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Update from the EAU Guidelines Office Latest publications, guidelines training and the appointment of Prof. Maria Ribal analysis from the European Association of Urology/European Society For Paediatric Urology Guidelines Panel. Eur Urol 2019 75(3)448.

• Management of sporadic renal angiomyolipomas: A systematic review of available evidence to guide recommendations from the European Association of Urology Renal Cell Carcinoma Guidelines Panel. Eur Urol Focus 2019, prior to print.

E U R O P E A N U RO L O GY 7 5 ( 2 019 ) 4 4 8 – 4 61

• Updated European Association of Urology guidelines on renal cell carcinoma: Immune checkpoint inhibition is the new backbone in first-line treatment of metastatic clear-cell renal cell carcinoma. Eur Urol 2019 76(2)151.

Platinum Priority – Review – Pediatric Urology Editorial by Jack Elder on pp. 462–463 of this issue

Treatment of Varicocele in Children and Adolescents: A Systematic Review and Meta-analysis from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel Mesrur Selcuk Silay a[1_TD$IF],*, Lisette Hoen b, Josine Quadackaers c, Shabnam Undre d, Guy Bogaert e, Hasan Serkan Dogan f, Radim Kocvara g, Rien J.M. Nijman c, Christian Radmayr h, Serdar Tekgul f, Raimund Stein i

E U RO P E A N U R O L O GY 76 ( 2 019 ) 151 – 15 6

Prof. Maria Ribal, new Vice-chairman Guidelines Office Board

available at www.sciencedirect.com journal homepage: www.europeanurology.com

Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey; b Department of Urology, Erasmus MC, Rotterdam,

The Netherlands; c Department of Urology and Pediatric Urology, University Medical Centre Groningen, Groningen, The Netherlands; d Department of Pediatric and Adult Urology, East and North Herts NHS Trust, Stevenage, UK; e Department of Urology, University of Leuven, Leuven, Belgium; f Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey; g Department of Urology, General Teaching Hospital and Charles University 1st Faculty of [2_TD$IF]Medicine in Praha, Prague, Czech Republic; h Department of Urology, Medical University of Innsbruck, Innsbruck, Austria; i Department of Pediatric, Adolescent

And “Treatment of Bladder Stones in Adults and Children: A Systematic Review and Meta-analysis on Behalf of the European Association of Urology Urolithiasis Guideline Panel” will be published shortly and has been selected as a CME (Continuing Medical Education) article and, as such, will be accompanied by six multiple-choice questions based on the article content. and Reconstructive Urology, University of Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

Brief Correspondence

New Vice-Chairman of the Guidelines Board We are delighted to announce that Prof. Maria Ribal, Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Spain has been appointed to be the Vice-Chairman of the Guidelines Office Board. Professor Ribal is also the Vice-Chairman and active member of the Muscle-Invasive and Infiltrative Bladder Cancer Guidelines Panel. We wish her every success in her new appointment. Recent publications from Panels We are very pleased to announce that several papers from Guidelines Panels have recently been accepted: • Time to adapt our practice? The European commission has restricted the use of fluoroquinolones since March 2019. Eur Urol 2019 76(2)151. • Greetings from Africa: The emergence of tropical urological diseases in Europe. We had better be prepared! Eur Urol 2019 76(2)140. Guidelines Office

Updated European Association of Urology Guidelines on Renal Cell Carcinoma: Immune Checkpoint Inhibition Is the New Backbone in First-line Treatment of Metastatic Clear-cell Renal Cell Carcinoma Laurence Albiges a, Tom Powles b, Michael Staehler c, Karim Bensalah d, Rachel H. Giles e,f, Milan Hora g,h, Markus A. Kuczyk i, Thomas B. Lam j,k, Börje Ljungberg l, Lorenzo Marconi m, Axel S. Merseburger n, Alessandro Volpe o, Yasmin Abu-Ghanem p, Saeed Dabestani q, Sergio Fernández-Pello r, Fabian Hofmann s, Teele Kuusk t, Rana Tahbaz u, Axel Bex v,w,x,* a

Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France; b The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary

University of London, London, UK; c Department of Urology, Ludwig-Maximilians University, Munich, Germany; d Department of Urology, University of Rennes, Rennes, France; e Patient Advocate, International Kidney Cancer Coalition (IKCC), Duivendrecht, The Netherlands; f Department of Nephrology and Hypertension, Regenerative Medicine Center, University Medical Centre Utrecht, Utrecht, The Netherlands; g Department of Urology, University Hospital Plze n, Plze n, Czech Republic; h Faculty of Medicine in Plze n, Charles University, Plze n, Czech Republic; i Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany; j Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK;

