < .001 for all). patients undergoing surgery after 2010. The survival analysis using Kaplan-Meier method showed that …neither race nor metabolic risk revision-free survival of 4.0 cm cuff was significantly improved after 2010 (p = 0.04). The use of a factors affect nocturia severity. transcorporal procedure also decreased significantly In contrast, variables that denote since the 3.5 cm cuff became available. A trend toward an improved continence rate was also noted nocturnal urine overproduction in the latter era for men receiving a 4.0 cm cuff. This institutional experience was confirmed using a nationwide cohort. The overall revision rate in patients receiving a 4.0 cm cuff significantly decreased after 2010. This rate was 16% before 2010 compared with 7% after 2010. This rate was comparable to that reported in patients treated with a 3.5 cm cuff placement. These findings highlighted that a not negligible group of patients receiving AUS before 2010 would have benefited from a 3.5 cm cuff at initial surgery. A better coaptation obtained by this cuff downsizing has led to significant improvement in overall AUS revision rate in a single institution series as well as in a nationwide cohort. However, several limitations have to be highlighted. Surgeon experience, surgical details, patient comorbidities were not recorded. Mean follow-up of the post-2010 cohort was also too short to compare strict revision rates between groups. Analysis controlling all these potential biases, as well as the use of validated questionnaires would confirm the independent impact of cuff downsizing on AUS outcomes.
Source: Decreasing Need for Artificial Urinary Sphincter Revision Surgery by Precise Cuff Sizing in Men with Spongiosal Atrophy. Simhan J, Morey AF, Zhao LC, Tausch TJ, Scott JF, Hudak SJ and Mazzarella BC. J Urol 2014; 192:798-803
Predicting nocturia severity in men Nocturia is one of the most common and bothersome of lower urinary tract symptoms. The authors examined the effect of race and metabolic risk factors on nocturia severity in men as measured by the number of nightly voids. A retrospective review from 2011 to 2013 was performed at a Veterans Affairs-based urology clinic in Brooklyn, New York, among 104 adult men, 18 years or older who completed a 24-hour frequency and volume chart. Metabolic risk factors included race and a history of diabetes mellitus, hypertension, and obstructive sleep apnoea. The 24-hour frequency and volume chart data included the nocturia index (nocturnal urine volume divided by maximal voided volume), the nocturnal polyuria index (nocturnal urine volume divided by 24-hour volume), and nocturnal urine production (nocturnal urine volume per hours slept).
sharply discriminate the risk of nocturia severity…
The authors concluded that neither race nor metabolic risk factors affect nocturia severity. In contrast, variables that denote nocturnal urine overproduction sharply discriminate the risk of nocturia severity and suggest that variable data may provide useful clinical correlation.
Source: Prediction of Nocturia Severity in Men: Nocturnal Urine Overproduction vs Race or Metabolic Risk Factors. Nassau D, Avulova S, Friedman FM, Weiss JP, Blaivas JG. JAMA Surg. 2014 Dec 10. doi: 10.1001/jamasurg. 2014.1332.
Temporary Implantable Nitinol Device: a novel, minimally invasive treatment for LUTS The authors reported the first clinical experience with the Temporary Implantable Nitinol Device (TIND Meditate®) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Thirty two patients with LUTS were enrolled in this prospective study. Inclusion criteria were: age > 50 years, IPSS scores of ≥ 10, urinary peak flow (Qmax) < 12 ml/sec, prostate volume < 50 cc. TIND was implanted within the bladder neck and the prostatic urethra under light sedation, using a rigid cystoscope. The device was removed five days later in an outpatient setting. Demographics, perioperative results, complications (according to Clavien system), functional results and quality of life (QoL) were evaluated. Follow-up assessments were made at 3 and 6 weeks, and 3, 6 and 12 months postoperatively. Student t, ANOVA and Kruskall Wallis tests, simple and multiple linear regression models were used in the statistical analysis.
The examiners concluded that TIND implantation is a feasible and safe minimally-invasive option for the treatment of BPH-related LUTS
A nocturia index of less than 2 vs 2 or higher, a nocturnal polyuria index of less than 33% vs 33% or higher, and nocturnal urine production of less than 90 vs 90 mL/h or higher, were chosen as clinically relevant cut-off points for nocturia severity. Nocturia severity was compared by race, the aforementioned variables, and the presence or absence of diabetes mellitus, hypertension, and obstructive sleep apnoea.
Patients' age was 69.4 years, prostate volume (+standard deviation -s.d.), IPSS score (interquartile range - i.r.), QoL (i.r.) and Qmax (+s.d.) were 29.5 (+7.4) cc, 19 (14-23), 3 (3-4), and 7.6 (+2.2) ml/sec respectively. All the implantations were successfully concluded with no intraoperative complications recorded. Mean operative time (+s.d.) was 5.8 (+2.5) min and median postoperative stay (i.r.) was 1 (1-2) day. All but one device (96%) were removed five days A total of 104 adult men (mean age, 64 years; age after the implantation, in an outpatient setting. Four range, 24-92 years) completed a 24-hour frequency complications (12.5%) were recorded, including and volume chart (mean number of nightly voids, urinary retention (1, 3.1%), transient incontinence due 2.93; range 0-15). The number of nightly voids was not to device displacement (1, 3.1%) prostatic abscess (1, statistically different for white vs black race (3.00 vs 3.1%) and urinary tract infection (1, 3.1%).
EAU EU-ACME Office
European Urology Today
Prof. Truls Erik Bjerklund Johansen Section editor Oslo (NO)
linked to improvement in insulin resistance seen as a result of both bariatric surgery and weight loss.
Source: Effects of bariatric surgery on untreated lower urinary tract symptoms: a prospective multicentre cohort study. Luke S, Addison B, Broughton K, Masters J, Stubbs R, KennedySmith A. BJU Int. 2014 Sep 29. doi: 10.1111/bju.12943.
email@example.com Multiple regression analysis failed to identify any independent prognostic factor for complications. Statistically significant differences were observed in the IPSS scores, QoL and Qmax when comparing pre- and postoperative results at every time point. After 12 months, IPSS score, QoL and Qmax were 9 (7-13), 1 (1-2) and 12 (+4.7) ml/sec respectively. Mean variations with respect to baseline conditions at the same time points were -45% in terms of IPSS score and +67% in terms of Qmax. The examiners concluded that TIND implantation is a feasible and safe minimally-invasive option for the treatment of BPH-related LUTS. The functional results are encouraging and the treatment significantly improved patient quality of life. Further studies are required to assess durability of TIND results and to optimise the indications of such a procedure.
Source: Temporary Implantable Nitinol Device (TIND®): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia: feasibility, safety and functional results at one year follow-up. Porpiglia F, Fiori C, Bertolo R, Garrou D, Cattaneo G, Amparore D. BJU Int. 2014 Nov 10. doi: 10.1111/bju.12982.
Effects of bariatric surgery on untreated lower urinary tract symptoms The investigators evaluated the effects of bariatric surgery on lower urinary tract symptoms (LUTS) in a prospective cohort study. Patients undergoing bariatric surgery were recruited into this study. LUTS were assessed using the International Prostate Symptoms Score (IPSS) in men and Bristol Female Lower Urinary Tract Symptoms Score Questionnaire (BFLUTS) in women. Serum glucose, insulin and prostatespecific antigen (PSA) levels were recorded; insulin resistance was quantified. Patients were assessed before surgery, and at six to eight weeks and one year after surgery. Weight loss, change in body mass index (BMI), total symptoms score as well as individual symptoms were tested for statistical significance with correction for multiple testing using the Bonferroni method. Linear regression analysis was performed with total symptoms score change at one year as the outcome variable and BMI, age, total symptoms score before surgery, HOMA-IR, glucose level before surgery, insulin level before surgery, change in insulin level after surgery, weight loss and BMI loss as predictor variables.
European urologists recommend measures to prevent hospital infections and resistance The EAU Section of Infections in Urology has been conducting an annual, global prevalence study investigating various aspects of healthcare-associated urinary tract infections (HAUTI) since 2003. In this paper the data on various clinical categories of HAUTI, the contamination status of HAUTI patients who underwent any urological intervention with regard to microorganisms isolated, resistance status and antibiotics used to treat HAUTI was presented.
The authors showed that around 10 % of hospitalised urological patients are at risk to develop HAUTI often caused by multiresistant uropathogens Of a total of 19,756 patients screened, 1,866 patients had HAUTI (9.4 %), 1,313 males (70.4 %) and 553 (29.6 %) females. Mean age was 59.9 ± 18.2. Asymptomatic bacteriuria (ASB) and cystitis were the most frequent clinical diagnoses representing 27.0 and 26 % of all HAUTI, respectively. Echerichia coli was found to be the most frequent uro-pathogen (544 of 1,371isolates) (39.7 %). The global resistance rate to ciprofloxacin was ([50 %), cephalosporins (35–50 %) and penicillins (50 %). Fluoroquinolones were the preferred treatment in 26.6 % of cases followed by cephalosporins (23.3 %), aminoglycosides (14.1 %) and penicillins (13.8 %). The authors showed that around 10 % of hospitalised urological patients are at risk to develop HAUTI often caused by multiresistant uropathogens. Increased antibiotic use with broad-spectrum antimicrobials will inevitably be followed by increasing bacterial resistance. To interrupt such a vicious cycle, the authors suggest two measures: 1. There is still room for improvement in surgical prophylaxis in terms of limiting exposure to antibiotics. 2. Far too many patients with ASB are being treated which shows that the new ESIU/EAU proposal of classification should be adopted where ABS is regarded as colonisation and not as an infection to be treated.
Source: Healthcare-associated urinary tract infections in hospitalized urological patients— a global perspective: results from the GPIU studies 2003–2010. Mete Cek, Zafer Tandogdu, Florian Wagenlehner et al.
World J Urol. DOI 10.1007/s00345-013-1218-9 …the study confirms the improvement in LUTS after weight Fifty-year-old antibiotic loss but there is no correlation rejuvenated as first-line between the improvement and the time course or degree of weight loss treatment of cystitis in patients without risk factors In all, 86 patients were recruited and 82% completed at least one follow-up after surgery. There was significant weight loss and reduction of BMI after surgery (p < 0.001). At six weeks, there was a significant reduction in overall symptom score (p < 0.001) and this improvement was sustained at one year. Linear regression analysis showed that total symptoms score at baseline, HOMA-IR, preoperative insulin level and change in insulin level postoperatively were predictive of the change in total symptoms score while the amount of weight loss was not. The authors concluded that the study confirms the improvement in LUTS after weight loss but there is no correlation between the improvement and the time course or degree of weight loss. Rather there is a suggestion that the improvement in symptoms is Key articles
Nitroxoline, a hydroxychinoline derivate, has been used for many years to treat urinary tract infections (UTI) and many uncontrolled, but only few controlled clinical studies have been published. In the present study, the authors identified four, so far unpublished, controlled clinical studies and included them in a meta-analysis. A narrative literature review was performed. In addition, the individual patient data (IPD) of 466 females with uncomplicated UTI of four prospective, single-blind, randomised, clinical studies with similar protocols using nitroxoline (250 mg tid) versus cotrimoxazole (960 mg bid) or norfloxacin (400 mg bid) as controls for 5 days (sporadic UTI) or 10 days (recurrent UTI) were meta-analysed. The primary aim
was eradication of bacteriuria 7 to 13 days after end of therapy (test of cure). Clinical efficacy was determined by elimination of symptoms and safety by adverse events and laboratory tests.
Considering the good safety and efficacy of nitroxoline and the world-wide increase of resistance of uropathogens against cotrimoxazole and fluoroquinolones…nitroxoline should be reconsidered as one of the first line antibiotics for the treatment of uncomplicated UTI Reviewing a total of 26 uncontrolled, 2 controlled and one post-marketing studies including more than 11,000 patients, good efficacy and safety of nitroxoline could be confirmed. In the four unpublished controlled studies a total of 234 patients were treated orally with nitroxoline and 232 with controls. The safety of nitroxoline was very good and comparable to the controls (adverse events 9.4% vs 7.8%; p = 0.360). In the mMITT set (at least one outcome result), in the PP set (test of cure outcome) and in the modified PP set (missing test of cure rated failure) more than 90% of the patients showed eradication of bacteriuria with nitroxoline, which also met statistical non-inferiority compared to the controls (10% non-inferiority margin) in all three evaluation sets. The clinical efficacy was similar between the two treatment groups. The authors concluded that the IPD meta-analysis using objective parameters (elimination of bacteriuria) demonstrated equivalent efficacy (non-inferiority) of nitroxoline with the controls tested (cotrimoxazole, norfloxacin) in the treatment of uncomplicated UTI. Considering the good safety and efficacy of nitroxoline and the world-wide increase of resistance of uropathogens against cotrimoxazole and fluoroquinolones, but not against nitroxoline within the last 20 years, nitroxoline should be reconsidered as one of the first line antibiotics for the treatment of uncomplicated UTI.
Source: Review of the literature and individual patients’ data meta-analysis on efficacy and tolerance of nitroxoline in the treatment of uncomplicated urinary tract infections. Kurt G Naber, Hiltrud Niggemann, Gisela Stein and Guenter Stein. BMC Infectious Diseases 2014, 14:628 http://www.biomedcentral.com/1471-2334/14/628
To catheterise or not to catheterise for a reliable culture test The cause of acute uncomplicated cystitis is determined on the basis of cultures of voided midstream urine, but few data guide the interpretation of such results, especially when gram-positive bacteria grow. The authors studied women from 18 to 49 years of age with symptoms of cystitis who provided specimens of midstream urine, after which urine was collected by means of a urethral catheter for culture. They then compared microbial species and colony counts in the paired specimens. The primary outcome was a comparison of positive predictive values and negative predictive values of organisms grown in midstream urine, with the presence or absence of the organism in catheter urine used as the reference.
…cultures of voided midstream urine in healthy premenopausal women with acute uncomplicated cystitis accurately showed evidence of bladder E. coli but not of enterococci or group B streptococci… The analysis of 236 episodes of cystitis in 226 women yielded 202 paired specimens of midstream urine and catheter urine that could be evaluated. Cultures were positive for uropathogens in 142 catheter specimens (70%), 4 of which had more than one uropathogen, and in 157 midstream specimens (78%). The presence of Escherichia coli in midstream urine was highly
Dr. Guillaume Ploussard Section editor Toulouse (FR)
g.ploussard@ gmail.com predictive of bladder bacteriuria even at very low counts, with a positive predictive value of 102 colony-forming units (CFU) per millilitre of 93% (Spearman’s r = 0.944). In contrast, in midstream urine, enterococci (in 10% of cultures) and group B streptococci (in 12% of cultures) were not predictive of bladder bacteriuria at any colony count (Spearman’s r = 0.322 for enterococci and 0.272 for group B streptococci). Among 41 episodes in which enterococcus, group B streptococci, or both were found in midstream urine, E. coli grew from catheter urine cultures in 61%. The authors concluded that cultures of voided midstream urine in healthy premenopausal women with acute uncomplicated cystitis accurately showed evidence of bladder E. coli but not of enterococci or group B streptococci, which are often isolated with E. coli but appear to rarely cause cystitis by themselves.
Source: Voided Midstream Urine Culture and Acute Cystitis in Premenopausal Women. Thomas M. Hooton, Pacita L. Roberts, Marsha E. Cox, and Ann E. Stapleton. N Engl J Med 2013;369:1883-91. DOI: 10.1056/ NEJMoa1302186
Comparing laparoscopic ureterolithotomy and semirigid ureteroscopy for upper ureteral stones > 2 cm Treatment of large stones of the upper urinary tract is still a matter of debate between endourologists to identify the best minimally invasive options that the patients should be offered. In an effort to provide good evidence to support the best treatment option, an Indian group has conducted a prospective randomised study comparing laparoscopic ureterolithotomy (LU) versus ureteroscopic lithotripsy with holmium laser (URS) for upper ureteral stones of > 2 cm in size. Even though details were not provided with respect to the power of study design and the 100 patients included in the analysis, the authors need to be congratulated for recruiting a relatively high number of patients per arm (50+50) over a short time span for recruitment (2.5 years) for such uncommon condition. Randomization was applied by using a computergenerated table.
This class of patients are at highrisk for stone recurrence and the correct management needs a holistic approach Either the procedures were performed in a standardised approach; a double J stent was left in place for three weeks after both operations. Patients were evaluated at 3-month and 12-month follow up by CT scan, DTPA and urine analysis; stone-free status was defined as the absence of stone fragments at the CT scan or asymptomatic < 3 mm residual fragment. Primary outcomes were stone free status at three months, retreatment rates and auxiliary procedure rates; a further outcome introduced was the modified efficiency quotient (EQ) to weight the proportion of patients who needed auxiliary procedure. LU showed to perform significantly better than URS in terms of open conversion rate (0 vs 10%), retreatment rate (0 vs 8%), auxiliary procedure rate (0 vs 26%), three-month stone free rate (100 vs 76%) and modified EQ (100 vs 67.1); LU performed better also with respect to the intra- and peri-operative complication rate (12 vs 26%), with a significant higher number of urinary tract infections (4 vs 8%) and stone upmigration (0 vs 8%) observed against URS.
EAU EU-ACME Office
European Urology Today
Unfortunately, no data are available for the 12-month follow up which would have been useful to record late complication, like ureteric stenosis. Follow-up is very important to also know why this patient developed such large proximal ureteric stones and which proportion of them would have required further treatment for recurrent stones. This class of patients are at high-risk for stone recurrence and the correct management needs a holistic approach; so far, any final statement in support of any surgical treatment should consider the whole “picture” of these patients and not just the size and site of the stones. It will be interesting to know what will have happened to these patients after a significantly longer follow-up time.
Source: Prospective Randomized Comparison Between Laparoscopic Ureterolithotomy and Semirigid Ureteroscopy for Upper Ureteral Stones >2 cm: A Single-Center Experience. Kumar A, Vasudeva P, Nanda B, Kumar N, Jha SK, Singh H. A J Endourol. 2014 Oct 30. [Epub ahead of print]
Perioperative outcomes of robotic and laparoscopic simple prostatectomy An interesting paper has been recently published in European Urology with respect to the results from a large retrospective, multi-centric series of patients with bladder outlet obstruction for large prostates, with an estimated volume of 100 gr in average, treated with a laparoscopic or robotic-assisted simple prostatectomy. The outcomes reflect the experience of elite surgeons from high-volume centres where laparoscopic and robotic programmes are well established; also, most of them have been pioneering new techniques with these approaches, including variants for the same simple prostatectomy. As a result, this series accounts for 10 different techniques variably used in the different centres.
Cost-effectiveness is becoming a major issue in all the healthcare systems of the world; so far it is an essential part of the analysis process for any new surgical technique to be introduced or assessed The authors arbitrarily introduced a new composite surgical outcome, the trifecta, paraphrasing similar composite outcomes applied for radical prostatectomy. In this case, trifecta was defined as the combination of no peri-operative complications, post-operative IPSS < 8, and post-operative Qmax > 15 ml/s. They conducted a multivariable analysis to identify factors predictive for trifecta. Among the 1,330 cases retrospectively included in the database, along a period of 14 years (2000-2014), there were 843 Laparoscopic Simple Prostatectomies (LSP) and 487 Robotic Assisted Simple Prostatectomies (RASP); however, there was a trend in favour of the robotic-assisted approach, which was the prevalent one over the last period observed. The mean operative time (OT) was 100 min., the mean EBL was 200 ml, time to Foley removal 5 days, and the length of stay was 4 days in average. Peri-operative and post-operative complication (at 90 days) rates were 3% and 10.6%, respectively. Mean post-operative Qmax was 22 ml/s and median IPSS was 4. Interestingly, LSP performed better than RASP in terms of OT (95 vs 154.5 min.), time to Foley removal (4 vs 7 days), and post-operative complication rate (7.1% vs 16.6%), whilst RASP accounted a smaller EBL (280 vs 200 ml) and length of stay (4 vs 2 days); however, as a comparison between the two approaches was not in the study’s outcomes, statistical analysis was not performed.
technique and follow up protocol, and no control group considered for comparison. Also, the trifecta composite outcome still requires external validation, the follow-up is limited (12 months), and no cost-related outcomes have been reported. The authors focused most of their conclusions on the safety and efficacy of RASP where a robotic programme is in place. Overall this paper gives indication of safety and feasibility of LSP/RASP just for the same type of centres the authors come from, i.e. high-volume, tertiary referral centres for laparoscopy and roboticassisted urological pelvic diseases. The impact of this study worldwide is minimal, considering that open simple prostatectomy and transurethral resection of prostate are still by far the techniques more diffused for prostate of 100 ml in average. Also, laser endoscopic enucleation techniques are still under evaluation, are adopted by a relatively restricted number of centres and require special skills with a significant learning curve. Cost-effectiveness is becoming a major issue in all the healthcare systems of the world; so far it is an essential part of the analysis process for any new surgical technique to be introduced or assessed. Sustainable innovation should be the new concept that is required for pioneers to drive their research to be then applied widely; otherwise, the risk is that most of current research might remain a simple exercise of skills and abilities with limited chances for reproducibility.
In a sub-analysis, a significant difference was noticed when comparing the stone passage rate of distal ureteric stones with an increment of 23% for the silodosin group (69% vs 46%; p = 0.01).
Sources: Role of Tamsulosin, Tadalafil, and Silodosin as the Medical Expulsive Therapy in Lower Ureteric Stone: A Randomized Trial (a Pilot Study). Kumar S, Jayant K, Agrawal MM, Singh SK, Agrawal S, Parmar KM.
Overall, both primary and secondary outcomes failed to prove any advantage from the use of silodosin with respect to placebo; moreover, as expected, there was a higher rate of adverse events observed for the silodosin group.
Urology. 2015 Jan;85(1):59-63. doi: 10.1016/j. urology.2014.09.022.
These results are in contrast with other studies which have proved positive effects of silodosin as MET1-2. One explanation might be the mean size of stones in the study was slightly above the 5 mm with respect to the 7.3 and 6.5 mm (including also stones < 5 mm) of the other two studies herein cited. Of course, the reduced number of the patients who finished the trial might have had a role in underpowering the study, which contributed in the failure to prove any benefit of silodosin versus placebo. It is likely that the major effect of silodosin (as observed for tamsulosin) would be more evident for distal ureteric stones of 6-7 mm in size, but to prove this another study is needed. However, an on-going large, multicentric, three-arm, placebo controlled trial –SUSPEND- will be able to provide more information regarding the real effectiveness of MET (Tamsulosin vs Nifedipine vs Placebo) and these results will be likely transferable to all the alpha blockers including silodosin3.
Medical expulsive therapy for distal ureteric stones: tamsulosin versus silodosin. Imperatore V1, Fusco F, Creta M, Di Meo S, Buonopane R, Longo N, Imbimbo C, Mirone V. Arch Ital Urol Androl. 2014 Jun 30;86(2):103-7. doi: 10.4081/aiua.2014.2.103.
Use of drug therapy in the management of symptomatic ureteric stones in hospitalized adults (SUSPEND), a multicentre, placebocontrolled, randomized trial of a calciumchannel blocker (nifedipine) and an α-blocker (tamsulosin): study protocol for a randomized controlled trial. McClinton S1, Starr K, Thomas R, McLennan G, McPherson G, McDonald A, Lam T, N'Dow J, Kilonzo M, Pickard R, Anson K, Burr J; SUSPEND Study Group. Trials. 2014 Jun 20;15:238. doi: 10.1186/1745-6215-15-238.
Silodosin to Facilitate Passage of Ureteral Stones: A Multi-institutional, Randomized, Double-blinded, Placebo-controlled Trial. Sur RL, Shore N, L'Esperance J, Knudsen B, Gupta M, Olsen S, Shah O. Eur Urol. 2014 Nov 20. pii: S0302-2838(14)01165-8. doi:10.1016/j.eururo.2014.10.049. [Epub ahead of print]
Source: Perioperative Outcomes of Robotic and Laparoscopic Simple Prostatectomy: A EuropeanAmerican Multi-institutional Analysis. Autorino R, Zargar H, Mariano MB et al. Eur Urol. 2014 Dec 4. [Epub ahead of print]
Silodosin as medical expulsive therapy- a multicentric, randomized, placebocontrolled trial
New feature in Poster Sessions: Associated Video Presentations 20-24 March 2015 Sharing knowledge - Raising the level of urological care
Silodosin is the latest alpha blocker introduced in the market for the treatment of Bladder Outlet Obstruction because of a benign enlarged prostate. Like the other alpha-blockers, it acts by blocking the alpha adrenoceptors of the prostate smooth muscles and of the bladder neck, but also those present in the trigone and in the ureters. As a consequence, new studies are ongoing to check the properties of this drug as Medical Expulsive Therapy for the passage of ureteric stones. A multi-centre, randomised, double-blinded, placebo-controlled trial has been conducted in the United States from 2010 to 2012 to evaluate the efficacy of silodosin in increasing the stone passage rate (primary outcome) with respect to placebo. Secondary outcomes included time-to-stone passage, A&E attendance and admission, incidence of pain and use of pain killers. Main inclusion criteria included unilateral, single and radiopaque ureteric stone of 4 to 10 mm in size; patients were randomised to receive silodosin 8 mg or placebo once daily for 4 weeks. A sample size of 240 patients was calculated to observe a 20% difference in the rate of stone expulsion between the groups, at a desired statistical power level of .85.
ESUI15 4th Meeting of the EAU Section of Urological Imaging In conjunction with the 7th European Multidisciplinary Meeting on Urological Cancers
12 November 2015, Barcelona, Spain EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
There were 239 patients recruited but only 214 (108 + 106) patients completed the study. An intent-to-treat analysis was conducted on 115 + 117 patients who received at least one dose of silodosin or placebo, respectively.
Overall, both primary and secondary outcomes failed to prove any advantage from the use of silodosin with respect to placebo…”
Mean stone size was 5.4 and 5.5 mm for silodosin The number of “trifecta cases” was not reported; at and placebo, respectively. No significant difference multivariable analysis, OT and estimated blood loss was observed for the overall stone passage rate at (EBL) were the only significant factors predictive for four weeks between the two groups (52% vs 44%, the trifecta outcome. The authors correctly pointed out respectively; p = 0.2). the limitations of this study which accounted the retrospective design, selection and reporting biases, lack of standardization for indication, surgical
Imaging and Individualised Medicine
European Association of Urology
European Urology Today
eULIS joins International Urolithiasis Meeting in Cape Town New standards for interdisciplinary platform introduced Mr. Noor Buchholz Sobeh’s Vascular and Medical Center Mediclinic City Hospital Dubai (UAE) U-merge Ltd London (UK)
Dr. Mohammed El Howairis Dept of Urology Mediclinic City Hospital Dubai (UAE)
EAU Section of Urolithiasis (EULIS)
It is no secret that basic urolithiasis research into the causes of stone formation has been stagnating for a long time. Emergence of effective stone treatment modalities has shifted the public and clinicians’ focus away from basic research towards symptomatic treatment solutions, and despite the fact that stone disease is a highly recurrent disease with an enormous socio-economic impact which warrants a prophylactic and recurrence-preventing approach. Recognising this, eULIS and its predecessor, the European Urolithiasis Society, have for many years provided a platform for urologists, radiologists, nephrologists, basic scientists, dieticians and other stake-holders interested in urolithiasis to come together for an exchange of knowledge, mutual education and understanding, and professional networking. This makes eULIS in its core different from other sections of the EAU. eULIS holds its own bi-annual interdisciplinary stone meeting, and also supports with its faculty members similar initiatives such as the recent Experts in Stones (ESD) meeting in Cape Town which was attended by 200 delegates amongst them many well-known names in stone research and therapy.
Traditionally, even in such combined meetings, apart from some keynote lectures in the main plenary session, clinicians and scientists are consequently split into sessions addressing their specific interests. For the first time during the eULIS meeting in London in 2011, a programme was devised which combined clinical and basic science activities (lectures, live surgeries or “as-live video surgeries,” mixed hands-on workshops, and combined poster sessions) throughout. Delegates voted and sessions remained full all the time. This was later repeated successfully in another eULIS meeting in Copenhagen in 2013, and in two eULIS-supported “Experts in Stone Disease” (ESD) meetings in Dubai (2012) and in Cape Town last year, also with a similar multidisciplinary audience.
nephrologists, dieticians, and students. This reflected the overall distribution of delegates at the conference. 71% felt that a closer co-operation and understanding between clinicians and scientists will ultimately benefit both scientists and clinicians, as well as the patients; 95% found the mixed session approach beneficial, with half appreciating it as very good and innovative; 94% agreed to have learned useful insights from the “other side,” and 94% also found that such mixed sessions are useful for their future work and understanding of urolithiasis. Another 94% agreed that such mixed meetings are useful in enhancing networking between the different Thus, not only was a platform created to facilitate stakeholders in urolithiasis research and treatment. multidisciplinary exchange and networking, but Consequently, 85% would like to visit future mixed delegates from all walks of life were encouraged to sit session meetings, and 89% would encourage their through presentations of “the other side.” This could juniors to also attend. be boring and off-putting, or it could be interesting, novel and stimulating. To find this out, we collected Sessions remained full and that reassured us that opinions of delegates in between sessions with a delegates appreciated this exposure to other standardised questionnaire. viewpoints. The results we have seen confirmed an overwhelmingly positive acceptance of this concept Of the 74 delegates interviewed, 60 (81%) were and encouraged us to continue with this concept in urologists, and 14 (19%) were non-urologists such as future meetings.
SEGUR aims to conduct comprehensive stone research Creation of South-Eastern European Group for Urolithiasis Research (SEGUR) Prof. Kemal Sarica Chairman of EULIS Chair, Dept. of Urology University of Yeditepe Medical School Istanbul (TR) saricakemal@ gmail.com A group which aimd to focus mainly on stone disease research has been founded in Istanbul on November 15, 2014, with members coming from various countries in South-Eastern Europe.
Physicians from Turkey ( Prof. K .Sarica), Italy (Prof. A. Trinchieri), Greece (Assoc.Prof. A. Skolarikos), Bulgaria (Assoc.Prof. I. Saltirov), Romania ( Prof. P. Geavlete), Serbia (Assoc.Prof. D. Basic) and Macedonia (Assoc.Prof. S. Stavridis) founded the research group called the South-Eastern European Group for Urolithiasis Research (SEGUR) with the goal to closely collaborate in this uological field.
particularly in epidemiology, aetiology, pathogenesis, metaphylaxis, medical and surgical treatment of urolithiasis. “We keep in mind the well-known saying – “united, we are stronger,” said Prof. Kemal Sarica, SEGUR chairman. He added: “We will do our best to contribute to urolithiasis research by
conducting well-planned and successfully performed basic research, epidemiologic and clinical study projects”.
“United, we are stronger” Taking the high incidence of stone disease in the region into account, the founding members acknowledged the group’s aims to organise and conduct scientific studies in south-eastern Europe
EAU Congress App The easiest way to navigate at EAU15 with your smartphone or tablet! The founders of the South-Eastern European Group for Urolithiasis Research (SEGUR)
Search for ’EAU 15’ in your app store!
2015 Genitourinary Cancers Symposium: Register Today Plan to attend the Genitourinary (GU) Cancers Symposium, February 26-28, 2015, in Orlando, Florida, as we discuss and connect the latest science in the screening, diagnosis, and multidisciplinary management of GU cancers. This year’s Symposium provides an ideal venue to debate and exchange ideas with a diverse group of international colleagues representing multiple specialties. The program includes Year in Review and Keynote sessions that highlight important milestones for each disease site, in addition to educational sessions showcasing the latest topics in the future of GU cancer treatment. Abstracts will feature practice-changing science and the latest discoveries in systemic therapy, exploration of biomarkers, genomic analysis, and more. Connect with colleagues and join us for the Genitourinary Cancers Symposium. Register now at gucasym.org
European Urology Today
Adelaide hosts USANZ Trainee Week 2014 Sharing training insights and expertise Dr. Goksel Bayar Sisli Hamidiye Etfal Training and Research Hospital Urology Dept Istanbul (TR)
firstname.lastname@example.org My selection by the EAU to participate at the annual Trainee Week of the Urological Society of Australia and New Zealand (USANZ) in Adelaide, Australia (from November 23 to 27, 2014) was very significant to me since we recently marked the 100th anniversary of the start of the First World War with the outbreak of conflict in Gallipoli. Gallipoli marked the war between the Ottoman Empire and other countries, which involved thousands of Anzac people who fought on behalf of the United Kingdom for their freedom. Thus, there are shared experiences in history with Australia and New Zealand even though we live in different continents.
An international programme Urology residents from around the world participate in this annual training week which is compulsory for all urology surgical and education trainees (SET 2-5) in the host countries. Two trainees from the EAU, two from the Special Urologist Registrar Group from UK (SURG), two trainees from the Canadian Urological Association (CUA) and four trainees from the Urological Association of Asia (UAA) participated as part of a reciprocal arrangement. There were 85 trainees from Australia and New Zealand. Examination was done on the first day followed by educational sessions during four days. The social programme included the welcome BBQ, winery or a cruise tour, a dinner with the major sponsors on the third day and a farewell dinner. The Trainee Week started with practice examinations (Oral and Written Examination). SET4 trainees were examined by a SET5 trainee together with a urologist. SET3 trainees and international registrars attended as observers. The exams covered the following; Anatomy and Operative Surgery, Pathology, Structure Oral and Clinical Investigation and Management. Each part takes about 30 minutes. Medical history and radiological imaging were presented on computer screens and the examiners asked questions about these cases. The questions were comprehensive such as BXO, retroperitoneal haemorrhage, emphysematous pyelonephritis, Bosniac Cyst Classification, invasive and metastatic bladder cancer, urethral injury etc.. Comprehensive training Written examinations were held after the oral examination for SET 3 and 5 trainees. Participants explain their opinion by writing. Approximately 90% of trainees in the first exam and 99% in the second exam succeed and pass one higher SET level.
A monument to the heroism of the Anzac people EAU International Relations Office
Trainees who want to continue in urology must take general surgery, emergency and intensive care unit practice. After completing the first part of their education, they apply at a urology clinic for training. With rotations in various clinics, the trainees benefit
Oral examination session
since they can learn various practices and clinical approaches. They have to pass the exam at the end of each trainee year to get a higher SET level. In Turkey, we always train at the same clinic during five years, and this could be a disadvantage since it may lead to a lack of practice in areas such as endourology, open surgery, paediatric urology etc.. We also do not take any exams during traineeship, and this may lead to a very passive attitude and a lack of theoretical information.
There were 25 new urologists from Australia, and their participation reflected the high number of urologists particularly in Sidney and Melbourne where employment is very competitive. A new urologist, however, has more chances in other cities. In comparison, in Turkey we have a different patient demographic, and while our Australian colleagues perform less ureteroscopy, they do radical prostatectomy more often than urologists in Turkey. In my view, this could be the reason why Turkey is seen as an “epidemic stone country,” while prostate cancer screening is a very common approach in Australia. For instance, I have seen a brochure regarding prostate cancer screening in an airport toilet, and this may explain why a uro-oncologic operation is more common in Australia. A friendly environment For this very comprehensive and enlightening experience, I am grateful to the EAU particularly to its staff members Astrid Venhorst and Wendy Dennissen for their assistance in preparing for the trip, to Deborah Klein and Richard Grills of USANZ for their warm welcome, and to Amanda Chung for her kind assistance.