Academic Urology Unit, University of Aberdeen, Aberdeen, UK;

• Benefits of empiric nutritional and medical therapy for semen parameters and pregnancy and live birth rates in couples with idiopathic infertility: A systematic review and meta-analysis. Eur Urol 2019 75(4)615. l

Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden;

Department of Urology, Coimbra University

Hospital, Coimbra, Portugal; n Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany; o Division of Urology, Maggiore della Carità

Hospital, University of Eastern Piedmont, Novara, Italy; p Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel; q Department of

Article info

Abstract

Article history: Accepted September 24, 2018

Context: The benefits and harms of intervention (surgical or radiological) versus observation in children and adolescents with varicocele are controversial. Objective: To systematically evaluate the evidence regarding the short- and long-term outcomes of varicocele treatment in children and adolescents. Evidence acquisition: A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. A priori protocol was registered to PROSPERO (CRD42018084871), and a literature search was performed for all relevant publications published from January 1980 until June 2017. Randomized controlled trials (RCTs), nonrandomized comparative studies (NRSs), and single-arm case series including a minimum of 50 participants were eligible for inclusion. Evidence synthesis: Of 1550 articles identified, 98 articles including 16 130 patients (7–21 yr old) were eligible for inclusion (12 RCTs, 47 NRSs, and 39 case series). Varicocele treatment improved testicular volume (mean difference 1.52 ml, 95% confidence interval [CI] 0.73–2.31) and increased total sperm concentration (mean difference 25.54, 95% CI 12.84–38.25) when compared with observation. Open surgery and laparoscopy may have similar treatment success. A significant decrease in hydrocele formation was observed in lymphatic sparing versus non–lymphatic sparing surgery (p = 0.02). Our findings are limited by the heterogeneity of the published data, and a lack of long-term outcomes demonstrating sperm parameters and paternity rates. Conclusions: Moderate evidence exists on the benefits of varicocele treatment in children and adolescents in terms of testicular volume and sperm concentration. Current evidence does not demonstrate superiority of any of the surgical/interventional techniques regarding treatment success. Long-term outcomes including paternity and fertility still remain unknown. Patient summary: In this paper, we review benefits and harms of varicocele treatment in children and adolescents. We found moderate evidence that varicocele treatment results in improvement of testicular volume and sperm concentration. Lymphatic sparing surgery decreases hydrocele formation. Paternity and fertility outcomes are not clear. © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Associate Editor: James Catto Keywords: Varicocele Children Adolescent Recurrence Hydrocele Paternity

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Clinical Sciences Lund, Lund University, Skåne University Hospital, Malmö, Sweden; r Department of Urology, Cabueñes Hospital, Gijón, Spain; s Department of

Urology, Sunderby Hospital, Sunderby, Sweden; t Department of Urology, Royal Free Hospital, Pond Street, London, UK; u Department of Urology, Elbe Kliniken

* Corresponding author. Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University, Doktor Erkin Caddesi, 34722, Kadikoy, Istanbul, Turkey. Tel. +90 505 6454005; Fax: +90 212 4530453. E-mail address: selcuksilay@gmail.com (M.S. Silay). E U RO P E A N U RO L O GY 76 ( 2 019 ) 3 5 2 – 3 6 7

Stade, Stade, Germany; v Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; w Specialist

Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK; x UCL Division of Surgery and Interventional Science, London, UK

Article info

Abstract

Article history: Accepted May 15, 2019

Recent randomised trials have demonstrated a survival beneﬁt for a front-line ipilimumab and nivolumab combination therapy, and pembrolizumab and axitinib combination therapy in metastatic clear-cell renal cell carcinoma. The European Association of Urology Guidelines Panel has updated its recommendations based on these studies. Patient summary: Pembrolizumab plus axitinib is a new standard of care for patients diagnosed with kidney cancer spread outside the kidney and who did not receive any prior treatment for their cancer (treatment naïve). This applies to all risk groups as determined by the International Metastatic Renal Cell Carcinoma Database Consortium criteria. © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Associate Editor: James Catto

Keywords: Renal cell carcinoma Metastatic Immune checkpoint inhibitors Ipilimumab Nivolumab Sunitinib Pazopanib Cabozantinib Guidelines

• Effectiveness and harms of using kidneys with small renal tumours from deceased or living donors as a source of renal transplantation: A systematic review. Eur Urol Focus 2019 5(3)508.