In Australia, after five years, the residents apply at urology clinics for a fellowship which trains their surgical skills. This type of fellowship programme can be implemented in Turkey to enable trainees to develop adequate surgical skills. The educational sessions were very comprehensive and interactive and SET 4, SET 5 and even SET 3 trainees play active roles in the programme. More than half of the trainees gave seminars on many topics, which hone their presentation skills. Debate, quiz and case discussion sessions were held in the final day. The debate involved two groups of three SET 5 trainees and the session was very stimulating and dynamic. The final session was an interactive case discussion. SET 5 trainees presented the cases and Information board and brochures about prostate cancer asked questions which ended in “take home screening displayed in airport toilet messages.”
USANZ Trainee Week 2014 Challenging, comprehensive urology training in Australia Dr. Kanerva Lahdensuo Department of Urology, Helsinki University Central Hospital Helsinki (FI) kanerva.lahdensuo@ hus.fi
My incredible journey to South Australia began when the EAU accepted my application to join the Urological Society of Australia and New Zealand (USANZ) Trainee Week held last year from November 23 to 27 in Adelaide. This annual training is mandatory for the approximately 90 second to fifth-year urology residents of Australia and New Zealand and the programme venue changes every year. The training was held in collaboration with urologists from South and West Australia and the key person behind the Trainee Week is USANZ’s Education and Training Manager Ms. Deborah Klein, whose organisational skills are unrivaled! The programme began on Sunday with the “oral vivas,” or practice exams taken by fourth and fifth-year residents who will be sitting their final exams in the following year. Observing these practice exams was very interesting as it gave visiting participants an idea about the extremely high level of knowledge that final-year residents must have to pass their exam. The welcome BBQ on the first evening was also a great and relaxed way to get to know the other participants.
EAU International Relations Office
On Monday the actual training programme kicked off. The first day covered oncology and infections, including a great radiology session where the trainees’ radiology skills were tested. Tuesday morning was dedicated to LUTS and a stellar pathology session, where residents learned to differentiate between various kidney tumours and to recognise different Gleason grade patterns in prostate cancer – no mean feat! The rest of the day was free and a big group headed off to a winery tour at McLaren Vale, a wine region 35 km south of Adelaide. Tuesday night’s dinner, hosted by Trainee Week’s sponsors from the medical industry, was also a great chance to share experiences. Wednesday’s topics included urethroplasties and statistics, ending with microteaching – an intense teaching session where trainees were given six minutes each to present a given subject in urology – a perfect way to review for the exams! Wednesday ended with a wonderful final dinner, an evening of good food, wine and thank-you speeches. After dinner, the party continued until the wee hours with the perfect send-off – great music and dancing! PCa issues The last day, dedicated to prostate cancer, was a mix of serious and hilarious sessions, ending Trainee
Week on a high note. The most anticipated session was a debate on the controversial question “Is Gleason 6 really a cancer?” The issue was debated by teams of hand-picked fifth-year trainees and the debate itself was a hysterical mix of bogus news clips, slandering the opposition, theatrics, operetta singing, and, astonishingly, even email correspondence from the late Dr. Gleason from heaven! At the end of the debate, the audience, still howling with laughter, got to vote. The outcome was that 67% of the participants still considered Gleason 6 to be cancer, ending the need to further discuss this controversial topic. The programme then continued with high-risk prostate cancer and a medico-legal discussion, and followed by the Section vs Section Quiz where teams from different states (and of course a team from New Zealand, “Ball Blacks”) competed against each other answering mostly urological trivia. The teams were judged on their names and costumes as well, with Mr. Nathan Lawrentschuk serving as judge. After all the merriment, the last session was a small-group discussion with clinical scenarios, after which it was time for good-byes, exchanging phone numbers and relaxing by the hotel pool to recover from all the intense training.
Making a case for renaming Gleason 6 prostate cancer as a "Prostatic Epithelial Neoplasm of Indeterminate Significance", or P.E.N.I.S.!
played a very big role at Trainee Week, with about a third of the presentations given by the trainees. The fifth-year residents also actively helped their younger colleagues in preparing for their final exams. To continue with their training, residents must pass exams within certain timeframes, otherwise their training may be terminated. Even to get into the urology training programme, the trainees are required to pass exams and interviews and have good references. On the other hand, the number of applicants that get chosen each year is regulated and are based on calculations on how many urologists will actually be needed; thus over-recruitment and unemployment are avoided.
Urology is quite a competitive field, with many young specialists hoping to work in the big cities and leading hospitals. To gain extra experience, skills and What did I learn in Australia, besides that the people are extremely friendly and hospitable? First, urology further boost their career plans, most residents will is practised similarly in Europe and Australia, which is apply for fellowships, preferably overseas, with the reassuring. The same recent, high-powered studies most sought-after positions often found in the USA, are read and referenced at both sides of the world Canada and Great Britain. Nevertheless, despite the and I was surprised to learn that USANZ follows both competition, I found a friendly and sociable AUA and EAU guidelines. atmosphere amongst the trainees, with many of them providing mutual support. Regarding resident training, I find remarkable the level of knowledge and skills that urologists in I am very grateful to the EAU and USANZ for the Australia and New Zealand possess by the time they chance to participate in USANZ Trainee Week, as it finish their residency. The trainees work very hard was an incredible and highly enjoyable training. I during their residency, perfecting their clinical skills warmly recommend to participants of the 13th EUREP and studying hard, in line with the expectations of in Prague in 2015 to also apply for the USANZ Trainee their consultants and professors. The trainees also Week – it was certainly an unforgettable experience! European Urology Today
ESGURS and ESPU’s 1st Joint Meeting Collaborative work yields fresh insights on paediatric and reconstructive urology Prof. Dr. Nicolaas Lumen Universitair Ziekenhuis Gent Dept. of Urology Ghent (BE) Nicolaas.Lumen@ uzgent.be Ghent hosted the 1st joint Meeting of the European Society of Genito-urinary Reconstructive Surgeons (ESGURS) and the European Society of Paediatric Urology (ESPU) held from November 21 to 22 last year. The meeting’s main focus was urogenital reconstruction in adolescent patients, a topic which can be truly examined in depth with a joint meeting between the two societies, hence the rationale for the collaborative event.
the first day, 10 surgeries (performed by local and international faculty) were broadcasted live from the Ghent University Hospital to the congress venue. In Operation Theatre 1, different types of urogenital reconstruction were demonstrated in difficult cases (patients with extrophia vesicae, epispadias, failed hypospadias repair and a genital gunshot wound). Prof. Dr. Piet Hoebeke, Mr. Dan Wood, Mr. Duncan Wilcox and Dr. Anne-Françoise Spinoit clearly showed the importance of the use of residual genital sensitive tissue in reconstruction. Meanwhile, the main focus in Operation Theatre 2 was urethral surgery in adults and adolescents. Lingual and buccal harvesting and its grafting into the urethra were nicely demonstrated by the author and Dr. Enzo Palminteri, respectively. The new nontransecting technique in bulbar urethroplasty was perfectly demonstrated by Prof. Dr. Anthony Mundy. At the end of the day, the author and Prof. Dr. Willem Oosterlinck reconstructed the posterior urethra of a
young patient for a pelvic fracture-related urethral distraction defect. In Operation Theatre 3, Dr. Karel Decaestecker demonstrated the use of robotic surgery in ureteric reimplantation for vesico-ureteral reflux. Thanks to reconstruction with multiple buccal mucosa graft in the excellent quality of the images, very interactive lateral position using the Kulkani procedure.” and interesting discussions could be held between the surgeons and the audience. During the meeting a new working group, the EAU on Congenital Lifelong Urology (CLU), also met under the direction of Dan Wood. Key players in this new On the second day, state-of-the-art lectures on urogenital reconstruction were interspersed with professional field explored the possibilities to continue the work through this working group and poster and video presentations. A total of 27 posters upcoming meetings are planned during the EAU and videos could be viewed during the meeting of Annual meeting in Madrid and at the annual ESOU which five posters and five videos were presented meeting in Prague. with an expert panel discussion. Dr. Marie Andersson (Gothenburg, SE) won the best poster with her study titled “Does the uroflow normalize at puberty after TIP?” Dr. Felix CamposJuanatey won the best video abstract (Santander, ES) for his video titled “Complete anterior urethral
The organisers expressed their optimism following this first successful joint meeting of ESGURS and ESPU which heightened their expectations of more beneficial collaborative work between the two societies.
Children born with congenital urogenital anomalies are treated and given reconstructive treatment by paediatric urologists. However, these children grow up and become adolescents and adults and, unfortunately, they can develop subsequent problems related either to their congenital problem or to the treatment given in childhood. The adult reconstructive urologist, in close cooperation with the paediatric urologist, is in the forefront in managing these subsequent problems. Thus, it is important that the reconstructive urologist has knowledge of the currently used techniques in paediatric reconstructive urology. On the other hand, it is equally important for the paediatric urologist to be aware of the reconstructive techniques used in adult reconstructive urology in order not to jeopardize future options. With Ghent’s historic location, the comprehensive programme attracted more than 200 attendees. In
Prof. Lumen hands over the award for best oral presentation to M. Andersson from Gothenburg (Sweden) for her abstract titled “Does the uroflow normalize at puberty after TIP?”
Dr. Albert Groen congratulates Dr. Felix Campos-Juanatey as winner of the best video
MADRID 20-24 March 2015 Sharing knowledge - Raising the level of urological care
EAU Member Benefits at EAU 2015! European Assoc iation
EAU PO Box 30016 6803 AA Arnhem The Netherlands
EAU members are kindly invited to collect the following complementary items:
T +31 (0)26 389 0680 F +31 (0)26 389 0674 guidelines@ uroweb.org www.uroweb .org
Pocket Guide lines
Poc ket Gui del ines
Historia Urolog iae Europaeae addressed to series is all to make known european urologists. its aim is the ideas and predecessors, the work of and to help us rent trends in understand the our the Unfortunately, development of our specia curancient Chine the treatises written in sansklity. se, greek and ficult to find latin are both rit, and difficult should, theref to understand, difore, be transl ated into englis and same applies h. to various langu more recent books publis the ages. hed in
EAU members are kindly invited to the EAU booth A42 to collect the following complementary items:
Most of 17th century, the treatises produced before even the legend the mistakes and ary inconsistencies. ones, have gaps, research allows Modern scient ific knowledge and us to re-evaluate this ancien tives. the Histor examine it from new perspe t ration with interny office of the eaU in collab coationally based torians, philol ogists and other urologists, hisresearch, accum experts, condu information in ulates and shares this fascina cts their annual ting publication, Histor Urologiae Europa eae. ia
EAU Extended Guidelines The EAU Extended urological guidelines edition 2015.
Poc ket Guide lines
EAU Pocket Guidelines The Pocket Guidelines can be collected at Bayer HealthCare booth F02. The distribution is supported by BAYER HEALTHCARE
Dr. Enzo Palminteri and Dr. Rafal Chrzan chairing one of the live surgery session during the 1st joint ESGURS-ESPU meeting.
Eur Europe opean an Ass tion Associa ociatio n of ofUro Urolog logyy
“remember the days of years of many generations, ask old, consider the will shew thee; thy elders, and thy father, and he (Deuteronomy they will tell thee.” 32:7)
De Historia Urologiae Europaeae Vol. 22 This year marks the 22nd edition of De Historia Urologiae Europaeae, the EAU History Office’s annual edited volume of Europe’s urological history. Beside the regular contributors from the History Office, newcomers tackle a broad range of fascinating topics. History european associ office SYSTEM REQUIR EMENTS ation of Urolo Window gy Pentium s • Intel 2015
de Histor ia Urologia e eUropaea e 22
III • Windows 7/9x processor or compatible / • 64 MB of availablNT4 / 2000 / XP / Vista e RAM
Congress delegates are kindly invited to collect the following complementary items: www.eaum adrid
SYSTEM REQUIRE MENTS Windows • Intel Pentium III • Windows 7/9x processor or compatible / NT4 / 2000 • 64 MB of available / XP / Vista RAM
USAGE Insert the CD-ROM
EAU Abstract CD 2015 A CD containing all presented abstracts during the 30th Anniversary Congress can be collected at FERRING booth B20. Supported by an educational grant from FERRING PHARMACEUTICALS
in the CD tray
20-24 March Sharing knowled 2015 30th - Raising the Anngeivers of urologica arylevelCon MA DRIDgresl cares
ge - Raising
ESU Courses DVD 2015 A DVD including all presentations and course materials of the ESU Courses given during the congress can be collected at the ESU Booth, North Building level 1. Supported by an educational grant from TAKEDA ONCOLOGY
European Urology Today
ge - Raising
20-24 March the level of urologic
EAU Posters 2015
30th Anniver Sharing knowledge
- Raising the
level of urological
Supported by an unrestricted educational grant from
Some products or part numbers may not be available in all markets. Contact your local Cook representative or Customer Service for details. © COOK 12/2014
Supported by an unrestricted educational grant from
For more informat European Associati ion: on of Urology PO Box 30016, 6803 AA Arnhem, T +31 (0)26 389 The Netherlan 0680, F +31 ds (0)26 389 email@example.com, www.uroweb.org 0674
EAU Posters DVD 2015 A DVD containing posters presented during the 30th Anniversary Congress. The EAU Posters DVD can be collected at AMGEN booth C22. Supported by an educational grant from AMGEN
MINIMAL SYSTEM REQUIREMENTS Windows PC * Macintosh * Windows XP / Vista / 7 OS X 10.5 and Installation newer (Intel) of Adobe Acrobat Reader to open PDF presenta USAGE tions. Insert the DVD-ROM in the DVD tray If the applicati of your or Finder, go on does not start automati computer. to your Disc Drive and run cally, please open the Explorer the “POSTER Some informat 2015” Applicati ion on. containe dosage, for an d in this DVD Before prescribiindication, or in a mannermay cite the use of products other than recomme ng the product in a available in always refer your country. to the prescribi nded. ng information
Perc NCompass® Nitinol Stone Extractor
the level of urologic
This DVD was supported by an unrestric TAKEDA ONCOLOG ted educatio Y had no control nal included on over the selection grant from TAKEDA ONCOLOG this DVD. or developm the use of products Some information in ent of the content Y. this DVD may in a dosage, cite investiga your country. tional therapies Before prescribi for an indication, or in a or manner other ng a product, available in than licensed your country. always refer in 2015 to the prescribi ng information 54755
Perc NGage® Nitinol Stone Extractor
Issue 2 March 2015
Perc NCircle® Nitinol Tipless Stone Extractor
Supported by an education al grant from:
For more informat ion: EAU Education Office PO Box 30016, 6803 AA Arnhem, T +31 (0)26 389 The Netherlan 0680, F +31 ds (0)26 389 firstname.lastname@example.org, www.uroweb.org 0674
Supported by an unrestricted educational grant from
EUROPEAN UR OLOGY
of your computer
If the applicatio n does not start Windows • Click on “Start” automatically: • Click on “Run” in your windows bar • Type “D:\start. exe” and click (If D is the drive “OK” of your CD player)
Grab hold of the possibilities.
E t CM nten -A d co EUcredite
edited by Prof . dr. dirk Schult
USAGE Insert the CD-ROM in the CD tray of your comput er If the applicat ion does not start automa Windows • tically: Click on “Start” • Click on “Run” in your windows bar • Type “D:\star t.exe” and click (If D is the drive “OK” Macintosh • of your CD player) Double click the “Abstracts2015” • Double click on the file “index.h icon on your desktop tml” For more informa European Associa tion: PO Box 30016, tion of Urology 6803 AA Arnhem T +31 (0)26 389 , The Netherla 0680, F +31 nds (0)26 email@example.com g, www.uroweb.or389 0674 g ISBN/EAN 9789079 754694
European Association of Urology
ESU, ESUT hold laser masterclass in Barcelona Comprehensive course on laser attracts urologists across Europe Assoc. Prof. Evangelos Liatsikos Course Director Patras (GR)
firstname.lastname@example.org Laser-assisted surgery is a rapidly expanding field in urology with various clinical applications in many areas such as in benign prostatic enlargement, urothelial and kidney cancers, urinary tract strictures and lithiasis. Following the creation of the first guidelines in laser technologies, the European Association of Urology (EAU) and European School of Urology (ESU) collaborated with the EAU section on Urotechnology (ESUT) to organize the first Masterclass on Lasers in Urology, which aims to provide basic and advanced training in laser technology to European urologists.
The masterclass, held on October 30 to 31, 2014 in Barcelona, Spain, gathered leading experts in the field of lasers and shared their experience with 40 urologists from around Europe. Expert lectures on laser treatments included the identification of patients who can benefit from laser treatment, tips and tricks for optimum results and the management of commonly encountered complications. The basic concepts of each laser treatment were discussed including the indications, limits and benefits compared with gold standard approaches. The masterclass had four sections, with the first section providing a historical perspective on laser application in urology. It also covered the basic science behind the mechanism of action of each contemporary laser systems including Holmium, Diode, 532-nm and Thulium lasers.
Faculty of the 1st ESU Masterclass on Lasers in Urology
Dr. Scoffone spaking on Ho:YAG laser lithotripsy
proper settings and state-of-the-art techniques of laser lithotripsy.
disadvantages of each laser system.
The second part tackled current applications of lasers in bladder and upper urinary track urothelial cancer and laser applications in urethral, ureteral and ureteropelvic junction stenoses. The third section reviewed laser management of lithiasis including
Finally, the last session provided a comprehensive description of laser applications in benign prostatic enlargement and renal cancer, and summarized the current evidence on the subject, plus a critical appraisal of the advantages and
Following this successful meeting, the ESU in collaboration with the ESUT will organize the second Masterclass on Lasers in Urology, with the aim to further boost and provide a high standard of knowledge on lasers to interested urologists based in Europe.
European School of Urology Teaching activities 2015 March 20-24
ESU Courses, HOT, Education and Innovation at the time of the 30th Anniversary EAU Congress, Madrid (ES)
ESU course on Imaging in urological cancer at the time of the EAU Baltic Meeting, Riga (LV)
The masterclass yielded an extensive exchange of opinions and expertise
ESU â€“ Weill Cornell Masterclass in General urology, Salzburg (AT)
13th European Urology Residents Education Programme (EUREP), Prague (CZ)
ESU course on Percutaneous nephrolithotripsy at the time of the EAU 15th Central European Meeting, Budapest (HU)
November 4-5 12
2nd ESU Masterclass on Lasers in urology, in collaboration with the EAU Section of Uro-Technology (ESUT), Barcelona (ES) ESU courses on Treatment of metastatic renal cancer and on Renal cancer and Castration resistant prostate cancer at the occasion of the 7th European Multidisciplinary Meeting in Urological Cancers (EMUC) 8th ESU Masterclass on Female and functional reconstructive urology, in collaboration with the EAU Section of Female and Functional Urology (ESFFU)
ESU Organised courses at National Urological Society meetings April 18
ESU organised course on Reconstructive urology at the time of the national congress of the Serbian Association of Urology, Belgrade (RS)
2nd ESU Masterclass on Lasers in urology In collaboration with the EAU Section of Technology (ESUT)
4-5 November 2015, Barcelona, Spain EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
ESU organised course on Diagnosis of prostate cancer and non-muscle invasive bladder cancer at the time of the national congress of the Moroccan Urological Association, Rabat (MA)
June 11 19
ESU organised course at the time of the national congress of the Slovak Urological Association, Presov (SK) ESU organised course on Prostate cancer at the time of the national congress of the Ukrainian Urological Association, Kiev (UA)
ESU organised course on Whatâ€™s new in male infertility and (locally) advanced prostate cancer at the time of the national congress of the Russian Society of Urology, St. Petersburg (RU)
ESU organised course on Any progress in prostate and kidney cancer treatment? And Update on modern stone treatment at the time of the national congress of the Moldavian Urological Society, Chisinau (MD)
ESU organised course on Male LUTS, urinary incontinence and fistula at the time of the national congress of the Scientific Society of Urologists of Uzbekistan, Tashkent (UZ)
Contact: email@example.com ESU courses are accredited within the
programme by the EBU with 1 credit per hour
European Urology Today
60th National Congress of Czech Urological Society ESU offers well-attended course on testis cancer Dr. Michal Staník Masaryk Memorial Cancer Institute Brno (CZ)
firstname.lastname@example.org Brno, the second largest Czech city, hosted from October 22 to 24 last year the 60th Annual Congress of the Czech Urological Society (CUS). With the attendance of 501 urologists and 230 nurses, the high number of submitted abstracts and an attractive cultural programme, the event was a success. The scientific programme included 153 posters that were presented during 13 sessions, majority of which focused on onco-urology, functional urology, urolithiasis and andrology. The poster sessions were interactive and provided a platform for young urologists to actively participate with many of them also chairing the sessions.
The annual event is a unique opportunity to further educate and train young doctors. The first day offered courses, organised by the working groups of CUS, which tackled challenging issues in urolithiasis treatment, diagnosis of prostate and invasive bladder cancers and medical oncology.
"...The programme also presented live surgery from the Motol University Hospital in Prague where Prof. M. Babjuk demonstrated the various techniques of transurethral resection of noninvasive bladder tumour..." With an attendance of 501 urologists and 230 nurses the Czech annual congress was very successful
The organizers were happy to host the ESU course which covered current topics in testicular cancer. With Prof. P. Albers (Düsseldorf, DE) as course chairman, he discussed the role of surgery stage-by-stage and concentrated on the post-chemotherapy setting. Prof. J. Oldenburg (Oslo, NO) lectured on the changing landscape of stage I treatment that needs risk-adapted approach.
treatment of the upper urinary tract cancer, while Chlosta discussed laparoscopic single site surgery (LESS) in renal tumours. Prof. Svihra reviewed neuromodulation in urology. A part of the regular programme was the lecture series by a Czech and a Slovak resident, which took
Both lecturers stressed that over-treatment should be avoided and gave an overview on long-term adverse effects of chemotherapy. Several cases were presented by young Czech urologists to challenge the experts and which prompted a very insightful debate. Many participants commented the course gave them a unique opportunity to acquire up-to-date information from distinguished speakers.
Prof. S. F. Shariat, doc. J. Doležel (President of the conference), prof. M. Babjuk (president of the Czech Urological Society)
The second congress day opened with state-of-art lectures from Professors S. F. Shariat (Vienna, AT), P. L. Chlosta (Cracow, PL) and J. Švihra (Martin, SK). Prof. Shariat gave a very interesting overview of the etiopathogenesis, demography, diagnosis, and
Prof. P. Albers chaired the ESU course on Testicular cancer
up fertility in men with spinal cord injury and molecular markers in renal cancer. The programme also presented a live surgery from the Motol University Hospital in Prague. Prof. M. Babjuk demonstrated the various techniques of transurethral resection of noninvasive bladder tumours and the panel discussed the impact of new tools such as photodynamic diagnosis or Narrow-Band Imaging and the use of intravesical therapy. Every year the CUS strengthens its ties and cooperation with neighbouring urologic societies based in central Europe through many programmes, such as clinical visits of residents, participation in national congresses and conducting collaborative clinical research, among other activities. Certainly, the annual congress is the optimal platform to build up these links share knowledge and provide training to many young urologists.
Explore all of urology with our new ESU courses ESU Course 13 Chair: S. Boorjian, Rochester (US) How to proceed with an hematuria The course is designed for the practicing urologist, to provide a guidelines-based and case-oriented approach to the evaluation and management of hematuria. Specifically, after attending the course, participants will understand the guideline recommendations for the initial evaluation of patients with asymptomatic microscopic hematuria, as well as the evidence supporting these recommendations. Recommendations for follow-up of these patients will also be covered. In addition, the course will cover the initial and follow-up evaluation for patients presenting with symptomatic microscopic hematuria and gross hematuria. The course will also include a practical, case-based presentation of frequently-encountered clinical management challenges, particularly for refractory hemorrhagic cystitis and persistent BPH-related bleeding. ESU Course 40 Chair: S. Minhas, London (GB) Penile diseases This novel course will give a state of the art update on the variety of penile diseases that Urologists will encounter in everyday clinical practice. The faculty will consist of a group of internationally renowned experts in this field. A spectrum of pathologies can affect the penis including benign disorders to cancers. The aetiology, diagnosis and medical management of the common penile diseases including inflammatory conditions of the penis, HPV, BXO and pre-malignant conditions of the penis will be discussed and illustrated with interactive case based discussions, The course will also deal with the surgical management of these conditions including the surgical indications and surgical techniques used in penile reconstructive surgery. Finally, the management of penile carcinoma including the aetiopathogenesis, techniques/outcome of organ sparing surgery and surgical management of advanced disease including lymphadenectomy will be discussed. There will also be interactive case based discussions highlighting the pit falls and controversies in management of these conditions. ESU Course 5 Chair: N. Mottet, Saint Etienne (FR) Comorbidity in urology Senior adults represent a growing number of patients with specific problems. Individual life expectancy is a key decision driver in multiple situations . . . provided it is approachable. This topic is probably one of the most important as chronological age does not mean that much: this is true at every stage: early diagnosis, major surgery or systemic treatments. Reliable simple and practical tools exist in order to approach this based on comorbidities. One of their main interests is to decide when to refer to a geriatrician in order to optimize the clinical situation or to be able to propose alternative less toxic strategy, balancing
the efficacy and the feasibility. The purpose of this course is to detail these tools, to show how helpful they are in real life and to provide guidance to implement an effective geriatrician program in urologic oncology. ESU Course 18 Chair: J-U. Stolzenburg, Leipzich (DE) Surgical anatomy In the last 2 decades there has been significant evolution in minimally invasive techniques, both robotic and laparoscopic surgery. The techniques employed in both radical prostatectomy and upper tract renal surgery is regularly being refined with a number of techniques being described in contemporary literature. Regardless of the techniques employed, an emphasis on anatomy is paramount. Extra-peritoneal and trans-peritoneal approaches have been described in both renal and prostate surgery. Both approaches have pros and cons. It is therefore vital that surgeons undertaking these complex surgeries are familiar with both approaches. A precise anatomical understanding and technological development has enabled standardisation of minimal access radical prostatectomy, partial nephrectomy as well as open surgery. This course addresses comprehensively important anatomical considerations for open and minimally invasive radical prostatectomy and partial nephrectomy. Key technical aspects such access, port placement, robotic docking and each step of the procedures will be discussed. Additionally interfascial and intrafascial of nerve-sparing surgery will be discussed. In partial nephrectomy the focus is on pedicle control, tumour excision, how to achieve adequate haemostasis and how to shorten ischemia time. Presentations will be combination of didactic lectures and audio-visual presentations. The audience will have ample opportunity to interact with the teaching faculty to clarify any doubts. The course is aimed at residents and consultants with a specialist interest in advanced upper tract and pelvic surgery. ESU Course 31 Chair: F.M.E. Wagenlehner, Giessen (DE) Infection diseases This ESU course on infection diseases provides a broad, up to date coverage of the most important and recent problems of infectious diseases in urology. It targets definitions and classifications of urogenital tract infections as well as topics such as diagnosis, treatment and prophylaxis. Urogenital tract infections range from benign infections, such as uncomplicated and recurrent cystitis to life threatening infections, such as urosepsis. The management of infections in general and of urogenital tract infections especially has been compromised by the rapid and continuous increase of antimicrobial resistance. Basic biologic principles and strategies to compete with antibiotic resistance will be discussed in this workshop.
MADRID 20-24 March 2015 Sharing knowledge - Raising the level of urological care
European Urology Today
A unique opportunity to train with international experts in laparoscopy The European training in basic laparoscopic urological skills (E-BLUS) is a first-rate programme offered to residents and urologists who want to improve their basic skills in laparoscopy.
and represent a unique opportunity to train with international experts in laparoscopy.
Because of the growing need for international standardisation in urological skills, the E-BLUS course can be attended during the Annual EAU Annual EAU congresses as well as several national and international society meetings in and beyond Europe.
• H ands-on training (HOT) sessions of different levels carried out under the guidance of experienced tutors. • A set of training-box exercises developed and validated by the Dutch project Training in Urology (TiU) to train basic skills needed in urological laparoscopy. • E-BLUS examination and certification. • An online theoretical course.
The E-BLUS courses are designed to cater to the specific needs of the participants
The E-BLUS programme includes:
Interested to participate in the E-BLUS course during the 30th Anniversary EAU Congress in Madrid? Send an email to email@example.com Interested to offer the E-BLUS course during your national or international event? Send an email to firstname.lastname@example.org
European training in basic laparoscopic urological skills
ESU Berlin 2014: Extensive state-of-the-art masterclass Enthusiastic discussions on female and functional urology issues Dr. Guillermo Martinez Urology Dept. Izola General and Teaching Hospital Koper (SI) memo.martinez@ gmail.com These are exciting times to be in Berlin with the city celebrating the 25 years since the wall fell down. I visited Berlin 14 years ago almost by accident and learned a lesson or two for life. Today, along with other colleagues who share the common interest in female and functional urology, I’m back in Berlin, and this time it is no accident.
report simple. So if I were to describe the course briefly, below are some of my key observations:
complemented them with comments informed by their own experience, and that of the participants.
Intensive: Female and Functional Urology is a broad field, and when you pack all of that knowledge in two-and-a-half days, you get a hectic agenda. But the faculty gave their presentations in a way that encouraged interaction. Questions were immediately raised as soon as the first set of slides was presented. To everyone’s satisfaction the time was spent discussing controversies, tips, tricks and interesting clinical cases.
Challenging: The sessions provided participants not only with new insights but also a critical look in many areas. By challenging us to step out of our comfort zones, and coupled with the right motivation, this could only help us improve our skills in daily clinical and academic work.
Young-oriented: As previously mentioned, most of the participants were young urologists. Right on the first day Prof. Heesakkers underscored the aim of the Evidencebased: Ranging from guideline course which is to raise the level of female and functional urology in and outside Europe. By investing recommendations to the most relevant available studies for controversial issues, all presenters excelled in people early in their careers, it is highly probable in providing relevant, unbiased information, and that they will spend their most productive years
developing this field. It is therefore clear that both the EAU and ESU are fulfilling their commitment to their members. Although the course was intensive there was enough time to socialise and exchange views with colleagues. The event dinner was held in a real Berliner setting that added to the charm of the host city. The event hotel, the Kempinski, wears the pride of a city that reemerged from dark times and is now at the frontline of European development. The meeting venue also had excellent meeting facilities and catering service. Certainly, the ESU Berlin 2014 was a highly rewarding meeting. Watch out for other Masterclass reports and don't forget to apply for 2015.