* Corresponding author. Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. Tel. +31 205 122 553; Fax: +31 205 122 554. E-mail address: a.bex@nki.nl (A. Bex).

available at www.sciencedirect.com https://doi.org/10.1016/j.eururo.2018.09.042 0302-2838/© ofpUrology. Published j o u r n a l h o2018 m e European p a g e : wAssociation ww.euro eanuro l o g y . c by o mElsevier B.V. All rights reserved.

Those invited will include new Guidelines Panel members and young urologists enrolled on the Guidelines Office associates programme. As usual, those attending the training workshop will come from across Europe. The intensive two-day event will see attendees participate in a packed programme of events. The training workshop will be led by members of the EAU Guidelines Office’s Methods Committee, who will give a series of presentations and lead participants in a series of practical sessions. The training will cover a diverse range of subjects aimed at underlining the importance of evidence synthesis methodology for young urologists. Topics covered will include the development of a search strategy, abstract and full text screening, assessing risk of bias, data abstraction, and data analysis and interpretation. Panel Meetings Once again, the autumn months mark a burst of activity in the Guidelines Office as Panels meet to finalise their Guidelines texts for 2020. The Paediatric Urology Panel met in Amsterdam at the end of August. September meanwhile sees meetings from the Non-muscle-invasive Bladder Cancer Panel in Prague, the Renal Cell Carcinoma Panel in Orto San Giulio and the Urological Trauma Panel in Berlin. The Guidelines Office Chairmen’s meeting will be held this October in Prague.

Review – Stone Disease

Treatment of Bladder Stones in Adults and Children: A Systematic Review and Meta-analysis on Behalf of the European Association of Urology Urolithiasis Guideline Panel James F. Donaldson a,*[25_TD$IF], Yasir Ruhayel b, Andreas Skolarikos c, Steven MacLennan d, Yuhong Yuan e[1_TD$IF], Robert Shepherd f, Kay Thomas g[2_TD$IF], Christian Seitz h, Aleš Petrik i, Christian Türk j,k, Andreas Neisius l a

Department of Urology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK; b Department of Urology, Skåne University Hospital, Malmö, Sweden; c Second

Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece;

Academic Urology Unit, University of Aberdeen, Scotland, UK;

Division of Gastroenterology & Cochrane UGPD Group, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, Canada;

European Association of Urology Guidelines Office, Arnhem, The Netherlands; g Department of Urology, Guy's Hospital, London, UK; h Department of Urology,

Medical University of Vienna, General Hospital of Vienna, Vienna, Austria; i Department of Urology, Charles University, First Faculty of Medicine, Prague,

• Are EAU/ESPU paediatric urology guideline recommendations on neurogenic bladder well received by the patients? Results of a survey on awareness in spina bifida patients and caregivers. Neurourol Urodyn 2019 38(6)1625. • Treatment of varicocele in children and adolescents: A systematic review and meta-

Czech Republic; j Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria;

Urologische Praxis mit Steinzentrum, Vienna, Austria;

Systematic Review Training Workshop Following the success of the last Guidelines Office Systematic Review Workshop, held in Amsterdam at the end of April, another workshop has been organised for the Autumn. Once again, the training session will take place in Amsterdam and will be held on 22 and 23 November. Attendance at the workshop is by invitation of the Guidelines Office. l

Department of Urology, Hospital of the Brothers of Mercy Trier, Johannes Gutenberg University Mainz, Trier, Germany

Article info

Abstract

Article history: Accepted June 18, 2019

Context: Bladder stones (BS) constitute 5% of urinary stones. Currently, there is no systematic review of their treatment. Objective: To assess the efﬁcacy (primary outcome: stone-free rate [SFR]) and morbidity of BS treatments. Evidence acquisition: This systematic review was conducted in accordance with the European Association of Urology Guidelines Ofﬁce. Database searches (1970–2019) were screened, abstracted, and assessed for risk of bias for comparative randomised controlled trials (RCTs) and nonrandomised studies (NRSs) with 10 patients per group. Quality of evidence (QoE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Evidence synthesis: A total of 2742 abstracts and 59 full-text articles were assessed, and 25 studies (2340 patients) were included. In adults, one RCT found a lower SFR following shock wave lithotripsy (SWL) than transurethral cystolithotripsy (TUCL; risk ratio 0.88, p = 0.03; low QoE). Four RCTs compared TUCL versus percutaneous cystolithotripsy (PCCL): meta-analyses demonstrated no difference in SFR, but hospital stay (mean difference [MD] 0.82 d, p < 0.00001) and procedure duration (MD 9.83 min, p < 0.00001) favoured TUCL (moderate QoE). Four NRSs comparing open cystolithotomy (CL) versus TUCL or PCCL found no difference in SFR; hospital stay and procedure duration favoured endoscopic surgery (very low QoE). Four RCTs compared TUCL using a nephroscope versus a cystoscope: meta-analyses demonstrated no difference in SFR; procedure duration favoured the use of a nephroscope (MD 22.74 min, p < 0.00001; moderate QoE). In children, one NRS showed a lower SFR following SWL than TUCL or CL. Two NRSs comparing CL versus TUCL/PCCL found similar SFRs; catheterisation time and hospital stay favoured endoscopic treatments. One RCT comparing laser versus