The ESU Berlin course, in collaboration with the EAU Section on Female and Functional Urology (ESFFU), has been providing state-of-the-art courses for the last seven years. This year it was organised with the help of an unrestricted grant from Pfizer, which reflected its commitment to support functional urology. The course participants are mainly young urologists and residents from Europe and beyond, with different levels of experience in this field. The faculty is composed of renowned experts with extensive teaching experience and many of them have been participating since 2007. Some of the lecturers have joined recently, recruited from the ESFFU’s pool of experts. The scientific programme is extensive and varied (a full description can be found at www.esuberlin2014.uroweb.org). When ESFFU chairman Prof. Heesakkers asked me to write about the masterclass, I wanted to keep my
Faculty and participants of the Berlin Masterclass 2014
ESU - Weill Cornell Masterclass in General urology
8th ESU Masterclass on Female and functional reconstructive urology In collaboration with the EAU Section of Female and Functional Urology (ESFFU)
26-28 November 2015, Berlin, Germany
5-11 July 2015, Salzburg, Austria EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
European Association of Urology
European Urology Today
ESU Courses & Hands-on Training
MADRID 20-24 March 2015 Sharing knowledge - Raising the level of urological care
ESU Courses Adrenals Advanced course on upper tract laparoscopy (UPJ, adrenal and stones) Sunday, 22 March, 08.30 – 11.30 Chair: G. Janetschek, Salzburg (AT) Female Urology Prolapse management and female pelvic floor problems Saturday, 21 March, 14.30 – 17.30 Chair: D.J.M.K. De Ridder, Leuven (BE) Advanced vaginal reconstruction Sunday, 22 March, 08.30 – 11.30 Chair: D. Pushkar, Moscow (RU) Kidney transplantation Renal transplantation: Technical aspects, diagnosis and management of early and late urological complications Sunday, 22 March, 12.00 – 14.00 Chair: F.J. Burgos Revilla, Madrid (ES) Infertility The infertile couple - Urological aspects Monday, 23 March, 08.30 – 11.30 Chair: W. Aulitzky, Vienna (AT) Male LUTS Modern management of BPO Monday, 23 March, 08.30 – 11.30 Chair: K.M. Anson, London (GB) Post-surgical urinary incontinence in males Monday, 23 March, 12.00 – 14.00 E. Chartier-Kastler, Paris (FR)
ESU Course 10
ESU Course 6
ESU Course 12
ESU Course 17
ESU Course 30
ESU Course 29
ESU Course 39
Neurogenic and non-neurogenic voiding dysfunction Chronic pelvic pain in men and women ESU Course 34 Monday, 23 March, 12.00 – 14.00 Chair: E.J. Messelink, Groningen (NL) General neuro-urology ESU Course 38 Monday, 23 March, 12.00 – 14.00 Chair: F.R. Cruz, Porto (PT) Lower urinary tract dysfunction and ESU Course 45 urodynamics Monday, 23 March, 14.30 - 17.30 Chair: P. Abrams, Bristol (GB) Paediatric urology Paediatric urology for the adult urologist: A practical update Saturday, 21 March, 11.00 – 14.00 Chair: J.M. Nijman, Groningen (NL) Penis/testis Testicular cancer Monday, 23 March, 12.00 – 14.00 Chair: P. Albers, Düsseldorf (DE) Penile diseases Monday, 23 March, 14.30 – 17.30 Chair: S. Minhas, London (GB) Prostate cancer Robot-assisted laparoscopic prostatectomy Saturday, 21 March, 11.00 – 14.00 Chair: P.T. Piechaud, Bordeaux (FR) Retropubic radical prostatectomy – Tips, tricks and pitfalls Saturday, 21 March, 14.30 – 17.30 Chair: H. Van Poppel, Leuven (BE) Focal treatment in prostate cancer Sunday, 22 March, 08.30 – 11.30 Chair: T.E. Bjerklund Johansen, Oslo (NO) Surgery or radiotherapy for localised and locally advanced prostate cancer Sunday, 22 March, 14.30 – 17.30 Chair: B. Djavan, Vienna (AT) Prostate cancer imaging: When and how to use it Sunday, 22 March, 14.30 – 17.30 Chair: J. Walz, Marseille (FR) Prostate cancer – Screening, diagnosis and staging Monday, 23 March, 08.30 – 11.30 Chair: A.R. Zlotta, Toronto (CA) Ultrasound for the urologist - TRUS and TRUS guided biopsies Monday, 23 March, 12.00 – 14.00 Chair: P. Hammerer, Braunschweig (DE) Metastatic prostate cancer Monday, 23 March, 14.30 – 17.30 Chair: K. Pummer, Graz (AT)
European Urology Today
ESU Course 1
ESU Course 36 ESU Course 40
ESU Course 3 ESU Course 8
ESU Course 11 ESU Course 23
ESU Course 25
ESU Course 28
ESU Course 35
ESU Course 41
Renal tumours Robot renal surgery Saturday, 21 March, 14.30 – 17.30 Chair: A. Mottrie, Aalst (BE) Management of small renal tumours Sunday, 22 March, 14.30 – 17.30 Chair: P. Gontero, Turin (IT) Advanced course on laparoscopic nephrectomy Monday, 23 March, 14.30 – 17.30 Chair: V. Pansadoro, Rome (IT) Management of locally advanced and metastatic renal cancer Monday, 23 March, 14.30 – 17.30 Chair: M. Kuczyk, Hanover (DE) Sexual dysfunction Office management of male sexual dysfunction Sunday, 22 March, 14.30 – 17.30 Chair: C. Stief, Munich (DE) Stones Percutaneous nephrolithotripsy (PCNL) Saturday, 21 March, 14.30 – 17.30 Chair: E. Liatsikos, Patras (GR) Update on stone disease Saturday, 21 March, 14.30 – 17.30 Chair: A. Patel, London (GB) Flexible ureterorenoscopy and retrograde intrarenal surgery: Instrumentation, technique, tips and tricks, indications Sunday, 22 March, 14.30 – 17.30 Chair: O. Traxer, Paris (FR) Trauma Urinary tract and genital trauma Monday, 23 March, 08.30 – 11.30 Chair: L. Martínez-Piñeiro, Madrid (ES) Unclassified and miscellaneous topics An introduction to social media: Why this is important for urologists Saturday, 21 March, 11.00 – 14.00 Chair: J.W.F. Catto, Sheffield (GB) Comorbidity in oncology Saturday, 21 March, 14.30 – 17.30 Chair: N. Mottet, Saint Etienne (FR) How to proceed with an hematuria Sunday, 22 March, 08.30 – 10.30 Chair: S. Boorjian, Rochester (US) How to write a manuscript and get it published in European Urology Sunday, 22 March, 08.30 – 11.30 Chair: J.W.F. Catto, Sheffield (GB) Surgical anatomy Sunday, 22 March, 12.00 – 14.00 Chair: J-U. Stolzenburg, Leipzig (DE) Ultrasound in urology Sunday, 22 March, 12.00 – 14.00 Chair: T. Loch, Flensburg (DE) Laparoscopy for beginners Sunday, 22 March, 12.00 – 14.00 Chair: A.D. Joyce, Leeds (GB) Infection diseases Monday, 23 March, 08.30 – 11.30 Chair: F.M.E. Wagenlehner, Gießen (DE) Urethral strictures Advanced course on urethral stricture surgery Monday, 23 March, 08.30 – 11.30 Chair: C.R. Chapple, Sheffield (GB) Urothelial tumours Diagnosis and management of non-muscle invasive bladder cancer (NMIBC) Sunday, 22 March, 08.30 – 11.30 Chair: J.A. Witjes, Nijmegen (NL) UTUC: Diagnosis and management Sunday, 22 March, 12.00 – 14.00 Chair: S.F. Shariat, Vienna (AT) Laparoscopic and robot-assisted laparoscopic radical cystectomy Sunday, 22 March, 14.30 – 17.30 Chair: P. Wiklund, Stockholm (SE) Management and outcome in invasive and locally advanced bladder cancer Monday, 23 March, 12.00 – 14.00 Chair: A. Alcaraz, Barcelona (ES) Nerve-sparing cystectomy and orthotopic bladder substitution - Surgical Tricks and management of complications Monday, 23 March, 14.30 – 17.30 Chair: A. Stenzl, Tübingen (DE)
ESU Course 7 ESU Course 27 ESU Course 42
ESU Course 43
ESU Course 22
ESU Course 4 ESU Course 9 ESU Course 24
ESU Course 32
ESU Course 2
ESU Course 5 ESU Course 13
ESU Course 15 ESU Course 18 ESU Course 20 ESU Course 21 ESU Course 31
ESU Course 33
Hands-on training ESU/ESUT Hands-on training in Advanced Suturing and Anastomosis - course 1 Saturday 21 March, 09.45 – 11.45 ESU/ESUT Hands-on training in Advanced Suturing and Anastomosis - course 2 Sunday 22 March, 09.45 – 11.45 ESU/ERUS Hands-on training Robotic surgery - course 1 Saturday 21 March, 09.30 – 11.00 ESU/ERUS Hands-on training Robotic surgery - course 2 Saturday 21 March, 11.30 – 13.00 ESU/ERUS Hands-on training Robotic surgery - course 3 Saturday 21 March, 13.30 – 15.00 ESU/ERUS Hands-on training Robotic surgery - course 4 Saturday 21 March, 15.30 – 17.00 ESU/ERUS Hands-on training Robotic surgery - course 5 Sunday 22 March, 09.30 – 11.00 ESU/ERUS Hands-on training Robotic surgery - course 6 Sunday 22 March, 11.30 – 13.00 ESU/ERUS Hands-on training Robotic surgery - course 7 Sunday 22 March, 13.30 – 15.00 ESU/ERUS Hands-on training Robotic surgery - course 8 Sunday 22 March, 15.30 – 17.00 ESU/ESUT Hands-on training in OnabotulinumtoxinA administration for OAB - course 1 Sunday 22 March, 09.30 – 11.15 ESU/ESUT Hands-on training in OnabotulinumtoxinA administration for OAB - course 2 Sunday 22 March, 12.00 – 13.45 ESU/ESUT Hands-on training in OnabotulinumtoxinA administration for OAB - course 3 Sunday 22 March, 14.30 – 16.15 ESU/ESUT Hands-on training GreenLight Laser Vaporisation course 1 Sunday 22 March, 09.30 – 11.00 ESU/ESUT Hands-on training GreenLight Laser Vaporisation course 2 Sunday 22 March, 11.30 – 13.00 ESU/ESUT Hands-on training GreenLight Laser Vaporisation course 3 Sunday 22 March, 13.30 – 15.00 ESU/ESUT/EULIS Hands-on training Ureterorenoscopy course 1 Sunday 22 March, 09.30 – 11.00 ESU/ESUT/EULIS Hands-on training Ureterorenoscopy course 2 Sunday 22 March, 11.30 – 13.00 ESU/ESUT Hands-on training Transurethral therapy of LUTS Bipolar TURP - course 1 Sunday 22 March, 13.30 – 15.00 ESU/ESUT Hands-on training Transurethral therapy of LUTS Bipolar TURP - course 2 Sunday 22 March, 15.30 – 17.00 ESU/ESUT Hands-on training in Women’s Health - course 1 Monday 23 March, 10.30 – 12.00 ESU/ESUT Hands-on training in Women’s Health - course 2 Monday 23 March, 13.00 – 14.30 ESU/ESUT Hands-on training in Women’s Health - course 3 Monday 23 March, 15.00 – 16.30 ESU Hands-on training in Social Media Saturday 21 March ESU Hands-on training in Social Media Sunday 22 March
ESU Course 14
E-BLUS TRAINING AND EXAMS ESU Course 16 ESU Course 26
ESU Course 37
ESU Course 44
Saturday 21 March, 12.00 – 14.00
E-BLUS Exam 1
Saturday 21 March, 14.15 – 16.15
E-BLUS Exam 2
Sunday 22 March, 12.00 – 14.00
E-BLUS Exam 3
Sunday 22 March, 14.15 – 16.15
E-BLUS Exam 4
Monday 23 March, 09.45 – 11.45
E-BLUS Exam 5
Monday 23 March, 12.00 – 14.00
E-BLUS Exam 6
Monday 23 March, 09.45 – 11.45
E-BLUS Exam 7
Monday 23 March, 12.00 – 14.00
E-BLUS Exam 8
Challenges in Endourology & Functional Urology (CIE) 5th Annual Meeting to be held from June 28 to 30 this year Prof. Olivier Traxer Paris VI Pierre and Marie Curie University Paris (FR)
Prof. Dr. Jean De La Rosette AMC University Hospital Dept. of Urology Amsterdam (NL) j.j.delarosette@ amc.uva.nl
of a high quality scientific meeting, which contributes to the advances of endourology. To achieve this, the CIE brings together the best surgeons, doctors and promising young doctors in endourology to present their latest and most cutting-edge scientific results, and for them to discover new scientific paths with even better clinical results and debate on current practices. The latest 4th CIE Meeting took place from 1-3 June 2014 in Paris, France, where endourologists, urologists with an interest in functional urology, stone experts, trainees, students and nurses gathered with great enthusiasm to attend a varied programme of exceptional and innovative sessions. Endorsed by the ESUT, EULIS, SIU, Endourological Society and the French Association of Urology (AFU) and supported by leading companies and with accreditation from the European Accreditation Council for Continuing Medical Education, the three-day
Inspired and organised by the authors, the International Meeting Challenges in Endourology & Functional Urology (CIE) has managed to become one of the most important events in the calendar of many endourologists. Since the very first Meeting in 2011, the CIE remains focused on its core mission: to meet the requirements EAU Section of Uro-Technology (ESUT)
Live surgery session in Paris
Faculty of the International Meeting Challenges in Endourology & Functional Urology (CIE)
programme included high quality lectures, symposia and debates on the latest endourological issues. There were more than 20 live surgery cases, 70 e-poster presentations and 10 video sessions, delivered by a distinguished and internationally renowned faculty of 71 top experts in urology. Participants came from 19 countries around the globe, making the event one of the most important meetings for both trainees and practising urologists.
performances that were viewed at the Meeting Hall, and were broadcasted live from operating facilities located at the Tenon Hospital.
The first day presented posters and video sessions, followed by society lectures, presentations, symposia and live surgeries. Particularly noteworthy were the Live Surgery sessions, the meeting’s main highlight. The highly educational Live Surgery sessions prompted intense discussions on the live surgery
For more information, visit: http://www.challengesendourology.com
Without a doubt, the international CIE meeting has become a congress of scientific excellence that aims to provide knowledge transfer whilst highlighting the latest updates in endourology. The CIE will hold the 5th annual meeting from 28-30 June this year in France.
Technology and Training in Endourology 2014 A highly attractive programme “born” in Italy Dr. Cesare Marco Scoffone Cottolengo Hospital Dept. of Urology Turin (IT)
Prof. Cecilia Maria Cracco Cottolengo Hospital Dept. of Urology Turin (IT)
The clinical cases in the Live Surgeries, (organised and managed according to ethical rules of the officially endorsed events) although less challenging, were intentionally chosen not only to allow a relaxed educational approach but also to provide benefit to all participants. The oral presentations focused on debate issues such as antibiotic prophylaxis in BPH/urolithiasis treatments, TURB optimisation, BPH medical treatments and surgical outcomes, holmium laser settings and tailored stone therapy. Two remarkable topics were also briefly presented: BPH surgery in Africa in 2014 (presented by Dr. Cracco and based on the experience of a missionary doctor from Cottolengo Hospital; open adenomectomy is widely performed there for lack of money, instrumentation and expertise) and the endourologist’s role in developing new instruments and devices (presented by the author), with some insights into the economic role of basic and clinical research and their practical applications.
The fourth edition of the Technology and Training in Endourology Course, organised by the author and Cecilia Maria Cracco, was held from November 6 to 8 at the Cottolengo Hospital of Turin, Italy, with the endorsement of ESUT and EULIS. A unique meeting in many ways, the event was “born” from the desire to organise a course that we would like to attend ourselves. Thus, this course reflects the passion and the personal commitment of the organisers, and year after year it has become a dynamic meeting with very practical tips and tricks being exchanged among the speakers and participants, as well as a platform of mutual enrichment between the audience and keynote speakers on endourology, with a particular attention to the technological aspects of our miniinvasive procedures as faithful to the ESUT essence.
Round table panellists
Among the updates on new modalities were the juxtaposition of the “teacher’s” descriptions of the various techniques (Prof. Aho for BPH laser enucleation, Prof. Miano for BPH laser vaporization, Dr. Naspro for BPH monopolar and bipolar resection, Prof. Osther for ECIRS, Dr. Frattini and Hoznek for miniaturised percutaneous procedures and Prof. Traxer for RIRS) and a roundtable discussion on the respective complications. The discussion featured a panel of outstanding endourologists who gave incisive insights and practical viewpoints.
urethral strictures, sexual dysfunctions and urinary incontinence. Profs. Liatsikos and Hoznek moderated a very lively roundtable entitled “Prevention, management and treatment of PNL complications,” with all the panellists (De La Rosette, Osther, Frattini, Montanari, Saita) presenting a variety of original and extensively documented clinical cases (both rare and more common) while trying to find together ex post the possible explanation of their occurrence. Radiologists (Drs. De Feo and Savio) were also involved in this session, discussing early diagnosis and interventional treatment of artero-venous fistulas and pseudoaneurisms. Drs. Cindolo and Proietti (two of our promising young Italian urologists) moderated the roundtable on “RIRS complications,” to elicit the opinions of a very representative panel (Breda, De La Rosette, Frattini, Giusti, Osther, Traxer and Scoffone) on every single step of both semi-rigid and flexible ureteroscopy. The session ended with a really insightful lecture by Prof. Traxer on intrarenal pressures and uroseptic risk, which examined in detail all the intraoperative manoeuvres that possibly increase the infectious risk in ureteroscopy.
Two additional roundtable discussions dealt with “Balancing bleeding and thrombotic risk in the patient with cardiovascular disease,” (panellists Drs. Naspro, Dongu, Trabattoni and Mancuso, urologist, anaesthesiologist and cardiologists respectively), and “The endoscopic management of UTUC,” moderated by Guido Giusti and Olivier Traxer. Both discussions highlighted useful and practical advice in managing difficult cases, as well as clear technical hints in the proper use of diagnostic tools and the optimal conservative treatment of urothelial tumours in the upper urinary tract. The panel also included experienced (Drs. Breda, Giusti and Traxer) and young (Dr. Proietti) endourologists, and a pathologist (Dr. Colombo). It was apparent that this course does not idealise any minimally invasive approach, but aims to offer solid technological knowledge, optimally exploit all available techniques, and clearly outline their pros and cons, whilst tailoring them based on patient pathology. Moreover, the underlying goal is to personalize the therapy instead of forcing a patient to undergo a certain approach just because it is popular. About 80 participants from Italy and other European countries (and a couple of guests from Taiwan as well!) enthusiastically attended the course. The participants had the chance to interact with a unique faculty of urologists and very skilled surgeons, providing them with new insights they can apply in their daily practice for the benefit of their patients.
technology November 11 Torino 2015 training Cottolengo-13Hospital in Endourology 2015 th
Ch ritas Ca
The programme presented 10 didactic Live Surgeries (ThuLEP, en-bloc no-touch HoLEP, Greenlight TUVEP, bipolar BPH enucleation, ECIRS, miniPNL, three RIRS, SPIES-TURB), excellent state-of-the-art lectures on the guidelines for BPH and urolithiasis treatments, Dr. Meneghini presented his bipolar enucleation of original presentations, and lively roundtable the prostate technique. Profs. Muto, Scarpa and Aho discussions that covered hot endourological topics. moderated the first roundtable on “Post-operative complications of BPH treatments,” with the panellists (Cindolo, Ragni and Squintone) analysing occurrence, EAU Section of Uro-Technology (ESUT) prevention and treatment of bladder neck sclerosis,
Faculty of the 4th Technology and Training in Endourology Course
Live surgery session
SAVE THE DATE
European Urology Today
Young Urologists/Residents Corner SURG 2014: Our experience Programme offers comprehensive sessions and inspiring ideas Mr. Geoffrey Ibe Core Surgical Urology Trainee Manchester (UK)
Mr. Arie Parnham Specialty Urology Trainee Manchester (UK)
The Specialist Urological Registrar Group (SURG) represents trainees both in the United Kingdom and Ireland. It is dedicated to provide a forum for discussing issues and expressing opinions pertaining to urological training on a regional and national level. SURG holds an Annual Scientific Meeting (ASM) with the aim to provide quality education through lectures on clinical and non-clinical topics presented by international experts. The annual meeting is also an opportunity for trainees to present their research and network. Following the successes of Brighton 2012 and Leeds 2013, this year’s Annual Scientific Meeting was held at the University College London Hospital (UCLH) education centre. Although mainly attended by urology registrars from the United Kingdom, the event is open to all trainees who have an interest or wish to pursue a career in urology. As core trainees aspiring to gain access to higher urological specialty training, this event provided us with a unique opportunity to learn from key opinion leaders in urology as well as participate in a variety of expert-led practical workshops.
The programme led to thought -provoking discussions. A lecture titled ‘How to get a National Training Number’ by Mr. Michael Mikhail (Urology ST3, London) was a concise and comprehensive guide of essential ‘dos and don’ts’ when applying for a urology national training number within the current competitive UK climate. Consultant-led practical workshops took up principles of diagnostic ureteroscopy and percutaneous nephrolithotomy (PCNL). These concise sessions afforded almost one-on-one, trainer-to-trainee experience with experts on high fidelity models in a safe, nonjudgmental environment. The first day ended with the annual urology quiz, which was an opportunity for trainees to compete for the highly coveted first prize, followed by a formal dinner. The momentum from Day 1 followed through into the second day with a lecture by Mr. Nik Vasdev (Consultant Urologist, Kent) on the current state of robotics in urology in the UK. Laparoscopic and robotic simulation sessions provided a ‘hands-on’ introduction for trainees with limited exposure to these two exciting technologies.
The short paper abstract presentations were of a high quality and contained a mix of basic science, translational and clinical research across multiple disciplines; some of which had true publication potential. Finally, the Annual General Meeting provided an appropriate close to a stimulating weekend programme. The SURG ASM evidently offers a wide variety of activities and has maintained its status as a wellrespected, national surgical meeting. Having been educated by talks from a number of UK opinion leaders in urology, there were also opportunities to network amongst peers of different levels and from varying geographical locales. This was a highly informative and motivational weekend and certainly enjoyed by all participants. Some messages from this event would be: Simulation has an increasing role in training and may be used as a tool of assessment in the near future, and trainee research collaboration can be advantageous for producing good quality, high-powered work.
GeSRU Academics – a network for junior scientists German residents society builds up network of 11 urological working groups Dr. Hendrik Borgmann University Hospital Frankfurt Dept of Urology Frankfurt (DE) Hendrik.Borgmann@ kgu.de
Horizontal and vertical networking Junior scientists are linked in 11 working groups which cover all aspects of the urologic field (Figure 2). Each working group consists of up to 10 junior scientists, one experienced researcher (assistant professor) who works with the group and a chairman (senior professor) who provides expert opinion and supervision. Each junior scientist can propose opportunities for cooperation in existing projects of the group. Furthermore, the group can initiate their own multicentre studies.
The networking will lead to several research activities of the working group. Networking opportunities are also used for structured networking linked to clinical and laboratory fellowships. Contacts with professors from successful partners for fellowships abroad are gathered and provided to members of GeSRU Academics. Another important tool of networking in In the early stages of their career, junior scientists GeSRU Academics is the academic skills database. Each member’s academic skills in clinical research, often lack contacts with other colleagues who are experienced research partners in their field. A trias of laboratory research, statistics and grant applications horizontal and vertical networking, structured training are registered in the academics skills database. The of academics skills and providing professional database is used for locating research partners and scientific support are among the aims of the GeSRU for planning large research projects based on the Academics. skills of the members. With multidisciplinary research as a key component for current urologic research in evidence-based medicine, the German Society of Residents in Urology (GeSRU) has created a structured research network for junior urologic scientists – the GeSRU Academics.
The GeSRU has 1,200 members and is active in training, education, career planning and networking for 15 years. In 2013, the GeSRU restructured its activities into four sections: training & education, career planning, research and multimedia. The research section contributes to national and regional congresses through courses and sessions and regularly publishes in four German publications. To bring forward young urologic scientists by providing a professional research network, the GeSRU Academics was founded in 2014. The GeSRU Academics are a network of junior scientists in urology (Figure 1). All German speaking junior urologic scientists can apply for the programme online (www.academics.gesru.de) and benefit from the research network. There are no limitations for participation in the research network. Junior scientists can apply irrespective of their preliminary experience. The key element for participating in GeSRU Academics is the motivation. To members of GeSRU Academics, the following are among the membership benefits:
Figure 1: GeSRU Academics – Network for junior scientists
European Urology Today
Training of academics skills A curriculum of courses for training of academics skills is provided by GeSRU Academics. Members can train their academics skills in literature search, statistics, grant applications, clinical research and medical writing. An “academic skills certificate” is given after successfully completing four courses.
Figure 2: Working groups of GeSRU Academics
support, and we aim to improve research output of German junior scientists early in their careers. Thus, we also focus on the recruitment of academic talent
and create successful cooperation and integration with established networks in both national and international levels.
Professional scientific support GeSRU Academics provides professional scientific support by means of a statistician, a survey expert and offers professional proofreading and review of research manuscripts (Figure 3). Professional partners GeSRU Academics closely cooperates with many partners in urology. Activities of the EAU’s Young Urologists Office are shared among GeSRU members. The most experienced junior scientists of GeSRU Academics have linked up with the research network of the Young Academic Urologists of the EAU. Furthermore, GeSRU Academics works together with the German Society of Urology. In particular, the Working Group on Urologic Research in Germany and GeSRU Academics are collaborating to support junior scientists in Germany. GeSRU Academics cooperates with existing uro-oncologic research networks in Germany by identifying and recruiting junior scientists who make up the talent pool for these established networks. A national research network of junior scientists is the base for recruiting future scientists and for providing them with the optimal structural and network
Figure 3: Organogram of GeSRU Academics
Young Urologists/Residents Corner YAU marks third year Besides ambition, dedication unites YAU members Dr. Francesco Sanguedolce Consultant Urologist Surgeon Chairman of the EAU Young Academic Urologists Working Parties francesco. email@example.com The EAU Young Academic Urologist (YAU) Working Party has celebrated its third year since its official establishment in October 2011 in Milan, Italy. Since then many actions and changes have been undertaken to strengthen the structure of this new EAU body – a branch of the Young Urologist Officeand to create the condition for their members and subgroups to fully express their talents and abilities.
The establishment of an executive board formed by the chairmen of the nine working parties, the statement of clear rules for membership, the setting of a transparent and rigorous process for the selection of candidates have significantly improved the effectiveness of the organization. Strategic collaboration has been successfully undertaken with the EAU Sections, with the matched YAU subgroups becoming more and more involved in relevant activities and their integration in the Sections’ structures. Other activities have been conducted or are ongoing in partnership with EAU bodies like the Guidelines Office, the European School of Urology, the EAUResearch Foundation and the European Urology Scholarship Programme.
Despite the initial difficulties and the limited resources, a significant number of original papers, systematic reviews and editorials have been published, with the The results of these intense and relentless efforts have Renal Cell Cancer group being the most proficient. been shown at last year’s YAU Autumn Meeting held What we consider as the biggest challenge is how to in Lisbon in November which coincided with the turn these groups into teams or -to use a more European Multidisciplinary Meeting on Urological romantic expression- how to give this (EAU) body a Cancers (EMUC). ‘soul.’ And our efforts were amply rewarded.
professionals who work around some projects and a group of individuals with the vision and commitment to create something more durable and ambitious. It would have not been possible to have achievements in a short period of time without the continuous and unconditional support of the EAU Executive Committee, the EAU Board and the Sabine Brookman-May (Germany) speaks on renal cancer issues EAU Central Office. Once again and on behalf of the YAU, I This kind of process usually takes time within large convey our gratitude to our supporters. organisations, but luckily it was not that long for YAU! For the first time since the very beginning of the YAU Finally, YAU is not an “exclusive” club but a very experience, enthusiasm was palpable among the dynamic group. Members are not guaranteed with a participants in Lisbon. full-term (four years membership) since one’s membership is assessed annually and everyone This was evident at the Welcome Dinner where all the needs to demonstrate that they deserve the YAU members discussed with their colleagues while membership. enjoying the wonderful local food. It was a dinner with friends, and friendship is what effectively links up Thus, it is very important for people who are all the YAU members, and which is unique considering interested to join a YAU subgroup to know if they the high level of ambition and competition. qualify or fulfil the minimum criteria, which can be found at this link: (http://www.uroweb.org/education/ The meeting attendance was very high and led to young-urologists-office-yuo/young-academicfruitful discussions among the participants with a urologists-yau/). number of new scientific projects identified and planned. Aside from the collegial atmosphere, the Competition is high and the number of accepted nurturing support shown by many made a crucial members is limited. We look for excellence and difference between what is a simple network of dedication, so take your chance!
Any comments, suggestions or articles for the Young Urologist/Residents Corner are welcomed at: firstname.lastname@example.org Giulio Patruno, Section editor YAU's Lisbon meeting attracts a high number of participants
Joint ESRU and ESRU Turkey Session Closer ties between ESRU, Turkish residents bring mutual benefits Dr. Selçuk Sarikaya Database and NCO’s Manager of ESRU Keçiören Research and Training Hospital Ankara (TR) drselcuksarikaya@ hotmail.com
including practical daily information which are useful for residents. The ESRU and ESRU Turkey has effectively cooperated up to now and the two groups will continue to collaborate. Dr. Zafer Tandogdu and Dr. Selçuk Silay were former members of the ESRU’s executive committee and they worked hard for ESRU which helped boost the links between the two associations.
The ESRU Turkey has also helped organise many national and international conferences and live surgery courses. And these conferences and courses have contributed to standardisation of the urology residency programme in Turkey. In coming months, ESRU Turkey plans to organise new courses and conferences to improve the theoretical and practical skills of residents. Live
surgery courses, in particular, are popular among residents, and these scientific activities have provided encouragement and support to many residents. The ESRU invites all residents to the Residents Day to be held in Madrid during the annual EAU Congress, and we definitely want to see more involvement of residents in the activities of the EAU. See you in Madrid!
The 23th National Urology Congress of Turkey was held in Antalya from October 16 to 19, 2014 and an impressive combined ESRU and ESRU Turkey meeting was also organised during the congress. The session had four parts. In the opening session, Dr. J.P. Michiel Sedelaar had a presentation about the Young Urologist Office, followed by Dr. Juan Luis Vasquez who discussed the aims and activities of the ESRU. Both presentations were very interesting and impressive. In the second part of the session, there was a discussion about the main problems of residents and the results of a survey conducted by ESRU Turkey. In the third part, there were Nightmare Cases presentations including remarkable cases which prompted many questions from the residents. In the session’s concluding part, there were presentations on tips and tricks for basic operative techniques, January/February 2015
Impressions of the Young Urologist Office presentation in Antalya
Dr. Juan Luis Vasquez (left) and the author (right) give their remarks on education and training issues
European Urology Today
Young Urologists/Residents Corner YUO Training, Education & Career Development (TEC) Group Connecting with the TEC group for resources and opportunities Dr. Guillermo Martinez Young Urologists Office Member Izola (SI)
trend among young doctors who leave their home country to develop their careers elsewhere. Since then, we have also recognised that young academics deal with such issues as well. Within the EAU, we find examples of promising young colleagues that have moved to other countries or re-examined their current options in the pursuit of an academic career. Training and education, career development issues, etc. - these all affect everyone, to a bigger or lesser extent. We believe that this is something that affects urologists with different backgrounds.
During the last Young Urologists Office's (YUO) Board meeting in Stockholm, I was appointed to deal with what we decided to call "non-academic issues." Since we already have an academic group, the expression felt only natural.
Tasks The Office’s next task is, thus, to define the scope and direction of its efforts towards young urologists. We're not here to invent or reinvent what's been out there for years. The EAU has been offering useful tools and opportunities to its members for years. Some of them, The initiative came following an observation made to like the EUSP and ESU Masterclasses, demand specific us by Prof. Hein Van Poppel in December 2013 that our research-related criteria and a certain profile that office should reach out to the majority of our "target" requires proof of experience in research. Some population, that is, urologists in the early stages of opportunities are more widely available, such as the their career, and to deal with issues that are EAU regional events, many of the ESU organised non-academic by nature. So far ESRU has excelled in courses and so on. doing their part with residents who are to become specialists. Young full members of the EAU deal with Some days ago though, during the national urological various issues ranging from lack of proper training to Slovenian congress, I realised local initiatives should migration. It became clear that our office has to do its be given a chance to evolve. During the Slovenian part as well. With the support of YUO Chairman triennial event, we enjoyed three days of conference, Michiel Sedelaar, I volunteered for this completely usually complemented by an ESU-organised course, new endeavour. or a similar EAU-facilitated event. There was one podium presentation by a young urologist that caught Lately it has become widely recognised that there are my attention. He discussed the use of videos to learn issues that affect residents and young specialists about specific surgical procedures, particularly on regarding their training and education, their laparoscopy. He emphasised the creation of a session professional expectations and even an emerging to promote learning by visually presenting a surgical
procedure, step by step. This is a challenging opportunity in future meetings. The potentials are manifold and it can range from videos of basic or advanced procedures to holding a best video session in the next national congress, thereby encouraging people to produce videos of their procedures and share them.
Identifying best practices It is important to identify best practices and promising initiatives and bring them into the mainstream and replicate them for higher impact. To achieve this, we need to provide our members with appropriate communication channels and let ideas flow to effectively connect people.
"...unprecedented collaboration among hospitals that aim to enhance surgical training,..."
This is when the EAU Young Urologists Office must rely on social media. We have created a Facebook Page for bi-directional communication, from bottom-up or the reverse. Look for EAU Young Urologists and give us a “like” or leave a post, share an experience, an idea, or just an opinion. Ask a question, help someone solve an issue. We will be online to give you a prompt feedback.
Another thing I realised with other young urologists during our national meeting was the unprecedented collaboration among hospitals that aim to enhance surgical training, not only in laparoscopic surgery but also other techniques. Young colleagues lead such initiatives and are finding ways to improve their training at home by networking. Some of us go abroad to complete our training and with our experience are also now fully involved in training. The lack of educational opportunities in previous years has been partially solved by mobility, both cross-border and nationally. Living in a country with roughly two million inhabitants and about 60 urologists tasked to provide optimal care is quite a challenge. The Slovenian case is just one example, and I am sure there are many local and regional activities throughout Europe, aimed at enhancing knowledgesharing and providing better training for residents and young urologists. I know because I have, as you all surely have, spoken to colleagues from various countries regarding these issues.
Also, a new EAUYUO Twitter profile (@eauyoungurology) has been created for the office in general and will be used to provide you with short updates, congress tweets and important news to generate trending topics among its audience base and EAU (@uroweb) followers. Be sure to start following us and the EAU on Twitter. During the next EAU Annual Meeting in Madrid, the Residents and Young Urologists Corner will be open during exhibition times for you to approach YUO and ESRU representatives. We will be there to answer your questions regarding any issues that are “young urologist-related,” ranging from using EAU resources to helping out with queries on training, education and mobility. The YUO’s TEC Group is online. It’s time to connect.
SUN Congress: Quality and informality Comprehensive meeting inspires Italian residents Dr. Giulio Patruno EUT Section Editor ESRU Chairman Elect Rome (IT)
On November 14-15, 2014, Turin hosted the XVI congress of the SUN (Società di Urologia Nuova). The society, established in 1998, has the ultimate goal to be a resident-oriented urological association. From its very foundation, the SUN has a strong bond with the European Society of Residents in Urology (ESRU).
Three roundtables were held during the congress, dealing with modern issues and resident-friendly subjects.The first roundtable was on lasers and BPH therapies, with the discussion tackling the query: Which one is better? Three speakers presented the advantages of using, respectively, Tullium, Holmium or Greenlight laser. The second panel discussion dealt with the role of the resident in a classic urological emergency: renal trauma. Too often the first specialistic evaluation is given by residents who are not specialists. It was stressed that there’s a need for the junior urologist to be properly trained in recognising a renal trauma and to know which approach is best for the case. Should the trauma be treated conservatively, with a mini-invasive technique, or a radical approach? Another concern was- how can the urologist be of support in a multi-specialistic trauma team?
theoretical part of the course, followed by a two-hour hands-on training session on both laparoscopic and open surgery. Chicken tissues were used to recreate the vesical-urethral anastomosis. Residents, with the help and supervision of skilled tutors, had the chance to practise both traditional and laparoscopic knot-tying and laparoscopic exercises such as camera handling.
The congress provided a great opportunity for residents to practice skills such as presenting, public speaking and public discussion in a less-formal-thanusual environment. As the Italian ESRU representative we are hopeful that there will be more opportunities and activities like these for Italian residents in the future.
A third session dealt with the renal colic, another classic case in daily practice. Various management approaches which somehow mirror the cultural differences in doctor-patients relationship between northern and southern Italy, emerged during the discussion. During these sessions, the residents also The Museo dell’Automobile (Car Museum) in Turin’s presented the different aspects and approaches to the Lingotto district served as meeting venue, in the same issues while their more senior colleagues would location where the car company FIAT had its original comment and ask questions, bringing their factory. The museum is considered among the 40 best professional experience and opinion. The day ended modern museums in the world. Today, the Lingotto is with a ‘gourmet highlight,’ a lecture by one of the a modern and culture-oriented area, with some of the managers of Ferrero, the world famous chocolate buildings restored by world-class architects and company from Piedmont, and producer of one of the transformed into hotels, museums and foundations. world’s favourites: Nutella! Despite the renovation, Lingotto retains its roots in manufacturing. In fact, the world-famous Italian The second day was extremely interesting and was gourmet food chain, Eataly, opened its first branch in dedicated to a theoretical and practical course on this area back in 2007. surgical instruments and sutures. That session was preceded by a lecture from 87-year-old Prof. Rocca Held amid beautiful surroundings, the Congress Rossetti who spoke on “Galateo of the Operating exuded an air of novelty with a less formal Room,” an evocative and poetic overview of surgical atmosphere, inspiring the residents to present to their practice 50 years ago. Although times have changed, peers, and with some of the big names in Italian Prof. Rossetti’s lecture reminded the audience that Urology in the audience. Sessions were moderated some core principles of education probably will and conducted by both residents and directors. The always remain. one-day-and-a-half programme had a good mix of lecture sessions from both seniors and their younger There were also three lectures by residents and young colleagues, complemented by poster and plenary urologists regarding instruments and knots in open, The hands-on training is very popular among the residents sessions. laparoscopic and robotic surgery, which formed the This year, the National Congress has been organised by the Turin School of Urology, Professors Bruno Frea and Paolo Gontero, with the help of the ESRU and residents and young urologists from all over Italy.