Associate Editor: James Catto

Keywords: Bladder stones Transurethral cystolithotripsy Percutaneous cystolithotripsy Open cystolithotomy Adults Children Stone-free rates Endoscopic treatments

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The Paediatric Urology Panel Meeting in Amsterdam at the end of August

* Corresponding author. Assistant Guidelines Office, European Association of Urology, Mr. E.N. van Kleffenstraat 5, Arnhem 6842 CV, The Netherlands. Tel. +31 0263890680. E-mail address: james.donaldson6@nhs.net (J.F. Donaldson).

Laurent Managadze “Urology is my whole life” 1944 - 2019

Professor Laurent Managadze’s career in urology coincided with a very difficult time for Georgia, politically as well as financially. Nonetheless, he undoubtedly was the most successful urologist in the history of the country: an innovator, progressive, and a reformer.

In 2000, Prof. Managadze founded the Georgian Urological Association (GUA) and became its first president. His activities in this position were directed at incorporating Georgian urology in the western world… and he succeeded. The GUA became an active member of the EAU and thus derived much benefit from its educational and other activities in the country. In 2002, Prof. Managadze was awarded the title Honorary Member of the EAU.

In 1972, soon after graduation from the First Medical Institute of Moscow, Prof. Laurent Managadze returned to Tbilisi. From the beginning, his professional interest was kidney transplantation. In 1976, he performed the first 6 cases of cadaver kidney transplantation in Georgia, together with a team of surgeons from Moscow. It was the first step towards the realisation of his lifelong wish: to establish a renal transplantation programme in Georgia. A wish that came true later in his life. Profs. Rudolf Hohenfellner and Peter Alken, to Georgia. Both of them became close friends and contributed In 1985, Prof. Managadze became Director of the greatly to the development of urology in Georgia. Institute of Urology in Tbilisi, the largest and oldest urological hospital in Georgia. This was a Eventually Georgian urology started progressing very turning point towards progress and development fast. Transurethral surgery, oncourology, for Georgian urology. All of Prof. Managadze’s reconstructive urology, kidney transplantation, enthusiasm, knowledge and professional activity endourology and many other disciplines developed was aimed at the evolution of urology. As he said under the leadership of Prof. Managadze. He was the in one of his interviews: “Urology is my whole first in the former Soviet Union who performed life”. radical prostatectomy, radical cystectomy, continent urinary diversions, nephron sparing surgery, etc. He Although he was educated in Russia, he realised and his colleagues developed the original technique that progress wasn’t possible without close of continent urinary diversion called “Tiflis Pouch”. cooperation with the western world. In 1986, he Publications about this technique appeared in 7 invited two German urology professors, different languages.

August/September 2019

In 1998, Prof. Managadze called me into his office and told me he wanted to start a living kidney transplant programme. He asked me to go abroad to be trained in transplantation surgery. This was followed by a 4-year training period in Israel, Italy and Germany after which I returned to Georgia. In 2000 we started a living kidney transplant programme in the country, the biggest and most successful programme so far.

Apart from his clinical and scientific activities, Prof. Managadze was a dedicated mentor for students and young urologists. He was a rector of the Tbilisi State Medical University and Chairman of the Department of Urology of the Ivane Javakhishvili State University. Under his mentorship several generations of successful urologists were raised. Many of them are now chairmen of different urological departments in the country.

Prof. Managadze was awarded numerous prizes and awards: the Alexander Tsulikidze Medal, Medal of Honour, the Order of Excellence, etc. He is the founder and Editor of the “Georgian Medical News”, the only PubMed-cited Georgian medical journal. Prof. Managadze had a strategic view on progress and With his passing, Urology in Georgia has lost an development: sending young urologists abroad for extremely talented scientist, a superb doctor, an training and supporting their activities after their excellent mentor and a humble person, whose return. USA, France, England, Germany, Netherlands, whole life was dedicated to urology. Austria, Italy, Switzerland, Sweden, Hungary, Poland, Turkey… this is the incomplete list of countries where Archil Chkhotua Prof. Managadze sent his fellows for training. Secretary General, Georgian Urological Association

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