European Urology Today
Personalized Cure and Care in Urology Anniversary congress on 11 September 2015, Nijmegen, The Netherlands Prof. Wim Moonen 1965 - 1979
Prof. Frans Debruyne 1979 - 2004
Prof. Peter Mulders Since 2004
50 Years of Academic Urology in Nijmegen
In a dynamic, interactive and inspiring setting, Urology staff members of the Radboud university medical center highlight the scientific achievements of the past 50 years, as well as its future perspectives. Here, highly-qualified international faculty members discuss their views, while a number of patients reflect on these different topics.
our staff: Wim Witjes Peter Mulders 5 7 Bart Kiemeney 5 Fred Witjes 5 Robert De Gier 3 Hans Langenhuijsen 4 6 Jack Schalken 5 Frank D’Ancona 4 6 Egbert Oosterwijk 5 Michiel Sedelaar 4 5 Kathleen D’Hauwers 1 Inge Van Oort 4 5 Barbara Kortmann 3 Wout Feitz 3 Jetske Van Breda 2 John Heesakkers 2
Toine Van Der Heijden 5
Themes and international faculty:
Pediatric urology: personalized
Christopher Chapple (GB), David Bloom (US), Raimund Stein (DE).
Andrologic urology and fertility
Loes Segerink (NL), Sjoerd Repping (NL), Eric Meuleman (NL), Francesco Montorsi (IT).
Functional urology: towards clinical application
Francisco Cruz (PT), Karl-Dietrich Sievert (DE), Dirk De Ridder (NL), Christopher Chapple (GB), Philip Van Kerrebroeck (NL).
Alexander Mottrie (BE), Inderbir Gill (US), James N’Dow (GB).
Cora Sternberg (IT), Winald Gerritsen (NL), Axel Heidenreich (DE), Jelle Barentsz (NL), Jurgen Futterer (NL), Arnauld Villers (FR), Michiel Warle (NL), Carlos Llorente (ES).
Minimal invasive and laparoscopic urology: precision medicine 6
Oncologic urology: top achievements
John Isaacs (US), Hans Lilja (US), Maria Ribal (ES), Joan Palou (ES), Laurence Klotz (CA), Hein Van Poppel (BE), Chris Evans (US), Theo De Reijke (NL), Martin Gleave (CA), Arie Belldegrun (US), Tom Powles (GB), James Catto (GB), Anders Bjartell (SE).
50 years of academic urology; what next?
Per-Anders Abrahamsson (SE), Claude Schulman (BE), Walter Artibani (IT), Arnulf Stenzl (DE).
For more information and registration please visit www.radboudumc.nl/urologycongress2015 Gold Congress Sponsors: Astellas, Janssen & Ethicon, Karl Storz
50 years of academic urology in Nijmegen, the Netherlands By Peter Mulders Why organise a conference on urology in Nijmegen? Obviously, 50 years of academic urology (as the title says), is quite an achievement. When in 1965 the Radboud university medical center and its quite young scientific environment decided to further develop urology to an academic level, it gave the roots for its independence and, consequently, the chance for it to grow to a full blown Department of Urology. As the first chairman Professor Moonen defined the department’s early years, it was Professor Debruyne who expanded the department into five subdivisions and initiated a Urology Research Laboratory with Professor Schalken. When I took over as chairman more than 10 years ago, it had the basis for a further growth of faculty and activities, with today’s 14 clinical faculty and six research faculty attending. Over 150 people currently work in our urology clinic and research laboratory, which makes us one of the largest urology departments in Europe. Once again, why a conference in Nijmegen? The title of the conference ‘Personalized Cure and Care in Urology,’ conveys that our aim is to show how urology has evolved and the possible directions. Our faculty and people involved in our department all realize the importance of a specific targeting of diseases, fine-tuning surgeries and learning from translational research to provide the best care to urology patients. With the patient in the centre of our treatment approach we also implement and highlight the values of the Radboud university medical center: "Personalized care and visible quality,” proving that we can have a significant impact on healthcare. This is the reason why we planned a conference that aims to fulfill these goals. Moreover, we invited a distinguished (inter)national faculty for them to provide insights on all significant subjects to be discussed. They will give views and expert advice on January/February 2015
how to bring urology to a higher level. What is also With this programme, I hope, indeed, that unique is that we will have direct patient’s input and Nijmegen will be the centre of urology. Finally, we reflection, a valuable learning experience that touches also call attention to the social programme with on the core and essence of urology, now and in the future. For the participants, there will be opportunities to learn from this interactive state-ofthe-art setting, allowing in-depth discussion and varied input.
wonderful evening activities to make the conference and Nijmegen a ‘not-to-forget’ experience to all visitors.
Why should a potential participant come to Nijmegen? Years ago my predecessor called Nijmegen the centre of Europe; geographically, with its borders, he may have had a point. But, seriously, when we have our faculty interact with international experts in urology on significant urology subjects, there will be an excellent programme for this conference in Nijmegen. We will show how urology is performed in the Radboud university medical center and get feedback on our progress and the path that we follow. In urology we have many discussion points, and our faculty is closely involved in guidelines in urology, development of new diagnostic and treatment options, and all these will be explored in a unique setting in the City Theatre of Nijmegen.
ESUR-SBUR15 11th World Congress on Urological Research 10-12 September 2015 Nijmegen, The Netherlands EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
What else can we expect? We, as Department of Urology of the Radboudumc in the city of Nijmegen, are honoured to host the 11th World Congress on Urological Research of the EAU Section of Urological Research (ESUR) and the Society for Basic Urologic Research (SBUR) from 10 to 12 September 2015. Translational research will be presented by a research faculty. It perfectly fits our activities but will be independently organised by the EAU (See announcement on this page). Moreover, we plan to have live surgeries on September 10. It will be a full day of surgeries, endorsed by the EAU Section of Female and Functional Urology (ESFFU), with live transmissions and interactions. We will also perform minimal invasive surgeries with laparoscopy and robotics, and discuss these techniques with more traditional approaches on the same day. Surgeries will be performed together with the international faculty.
European Association of Urology
European Urology Today
13th European Urology Residents Education Programme
3rd Meeting of the EAU Section of Urolithiasis
4-9 September 2015 Prague, Czech Republic
10-12 September 2015, Alicante, Spain EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
12-15 November 2015, Barcelona, Spain
13th Meeting of the EAU Section of Oncological Urology 15-17 January 2016, Warsaw, Poland EAU Events are accredited by the EBU in compliance with the UEMS/EACCME regulations
Abstract submission deadline
1 July 2015
7th European Multidisciplinary Meeting on Urological Cancers In conjunction with • ESU courses on Renal cancer and Castration resistant prostate cancer • European School of Oncology Interdisciplinary Conference on Predictive Models • 4th Meeting of the EAU Section of Urological Imaging (ESUI) • Young Academic Urologists meeting European Association of Urology
European Urology Today
www.emuc15.org European Association of Urology
ERUS15 12th Meeting of the EAU Robotic Urology Section
Robotic Live Surgery
CEM15 EAU 15th Central European Meeting 2-4 October 2015, Budapest, Hungary
15-17 September 2015, Bilbao, Spain EAU meetings and courses 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
Abstract submission deadline: 1 April 2015
2nd EAU Baltic Meeting #BALTIC15
29-30 May 2015, Riga, Latvia
Early registration deadline: 13 April 2015
Prospects and updates on urological strategies Riga, Latviaâ€™s capital city, will host the 2nd EAU Baltic Meeting from 29-30 May 2015. Drawing on the talents and expertise from the region, the EAU Baltic Meeting provides a platform that showcases the scientific and research gains of the Baltic countries.
Faculty covers topics such as prostate cancer, bladder cancer, open radical prostatectomy, laparoscopic partial nephrectomy, ureterorenoscopy and also an ESU course on Imaging in urological cancer is included in the programme.
Expert urologists from across Europe join their colleagues in this annual meeting which aims to support the clinical and research careers of young and mid-career urologists. Aside from boosting professional exchanges, current and controversial topics in both regional and international urology are discussed and assessed.
Riga extends a warm welcome to everyone with its charming ambience and colorful cultural life. For a comprehensive urological update and to link up with your colleagues, donâ€™t miss the opportunity to join us in Riga for the 2nd EAU Baltic Meeting!
Prospects in treatment strategies and multidisciplinary approaches are examined in various activities such as hands-on training in laparoscopy, panel discussions, debates, stateof-the-art lectures and abstract sessions.
For registration or more info: www.baltic15.org
European Urology Today
Congress calendar 2015/2016 February 12–14: Doha, Qatar AUA Segura International Urolithiasis Course Contact: Departments of Urology and Medical Education at Hamad Medical Corporation Phone: +91 268 2520248 or +974 4439 1864 E-mail: email@example.com or firstname.lastname@example.org Website: auasegura.hamad.qa
19–20: Hall in Tirol, Austria Minimally Invasive Percutaneous Stone Therapy – Clinical Workshop Contact: Ms. Sabine Weinberger and Ms. Miriam Faik Phone: +43 50 504 36310 Fax: +43 50 504 67 36310 E-mail: LKH.email@example.com
26: London, United Kingdom Urological Anatomy for Surgery Contact: The Royal College of Surgeons Phone: +44 20 7869 6300 E-mail: firstname.lastname@example.org Website: https://www.rcseng.ac.uk/courses/ course-search/urological-anatomy.html
20–27: Istanbul, Turkey 11th Pan Arab Continence Society Meeting in collaboration with International Continence Society Contact: PACS Fax: +2 245 534 43 E-mail: email@example.com Website: http://www.pacsoffice.com/PACS/
March 4-8: Vienna, Austria European Congress of Radiology (ECR2015) Contact: European Society of Radiology (ESR) Phone: +43 1 533 4064 0 Fax: +43 1 533 4064 448 E-mail: communications@myESR.org Website: http://www.myesr.org/cms/website. php?id=/en/ecr_2015.htm
Worldwide, continually updated urological meeting calendar at
17-18: Belgrade, Serbia
27-31: Sochi, Russia
National Congress of the Serbian Association of Urology Contact: Central Office Urological Association of Serbia Phone: +381 11 2656277 E-mail: firstname.lastname@example.org Website: http://www.uas.org.rs/
2nd Russian-Asian Uro-Andrology Congress in cooperation with the 10th Anniversary Congress of Professional Association of Andrologists of Russia Contact: CTO Congress Phone: +7 495 960 21 90 / ext. 115 E-mail: email@example.com Website: http://www.icongress-paar.ru/
18: ESU organised course on Reconstructive
29-30: Prishtina, Kosovo
urology at the time of the national congress of the Serbian Association of Urology. Contact: ESU
11th national Congress of the Kosovo Urological Association Contact: Prof. L. Dervishi, President E-mail: firstname.lastname@example.org
18-21: Kanazawa, Japan
29–30: Riga, Latvia
103rd Annual Meeting of the Japanese Urological Association Contact: Secretariat 102JUA Phone: +81 11 738 3503 Fax: +81 11 738 3504 E-mail: email@example.com Website: http://www.urol.or.jp/en/meeting.html
2nd EAU Baltic meeting Contact: EAU Regional Office Phone: +31 26 389 0680 Fax: +31 26 389 0674 E-mail: firstname.lastname@example.org Website: www.baltic15.org
21-25: Acapulco, Mexico 39th Annual Meeting of CMU Contact: CMU Phone: +52 664 634 1138 E-mail: email@example.com
23–26: Antalya, Turkey 11th National Turkish Endourology Congress Website: www.endouroloji2015.org
24–25: Lyon, France Tenth European International Kidney Cancer Symposium Contact: Jeanne Burau Phone: +33 815 753 1687 Fax: +33 815 753 6900 E-mail: firstname.lastname@example.org Website: http://registeruo.niu.edu/iebms/wbe/ wbe_p1_main.aspx?oc=40&cc=WBE4013860
30: ESU organised course at the time of the EAU Baltic Meeting Contact: ESU 29 May–2 June: Chicago (IL), USA American Society of Clinical Oncology (ASCO) Annual meeting 2015 Contact: ASCO Phone: +1 571 483 1300 E-mail: email@example.com Website: www.asco.org/portal/site/ascov2
June 9–13: Nice, France 40th Annual Meeting IUGA-ICS 2015 Contact: IUGA Office Phone: +44 117 944 4881 Fax: +44 117 944 4882 E-mail: firstname.lastname@example.org Website: http://www.ics.org/2015
24–26: Beijing, China
10-12: Athens, Greece
The Third Academic Conference of SUA Contact: Sudanese Urological Association Website: www.sudaneseurology.net
4th International Forum on Frontiers in Urology (IFFU) Contact: Wu Jieping Medical Foundation E-mail: email@example.com
8-10: Newcastle upon Tyne, UK
27–28: Hall in Tirol, Austria
Mediterranean and Gulf Urological Forum (MGUF) Annual Conference Contact: Mr. Pierre Refaat, Dr. Samer El Kilany Phone: +2 01 002 792 589/ 01 096 284 040 Fax: +2 02 262 170 55 E-mail: firstname.lastname@example.org Website: www.pte-eg.com
6-8: Sudan, Sudan
Robotic Urology Training course Contact: Newcastle Surgical Training Cenre (N.S.T.C.) Phone: +44 191 24 48913 E-mail: email@example.com Website: www.nstcsurg.org
12-13: London, UK Operative Skils in Urology: Modules 3 and 4 Contact: The Royal College of Surgeons Phone: +44 20 7869 6300 E-mail: firstname.lastname@example.org Website: https://www.rcseng.ac.uk/courses/course search/operative-skills-in-urology-modules-3-4
20-24: Madrid, Spain 30th Anniversary EAU Congress Contact: Congress Consultants B.V. Phone: +31 26 389 1751 Fax: +31 26 389 1752 E-mail: email@example.com Website: www.eaumadrid2015.org
21-23: ESU Courses, HOTs, Education and Innovation at the time of the 30th Anniversary Congress Contact: ESU
21-23: 16th International EAUN Meeting Contact: Congress Consultants B.V. E-mail: firstname.lastname@example.org Website: www.eaumadrid2015.org/eaun
April 11-14: Adelaide, Australia 68th Annual Scientific Meeting of the Urological Society of Australia and New Zealand (USANZ) Contact: USANZ Phone: +61 2 9362 8644 Fax: +61 2 9362 143 E-mail: email@example.com Website: www.usanz2015.com
European Urology Today
Minimally Invasive Percutaneous Stone Therapy – Clinical Workshop Contact: Ms. Sabine Weinberger and Ms. Miriam Faik Phone: +43 50 504 36310 Fax: +43 50 504 67 36310 E-mail: LKH.firstname.lastname@example.org
May 7-9: Rabat, Morocco National Congress of the Moroccan Urological Association Contact: Prof. A. El Kadiri (President of the Morocco Association of Urology) E-mail: email@example.com
11–12: Presov, Slovakia National congress of the Slovak Urological Association. Contact: Assoc. Prof. Ivan Mincík, PhD (President of Slovak urological society) Phone: +421 51 77 22 756 Fax: +421 51 77 22 756 E-mail: firstname.lastname@example.org Website: www.sus.sk
11: ESU organised course at the time of the national congress of the Slovak Urological Association. Contact: ESU 15-18: Manchester, United Kingdom
9: ESU organised course at the time of the national congress of the Moroccan Urological Association, Rabat (MA) Contact: ESU
Annual Meeting of The British Association of Urological Surgeons (BAUS) Contact: BAUS Phone: +44 20 7869 6950 E-mail: email@example.com Website: http://www.baus.org.uk
15–20: New Orleans (LA), USA
18-20: Kiev, Ukraine
Annual AUA Meeting 2015 Contact: AUA Phone: +1 410 689 3700 Fax: +1 410 689 3800 E-mail: aua@AUAnet.org Website: www.auanet.org/eforms/planning/ index.cfm
Congress of the Association of Urology of Ukraine Phone: +380 44 489 39 80 Fax: +380 44 254 00 40 or +380 44 486 65 69 E-mail: firstname.lastname@example.org
20–22: Madrid, Spain 10th European Congress on Menopause and Andropause Contact: EMAS administrative office Phone: +49 30 24603-0 Fax: +49 30 24603 310 E-mail: email@example.com Website: www.emas-online.org
19: ESU organised course on Prostate cancer at the time of the national congress of the Ukrainian Urological Association Contact: ESU 21-23: Noordwijk, The Netherlands 8th International Symposium on “Focal Therapy and Imaging in Prostate and Kidney Cancer” Contact: Erasmus Global INC Phone: +1 30 6947 008 044 E-mail: firstname.lastname@example.org Website: http://www.focaltherapy.org/
24–26: Rome, Italy 2nd Edition Global Congress on Lower Urinary Tract Dysfunction Contact: Vita-Salute San Raffaele University Website: http://lutd.org/
27–30: Ottawa, Canada 70th Annual meeting of the Canadian Urological Association Contact: Canadian Urological Association Phone: +1 514 392 7703 Fax: +1 514 227 5083 E-mail: email@example.com Website: www.cua.org/
28–30: Paris, France 5th International Meeting “Challenges in Endourology”(CIE 2015) Contact: Erasmus Conferences Tours & Travel S.A. Phone: +30 210 7414700 E-mail: firstname.lastname@example.org Website: http://www.challenges-endourology.com/
July 5-11: Salzburg, Austria ESU – Weill Cornell Masterclass in General urology Contact: European School of Urology (ESU) Phone: +31 26 389 0680 Fax: +31 26 389 0674 E-mail: email@example.com Website: www.esusalzburg15.org
August 17-21: Queensland, Australia Prostate Cancer World Congress 2015 Contact: Congress Organisers ICMS Pty Ltd Phone: +61 1300 792 466 Fax: +61 3 9818 7111 E-mail: firstname.lastname@example.org Website: http://prostatecancercongress.org.au/
19-23: Cartagena, Columbia Congreso Curso Internacional de Urologia Contact: Sociedad Colombiana de Urologia Phone: +571 218 67 00 / 57 310 322 12 10 Fax: +571 218 86 95 E-mail: email@example.com Website: www.scu-congreso.com/ www.scu.org.co
21-23, Hualien, Taiwan 37th Annual Congress of the Taiwan Urological Association (TUA) Contact: TUA Phone: +886 227290819 Fax: +886 227290864 Website: http://www.tua.org.tw
27-29: Zurich, Switzerland 4th International Neuro-Urology Meeting Contact: Swiss Continence Foundation Phone: +41 44 386 3721 Fax: +41 44 386 3731 E-mail: firstname.lastname@example.org Website: www.swisscontinencefoundation.ch
September 3-6: Shanghai, China Asian Urological Association meeting Contact: Angie See, Department of Urology Phone: +65 6 3214693 Fax: +65 6 2273787 E-mail: Angie.email@example.com / firstname.lastname@example.org Website: http://uaanet.org/
4-9: Prague, Czech Republic 13th European Urology Residents Education Programme (EUREP) Contact: European School of Urology (ESU) Phone: +31 26 389 0680 Fax: +31 26 389 0674 E-mail: email@example.com Website: www.eurep15.org
Congress calendar 2015/2016 10-12: Nijmegen, the Netherlands
11th World Congress on Urological Research (ESUR-SBUR) Contact: Congress Consultants B.V. Phone: +31 26 389 1751 Fax: +31 26 389 1752 E-mail: firstname.lastname@example.org Website: www.esur-sbur15.org
2-4: Budapest, Hungary
10-12: Alicante, Spain
4: ESU course on Percutaneous nephrolithotripsy at the time of the EAU 15th Central European Meeting Contact: ESU
3rd Meeting of the EAU Section of Urolithiasis (EULIS) Contact: Congress Consultants B.V. Phone: +31 26 389 1751 Fax: +31 26 389 1752 E-mail: email@example.com Website: www.eulis15.org
11: Nijmegen, the Netherlands "Personalized Cure and Care in Urology - 50 Years Academic Urology in Nijmegen" Contact: Dept. of Urology, Radboud UMC Phone: +31 6 223 116 30 E-mail: firstname.lastname@example.org
15-17: Bilbao, Spain 12th Meeting of the EAU Robotic Urology Section (ERUS) Contact: Congress Consultants B.V. Phone: +31 26 389 1751 Fax: +31 26 389 1752 E-mail: email@example.com Website: www.erus15.org
18-20: St. Petersburg, Russia Annual meeting of the Russian Society of Urology Phone: +7 499 248 71 66 E-mail: firstname.lastname@example.org Website: http://ooorou.ru
20: ESU organised course on What’s new in male infertility and (locally) advanced prostate cancer at the time of the national congress of the Russian Society of Urology Contact: ESU
23-26: Hamburg, Germany 67th Congress of the German Society of Urology (DGU) Contact: DGU Phone: +49 211 516 0960 Fax: +49 211 516 0960 E-mail: email@example.com Website: www.dgu.de/
15th Central European Meeting (CEM) Contact: Congress Consultants B.V. Phone: +31 26 389 1751 Fax: +31 26 389 1752 E-mail: firstname.lastname@example.org Website: www.cem15.org
5-9: Montreal, Canada Annual Meeting of the International Continence Society (ICS) Contact: ICS Office Phone: +44 117 944 4881 Fax: +44 117 944 4882 E-mail: email@example.com Website: http://www.ics.org/2015
15-18: Melbourne, Australia 35th Congress of the Société Internationale d'Urologie (SIU) Contact: SIU Central Office Phone: +1 514 875 5665 Fax: +1 514 875 5665 E-mail: firstname.lastname@example.org Website: www.siu-urology.org/
22-23: Chisinau, Moldavia National congress of the Moldavian Urological Society Contact: Prof. V. Ghicavîi Phone: +373 79469515 Fax: +373 22 733805 E-mail: email@example.com
23: ESU organised course on Any progress in prostate and kidney cancer treatment? and Update on modern stone treatment at the time of the national congress of the Moldavian Urological Society Contact: ESU
November 2: Tashkent, Uzbekistan National Congress of the Scientific Society of Urologists in Uzbekistan E-mail: firstname.lastname@example.org
Worldwide, continually updated urological meeting calendar at
2: ESU organised course on Male LUTS, Urinary incontinence and fistula at the time of the national congress of the Scientific Society of Urologists of Uzbekistan Contact: ESU 4–5: Barcelona, Spain 2nd ESU Masterclass on Lasers in urology, in collaboration with the EAU Section of UroTechnology (ESUT) Contact: ESU
12-14: 17th International EAUN Meeting Contact: Congress Consultants B.V. Phone: +31 26 389 1751 Fax: +31 26 389 1752 E-mail: email@example.com Website: www.eau16.org
June 2016 3-7: Chicago (IL), USA
12-15: Barcelona, Spain 7th European Multidisciplinary Meeting on Urological Cancers (EMUC) Contact: EAU, ESMO, ESTRO Phone: +31 26 389 0680 Fax: +31 26 389 0674 E-mail: firstname.lastname@example.org Website: www.emuc15.org
American Society of Clinical Oncology (ASCO) Annual meeting 2016 Contact: ASCO Phone: +1 571 483 1300 E-mail: email@example.com Website: www.asco.org
12: ESU courses on Renal cancer and Castration
resistant prostate cancer at the occasion of the 7th European Multidisciplinary Meeting in Urological Cancers (EMUC) Contact: ESU
26-28: Berlin, Germany 8th ESU Masterclass on Female and functional reconstructive urology, in collaboration with the EAU Section of Female and Functional Urology (ESFFU) Contact: ESU
January 2016 15-17: Warsaw, Poland 13th Meeting of the EAU Section of Oncological Urology (ESOU) Contact: Congress Consultants B.V. Phone: +31 26 389 1751 Fax: +31 26 389 1752 E-mail: firstname.lastname@example.org Website: http://esou.uroweb.org
12–16: Tokyo, Japan Annual Meeting of the International Continence Society (ICS) Contact: ICS Office Phone: +44 117 944 4881 Fax: +44 117 944 4882 E-mail: email@example.com Website: http://www.ics.org/2016
28 Sep–1 Oct: Leipzig, Germany 68th Congress of the German Society of Urology (DGU) Contact: DGU Phone: +49 211 516 0960 Fax: +49 211 516 0960 E-mail: firstname.lastname@example.org Website: www.dgu.de/ For more elaborate information on all EAU meetings please contact Congress Consultants or consult the EAU website: Phone: +31 (0)26 389 1751 Fax: +31 (0)26 389 1752 E-mail: email@example.com Website: www.uroweb.org For more elaborate information on all ESU courses please contact the European School of Urology or consult the EAU website: Phone: +31 (0)26 389 0680 Fax: +31 (0)26 389 0684 E-mail: firstname.lastname@example.org Website: www.uroweb.org
11-15: Munich, Germany 31st Annual EAU Congress Contact: Congress Consultants B.V. Phone: +31 26 389 1751 Fax: +31 26 389 1752 E-mail: email@example.com Website: www.eau16.org
Applying for EUSP research and laboratory scholarship ‘The first blow is half the battle...,’’ says veteran researcher Prof. Dr. Jack Schalken Radboud UMC Dept. of Urology Nijmegen (NL)
jack.schalken@ radboudumc.nl The European Urology Scholarship Programme (EUSP) provides one-year scholarships for urologists (in training) to acquire hands-on laboratory experience. Most of the projects address an unmet clinical need; hence the projects mostly deal with translational research. Many young urologists have a research interest, but are asking themselves: ‘’Where should I begin?’’ Let me try to lead you through the process, in three distinct steps. 1. Choice of host laboratory and research topic; the EUSP website has a list of host labs, an e-mail to the EUSP office or any of the board members in which you express your interest can help you in making a short list. Communicate with the principal investigator or director of the host lab European Urological Scholarship Programme Office
and apply for a short-term visit (Interestingly, there are now two projects already formulated from clinical trials that were coordinated by the EAU-Research Foundation). 2. Short-term visit application to spend a week or two in the host laboratory. Get acquainted with people in the laboratory, the projects, the clinic and start writing you research proposal. 3. Complete your research proposal and submit to the EUSP board before the given deadlines. In case your proposal is granted, prepare everything on time with the host laboratory, such as visa (if needed), housing, badges etc, so that you can start your experiments in the week you arrive! The first blow is half the battle! Personally, I feel that the second step is crucial. The candidate EUSP fellow and the host laboratory are going to invest a significant amount of time in one another. A good match provides solid ground for a scientific- and also social success. In the past decade in my team, most of the EUSP fellows published in peer-reviewed journals and long-term friendships developed. This in turn, ideally forms the basis for a network and/or longstanding collaboration between the host laboratory and the department where the fellow returns to.
‘match making..‘ EUSP/EAURF website Network
Apply for short term visit EUSP Visit candidate host laboratory Draft Research proposal
Complete research proposal with host lab submit to EUSP When granted; Prepare scholarship
The EUSP research scholarships can be an important step in the road towards becoming a physician scientist, a ‘breed’ that urology urgently needs to scientifically develop this most interesting medical specialty. European Urology Today
Identifying critical points in post-PCa treatment support Continuity of follow-up care for prostate cancer survivors is crucial of involvement of a more diverse range of clinicians based on cancer patients’ needs and complexity. The 2012 document advocates general practitioners and nurse specialists with oncology training having key involvement in the follow-up of cancer patients. It recognizes the impact of the rising number of cancer survivors in NZ as a result of an aging population, earlier diagnosis and advances in oncology treatment.
Sue Osborne Urology Nurse Practitioner Waitemata District Health Board Dept. of Urology Auckland (NZ) Sue.osborne@ waitematadhb. govt.nz
The document also challenges us to move away from the traditional model of hospital-based follow-up care provided by specialists in outpatient clinics since this mode of care delivery places a significant burden on resources, and is of debatable value for many cancers in terms of early diagnosis of recurrence and survival.
In October last year I delivered a presentation to a group of around 100 urology nurses attending the New Zealand Urological Nurses Society (NZUNS) North Island Study Day. Whilst my session was entitled ‘Post prostate cancer treatment surveillance and support,’ I never intended to simply present evidence-based guidelines on international prostate cancer follow-up protocols. I instead aimed to combine this material with content meant to encourage the audience to reflect on how they, as nurses with advanced practice skills, contribute to prostate cancer follow-up in their various workplaces. I asked them to consider if their healthcare team optimally utilise the personnel, communication modalities and locations that are available, for them to deliver high-quality, timely follow-up care to their patients. My presentation focused on a new model for cancer care in New Zealand (NZ) which calls for a wider level
Alternative models Various alternative models of cancer follow-up have emerged, including nurse specialist-led, primary care-led, telephone and /or internet based, and patient-initiated follow-up. There are also various combinations of these that exist as ‘shared care’ models. Each utilises appropriate monitoring and post-treatment follow-up strategies to achieve many goals. One important objective is to detect signs of disease progression or recurrence in a timely manner. Another is to assist patients with management of treatment related morbidity using evidence-based strategies. Alongside both of these aims, the healthcare provider also endeavours to address the individual’s psychosocial needs. Cox and Wilson (2003) stressed the single most important factor in improving the follow-up care of
European Association of Urology Nurses
cancer patients is targeting and responding to the needs of vulnerable groups. In New Zealand, District Health Boards consider how best to meet the follow-up needs of their cancer population based on multiple patient-focused factors including ethnicity, first language, geography and socioeconomic status. Health care teams aim to identify what supportive care packages are needed and at what time in the cancer treatment and recovery pathway they should be delivered. Critical points in the prostate cancer trajectory have been identified as pre-treatment (dealing with a new cancer diagnosis and information needs pertaining to decision making), mid-treatment (management of acute side effects) completion of treatment (uncertainty in the future and management of on-going side effects) and post-treatment (anxiety about cancer recurrence and prognosis).
They prefer instead to build relationships with the healthcare professionals they dealt with. I believe advanced practice nurses are well-placed to contribute to the continuity of follow-up care for men on a prostate cancer pathway. As we begin a new year of urology nursing in 2015, it is timely to reflect on how expert nurses are employed to fully contribute to the continuity and quality of cancer follow-up. Where you practice, do nurses have access to the academic preparation, on-going specialised education, skills accreditation, practice audit and mentorship that you need to enable you and others to fulfil your potential within the multidisciplinary team? Reference Cox, K. & Wilson, E (2003). Follow-up for people with cancer: nurse-led services and telephone interventions. Integrative literature reviews and meta-analyses. 43(1) 51-61.
Patients report one of the benefits of cancer follow-up as ‘a feeling of being kept an eye on.’ This perception increases their sense of security and confidence, and is often associated with reduced physical and psychological distress. Patients also value continuity of care following cancer treatment, with many reporting that they found it harder to ask questions or discuss emotional issues with a stranger. Building links While they perceive one of the advantages of hospital-based follow-up as the ready access it provides them to specialist knowledge and investigations, they dislike the way that they often see a different team member each time they attend outpatient’s clinic. They report this lack of continuity in the follow-up phase as adding to their distress.
EAUN Board Chair Chair Elect Past Chair Board member Board member Board member Board member Board member Board member
Lawrence DrudgeCoates (UK) Stefano Terzoni (IT) Kate Fitzpatrick (IE) Paula Allchorne (UK) Simon Borg (MT) Willem De Blok (NL) Erica Grainger (DK) Susanne Vahr (DK) Giulia Villa (IT)
Registration online until 2 March Registration onsite: 19-25 March
EAUN Meeting 21-23 March 2015, Madrid, Spain
Sunday, 22 March
Monday, 23 March
Saturday, 21 March
09.00 – 10.00
Workshop Intravesical instillation in NMIBC Chair: S. Vahr Lauridsen, Copenhagen (DK)
09.00 – 10.00
Workshop Difficult case session Chair: S. Vahr Lauridsen, Copenhagen (DK)
09.00 – 10.15
Inside the body - surgery in motion (videos) Chair: S.J. Borg, St. Julians (MT)
09.00 – 10.00
10.15 – 10.45
State-of-the-art lecture BCG treatments for superficial bladder cancer
Workshop Pelvic floor rehabilitation for LUTS: What’s new? Chair: L. Van De Bilt-Sonderegger, Eindhoven (NL)
10.15 – 10.45
10.15 – 11.15
State-of-the-art lecture PSA, is it a Patient Stress Amplifier?
Workshop Contemporary issues in patient pathways and cancer treatment Chair: J.T. Marley, Newtownabbey (GB)
Workshop Troubleshooting and quality of live in indwelling catheterisation Chair: V. Geng, Aglasterhausen (DE)
10.45 – 11.15
State-of-the-art lecture 3Tesla Magnetic Resonance Imaging for PCa
10.45 – 11.15
10.15 – 12.45
Workshop Ongoing challenges in health and sexuality in male patients Chair: I. Banks, Spa (IE)
State-of-the-art lecture Not only instillation: BCG perfusion for kidney and urethra G.N. Thalmann, Berne (CH)
EAUN-ESU Course - 2 Female sexual assessment and rehabilitation
11.30 – 12.15
Workshop Care pathway and rehabilitation in bladder cancer surgery
13.15 – 13.45
EAUN General Assembly Chair: L. Drudge-Coates, London (UK)
13.45 – 14.00
EAUN Award Session Chair: L. Drudge-Coates, London (UK)
09.00 – 10.15
10.30 – 11.15
10.30 – 11.15
11.30 – 12.30
Opening Plenary Session The future of urological nursing The need for a common framework: time is running out Chair: L. Drudge-Coates, London (GB) Workshop Nursing challenges in urodynamics Chair: L. Van De Bilt-Sonderegger, Eindhoven (NL)
11.30 – 12.30
Nursing Research Competition Chair: R. Pieters, Ghent (BE)
12.45 – 13.45
EAUN-EORNA Workshop Diagnosis and peri-operative care in prostate disease Chair: S. Borg, St. Julians (MT)
14.00 – 14.30
State-of-the-art lecture Best practice principles in the urological care for people who have a learning disability
14.00 – 15.15
Poster Abstract Session Chairs: J.T. Marley, Newtownabbey (GB), S. Terzoni, Milan (IT)
14.45 – 17.00
EAUN-ESU Course - 1 Practical management of urological emergencies
16.00 - 17.00
Industry Session by Coloplast Honouring sexuality in women with neurogenic disorders
11.30 – 13.15
Poster Abstract Session Chairs: J.T. Marley, Newtownabbey (GB), S. Terzoni, Milan (IT)
12.15 – 13.15
Workshop Living with prostate cancer: Daily issues and quality of life Chair: B. T. Jensen, Arhus (DK)
10.00 - 11.30
Hospital Visit to University Hospital Infanta Sofía, Madrid
12.30 - 14.00
Hospital Visit to University Hospital Infanta Sofía, Madrid
14.45 – 16.45
Market Place Session Rehabilitation in urology cancer care A. Campbell, Guildford (GB) M.A. Risolo, Milano (IT) I. Geraerts, Leuven (BE)
Registration for the Hospital visits is on a first-come, first-served basis and can be made online during congress registration. Contact firstname.lastname@example.org if you wish to add a Hospital Visit to a finalised registration.
14.45 – 15.45
Workshop UTI in clean intermittent catheterisation: What’s new? Chairs: M.J. Grabe, Malmö (SE), L. Van De Bilt-Sonderegger, Eindhoven (NL)
16.00 – 17.00
Workshop Clean intermittent catheterisation and self dilatation: quality of life and success factors Chair: J.P.F.A. Heesakkers, Nijmegen (NL)
Supported with an educational grant from AMGEN
Download the EAUN App from the App store. Search for “EAUN 15”
For more information: email@example.com
in conjunction with
European Urology Today